 
**About the author  
and his book:  
** _No Such Thing as Impossible—From Adversity to Triumph_

Jairo Alvarez-Botero – a man with a mission – is an immigrant and Colombian businessman who at seventy-three years is proof that the American dream is not a myth. Raised on a farm growing potatoes and corn in the small town of Sonson, Antioquia, in the midst of the Andean mountains of Colombia, Jairo triumphed in the army of his country to live the dream of being part of the elite Presidential Guard. Trained to fight the guerrillas in the rainforest, Jairo would eventually have to put all of his survival instincts into action after becoming a spy for the Army of Colombia.

From a young age, the protagonist had the ambition of becoming a great general, but fate would put him on a different course. It was a path that would strip him of his military career, but also give him the chance to save the life of the president and prevent a coup that sought to restore a dictatorship in Colombia. The fear of losing his life forced him to flee his beloved country into a military cargo plane bound for the United States.

At twenty-five, Jairo had a hundred dollars in his pocket. He was unable to utter a single word in another language. However, his tenacity made him practice his English every day in front of the statue of Moses in Washington Park. Three-and-a-half years later, after incredible hardships and adversities, he earned a degree with honors from the Albany School of Business in New York.

After struggling for many years in this country and failing in various businesses, Jairo, at age 52 start a new venture, home builder. Today, he owns one of the largest developers and residential construction companies in Louisiana. He manages this company along with his children.

In addition, this retired military man is an Olympic champion, an artist, a prostate cancer survivor, a writer, a motivational speaker and a philanthropist who used his good fortune to help numerous charities in his two countries. All the proceeds from his books and conferences are donated to recognized charities organizations.

_No Such Thing as Impossible_ was a finalist for the National Indie Award in the category of Inspirational Biography in 2008 and was entered as a biography in the Pulitzer Prize competition in 2009. Jairo was also honored with The 2009 Golden Pen by the International Association of Hispanics Poets and Writers.

_No Such Thing as Impossible_ narrates the adventures of a man whose heroic actions changed the course of history. It is a story full of sadness, anger, fear and death. It is a story of sorrow, of courage, of fear, of death. It is a story of persistence and survival, love and happiness. It is a story of hope. Jairo Álvarez-Botero's life is a reminder to all that there truly is no such thing as impossible.

This book is available in English and Spanish online at

www.jairoAlvarezbotero.com

Spanish version: _Nada Es Imposible—De la Adversidad al Triunfo_

Readers' Comments

Jairo Alvarez-Botero, author of the award-winning autobiography, No Such Thing as Impossible—From Adversity to Triumph, concerned with the overall health of men and as a service to humanity, tells us his valuable experiences through his new book Cancer—A Message of Hope as a tool to overcome prostate cancer and acquire a "newlife."

The author reveals a hidden part of his life that he does not wish to recall, the detailed account of his personal experience of facing cancer with courage and an altruistic and positive sense, while wishing to bring out the best in this dramatic situation through which he had to live. It is an educational book in the prevention, treatment and recovery of what Jairo calls, "the monster," or prostate cancer, known worldwide as the silent murderer. The purpose of this piece is simply to save lives.

It is admirable to see how, out of a traumatic situation of pain and adversity, the author converts the situation into one of educational and positive learning that will serve as a tool to all cancer patients who wish to achieve a "newlife."

Palmira S. Ubinas

Chairman, International Association of Poets and Writers Hispanic

First I would like to commend Jairo Alvarez-Botero for writing this needed book on prostate cancer and donating the proceeds for prostate cancer treatment and research.

Prostate cancer for males is the breast cancer equivalent for females. The main difference is that the research and treatment of prostate cancer severely lags that of the treatment of breast cancer. The main reasons are that the presentation of prostate cancer is less obvious than breast cancer and males are less verbal about health issues in general.

Any cancer has a mental and physical impact. The impact is even greater when it evolves disfigurement or dysfunction. This is especially true if it involves our reproductive organs which are basic to our own ideas of sexuality.

Even thought the cure and treatment of prostate cancer lags from many other cancers; there are many new treatments on the horizon. These include new chemotherapy drugs, vaccines, and stimulation of the body's own immune system.

With any cancer one of the major factors in cure and survival is early detection. Prostate cancer is easy to detect if you have the recommended exams and blood work. If you have a family history of prostate cancer it is even more important that you are tested earlier than recommended.

John Frusha, M.D.

CANCER – A Message of Hope – is a very encouraging and informative book based on the real life experiences of Jairo álvarez-Botero, a prostate cancer survivor. This is a subject that most men fear because of myths, rumors and misinformation. I am a successful prostate cancer survivor, which is why I can personally relate to this subject.

We live in an age of the most advanced medical knowledge in history, yet without a common sense approach, such as regular checkups for prostate health, man is playing Russian roulette with this "silent killer" disease.

This book will help men to reach what the author calls "newlife." It has informative, practical and valuable explanations concerning decisions that are to be made to improve the quality of life and it will provide very useful data for those who had the disease and are in the process of recovery.

The tremendous effort it took Jairo Álvarez-Botero to write his tory will certainly be informative and encouraging to men who read and heed the message of this book, not to mention the peace and happiness this will bring to their family and friends.

Bob Brooks, CEO

Bob Brooks School of Real Estate & Insurance, Inc.

-Cancer survivor -

I admire Jairo Álvarez-Botero, author of a great classic No Such Thing as Impossible—From Adversity to Triumph, which I devoured and recommend it as a wonderful work of personal achievement. Jairo now delights us with his new book, Cancer— A Message of Hope, which I have also read and which represents to me great hope for those who have suffered the ravages of this painful disease. This book will save many lives.

Ricardo Tribín-Acosta

Author, Entrepreneur and International Speaker
Dedication

This book is dedicated to those who suffer with prostate cancer and will reach a "newlife."
INTRODUCTION

" _There is more to know than we have time to learn. I think civilization suffers from a lack of knowledge,"_ said the well-known American writer Andy Rooney. Nothing could have been said more accurately. I believe that the fast-paced life in which we live and the poor management of our time prevents us from writing and transmitting to future generations our experiences, knowledge and the precious legacies left by our ancestors. Things I want you to know and that we must pass on.... In the time it takes you to eat lunch four men: husbands, brothers, grandfathers, sons, will die needlessly from prostate cancer. Prostate cancer can be in a man's body for several years before he has any symptoms and many men are dying from kidney, bladder, bone, or lung cancer that was originated by silent prostate cancer.

My purpose with this book is to save as many lives as possible. Without a doubt, one of the chapters that caused the greatest impact on the readers of my autobiography _No Such Thing as Impossible—From Adversity to Triumph_ , has been chapter thirty-two, "Newlife," in which I narrate my experiences with prostate cancer, the disease commonly known as "the silent murderer." Six years ago, I eradicated this disease, and I am still learning how to live with the consequences.

In my biography, I provided only a brief analysis of this experience. I did not consider it necessary then to provide personal, physical, spiritual and emotional information and the tools I used before, during and throughout my prolonged period of recovery. I never imagined that soon family, friends, associates and even strangers afflicted by this disease could benefit from my experiences or that those experiences would help them make the appropriate decision to rebuild their live—lives that would be full of health, happiness and prosperity. I am very grateful for their words of gratitude and pleased to have established a wonderful relationship with these survivors and their families.

Today, prostate cancer is the number two killer of men in the United States after skin cancer. The American Cancer Society (ACS) estimates 217,730 new cases of this insidious cancer will be diagnosed in 2010 and 32,050 people will die. My purpose in writing this book is to save as many lives as possible.

It is common for many men to avoid uncomfortable tests, such as the digital examination, biopsies or blood work. I believe that we, as men, are very fearful of the diagnosis of serious diseases. We come to consider, erroneously, that avoiding, ignoring or delaying the diagnosis is the best solution. We think that silence and denial is the way to cope. In fact, this behavior is irresponsible, and even worse, it may cost the life of the patient.

Many men avoid talking about or recognizing their failures or physical or mental weaknesses, shortcomings and deficiencies because we think we are "super-males," and if we talk about them, we are no "macho." We also avoid talking about personal and private matters, such as sexual limitations, control of the digestive and urinary systems, sleep disorders and prescription drug addictions. I want to discuss my experience about these topics very openly.

Similarly, the refusal to write and talk about this field has led to the proliferation of a number of taboos, myths and false theories, which, without any basis, is costing countless lives and has significantly impacted those suffering from prostate cancer and their families. These myths reach the limits of absurdity, and I intend to prove this by honestly and openly sharing my story with you, so that you will learn the realities of this disease in an accurate manner.

Each one of us is unique. There has never been a person like me; therefore, my case of cancer is simply unique. As a patient, I lived through a number of special conditions that led me to use my imagination to create procedures that I put into practice to make the healing process and recovery more bearable and comfortable.

This book is meant to save the lives of those diagnosed and help their loved ones who sometimes feel that "the end of their lives has come." Those close to the patient should be part of the cure and not serve to aggravate the disease. To them, I say that instead of seeing illness, they should see this as an opportunity to start a physical and spiritual "newlife," which will bring peace, joy and wellness to the patient and his loved ones.

I also dedicate this book to those who do not suffer from this ailment but who might in the future. I invite you to make use of my experiences to act now. An early diagnosis will enable a fast and successful recovery.

As a successful prostate cancer survivor, I have been an observer and a student of this area. Most importantly, I am convinced that my testimony may be helpful to mankind.

I consider it a moral obligation to publish it. All profits from the sale of this book will be donated to the Prostate Cancer Foundation to help those who are risking their lives due to lack of knowledge, lack of resources, negligence or fear and have failed to act promptly.

This book is not only for men. It is written for women, as well, in the hope that you will become better informed so that you can help to save your husband, boyfriend, brother, father or friend's life. Go to the doctor with the man in your life. Listen carefully to all of the information provided and then assist with making the most important decision you and your loved one will ever face.

I would also like to challenge the media to become a part of the mission to inform the public about how there can be newlife after prostate cancer. We hear so much about other types of cancer—heart, lung, cervical, skin—but we don't hear much about prostate cancer, yet so many men die from this disease every year. There are screenings available at no charge at many hospitals throughout the United States, yet men still go undiagnosed for years. I ask that the media and other organizations that deal with cancers focus some of their resources to help eradicate the deaths associated with prostate cancer. With your help, we can inform the public and save lives. No one person should die of prostate cancer.
Foreword  
By Angelo Annaloro Jr., M.D., F.A.C.S.

Jairo Álvarez-Botero

When Jairo Álvarez-Botero became my patient, I diagnosed him with prostate cancer and recommended radical surgery to remove his prostate. Like many men who are faced with this decision, he had questions that needed to be answered and concerns about taking such a drastic step to rid his body of this cancer. Jairo took my advice and is now living a happy, cancer-free life. I would like to congratulate him for taking the initiative to write this book—his effort to help other men who must face difficult decisions when fighting cancer.

Cancer—A Message of Hope is very informative and will certainly provide inspiration to anyone who has received a diagnosis of prostate cancer. This book encourages men with prostate cancer to face their diagnosis and treatment options. It helps families understand what their loved one will face as he battles this cancer and teaches family members how to help. Perhaps most importantly, this book can create a much needed awareness of this disease, while dispelling the myths that surround it. My hope is that it will also help men to talk more openly with their physicians, families and friends about what they face while fighting this cancer.

Overcoming the fear of cancer and keeping a positive attitude throughout the healing process can be a difficult task for anyone, but Jairo faced this ordeal with courage and resolve that he would win his fight against cancer. His positive attitude and determination helped him to heal, and his book encourages others to do the same, while providing the information and tools necessary to make help men make the decision to live a longer and healthier life.

Physical issues, such as the possibility of incontinence and erectile dysfunction; emotional issues, such as facing death and the possibility of living life without the ability to perform sexually; and interrelationship issues, such as how this disease can affect a marriage, are all addressed in a positive and understanding manner. The truth that Jairo stresses throughout this book is that many men live normal, sexually active lives after prostate cancer, and his message of hope includes that possibility for men who opt for radical surgery. This book is also written for women and will help them understand the issues their loved one will face after being diagnosed with cancer.

My best advice to men is to talk to your urologist and encourage your family members to talk with your physician, as well. Read all of the literature the urologist provides and do not be taken in by unreliable information that has been distributed on the Internet. Listen to your doctor and take his best advice. Talk with other people you may know who have been diagnosed with prostate cancer and learn from their experiences. Then make the decision about how you wish to treat your cancer based on all the information you have been given.

After reading this Message of Hope, my hope is that you will make the decision to live!
PART ONE

My Story

On December 13, 2005, I was diagnosed with prostate cancer. After careful consideration of the alternatives and consequences, I opted for the clinical procedure called, "Radical Surgery," which consists of the complete removal of the prostate gland. The surgery was performed January 23, 2006. The first eleven chapters of this book will narrate all of experiences with this disease until January 14, 2011, the day of my seventy-third birthday. Within this book are six full years of valuable knowledge that I wish to make public to help those who are afflicted with the disease so that they, too, can experience a "newlife."
Chapter 1

Dominated by Fear

I was very happy when 2005 ended. It had been a year of many family hardships. The death of my mother, Adela Botero, had closed a chapter in my life. With her death, my previous generation had passed into eternity. This year great tragedies were not absent; the devastating hurricanes Katrina and Rita hit the Gulf of Mexico. We have not yet recovered from this scourge of nature.

I was very excited about my construction project, and at the same time, I was training for my next cycling competition. My goal was to participate in the National Senior Olympic Games of 2007 in Louisville, Kentucky. Somehow I knew my shortcomings were now increasing. My age was becoming a limiting factor for cycling. I remember back home in Colombia when I was young I climbed mountains quickly, beating my dad, who was behind me in his pickup truck. Those days were long gone, but inside I still had that great sense of control and was determined to get a better place in the Olympics.

A few weeks earlier I had undergone a strict medical examination before departing with Anita for a vacation to Asia. My health was in good condition according to the results, but I was not feeling well. There were a number of conditions that worried me.

First, I have always been energetic, active and healthy and have led a good lifestyle. I lived with little stress, had a good diet and never smoked or drank liquor. Suddenly, I noticed that by four in the afternoon I felt considerable fatigue and weakness in the legs. This weakness could not have been caused by my biking, as my training program had been stable and sustained for many years. I got enough sleep, and my diet was truly healthy and controlled. I felt that the weakness and lack of energy meant that something serious was happening. This condition was accompanied by a very irritable emotional state. I had frequent confrontations with Anita and my children, characterized by strong and irrational demands on my behalf. They asked me sensitively, "Daddy, what is happening to you for you to respond like that?"

Fortunately, I reacted with silence to escape from my own wounds and camouflage the tremendous physical weakness I felt.

The other aspect that worried me was my sexual activity. Although I was almost sixty-eight years old, my sexual life had always been very active. I could not understand why everything had suddenly gone down. Now I could not wait to fall asleep in bed, but my sleep was not restful. At three or four in the morning I would wake up anxious. I was certain something serious was happening to me.

My participation at the Olympics in Louisville was not to my satisfaction. Unfortunately, the changes in elevation of the terrains at the races were not my allies because I had trained in the flat lands of Louisiana. When I got back home, I set the goal of improving my mountain climbing, and I decided to train with dedication on changing elevations. With that idea, I went on a Sunday morning to St. Francisville, a city north of Baton Rouge. It was a very cold winter day. I remember it was in the fifties, and unfortunately, my clothes did not give me enough protection from the weather. The cold got into the deepest part of my bones.

The following Monday, when climbing the stairs at the office, the bodily pain was unbearable. I felt as if a bus had run me over. By nine o'clock, when Ana Marcela came into my office and found me, my body was shaking. I had a fever and could not move a joint. I immediately went to an emergency clinic close to my office and underwent a series of urine and blood tests. The doctor diagnosed me with pneumonia but did not let me go without asking me a question, one which had always been one of my deepest fears.

"Mr. Álvarez, when was the last time you checked the prostate?" he asked.

"About six months ago, doctor, and everything was fine."

He shook his head and said, "Very strange, because your PSA (Prostate Specific Antigen) is very high. Let's treat the pneumonia then."

He prescribed strong antibiotics for about a week. After this, the pneumonia was controlled, but I had a very strong infection that would not let me empty my bladder. I returned to the same doctor, who referred me to an urologist as an emergency case.

The urologist, Dr. Angelo Annaloro examined me and immediately ordered blood and urine tests. He also performed a digital examination of the prostate. Shortly after he returned to the room, he told me I had two problems.

"First, you have a serious infection in the bladder," he said. "Secondly, I do not like the way your prostate felt during my digital test. Your PSA is nineteen, which is extremely high. You need to have a biopsy."

Fear ran through my body. It felt like my heart wanted to jump out of my chest. I could feel my heartbeat in my throat. I wanted to escape reality. I tried to convince the doctor that a biopsy was not necessary, although my inner self had a feeling that something was wrong. I informed him that I had received a thorough examination of the prostate with another urologist six months before the National Olympics and that everything had been normal. My appointment for my next review was scheduled in two years, mid-2007.

"To me, it looks suspicious," he said, without giving in. "Very suspicious." He had a serious and concerned look. Then there was deathly silence. I could see that he was convinced of the seriousness of my condition but wanted clinical verification. His professional experience was accompanied by sincerity, wisdom and sensitivity, and this gave me great comfort and confidence.

At that moment, my brain, which was working at high speed, brought to mind something that had happened to me the year before, something I had not paid attention to because of lack of courage and responsibility. It had started with a severe pain that had affected my lower back and hip. I asked an orthopedist, my good friend, Dr. Jorge Isaza, about it. After a series of tests, he said, "Jairo, I do not see anything wrong orthopedically, but I recommend you to visit an urologist to check your prostate. Have you checked it?"

A few days later, I began to feel relief, possibly due to the fear of having to face what I was now facing with Dr. Annaloro.

I wondered, is it too late? Why had I lacked the courage? Why I am so irresponsible with myself? Is it time to face reality?

As I was asking myself these questions, Dr. Annaloro said, "I recommend that you first treat the bladder infection. When that's under control, we will check the prostate."

I felt relieved because I had such a deep fear of prostate cancer. I had deceived myself and had wanted to hide the truth, but I knew I was very sick.

Two years before, the fear had started torturing me. I had unresolved questions about prostate problems.

Fear reappeared every year when I had my routine physical checkups. Each time, it was necessary to repeat the PSA test when general practitioners saw the levels elevated, but they ended up postponing the test for the following year. I knew there was something wrong because I had started feeling discomfort in the area of the prostate when I rode my bike. I talked to my coach, William Cheramie, and he recommended changing the seat to one that is open in the center and has orthopedic dimensions. The improvement was minimal. I could not handle the pressure in the prostate area, which forced me to change position constantly and affected my performance.

My fear of having something seriously wrong in the prostate was aggravated by the sadness of having recently lost two great friends of mine to the same illness. The symptoms I felt were the same as those felt by my great friends, Doctor Vinicio Echeverri and Gerardo Cuartas. I was afraid to face reality. Still ringing in my ears were the words of my friends, who had told me about their physical exhaustion and the unbearable pain in their legs, as well as exhaustion after four in the afternoon.

Fear gripped me as I recalled the words of President Franklin D. Roosevelt, "The only thing that we have to fear is fear itself."
Chapter 2

A Hard Pill to Swallow

I was in a meeting with Sebastián and some subcontractors talking about our big project when I received the call.

"Mr. Álvarez, this is Helen from Dr. Annaloro's office. Can we speak in private?"

"Yes, Helen, of course," I said after I excused myself from the meeting and went to my office.

I felt a cold chill all over my body, and my heart wanted to jump out of my chest.

"I'm so sorry, but the tests are positive for cancer. Can you come with your wife tomorrow morning at ten?"

"We will be there Helen, thank you."

I remembered when I had received a similar call about Anita. Now I knew how she felt when she had learned she had breast cancer. Immediately I went to Carlos Mario's office, who gave me a great lesson

"My God. My God!" I cried. "Carli, I have prostate cancer!"

"Daddy, calm down, please. There is nothing you can do at this time. You'll be fine! Just calm down!"

I absorbed his words as my chest calmed down, and I immediately thought, _I have prostate cancer, I should not have told my son about it this way. He's right, what I can do right now? Nothing! Carlos is right._

I took a deep breath, dried my eyes and went back to my meeting. Sebastián must have noticed the paleness and transformation of my face because he asked, "Dad, are you okay?"

"Yes son, I'm all right."

We had scheduled lunch together with contractors after the meeting, so I went with them, trying to pretend that nothing had happened. For the first time in many years, I ordered a hamburger. I wanted just a quick bite, and I devoured it in a few bites since my desire was to get out of there as soon as possible. As soon as our lunch was over, I said, "I'm sorry, gentlemen. I think you have seen that my behavior is not normal. The news I have just received about my health is not good, I have prostate cancer. I would appreciate it if you would pray for me. I have to go. Thank you very much." I shook their hands and left.

I hastily returned to the office, and from there, I called Anita and our children. I wanted to gather them to inform them of the situation. I assured them that I would triumph over this adversity. I asked them to have faith that I would endure if it was God's will. I then hugged each one of them and ended the meeting. It took only five minutes. There was little to say and much to do in this situation. Next, I called my coworkers and told them what had happened to me. It was important for them to have the news from me. It was crucial for us to focus our energy in the same direction in order to ensure a speedy recovery. Within minutes, I narrated what had happened and made the same promise to fight and succeed. Some already knew, and it hurt me greatly to see their teary eyes. I said goodbye and went back to work, trying to keep my mind occupied.

That afternoon, when I arrived home, Anita and I were very calm. Although we had been together through so many difficulties, we still did not know how we would overcome this new obstacle. At dinner, we were still in a dead silence. As I had at lunch, I ate quickly. I decided to go to bed early as if this would help me hide from the danger that stalked me. Throughout the entire night I was traveling through my past, analyzing my present and worrying about the uncertainty of my future. I had lost two great friends to this illness, and I was afraid that my turn had come. This was a feeling that overwhelmed my entire being. I could not sleep. I was not aware that this night would be the beginning of other painful conditions, different from the cancer that would cost me greatly in the years to come.

The next morning, after stuffing my breakfast down as fast as I could, Anita and I headed to the doctor. I asked Anita to leave early so we have time to visit the small, beautiful church at Our Lady of the Lake hospital, located where Dr. Annaloro had his office. The non-denominational chapel represented different faiths and was adorned with various symbols representing major world's religions. I wanted to pray and meditate for a few minutes.

I asked the Lord to help me and my beloved family to accept His will. I did not ask for a cure or a miracle, but I begged Him to give me the strength and courage to accept it and help me with the path before me. I asked Him not to let me show any weakness to Anita and our children and thanked Him for the many great years He had given me.

I pondered over what had happened day before. I was talking about plans, money, wealth, goals and success, and now I was talking about the reality of life—death. Definitively, I think, "life is what has happened, is happening and will happen as you plan other things." When we left the chapel, I felt at peace and was calm for having accepted my reality.

Anita and I made a mutual commitment to listen carefully to what the doctor had to say. "You'll be fine," she said, squeezing my hand. "With that hard head of yours, you will be fine." She had said that several times the day before. That reminded me what she said jokingly a long time ago—"When you are incinerated, the only part of your body that will not be ashes is your head."

The doctor presented the situation in a detailed and thorough way using plain and logical terms. I could choose between radiation treatments, radical surgery or I could choose other experimental procedures that I will analyze later. Also, considering my age, I could choose to do nothing. He asked me how I felt.

"I'm fine, doctor!" I said emphatically.

He looked at me with sympathy before continuing our conversation. He asked me the same question a few minutes later.

"I'm fine, doctor," I repeated.

A few minutes later, he asked again.

"Doctor, why do you keep asking me that question?"

"Because most people get very emotional during this conversation. You have not shown any emotion. I just wanted to ask."

"Don't you think I'm better now than a week ago? Last week, I had this animal inside of me and did not know about. Now I know, and I can do something about it," I said.

"Ah. If you think like that, you will overcome this without any problem," he said. "Well, do you have any idea which treatment you would like to choose?"

"Doctor, imagine that you are my younger brother. What would you suggest for me?"

"I would recommend radical surgery. With radiation or other procedures, there is a very high probability that you will experience a recurrence in about eight years. By then, you will be older and perhaps not strong enough to go through this again. However, if the prostate is removed now, you will not have to worry about this anymore, and you will probably be fine.

"Go ahead. Take it out of me," I told him.

"I like the personality of this man," I said to myself. He was very frank but also prudent. He radiated sincerity, compassion and knowledge. Moreover, he inspired confidence and security in me. He had all the qualities to be my surgeon.

"Do you have any other questions?" Doctor Annaloro asked.

"Yes, doctor. When can I ride my bike again?"

He had told me that my recovery would take several months, but I knew that the Senior Olympics in Mississippi would be held in exactly three months. This worried me because I already had booked my registration, hotels.

"Wait a minute. The reading of your biopsy is very high. We also need to do a cystourethroscopy of the bladder, a kidney ultrasound and a bone scan," he explained. "When the prostate gland is cancerous to the degree yours is, the disease can spread to those areas. In other words it can metastasize."

I nodded, indicating that I understood the situation. I thought that the situation could be worse than I had expected.

"Very well. What do I have to do?"
Chapter 3

The Monster

Thirty-six hours after being diagnosed with cancer, I had lost about six pounds. I kept a strict log of my weight as part of my cycling training. I weighed myself daily at the same time before entering the shower. I soon realized that although I was trying to be strong externally, the tension and fear of knowing I had cancer of was taking its toll on me. I was very scared because of my friends who had died of prostate cancer.

The next day when I woke up, I looked at myself in the mirror and realized that my appearance looked fatigued. I concluded that the stress, anxiety and fear would end up killing me long before the cancer did. I asked myself, why I did not lose any weight in the ten days between the biopsy and diagnosis and now thirty-six hours after learning I have cancer, I had lost all this weight.

My answer was, _it is the fear not the cancer that is killing me now!_

_Enough Is enough!_ I said mad and aloud to the mirror.

_You have to stop this because it is insane._ Then I started to speak to the "monster" that was inside me. It was my only opportunity to practice the first English words that I learned from the workers in the basement of Albany Medical Center upon my arrival to this country in 1963.

_Bastard...you bastard! You're in the wrong body, at the wrong time and I'm going to kick you in the ass. I have fought bigger "monsters" than you!_ _You got into a big one, and it will cost your life, son of a bitch!"_ I also said other dirty words that I don't say now out of respect for my readers.

From now on, your name is, The Monster."

I realized that what was killing me was the word, "cancer," not the malignant cells.

I was sitting in the waiting room of Dr. Annaloro to review my previous tests. I was pale and destroyed, not knowing how severe my cancer was. It was a big surprise when the door opened, and I saw Bob Brooks exiting. Bob was a good friend that twenty years ago, at fifty two years old age, helped to change my life starting a new career as a home builder and developer.

"What are you doing here, Jairo?" he asked.

"I have prostate cancer, Bob," I informed him.

"What severity Gleason factor do you have?"

"The doctor says six," was my response.

"So, don't worry. You'll be completely fine. You don't have a problem. Mine was grade seven, more serious. A year ago, I had radical surgery, and I'm completely fine. I just came in for my routine checkup."

Bob saw my face in a state of distress and immediately proceeded to give me orders like a general.

"Tomorrow at 10 a.m. I want to meet with Anita and all your children in your office," he said.

At the meeting, Bob explained the procedure he had undergone and told us what to expect and how to handle it. He gave me a number of recommendations and instilled in us a lot of courage and the certainty of success.

Without a doubt, the encounter with Bob was essential for me to start developing a positive attitude and was an example that I would use with others in the future. This angel that the Lord put in my path inspired me to follow his example, an example that culminates today writing this book.

After that meeting, I set about taking care of my problem. Prior to the bone scan, an injection of a radioactive substance was required. I had to wait two hours for the liquid to flow through the body. I do not want to stay there seeing so many sick people. I told Anita that we should to go to the office for a while. She just laughed. I tried to lighten the mood in the room by telling everyone to be very careful as I might explode.

I was very relieved that the additional tests, the cystourethroscopy of the bladder, kidney ultrasound and the bone scan went well, and the cancer had not spread to other organs.
Chapter 4

"Newlife"

In the midst of this challenge I thought that modern civilization should change the word, "cancer." This single word is probably costing thousands of lives. As I looked in the mirror, I thought of another word more appropriate—"newlife." It would be very different if the doctor had told me, "Come in, Mr. Álvarez, I want to talk to you. The results of the biopsy indicate you have 'newlife.'" And then he would explain, "Well, you have no problem. Chances are you survive, and you will see and feel what is around you completely differently. That is, you will see your wife differently, your family, friends and workers, the rising sun and darkness, storm and calm, the taste of water and tears... even your spouse's snoring will feel different. In other words, you will fully live a "newlife." Yes a "newlife," full of appreciation and love. And on the other hand, if you die of this disease you will also have a "newlife." So do not worry."

This kind of message would produce a lot of peace and tranquility.

I liked the new name I had given my disease, and I felt better from that moment on. A few days later, my weight stabilized. I decided to face my "newlife" with a positive attitude. For me, it was important to do well because it was hard to endure the suffering and fear on the teary and distressed faces of my wife, children and employees. I wanted them to know that I was not scared and that through self-control I would fight this "monster." In this way, they could count on me and my "newlife."

The next day, Sebastián came into my office and handed me a book. "Daddy, you have to read this," he said. I looked at what he had given me, and I realized he was right. It was, _It's Not about the Bike,_ by Lance Armstrong, a famous cyclist who won the Tour de France seven times. As I began to read about Armstrong's experience with cancer, which he called, "Bastard," I started feeling better, stronger. I read that book more quickly than any other text I had read in my life. The history of this cyclist opened my mind and changed the way I looked at my situation. I realized that this was just another challenge to overcome. Anyone with cancer should read this book. Doctors should prescribe it as part of cancer treatment. I thanked Sebastian for the wonderful gift he had given me and got ready to face my "monster" with renewed vigor.

A few days later, I received a packet of material published by the organization, LIVESTRONG, the foundation Lance Armstrong created. There, I found a few programs and information that would guide me to overcome difficulties in my "newlife."

Dr. Annaloro had decided to use my own blood, in case of an emergency for the procedure, since the blood donated at hospitals is not one-hundred percent guaranteed, and it might be infected with other diseases. I had to wait thirty days for the surgery because my body needed to recover the blood stored in the clinic. Those were thirty days in which I dedicated myself to working normally and strengthening my body and spirit. I did not think I was going to die, but just in case, I contacted my friends, attorneys Aubrey and his son Kevin, to make sure that my affairs were in order. God had plans for my "newlife" but, obviously, I did not know what they were.

During those days I focused on my fitness. I rode my bike daily and exercised. For my mind and spirit, I performed relaxation exercises three times each day. I meditated a lot because I did not know how many days, months or years God has planned for me.

One day as I reflected on my life, I wondered what I should do with my life from now on.

Immediately I had the vision of my life like a table. From now on, I had to keep it straight, level and clean. During my meditation, I thought that the table needs at least three legs for support. The first leg of the table was my **faith in God**. I did not ask for a cure for my cancer, I simply offered my acceptance of whatever my "newlife" was to be. The second leg was **faith in myself** , in my body, my spirit, my soul, my desire, my energy, my Christian principles. The third leg was my **faith in my family** **and my friends**.

I set my mind to keeping my desk clean and leveled, with the three legs strong and healthy so that I could hold it firmly. The interesting part of this mysterious vision was that material wealth and money were not included, at least they were not seen in my meditations as a requirement for my "newlife." They were not essential even though they were considered to be required in modern civilization.

While meditating on material wealth, a picture that was published by newspapers in my youth came to my mind. It was a picture of the world's richest man at that time, Aristides Onassis, who was suffering from a muscle disease that affected his control of the eyelids. To be able to see his beloved wife, Jacqueline Kennedy, his eyelids were supported by two pieces of plastic tape that were not worth more than a penny. What a valuable lesson that was of what wealth really is.

A few days before my surgery, I sent an e-mail to my cycling friends. In it, I said, "I have a monster inside me, I do not know for how long, all I know is that he has loved cycling. This "monster" has been sentenced to death on January 23. In that date, it will be incinerated. His last wish is for a bike ride on Saturday, the 21st on the road that runs along the Mississippi River. I invite you to say goodbye to this monster."

More than thirty riders followed me for a long ride along that road parallel to the Mississippi River. One of my friends, Llew, had a big sign on his shirt that read, "The monster will die." After this event, I was ready for my "newlife," and I was willing to accept what I do not control, the Will of the Lord.

Today, many people talk about the "C" word instead of talking about cancer because they know how malignant this word is. I sincerely hope it will be replaced by "newlife."
Chapter 5

The Joy of Being Free Again

One week before the surgery, the nurse did an EKG to check my heart and my overall health condition. She could not believe my heart's beats were so low, fifty-two per minute. She did another test and got the same result, or lower. Concerned, she went to tell the doctor while I smiled because I knew what was happening. He came back saying everything was fine. The doctor knew I had the heart of an athlete.

Surgery was scheduled to last two hours, but I told the doctor that it would not take that long. I had exercised vigorously in the weeks before surgery. I had given priority to my abdominal muscles.

"Doctor, you will find only muscle and when you open my stomach, zero fat," I said.

I was right. The surgery only took an hour-and-a-half. I stayed three days in the hospital recovering until the results of pathology and laboratory returned. It is standard procedure when a gland is removed to perform tests to verify that all of the malignant cells have been removed. Dr. Annaloro and Helen came into my room smiling.

"Who is the best patient in the world? Who is the best doctor in the world?" Dr. Annaloro said, extending his arms high and congratulating me because everything had gone well and I was now cancer-free. There were no traces of the monster in me.

In other words, I was ready to start a "newlife." Anita and Ana Marcela were with me. The lifting of this great weight overwhelmed our spirit and dampened our eyes.

Recovery at home was a little uncomfortable. For two weeks, I had to carry a catheter attached to a plastic bag where my urine was collected. I will explain later how I managed this situation.

Twice each day I walked around the lake close to our home. Soon I was walking one kilometer. My priority was to follow carefully the instructions from the doctor, especially by doing the Kegel exercises that, which were very important for my full recovery.

Dr. Annaloro was very impressed with my progress. I visited him weekly for a few weeks, then monthly. I had registered myself for the Mississippi Senior Olympics several months in advance, even without knowing that I had "the monster" inside me. Two months after surgery, the doctor said in reply to my question said, "You can go next month but not to compete. You can only hang around with your friends."

I took my bike to have fun with my friends in Philadelphia, Mississippi while they warmed up before competition. There were four races in two days. I was still using diapers, not yet having complete control of my bladder. When it came time for the first race, a microphone called the cyclists. I asked Anita to give me my helmet and the water bottle because I wanted to "be with my friends," as the doctor had told me to do. I promised I was not going to compete. I will ride with care and without pushing my body too hard.

The race started. The feeling of being alive was unbelievable. To be on my bike again was like a dream. I felt like I was flying. This was in the forty kilometer race. I was climbing a hill comfortably at the twenty kilometer mark, halfway through the race, when suddenly I felt myself riding alone. I was very confused not knowing what was going on. I looked back and realized that I had escaped and was in the first place. I recognized my contenders downhill. When I reached the top, I decided to continue alone for the remaining twenty miles.

It was incredible that only three months and five days after having my surgery, I was returning home with four gold medals.

The following Monday, I hid the medals under my shirt and went to see Dr. Annaloro. "Doctor, I dedicate these medals to you. I was having fun with my friends," I said as I opened my shirt. Surprised, Dr. Annaloro shook his head in disbelief.

During the medal presentation ceremony, I told the audience, "Not bad for someone who just had radical surgery for prostate cancer."

After the ceremony, Paul, a strong cyclist from Texas approached me privately to talk. He had problems with his prostate, but he was postponing the biopsy prescribed by his doctor. He was afraid of the results of the test. He was doing what I had done—believing that the problem would be solved by running away from it. I unsuccessfully used all persuasive tools available to convince his to do the exam. He left for Texas, and we left for Louisiana. He had not committed. He was just scared to death. While we were on the way home, I spoke by phone to him. He continued to refuse to undergo the procedure. The next night I called him at home, talked to his wife and she agreed with me. Then Paul said, "I want to do the biopsy after my trip to my grandson's birthday in a few months." He was still looking for excuses.

"Paul, do you love your grandson?" I asked. "If so, do it now for him."

He understood my message and promised to schedule the biopsy for the next day. The biopsy later confirmed he had cancer. His surgery was successful, and he is now living a "newlife." I cannot describe the words of gratitude I received from him and his wife that so touched my heart. I had experienced the disease firsthand and knew that you cannot play with cancer. I also know that I cannot lose any opportunity to help others stricken by the monster.

Three years later, I was competing in the National Olympic Games in San Francisco. The competition for the forty kilometer race was very harsh and ended with a slope of one kilometer with an inclination of ten percent. At the front was a group of ten of us, who were ahead out of the ninety riders who competed. In the final part, I was dropped and alone. I was half of a kilometer from the finish line when I saw a cyclist ahead slowly climbing without effort to reach the line. Very soon I was by his side, and then I sped up, passing him. Seconds later I recognized him. It was Paul, my friend from Texas, who I had not seen for years. After the competition, I asked, "Paul, what happened? Why did you not want to attack? You were riding very easy."

"Jairo, that was the only way to pay you back for what you did for me, to let you win. Thank you," was his response. It was a noble gesture from my friend.

Soon I would learn another lesson from my close friend and personal trainer for so many years, Dr. Vinicio Echeverri, who was also diagnosed with prostate cancer. He was an incredible human being who dedicated his life to serve humanity, In Colombia, he was a model worthy of emulation, an athlete and an active rider until his nineties. When I visited him he said, "Jairo, I made a mistake when they found my cancer. I decided to go through radiation instead of radical prostatectomy. Eight years later, it has returned."

When I left, at the door of his house, he gave me an affectionate kiss on the cheek and said, "Jairo, I do not say goodbye to you."

He turned and shut the door, and I never saw him again.

This event reminded me when Doctor Annaloro had told me this could happen if I chose radiation or chemotherapy. I was very grateful for the choice I had made but sad for my great friend. The Monster finally defeated Vinicio just a few days after I finished writing my biography. One of my best friends was absent, and thousands of Colombians had lost this angel. Vinicio went to his "newlife," for which he was very well prepared, sooner than he should have.

The only thing I regretted during my surgery was that while I was in the preparation room, I was surrounded by my entire family. Everyone was talking, and I did not realize that they would administer the anesthesia so fast.

"Mr. Álvarez, we will give you some drops to help you relax," the nurse told me. I did not know I would be anesthetized before I could tell them how lucky I was to have them. Fifteen seconds later, I had succumbed completely to the anesthesia. I was unable to tell my loved ones the parting words I had prepared. I did not have the opportunity to thank and tell them how much I loved them. I think often about this and the effect it would have had if the procedure had not been successful. I felt like I had always been the captain of a ship that always faced several incredible waves. Anita is my co-pilot and my children are my fellows aboard. We all will survive and prosper due to teamwork and helping each other. I'll be sure to tell them if there is a next time.

A few days before my surgery, Sebastián asked me how I could work as hard, as if nothing was happening.

"I cannot change this, son, so why bother?" I said. "If a problem has a solution, do not worry, and if it has no solution, don't worry either. You cannot change reality."
PART II

My learning experiences

Many men avoid talking about or recognizing their failures or physical or mental weaknesses, shortcomings and deficiencies because we think we are "super-males," and if we talk about them, we are no "macho." We also avoid talking about personal and private matters, such as sexual limitations, control of the digestive and urinary systems, sleep disorders and prescription drug addictions. I want to discuss my experience about these topics very openly. Similarly, the refusal to write and talk about this field has led to the proliferation of a number of taboos, myths and false theories, which, without any basis, are costing countless lives and have significantly impacted those suffering from prostate cancer and their families. These myths reach the limits of absurdity, and I intend to prove this by honestly and openly sharing my story with you, so that you will learn the realities of this disease in an accurate manner.
Chapter 6

Learning and Living the Consequences

What I will narrate below may not be exactly what will happen to all patients with prostate cancer. I also do not mean that the procedures I used will benefit all patients with prostate cancer. They were useful to me, and in some cases, they were the result of my imagination. I recommend talking with a doctor before putting them into practice because each body reacts differently and no two cases are clinically identical, Nevertheless, I want to share the lessons and experiences I had before, during and after the radical surgery. I had to go through several unique procedures.

1. A Jacuzzi may be your temporary solution

Undoubtedly, the situation of suffering that struck me the most was the condition of my health a week or two before the operation. It was so serious that my urethra was almost completely blocked by the inflammation caused by the cancer, and I could hardly urinate. I was pinned to the wall, and the pain was so strong that my eyes would water when I would go to the bathroom. My bladder was close to being completely blocked, and I did not believe I would be able to get to the day of surgery. Anita had a great idea—get me in the Jacuzzi with hot water and a cup of Epson salt to shrink the tissues. I spent endless hours there. It was the only way I could go to the bathroom.

2. Post-operative surprise

First, when I was in hospital recovery room, the pain in the affected area was brutal. I was screaming like they were pulling out my entrails. Fortunately, the assistants in charge were able to calm me down with a good dose of medicine that made me begin to talk like a parrot for the rest of the day and then dive into a deep sleep. Upon waking, I noticed that a catheter was attached to my penis and to a bag to receive the urine. This image gave me no joy. The first opportunity I had, I wanted to explore my wound. I was surprised to see a cut of seven inches long, about twenty centimeters, ranging from the base of the navel to the base of the penis. What surprised me the most was to see my penis, testicles and the area around them completely dark purple, almost black. Anita immediately called the nurse. She calmly informed me that this situation occurred in some cases but not to worry because it would soon disappear. And so it did. That surprise scared me a lot.

3. The plastic bag—mental torture

Dr. Annaloro instructed me to walk every day and to increase the distance little by little without over doing it. Going out with a bag in my hand full of urine was not my idea of a good time. For two weeks, I had to carry a catheter connecting my penis to a bag by plastic tubing where my urine was collected. A few days into it, carrying and seeing the urine bag constantly was a torture that was making me sick. I got to the point of distracting myself by counting the drops of urine that my kidneys were producing—approximately one per second, three hundred sixty drops per hour. I decided I had to take action.

To take away this torment, I asked Anita to go to the store to buy some Velcro straps. I tied the bag to my leg with Velcro so I could camouflage the bag under my jeans. After adjusting the drainage and attaching the bag to my leg, the system worked. Then I put on some jeans and went on comfortable walks and to the office to greet my co-workers. I was very happy to see them again around me. Because of that Velcro, I could go to the office as if nothing had happened.

3. Origin of my autobiography

I stayed only three days in the hospital. During that time, I walked through the corridors with my bag in my hand. The day after I went home, Carlos Mario and Richarda came to visit me. They brought me a tape recorder, Carlos said. "Daddy, you have lived great moments in your life, and it is important for us to hear it. Now it is you who can entertain us with that now that you have plenty of time."

Thus was born the idea of writing my autobiography, _No Such Thing As Impossible—From Adversity to Triumph._ It is now two years later, and the book is on its third edition and published in Spanish under the title, _Nada Es Imposible_.

4. Bad sleep during the nights before surgery

One of the symptoms of cancer is going to the bathroom frequently. Ten days before the operation the illness was so aggravated that my body could barely stand it, and the pain was immense. I did not think I would get to the day of surgery, I felt like dying.

I got to that date by doing the following:

I deleted the consumption of soft foods and liquids after 4:00 p.m. so that before bedtime the body had little fluid to digest. Also, I always emptied the bladder before going to bed.

Reducing dinner and having a better lunch

When the body could not evacuate the urine, I dived into the Jacuzzi with plenty of Epson salt.

Running when I went to the bathroom to urinate. That motivates the bladder relief.

5. Use of the donut

Before the prostate cancer condition, I constantly suffered from hemorrhoids. One way to alleviate hemorrhoids was the use of a devise with the shape of a donut, named in pharmacies as the "ring contoured pillow." This is a ring of soft rubber foam, about twelve inches in diameter with a four-inch hole in the center. When sitting on the ring, the rectal area is relieved, and the area affected by the surgery is relieved from pressure because there is no contact. After the operation, it is not comfortable to sit. I had the idea to use the donut every time I was sitting, both at home and at office, and also to drive the car when I was allowed. I recommend its use from the day they take the patient home from the hospital. By the way, after the surgery, hemorrhoids never bothered me again. I do not know if the radical prostate surgery had anything to do that particular issue, however, I highly recommend the use of the contoured ring pillow.

6. Use of a pillow for those bad nights after surgery

The emotional unrest and physical discomfort from the catheter and the healing process of the wounds from surgery made sleep practically impossible in those first days. For people who sleep on their sides, as I do, the weight of the upper leg creates pressure in the area affected by surgery. I started using a pillow to support my leg, which allowed me to have a relative good sleep. Because those nights when I couldn't sleep led me to develop an addiction to prescribed medicine.

7. Bleeding surprises, not surprises anymore

About a year after the surgery, I was preparing for an Olympics event that demanded training routines based on hard work, especially for sprints. One day when I got home after training, I felt a strong urgency to urinate after a workout. I began bleeding heavily. I immediately went to see Dr. Annaloro, who performed a cystoscopy.

This procedure consists of entering the bladder through the urethra with a thin instrument that has light called a cystoscope. The doctor explained that it was normal sometimes after radical surgery for excess scar tissue to detach from the area where the operation had occurred. He told me not to worry because that was part of the healing process and that I could possibly have other episodes of hemorrhage in the near future but to inform him immediately if it happened again. Months later, the same incident occurred but on a smaller scale. I repeated the test and everything was fine. To my delight, my urethra was clean of excess tissue. It is simple, just another part of the process, but your doctor must be informed immediately. After that scare, the result was that my health was excellent.

8. Sharp pains in the affected area

Six months after the operation, I began to feel a sharp pain in the area where I had surgery. It was as if they had shot or pinched my nerves. Unfortunately, the idea that the Monster wanted to get its claws on me again immediately came to mind. Dr. Annaloro did urine and blood tests and told me the same thing he had said when I had experienced the bleeding. For a long period of time after surgery, the nerves that have been disconnected try to connect again, which can cause pain.

This event reminded me of an accident twenty-five years ago with the blade of a metal attic fan. That time, I had severely cut the phalanx of my right index finger. After the suturing, the fingertip was left without the sense of touch for few years. However, five years later, I began to feel a sharp pain in finger until I gradually regained my sense of touch. The nerves had finally reconnected.

During prostate surgery, it is necessary to cut many tiny nerves. Over the past years, these nerves have continued to try to reconnect, causing the sharp pain I mentioned. My prostate surgery was performed five years ago, and still I have nerves that are reconnecting. Once in a while, it stings in the prostate area where the surgery was performed. Also, itching in the scar on the stomach is common. Just now when writing this book, the strong red color of the cut finally started dissipating after five years.

The best thing a patient can do is to have a constant communication with the doctor. The patient should not panic himself, imagine the worse and should not take anything for granted. Let the doctor do the work in which he specializes. He will have constant control of the situation, and eventually he is going to turn you loose. In my case, now I visit this wonderful man only twice a year. I say "only" because you are going to build up a great friendship relation with your doctor based on admiration, love and gratitude.

9. My four greatest scourges

Undoubtedly, there are four obstacles that affected me greatly for a long time, from the day I was diagnosed with prostate cancer and then especially after surgery. I had to fight these obstacles very hard to be able to triumph over them. They included:

Loss of bladder control or incontinence.

The loss of sexual capacity due to the lack of erection.

Insomnia that led me to an addiction to sleeping pills.

Decreased physical and mental performance.

I will spend the next four chapters discussing each one of these issues because I consider them of great importance for physical and mental health.

During the stage of diagnosis, or what I called "fear and denial", I obtained some fundamental personal teachings:

Do not run away, hide or conceal reality. The sooner you confront the fear, the faster you overcome adversity.

First of all, you should hear yourself. That premonition or "gut feeling" is the same Creator, Divine Power, Nature and Universe that is speaking to you. Listen and be swift, do not hesitate.

In Colombia, there is an expression—"Shoemaker to your shoes." I believe that the analysis of the prostate should be performed by a physician experienced in the field, a urologist. In addition, the test should not be limited to the digital examination.

Consider that each person is unique and special; it is not surprising that cases arise outside of the general rules, means and standards. For example, my exams were fine six months earlier.

The Law of Attraction is, at the end, what governs our future. You attract what you think.
Chapter 7

Good-bye Diapers/Incontinence

After the catheter was removed came the most delicate stage of recovery—regaining bladder control. Fortunately, the success of the operation and the dedicated effort to follow the instructions of Dr. Annaloro let me to a full recovery, but it was not an easy process.

As a result of the surgery and the presence of the catheter in the urethra for two weeks, the temporary loss of bladder control is to be expected. The sphincters are delicate muscles that form a valve that opens and closes to allow urine to flow from the bladder and the stool from the rectum. These muscles are at the base of the pelvis. Once the catheter is removed, the drop of urine that fell every second into the bag now was going into the diaper I had to use. I was not prepared for this stage. It haunted me because a question was lingering for me—Will the urethral sphincter regain its function?

Recovery will depend on these circumstances:

The success of the surgery

The ability of the surgeon – knowledge and experience

The physical conditions, health, age etc. of the patient

The patient himself, including the careful compliance with the surgeon's instructions, especially the Kegel exercises

To solve the problem of bladder leaking, there are sanitary pads to use for incontinence. They come in two sizes depending on the frequency and amount of urine.

On one occasion, I read in the newspaper about a statistical study indicating that an urologist had to perform about two thousand surgeries on the prostate to accumulate the necessary experience to carry out the procedure without causing secondary effects to the patient, such as loss of bladder control or erectile dysfunction. Also, I read an article in the paper about another urologist in Canada celebrating as a milestone his two thousandth surgery.

I believe to regain bladder control it is indispensable the strict following doctor's instructions on the Kegel exercises.

The following are the most important lessons I received about this subject:

1. More does not mean better

The urethral sphincter muscle is very sensitive and delicate, therefore, exceeding the number of exercises can lead to fatigue and could hurt the muscle instead of helping it. I remember that when I decided to increase the amount and frequency of the exercises prescribed, my condition worsened and bladder control was not achieved. Fortunately, after consulting Dr. Annaloro about this, he asked me to limit the number of exercises to the number that that had been prescribed—no more, no less.

2. Punish the bladder

As soon as my sphincter began to hold some urine, I chose to "re-educate" it. I would wait a few seconds before emptying the bladder to demand that the sphincter be more active. As each day passed, the delay was prolonged until control was re-established.

3. Habits are the result of our thoughts

Personally, I believe that once you have had radical surgery, incontinence and bladder control are issues to be considered for the rest of your life. Doing Kegel exercises permanently is a prerequisite to properly maintaining control of the bladder. As soon as I stop them, the scourge returns on me. The best way to get a new habit is through repetition. Studies show that you need to consciously repeat the same event approximately twenty-one days for it to become an unconscious habit. I have created the habit of doing Kegel exercises automatically every time I go to the restroom with excellent results.

Every time, anywhere, right after I go to urinate, I do the exercise fifteen times. It has become a habit. I think these exercises are very important because it is the only way to have a properly functioning sphincter. In addition, incontinence is common in virtually all seniors, so these exercises are of great benefit for all even if you did not have cancer.

4. Enemy number one--Alcohol

Alcohol acts on the body as a relaxing agent for the nervous system; therefore, over-consumption is not the best friend for incontinence because it relaxes the sphincter. The leaking of urine will be in direct proportion to the relaxed state induced by alcohol. In other words, the amount of alcohol there is in the body, the higher the percentage of alcohol in the blood and the greater the problem. In my body, more than two drinks of any liquor or beer produces not very pleasing effects. I have noticed that the sphincter reacts differently depending on the type of liquor. Champagne and beer are the worst. Wines are not as bad but will still result in relaxation of the sphincter. I am sure the types of chemicals used to make alcohol have something to do with this. It is best not to drink alcohol or to limit your intake.

5. Some prescription drugs

I will not name several drugs I have been prescribed that have directly affected my urinary control, but I categorically conclude that products containing any type of sedative, pain killer or muscle relaxing agent affect the nervous system and therefore the normal sphincter function. I recommend that each patient should be a very good observer of what he drink, eats and what medications he takes when he notices irregularities of the bladder function.

6. Prolonged exercise

I have found that prolonged exercise, such as walking for more than an hour affects the bladder and causes a tendency for leaking. Fortunately, this does not happen with cycling. I can stay on the bicycle for up to five hours without any problems. Perhaps the seat helps to support the bladder so the sphincter does not have to work too much. When it comes to walking, it's best to take breaks at appropriate intervals. It is good to empty the bladder before you start any type of exercise.

7. Consumption of liquids

The decrease in fluid intake after four in the afternoon eases the need of bathroom use during the night. The more trained and strong the sphincter is, the greater the storage capacity of urine in the bladder.

8. Kegel exercises

I wish I had known about Kegel exercises before surgery. I expended one month preparing my body and mind before I went into the hospital. The sphincters are muscles that we use but do not exercise. It does not hurt to exercise them even before the surgery. I have recommended to several cancer patients that they exercise these muscles immediately after their diagnosis was made. They followed my recommendation, went to surgery with stronger muscles, and they regained the control of the bladder immediately after the catheter was removed. It takes discipline and self-control to have the determination to do this exercise during a period of great stress, but the effort is definitely worth it.

9. Last minute surprises—effects of anesthesia

I decided to write this book when I thought I had understood that after five years all the effects of radical surgery were gone, but I had another surprise just a few days ago. I was placed under total anesthesia for one hour or so while the gastroenterologist performed a colonoscopy on me. I noticed that after the procedure, the anesthesia weakened my sphincter function for several hours while my body eliminated the drug.
Chapter 8

Sex is Not Everything, but Life's Better with It

ERECTILE DYSFUNCTION

The success in defeating the monster inside me depended, in part, on the determination and aggressiveness with which I fought it. The circumstances of the ailment, the strength of my character, my determination and confidence helped me made me the decision to undergo radical surgery. The main risks I had to take were that of possible erectile dysfunction and incontinence.

At first, when I discussed my surgery with Dr. Annaloro, I did not address the subject because I was sure that as a result of surgery, I would face the permanent loss of the ability to have an erection. I could not have imagined how wrong I was.

Months before my diagnosis, I began to feel ill, very low in energy. I noticed that my sexual activity had decreased significantly. I did not discuss this with Anita because I considered that my age, close to seventy years old, was responsible for this situation.

While waiting for surgery, Anita and I discussed this issue extensively. Fortunately, our love and mutual respect was bigger than sexual desire. I felt very reassured when she told me that the recovery of my health was more important than the possibility of having sex. Regardless, we talked about the miracle of life and its purpose. As we age, our bodies change so our goals change, and we adapt to these purposes. Therefore, we felt that sex was not a prerequisite at our age, and we could live without it.

The purpose of having children had been met. We should accept the challenge that our Creator had commanded us in the same way we accepted the falling of hair, facial wrinkles, slack skin, loss of muscles and teeth, etc. All our physical body will gradually decline until the end. What remains goes into the ground and eventually back to the universe. Thinking this, we agreed that the "fall of the penis" was not so important at this stage of our lives.

Just a few days after surgery, Dr. Annaloro prescribed Cialis for me. I didn't know why, nor did I ask. I was more concerned about my recovery than anything else. Today, I think that was the best prescription I received because the purpose was to revive the circulatory system, which was surprisingly bruised and under stress due to the surgery.

Months later, during a visit, I mentioned to the doctor that "nothing was going on," and he told me to be patient, to continue the medication and my exercises. He advised me that my sexual activity may return, and it might even be much better. I followed his instructions, and almost a year later, I started having feeble erectile attempts but without the desire to have sex.

He said that if I wished, I could try the pump system to help me get an erection. I bought the device, and its use was one of the most painful sexual experiences of my life. Perhaps this system is of use to some, but I was not interested in this at all. The fact of pressing a pump to bring blood flow to allow an erection, and then, strangling the base of the penis with a rubber to keep it erect for a few minutes through the duration of intercourse was inhuman. This was torture for me. In my opinion, I considered this procedure insane, risky and even irrational. Anita and I went back to our philosophical bases to find peace: "Everything in our lives will fall sooner or later so it may be time for this organ to come down."

Dr. Annaloro told me to continue with medicine and to be patient. After a year of been dysfunctional, the surprises began. At first, they were very weak erections that did not allow us to have sex, but over the weeks, things got better until it was possible. Gradually, our sexual relations were normalized to the point Dr. Annaloro had predicted. He had told me that, "Your sex life is going to be even better." The only difference is that the orgasm is performed without ejaculation because of the lack of prostatic fluid, a result of not having the prostate.

It is also important to know that after radical surgery men become sterile. I repeat, sterile, not impotent. Here are some tips that help:

Lubricants are a convenient and necessary aid for the purposes of having sex. They can be found at the counter in any drugstore.

I found it very beneficial to empty the bladder completely before having sex.

If the patient wants to have a family of his own after surgery, he needs to place his sperm in the appropriate storage bank.

Please keep in mind that these tips are based on my experiences. Each person's mind and body is different, and each patient should discuss details of their sexual performance with their physician. I know this is difficult for many men, but the results are worth whatever embarrassment you may feel while discussing this subject.

I am sharing these intimate details of my life so that men will not be afraid to go for radical surgery and to confirm that many comments that are out on the street about sexuality after surgery are simply part of the many taboos and rumors that I will discuss later in this book.
Chapter 9

The Insomnia that led me to an Addiction

I believe that this chapter is important not only for those who suffer with prostate cancer, but for those with any other type of cancer or acute illness. I also hope to help those who suffer with sleeping disorders caused by stress or anxiety. Sleep disturbance is considered a serious alteration of health. No doubt there are millions of citizens who suffer from this condition as a result of serious medical treatment.

I never thought that I would suffer tremendously from insomnia or a sleep disorder to the point of becoming severely addicted to sleep prescription medication. From the moment of the biopsy until three years after surgery, my sleep was abnormal. Basically, I had to drug myself in order to sleep. Fortunately, I managed the problem in a way that today I sleep like a baby, free of dangerous drugs.

Sleep disorders create problems not only for the patient but for those around him. There are also the additional risks for drivers, operators of machinery and a reduction in performance at work. For three years, I suffered and made Anita suffer because of my lack of sleep. This situation affected my mind, my temperament, my energy and concentration—in other words, my entire being. Even my children often asked me why I was in such a bad mood all the time.

Many people have told me about friends or relatives who suffered serious illness, like heart attacks, etc, that began having a bad temper or mood swings. I personally think that is because a lack of sleep.

I started having sleep problems from the very moment my health began to weaken. The situation became worse when I was diagnosed with the illness. That first night, I did not sleep properly, and I began a destructive cycle from that point. Because I did not sleep well at night, I would have a miserable day. Because I had bad night, I took naps during the day. Some days, I took a nap in the morning and other days in the afternoon. Often after lunch, I slept on the couch in my office. This is how I spent the month before the surgery and months after it. Because I napped, I did not sleep at night, and so on. That was all I needed to create a destructive cycle. My situation was intolerable because of the fatigue accompanied by my bad temper.

I explained the situation to my family physician in a regular consultation. He told me it was something common for people who had cancer and gave me a prescription for sleep medication. When the medicine he prescribed did not work anymore, I went to visit him again and he changed my prescription, giving me a stronger one. Several months later, I reported that I continued having difficulties sleeping, and he proceeded to double the dose. The problem began to spiral. It became increasingly serious with me experiencing less and less sleep and taking more and more medication. When I visited the doctor for the third time, I had been in this situation for three years, and I was anxious to take three pills at a time because the problem had gotten increasingly worse. He said the solution was to increase the dose again. That was the point when I reacted. I opened my eyes and said, "I'm addicted to sleep prescription drugs." I was filled with fear and convinced that if I continued I would end up like I had in many years past, addicted to Valium and Diazepam as I narrated in _No Such Thing as Impossible_. I undertook this new challenge to quit all drugs from that moment on.

I told the doctor I would refuse to take more sleep medicine and that I needed an alternative. He replied that the only way to solve my situation was to consult a sleep specialist.

I visited one immediately. He made me fill out a lengthy questionnaire and upon seeing it he knew what was wrong with me.

"You are like that because you had cancer," he said. "Your biological clock that controls the sleep cycle went completely out of sync. It will take approximately twenty-one days of conscious daily repetition for something to become a habit. You have created a destructive habit. You do not sleep at night, you sleep during the day. You sleep badly during the day, you sleep badly at night. Solution: Fix the biological sleep clock," the doctor told me.

"I have a number of alternatives, from hard ones to easy ones," he said, "from

psychotherapy to medication here in my clinic, or in your house, with drugs, without drugs. The hardest one is the most effective and quickest. I see you're the kind of man to make the most effective alternative. It would take about one month."

"Tell me, doctor. I'm ready! What do I have to do?" I hastily replied. I had not slept the night before, was tired of the problem and was willing to confront "my new enemy" immediately.

"I simply want to put you on a very strong regime of sleep restriction. **** That is, a diet of not sleeping."

"How does this work? Can I start tonight?"

"Sure," he said. "Here is the procedure. Starting tonight set your alarm clock for six in the morning. Whatever happens, you should stay awake until two in the morning. Watch TV, walk, read, do whatever, but you cannot sleep, even for a minute until two o'clock in the morning. Then go to bed. When the alarm sounds, get up immediately without hesitating. You cannot stay for a minute extra. During the day, whatever happens, you cannot sleep no matter how tired you are. No naps. Do this for a week. The following week, go to bed at one o'clock, the next, at twelve, and the next, at eleven. Follow the same procedure of getting up at six o'clock and do not sleeping during the day. Do not take any medicine for sleep, and I will see you in a month."

"Very well doctor. Thank you. In a month, I will bring you a surprise."

That night I started the treatment. It was extremely difficult to stay up because I had gone almost two nights without sleep. By midnight, I was dying to go to sleep. With determination, I followed the doctor's instructions. In less than four weeks I was going to bed at nine in the evening and sleeping like a baby with no medication.

A month later, I went to my appointment and handed the doctor a copy of _No Such Thing as Impossible_ , which included a thank you dedication to him.

I am going to stop writing now because it is 9:00 p.m., and I need to go to sleep without medication. It was necessary for me to meet this challenge in order to recover my physical and mental health and my happiness, as well as my family's happiness.
Chapter 10

Physical and Mental Performance

Prostate cancer, like any type of cancer or serious illness, attacks not only the body, it attacks the mind and spirit. A positive and active attitude based on stress management, proper use of imagination, compliance with medical instructions, care and respect for the body based on the best nutrients possible and faith will be the foundations of the fight against these evils.

Undoubtedly, this chapter does not apply only to those who suffer from prostate cancer, although it will definitely help the family and friends of prostate cancer patients. This chapter is for anyone with difficulties in life of any kind, not just physical problems. The more severe the adversity, the more important it is to consider this issue. In Chapter 3, I stated:

Stress moves us. All of our physical and emotional activities are filled with stress, which can be good or bad. Our lives are full of challenges that we cannot foresee or avoid. If stress is not handled properly, it can lead to many physical and mental problems. Stress can make us prosperous or can cause our death.

There is a positive stress that produces excitement, joy, courage and exuberance in our lives. But there is also a negative stress, which can be the result of hate, sadness, pessimism and especially fear. The real success and difficulty in life is to maintain its balance or what we commonly call "keeping our feet on the ground." If we can find that balance, all aspects of our lives will improve—physical and emotional, family and work relations and everything else.

Given the circumstances in which I lived, I was made aware of the role of stress in life when I was about fifty years old. Fortunately, this discovery has allowed me to recover several years of life and most importantly, it has saved my life. At that time, I decided to make some inexpensive investments that I recommend to readers: Attend a course, seminars or lectures on stress management. This is the best investment you can make for you and your loved ones.

I believe I took control of the situation generated by the cancer two days after diagnosis, when I challenged the monster in the mirror. This occurred as a result of my realization that my weight had decreased significantly because of my poor mental attitude, not because the cancer. Until then, fear had gripped me and I had lost control of the situation. I required a positive outlook to change my situation.

These were the main considerations I had:

To take control of the situation, I could not let the negative stress control my life. I had to control everything that came in and out of my mind. I had to reduce all information that caused me stress and fatigue. There was no need to investigate. Everything was in the hands of science and the will of God. There was no need to talk about it all the time with family and friends. I limited conversation about my cancer to important facts and decisions. I realized this was important when I found myself telling a supermarket cashier that I had been diagnosed with cancer. What does she care? What did I gain? Was I looking for sympathy in others? I was succumbing to my own mental destruction.

The power of the mind has no limits, and for this reason it has not been possible to measure it. Inside of my head, there are all mechanisms that control my body. Therefore, I should not let stress take control over me. The information that I put in my mind is optional. I can feed it with elements based on anger and fear or based on love and faith.

It did help me to know that there have been many cases of patients that doctors declared terminally ill, with days or months to live, who have recovered completely. By natural instinct, we all have a healing force. Because of this, there have been many cases we consider miracles. Unfortunately, I do not have enough space in this book to recount these incredible cases.

With our mental attitude we can exacerbate or minimize the situation. We can accelerate the illness, cure it, or in some cases, delay it. Therefore, I realized my future depended on my attitude, and the first thing I had to defeat was fear itself. If I accept the fear, I am accepting failure. I had to listen to my best friend inside me. Myself! This is the best medicine.

If we use the natural healing force that we have, we can accelerate and facilitate the curing process.

I consider we should learn from nature. In nature, processes do not require effort; there are no forced situations. Therefore, I should not ask, why did this happen to me? Instead, I should ask, what is the purpose of this challenge I must face? What should I take from this experience? How can I grow from this and become a better person?

Without a doubt, evidence of this reality is the analysis of the benefits I gained through my experience with cancer. I think about the changes in my life. I think of the thousands of people who have been helped by my lectures and my previous book. I think of the thousands of people who this book will help. I think about the lives and families I have helped with my testimony. I think how much I have matured mentally. What seemed before a tragedy, a problem, a terrible suffering and adversity has turned into relief and happiness for my family, many others and me.

Prostate cancer became a reality for me when I was diagnosed, therefore, I had to accept it as soon as possible and not force any situation because otherwise it would damage the final result. Many people expend lots of valuable time denying it, time that can be used healing the disease.

These were the main steps I took:

Physical actions:

From the time I was scheduled for surgery, I committed myself to improving my physical condition. I decided to ride my bike more, walk and exercise more. I focused on abdominal exercises to facilitate the procedure. In fact, I practiced cycling until the day before the operation. If the monster had possibly been in me for years, then there was every reason to continue my life as normally as possible. I also decided to maximize the quality of food I consumed.

I was determined at all costs to not allow my self-esteem to suffer. Self-esteem is often the first factor to be affected when adversity occurs. Discouragement, lack of concern and enthusiasm for oneself, not caring about appearance, walking with your head down and not smiling are all symptoms of poor self-esteem that can occur when you are confronted with cancer. It is important that you pretend you are fine, even to yourself. By pretending you are okay, your outlook is much better. Dwelling on your illness or fear can lead to a host of self-esteem issues.

Wherever possible, I avoided being idle. During this battle, I always tried to keep myself busy doing something.

At any cost, do not nap. Unfortunately, I was not aware of the dangers a sleeping disorder can produce. It was a mistake to take naps or sleep during the day or to go to sleep too early at night.

I stopped talking about my situation, especially with strangers because it did not produce anything positive.

Mental actions:

The renowned parapsychologist Jose Silva (1914-1999), author of _Silva Mind Control Method_ was convinced that the brain is more energetic when it is less active. In other words, we can accomplish more when we made less effort. He spoke of an alpha state in which the brain waves diminish in intensity. The Alpha State, (7.5- 14 cycles per second or hertz), is the perfect condition in which to program our minds.

Here are some of my suggestions based upon my studies of Silva:

**Relaxation exercises—** Silva said that if these exercises are done once a day it was good, twice a day, very good and three times, excellent. He also said if relaxation was done for five minutes a day, it was good, ten minutes was very good and fifteen minutes, excellent.

Whenever I find myself in difficult situations, I do not deviate from this guide, and the results are incredible. These exercises consist of lying down or sitting comfortably and relaxing. While you are listening to the soft music, just concentrate on your breathing and relax for a few minutes.

There are excellent relaxation tapes and CDs on the market for these purposes. These relaxation exercises are complemented with meditation that includes visualizations of a positive outcome. Replace negative thoughts with positive ones. If you are not using special relaxation tapes or cassettes, use easy music that might consist of classical music or the music that mimics the sounds of nature. The ocean, rain, etc. It is very important to assess the origin and the professionalism of the author of whatever relaxation medium you choose.

The Law of Attraction is final in everything, but especially in health challenges. Healing has to start in the mind and must be started from the day of diagnosis.

**Change of cassette—** When negative thoughts that affect your mood come into your mind or when your imagination is flying without aim or logic, it is more practical to change the image you are having.

What do you do when you do not like what see on TV or what you are listening to on the radio or computer?

You change, cancel or delete what you don't want to see or hear immediately. You should do exactly the same thing when you have bad thoughts. I do what I call, "change of cassette." I replace immediately. Instead of seeing myself dying of cancer, I thought about myself recovered, healthy and full of energy. I just talked to myself and said, "delete...delete...cancel...cancel," and instead continuing to contemplate the picture of negativity, I replaced that image with a more attractive and positive one.

To succeed against prostate cancer or any adversity in life, I recommend that you do what I call "The triple A Álvarez formula to overcome adversity."

**a) Accept the reality.** The sooner you accept, the sooner the healing begins.

**b) Adapt to new circumstances.** Having faith in your Creator, faith in you, faith in you family and friends and faith in your doctors and clinical procedures that will help you overcome this adversity.

**c) Action to achieve your new goal.** Having a positive expectation of success and acting will attract the ultimate cure for your cancer. Nothing is achieved without these requirements because we are the fruit of our thoughts. We attract what we think.

Stress

Stress moves us. All of our physical and emotional activities are filled with stress, which can be good or bad. Our lives are full of challenges that we cannot foresee or avoid. If stress is not handled properly, it can lead to many physical and mental problems. Stress can make us prosperous or can cause our death.

There is positive stress, such as excitement, joy, courage and exuberance. Negative stress, such as anger, sadness, pessimism and especially fear can be very harmful. The real success is in how we balance stress. That is what we commonly understand as, "keeping your feet on the ground."

Dr. David Illig aptly summarizes the negative stress that we experience in three ways:

• Unconsciously we believe we are in physical danger, at risk or in distress.

• We maintain the body in a state of tension, anxiety and biochemically unbalanced.

• Our mind is receiving and sending too much information.

• We are body, mind and spirit. Our mind controls our body, and therefore, we are the result of our thoughts. Imagination is a factor in all of our lives, and if we do not think and have the proper attitude we will not triumph over prostate cancer.

I consider it important to elaborate on this area because, after my experience with my newlife, it is hard for me to hold a conversation with the wife of a patient begging me to convince her husband to think positive, to convince him that he is going to be fine and will overcome the disease. I am talking about a patient with a less severe type of prostate cancer, who was in better health than me because he was more than twenty-five years younger. But he, submerged in depression, still thinks he will not succeed in the fight against the disease. This was because of the way he thought, what he has in his head, what I call the "control tower." He does not want, or maybe does not know how to use the tools available properly. To battle cancer, it is just as important to study the body as it is to study how the mind works.
Chapter 11

Witch Tales and More-  
Myths and Rumors that Cost Thousands of Lives

There are a number of stories and rumors about prostate cancer, ranging from funny and ridiculous to the surprising and very sad. All of them are alarming because they affect the assessment of reality, they affect the decision-making process of the patient, they add stress and confusion and what is worse, they cause the loss of thousands of lives and bring suffering to patients and their families.

In my conferences and presentations, people come to me with incredible comments. These are the main tales that had come to me personally and do not include the unbelievable junk you can find on the Internet

"There is no need for a prostate exam before the age of fifty."—It is not true.

It saddens me to see several organizations telling men that no control of the prostate is necessary before the fifties. My personal circle of friends is very small. During the last six months, I have met three young men in their forties and full of life diagnosed with cancer. What is worse is that none of these men's genetic records showed predisposition to this type of cancer, and they had no family history of cancer.

The American Cancer Society recommends an annual screening for men over fifty with average risk and whose life expectancy is more than ten years. If you are African American or a member of your family had cancer, you should begin your routine checkups at forty-five. If there have been several cases in family members, then the association recommends to begin the monitoring at forty. I think this is very appropriate.

My father, Mario, had prostate cancer, like my brother, Rubén, and several other relatives. Therefore, I have urged my children, Carlos Mario and Sebastian, and my grandchildren, Alek and Lucas, take complete control by of their health by having PSA exams of the blood and urine and digital tests after they turn forty.

"All radical surgery will produce erectile dysfunction."—It is not true.

Nothing could be further from the truth. As with incontinence, erectile capacity depends on the patient's condition, their physical health and ability. The mental attitude of the patient, physical condition and surgeon's skill are critical. A well qualified and experienced surgeon can perform a nerve-sparing radical prostatectomy, so the gland can be removed but the nerves controlling erections are still in the proper place.

Studies conducted by the University Of Pittsburgh Medical Center indicate that radical prostatectomy, or removal of the entire prostate gland, is the most common treatment for patients with localized prostate cancer. Studies show that recovery from prostate cancer is significantly associated with a surgeon's lifetime experience with performing this operation. The report said, "Research supports common sense: Patients undergoing surgery by more experienced surgeons will have a better chance of being cured of their cancer. With a practice entirely focused on men with localized prostate cancer has come a wealth of experience, leading to continuous refinement in surgical technique and improved outcomes."

"Whenever there is radical surgery, incontinence will be permanent and definitive."—It is not true.

Incontinence or lack of bladder control depends on the conditions of the cancer and the physical and mental attitude of the patient. Also, the fulfillment of the physician's instructions, as well as the professional capabilities and experience of the surgeon are vital to helping this problem.

"Infidelity causes prostate cancer."—It is not true.

On one occasion I was giving my presentation to a group of about six hundred people in a church of Miami, Florida. In the long line of people waiting to get their book signed was a lady with a very concerned look on her face. She said, "Mr. Álvarez, could you spare a few minutes to talk privately?"

Upon seeing her anxiety, I said I would gladly do so but that she would have to wait until I was finished signing the books. During the conference, I had mentioned that I had been happily married for forty-two years. After the signing, we went to a nearby office, and I asked her what I could do for her.

"Excuse me, Mr. Álvarez, but have you ever been unfaithful to your wife?" she asked with a look of pure agony on her face.

"What does that have to do with my book, Madam?" I said, rather taken aback by the question.

"What happened is that my husband has prostate cancer, and his prognosis is very serious. I have been told that unfaithful husbands get prostate cancer, and I have had great resentment against him. I have not been able to forgive him."

"Madam, with all due respect, that's the most absurd thing I've ever heard in my life. I can only say for the love of my mother who is in heaven I have never been unfaithful to my wife. I have not inappropriately touched another woman's hand other than that of my wife."

She opened her eyes in surprise, and I saw an immense smile of relief. She said good-bye within seconds, gave me a hug and left. I do not want to comment any further on this painful case, only that if my book served only to help that family, then my effort has been justified.

"Prostate cancer is sexually transmitted."—It is not true.

Similarly, in the process of presenting my previous book, a gentleman wanted to talk about a very delicate problem he had. He had undergone radical surgery to cure prostate cancer. His health was excellent, and he was free from the illness. His sexual abilities had been restored, but his wife rejected all sexual activity because she feared she might contract cancer.

There is not a single case in medical literature that shows that cancer is contagious and can be transmitted by any means, including sexual, oral, needles or blood transfusion. Cancer is not a virus; it is simply cells that develop abnormally. I advised the gentleman to visit a specialist with his wife to discuss this further.

"Cycling causes prostate cancer."—It is not true.

There have been several articles written in newspapers, magazines and some medical publications that propagate this myth. Let me say there is no scientific evidence showing that cycling causes prostate cancer. The majority of oncologists and urologists agree with my statement. I learned that one of the leading newspapers in Montreal, Canada, printed an article on its front page linking cycling with prostate cancer. Unfortunately, after hurting the cycling community of the world with this rumor, they were unable to prove anything.

The following considerations are very clear to me and may apply to cyclists, too:

1. The increased statistics about prostate cancer in men is due to an increase in preventive measures after learning that this type of cancer is the second most severe type of cancer in the United States.

2. With the aging of the population, it is expected that in accordance with these factors, the rate of cases of this type of cancer will increase progressively over the years.

3. The number and age of adults that practice cycling have increased considerably, therefore, is not unusual to find elderly men more than eighty and ninety years old competing in the Senior Olympics.

For these reasons, we can see that the number of cases of prostate cancer has increased. No matter what a man does, as you get older, if a man does not die of other causes, he will most likely get prostate cancer anyway. Considering the statistics mentioned earlier, the number of cases has increased because more people are being tested. If we listen to everyone, acts such as eating fresh bananas, playing with your grandchildren and taking out the dog to pee could be described as causes of cancer.

At seventy-two year of age and nearly sixty years of cycling and with one hundred and eight Senior Olympic medals and three national championships to my credit, I believe I am qualified to express my opinion on this particular subject.

I think that cycling helps the prostate. It doesn't harm it. Personally, it helped me keep it healthy and active. From a young age I suffered from prostatitis, a benign prostate inflammation, and I was often in need for massage treatments. The bike seat massaged and kept the gland active. Thanks to cycling, I detected the prostate cancer. When preparing for the National Olympics in Philadelphia in 1995, I told my coach, William Cheramie, that I felt very uncomfortable in the seat and that my prostate hurt. This was possibly due to the pressure of the seat on the gland. He studied the situation from a cycling point of view, not knowing that what I had was cancer.

William took measures that I want to share with readers and cyclists. These measures were very helpful to overcome this illness when the "monster" revealed itself completely. Most of the aficionados who go biking often do not give much attention to the placement of our body on the bicycle, especially the seat, one of the most important parts of the bicycle in terms of health, performance and comfort.

I have learned that:

1. One should not sit on the prostate area but should support oneself on the two lower bones of the pelvis. Well-established bike shops have a gel seat in which one sits and where these two bones are imprinted. With this measure as a reference, you can buy the most suitable seat for your body.

2. One must use a butterfly-shaped seat with an opening in the center so that the prostate area is free and can facilitate good circulation.

3. Any person riding a bicycle must be sure that it has been adjusted to his physical dimensions of height, including length of legs and arms. This measurement must be made by a person skilled in the field. For example, if a seat is very high and the handle is too low, there may be abuse to the prostate. This does not take into account the occurrence of neck or back problems.

Often when I am training, I see people riding bikes who have posture that makes me think they are doing more damage to their body than benefiting from the exercise. I see cases of people, who if they continue, will very soon suffer from acute prostatitis or will destroy their knees and backs. They will do better not to exercise at all. These are my recommendation for anyone riding a bike:

1. The seat of the bicycle must be completely level. Otherwise, there is a chance that the prostate and others part of the body will be harmed, especially if the tip of the seat is lifted.

2. It is very important that the rider does not save money by buying seats without a pad of the highest quality.

3. There are extremely lightweight elastic pads that can be put on the seat as covers and provide excellent comfort.

"You have cancer if you go to the bathroom too often at night."—It is not true.

Excessive urination is a symptom of a deficiency or disease in the urinary system that needs to be examined and treated by the doctor. Children, as babies, have no control of the bladder because the muscle, the sphincter valve, is not strong enough to hold the pressure of the urine. As men age, his muscles become weaker so this muscle also becomes weak. Kegel exercises make it possible to have good control of the urinary valve. Visit an urologist as soon as possible. He has the last word.

"If there is blood in your urine, cancer is present."—It is not true.

It is a symptom of a deficiency or disease in the urinary system that needs to be examined and treated. The patient may have other causes such as an enlarged prostate, prostatitis, bladder infections, kidney disease or something else. Visit an urologist as soon as possible. He has the last word.

"A high PSA reading always indicates the presence of prostate cancer."—It is not true -

Nothing could be further from the truth than this assertion. Infections in the urinary system can also cause high readings of PSA factor. To determine the health of the prostate, it is necessary to verify and monitor any urinary tract infection first. Only the doctor can determine the true cause of a high PSA reading. Visit an urologist as soon as possible. He has the last word.

"You can find a solution on the Internet."—It is not true.

Without a doubt, to be successful with prostate issues and any other health problem, it is required for you to have one hundred percent confidence in the doctor who will treat you. My discipline in following doctor Annaloro's instructions carefully greatly contributed to my success. The day I was diagnosed with the "monster," the doctor told me, "Please do not research online because it will only confuse you .If you wish to investigate further, seek another medical opinion, but be very careful with what you find on the Internet." I think it has been one of the best recommendations I have received.

Since I was diagnosed with the disease I never typed the words "prostate cancer" on the keyboard of my computer. Only now, while conducting research for this book have I done so.

It is very sad for me to witness young people with prostate cancer with a lower severity grade than mine who could solve the problem with radical surgery, but are dedicated to investigating on the Internet, or I should say, "confusing themselves on the Internet." They are pretending to be doctors and end up making decisions that may cause many other problems and even the cost them their lives.

Entering the Internet as a patient and basing your decisions on that research is dangerous because normally the patient does not know anything about his illness and usually at that moment the state of mind of the person is not good. On the internet you can find all kinds of writing, from garbage to sad and painful stories to scientific research so profound that it cannot be understood by an ordinary person.

While writing about this subject, for example, I entered into a search engine: "What causes prostate cancer?" I found seventy-one pages with seven hundred links that featured all kinds of material.

In summary, the first thing the patient should do if they decide to search the Internet is assess who wrote the article and the author's level of expertise. Possibly a better option is to seek a second opinion for a qualified professional in the field.

If you want basic and educational information on prostate cancer on the Internet, you can find everything you need, in my opinion, on The American Urological Association, The Prostate Cancer Foundation and The American Cancer Society websites.

"A very active sexual lifestyle causes prostate cancer."—It is not true.

High levels of sexual activity and frequent ejaculation have been rumored to cause cancer. Nothing could be further from the truth. There are some studies that suggest the opposite—men with this behavior have a lower risk of prostate cancer.

"Having a vasectomy causes cancer."—It is not true.

Previously, the vasectomy was considered to cause cancer or increase the risk of having it. Recently, this assertion has been devaluing.

"The presence of non-cancerous conditions on the prostate cause cancer."—It is not true

The existence of prostatitis, prostate enlargement and other benign diseases does not imply that the cancer will appear as a result of these conditions. The nature and severity of these ailments can be a potential risk, but only a doctor can determine with certainty. Visit an urologist as soon as possible. He has the last word.
PART II

Answers to YOUR Questions

The following chapters are a compilation of most basic questions that I had raised during my five years of experience successfully overcoming prostate cancer. I am very sure any person interested in the field will find the answers to these questions informative. Many of these answers were supplied by my urologist, Dr. Annaloro. I have supplemented them with information provided by the American Cancer Society (ACS), National Cancer Institute (NCI), ZERO - The Project to End Prostate Cancer and the Prostate Cancer Foundation (PCF).

However, I recommend that readers consult a doctor before considering the use or practice of any information presented below.
Chapter 12

Anatomy of the Prostate

It is very important to know the functions of the prostate, where it is located, what parts are attached to it and which parts of the body to which it is related. Knowing this allows us to understand how cancer develops, what impact it can have on a man's life and what the impact of different treatment options could be.

What is the prostate?

The prostate is a gland made up of three lobes, one central and two laterals on each side of the urethra. The prostate is part of the male reproductive system and produces sixty percent of the fluid that makes up semen. The gland is about the size of a walnut (twenty milliliters) and weighs approximately one ounce. The prostate is located below the bladder, at the neck that connects to the urethra and the front of the rectum. The prostate gland goes around the tube called the urethra. Through the penis, the urethra is responsible for evacuating urine from the bladder and the semen from the glands. The prostate is connected to the urethra through ducts and has a soft and uniform muscular consistency.

What is the purpose of the prostate?

The main purpose of the prostate is to produce fluid for semen. During ejaculation, sperm produced by the testicles goes into the urethra. There it meets with the prostatic fluid and seminal vesicle fluid and then exits through the penis. The prostate and seminal vesicles produce other chemicals, such as zinc, citrate and fructose to give the sperm more energy to accomplish its purpose. It also produces other antibodies to protect the urinary tract and sperm against bacteria and other pathogens. The prostate typically grows during adolescence under the control of the male hormone, or testosterone.

Is the prostate essential?

The prostate gland is not essential to live, but it is necessary for reproduction. The liquid produced by the prostate provides substances to facilitate fertilization and allow sperm to live.

What controls the bladder?

The sphincters that are muscles in the shape of rings, some located between the prostate and the penis around the urethra and others around the anus.

What controls an erection?

Throughout the prostate and attached to it there are small nerves that control the erectile function.

What do the sphincters do?

Their main function is to serve as valves that open and close to allow the evacuation of urine, semen and fecal matter. The sphincters are part of a series of muscles on the pelvic floor area and have a network of muscles that support the bladder. There is an "anal sphincter" that is responsible for allowing the passage of the stool out of the body and a "urethral sphincter" that controls the excretion of urine and semen. Because of their close location of one to another, these two sphincters may be affected by the surgery.

Chapter 13

Cancer and Other Illnesses of the Prostate

What is prostate cancer?

The human body consists of millions of cells that grow and die in an orderly way, especially when the organism is young. With the passage of time and the presence of other conditions—age, lifestyle and genetic predisposition—some cells begin to multiply abnormally and uncontrollably. These cells are called malignant or cancerous. These cells do not die and tend to spread from the prostate to other parts of the body, especially to the bones, lymph nodes, kidneys and bladder. This is what is known as _metastasis._

Prostate cancer can cause pain, difficulty urinating, erectile dysfunction, bleeding and other symptoms. Although there are cases of prostate cancer in which there are no typical symptoms.

This disease develops most often in people over fifty years. However, according to statistics, many men who develop prostate cancer die without ever having shown symptoms or undergone therapy. That is why prostate cancer is also known as **The Silent Killer.** Because prostate cancer usually grows very slowly, many individuals will die of other causes before the cancer can spread or cause symptoms.

What is Benign Prostatic Hyperplasia?

It is a noncancerous enlargement of the prostate. Because the urethra runs through the prostate carrying urine, the growth of the gland squeezes it and makes it difficult and painful to urinate.

What is Prostatitis?

It is an infection of the prostate. It is the most common disease in the urinary tract system for men. It causes fever, chills, and, of course, difficulty and pain when urinating. There have been many conflicting studies about whether this type of infection can eventually turn into cancer. It must be monitored very careful by an urologist.

What causes prostate cancer?

It is not known exactly what causes prostate cancer, despite many research studies on the subject. However, according to research how cells are born, how they grow, reproduce and die are considered several factors that contribute to prostate cancer. These include:

**1. Testosterone—** the male hormone, which obviously does not cause cancer but has been proved to fuel the growth and development of cancerous cells. It has been recommended in some cases, especially for elderly people, to suspend the production of testosterone of the body.

**2. Age—** There are very advanced studies that indicate as men age a biochemical process that contributes to abnormal growth of cancer cells presents itself. This topic is currently in intense research but without doubt is the most important aspect in the diagnosis of prostate cancer is age. The chances of contracting prostate cancer increase after fifty years of age. Two out of three men in the United States will have cancer after they are sixty-five years of age. My great friend, doctor, biker and prostate cancer survivor, John Frusha, presented this to me in a very precise way so I could memorize it. For men with no family history of cancer in their father, father and brother, the probabilities to have cancer is sometime after fifty. For example, if a person is fifty-eight, the chances are fifty-eight percent. At seventy-three, the chances are seventy-three percent. At eighty-four, the chances are eighty-four percent, and so on.

**3. Genes, inheritance, family history—** Family history is very important because DNA is inherited and controls the behavior of cells. A man whose father or brother has had prostate cancer is twice as likely to get the illness and should be tested after age forty-five. This likelihood is further increased if several family members have suffered from this type of cancer. If this is the case, care must begin at the age of forty. After age fifty, all men should begin routine care without exception. This author is aware of several cases of men with prostate cancer under fifty who did not have a history of cancer in the family.

There are many studies that demonstrate that genetics has much to do with various types of cancer, especially prostate cancer. The man inherits many characteristics in his enzymes that are vulnerable to producing cancer or produce defenses against it. Science has identified genes that are under study. More progress is needed in the field.

The family history is very important to study because the DNA is inherited and controls the behavior of the cells. The man whose father or brother has had prostate cancer is twice as likely to growth maligns cells and should be tested after forty-five years of age. The probability increases if the patient's family history indicates several members have suffered this type of cancer. In this case, the prostate must be monitored from forty years and up. After fifty years, all men without exception should considered yearly testing.

**4. Diet—** There are serious studies that indicate the risk of prostate cancer increases considerably if the patient has a nutrition diet very rich in animal fat. Also, for unknown reasons there is a difference in the risk base in different regions of the planet. Studies are still underway.

**5. Race and Nationality—** There are studies indicating, for unknown reasons, race and nationality has to do with the probability of prostate cancer.

For example:

It is more common in African Americans than any other race.

The Asian American and Hispanic Latinos have a lower risk than the American whites.

For unknown reasons that are being studied, prostate cancer is more common in North America and Northwest Europe area than in Asia, Africa and Central and South America.

Who will have prostate cancer?

As a man ages, his chances of getting prostate cancer increases. Prostate cancer now ranks second as the primary cause of death among men in the United States. It is the leading cause of death among men over sixty-nine.

What is the duration of prostate cancer?

This cancer is considered as one of the slowest to develop in most cases. It is estimated to take between eight and ten years to cause death if nothing is done. Therefore, age and physical and mental conditions are the most determining factors to deciding the type of treatment.

What are the effects of prostate cancer?

The patient should be prepared for a change of life once the diagnosis is made. Each case is unique due to the individual physical and mental conditions of the patient. Additionally, the treatment selected should be determined by the capacity and experience of the physician providing the care. The detection of the presence of cancer, the treatment process and post-operative conditions are very demanding but provide an opportunity to assess life both emotionally and physically. The patient will begin to adopt healthier activities in terms of food and exercise and in their personal behavior and interaction with others. The patient will possibly be transformed into a more caring and affectionate being who will avoid activities that affect his physical and mental health.
Chapter 14

Symptoms of Prostate Cancer

What are the symptoms of prostate cancer?

Not everyone experiences symptoms. Often, this cancer is detected by routine medical examinations without the patient ever having had any previous symptoms. The quantity, frequency and strength of the symptoms depend heavily on the classification of the severity of the illness. Below, I will refer to the symptoms I experienced during illness.

What were the symptoms I felt before being diagnosed with cancer?

Discomfort in the prostate area when I sat on the bike or on hard seats.

Tiredness and fatigue, even though I was and still am a very energetic and active man. At approximately four in the afternoon every day, the fatigue doubled.

Decrease in sexual activity

Frequent urge to urinate at night and during the day. Upon urinating, little was evacuated despite having large urges.

Poor sleep. I woke up at about four o'clock in the morning.

Difficulty starting to urinate

Urinating with a slow and weak flow

Frequent pain in the lower back, hips and legs

Irritability, aggression, moodiness and lack of motivation

What were the symptoms after the diagnosis, before the surgery?

My cancer was progressing at an alarming rate, and so were the symptoms, in addition to the one listed before they were:

Increased frequency and difficulty urinating to the point of almost not being able to do so

Blood in the urine

Inability to achieve an erection

Feeling of a lack of energy in the body and constant fatigue that was not relieved by rest

Haggard appearance

According to experts, the following are other symptoms that may occur, but I did not experience:

Pain during ejaculation

Blood in the seminal fluid

Difficulty with bladder control, dribbling after urinating

Lower abdominal pain

Pain when defecating

Are the symptoms above evidence of the existence of cancer?

The symptoms indicated above do not always indicate the existence of cancer. There may be other causes, such as urinary tract disease or prostatitis, for example. Similarly, the man in his natural aging process may suffer from some of these symptoms, which does not necessarily indicate the presence of cancer. However, the presence of these symptoms does make an immediate evaluation of the patient by an urologist a necessity.
Chapter 15

Diagnosis of Prostate Cancer

What is the best way to reduce mortality from prostate cancer?

Have a clear commitment for the care of health

Prevent the illness through early diagnosis

Increase your knowledge about the latest procedures and treatments

Advances in research and the development of new procedures.

How is prostate cancer diagnosed?

The basic tests to detect prostate cancer are:

**1. Digital examination of prostate--** This test is done through the rectum. It is known as Digital Rectal Exam (DRE). It consists of a physical examination of the prostate gland in which the physician, using a surgical glove, lubricates his index finger, inserts it into the rectum and feels the texture of the tissue of the prostate. The gland in normal conditions is soft, spongy and smooth. If the doctor finds that there are parts with hard nodules or an irregular consistency, it may indicate the possible presence of cancer. The detection of an irregularity is not always an indication of cancer. It may mean the presence of another non-malignant irregularity.

In my case, the routine testing during the previous years was not painful. But the test really hurt when the cancer was detected. Despite the vast experience of Dr. Annaloro with these tests, he wanted to confirm the diagnosis and said, "Mr. Álvarez, your prostate seems suspicious but the only way to verify what you have is through a biopsy."

**2. Test of PSA in the blood—** Another procedure that is effective, safe and scientifically accurate is the PSA blood test, which means, "Prostate Specific Antigen."

The PSA is a protein produced exclusively by prostate cells and can be detected through blood tests given that measure this protein's flows through the bloodstream. When prostate cells are healthy, they have a low PSA reading. Similarly, a low reading does not rule out the possibility that the cancer is at an early stage and is not yet detectable. By contrast, a high reading could be an indicator of cancer, a noncancerous tumor or an infection of the prostate or urinary system. A high PSA reading **is not** always an indicator of cancer.

The values in PSA readings can vary slightly depending on the laboratory because the unit of measurement is microscopic. Readings below four ng/m are considered normal, in other words four nano grams per milliliter or 4/1.000.000.000 for a thousandth of a liter. Most healthy men have a reading below four. This reading can be normal with a variance of up to fifteen percent. As men age, the reading may increase, but this does necessarily not indicate the presence of cancer.

The discovery of PSA has been surrounded by much controversy regarding its creator, because it was a research process built through time. What is certain is that PSA was first measured quantitatively in the blood by Dr. Lawrence D. Papsidera. This happened in 1980, and that same year, Dr. Thomas Stamey made the first clinical procedure with PSA as an indicator of prostate cancer.

Today, the diagnosis of prostate cancer using the PSA test in the blood has been successful for early detection and has helped save countless lives. All medical organizations recommend the two tests, digital and PSA, after the age of fifty or after the age of forty-five if there is history with a father, brother or uncle.

The earlier the cancer is detected and clinically treated, the higher the chances that the patient will recover and lead a normal life after treatment.

It is very important that the doctor has knowledge of drugs and other substances the patient might be taking because the PSA reading may be affected by medications. Some medicines for the treatment of enlarged prostate (prostatitis) and other urinary diseases can affect the reading of the PSA. Also, medicines and food supplements based on herbs may affect the readings, as well. The patient should inform the doctor if he consumes any of the substances mentioned above. PSA tests are also used to track and monitor the prostate while undergoing treatment or when in remission.

If any of the symptoms or results of the two previous tests are suspicious and raise the possibility of prostate cancer, a biopsy exam should be sought immediately to verify the condition of the prostate.

**3. Biopsy—** During this procedure, the specialist goes through the rectum with a needle and takes tissue samples. The needle removes several cylinders of tissue, typically one cm in length and two mm in diameter. The samples are sent to a pathologist for examination through a microscope that looks for cancerous cells. The pathologist classifies them according to the features of severity. For the biopsy, the patient is lightly sedated. The test takes thirty minutes. The procedure is not painful. The laboratory results take three to eight days.

How to measure the severity of prostate cancer

Severity is measured by a system called the Gleason score named to honor the memory of Dr. Donald Gleason, an American pathologist who, with his colleagues, developed the system in the 1960s.

The scale that the pathologist uses to classify the cancer is from two to ten. This scale factor indicates the possibility that the cancer will spread to other parts of the body. An indicator of two is the best increasing until ten, the most serious. The Gleason score is obtained by using the two most affected samples. Each sample is ranked from one to five. A one rating exhibits cells that seem normal, and a five, shows cells completely deviant from normal. The two factor scores are added and give the classification of two to ten, as follows:

Two to four means well-differentiated tumor and a little aggressive.

Five to six means moderately differentiated and aggressive tumor.

Seven to ten means poorly differentiated or undifferentiated tumor and aggressive.

The higher the score the greater the severity of the cancer. If the pathologist finds any cells classified as five, they are reported separately, given their seriousness and high risk. In my case, it was six when the biopsy was performed and had developed to seven when the pathology was done after the surgery.

Additional clinical exams required

Usually once the prostate cancer has been detected, the standard procedure is to verify that the cancer is limited to the gland or to determine if it has affected other organs, which is called metastasis. The three main organs that can be affected are the bladder, kidneys and the bone system. These are the exams used to determine if the cancer has spread:

**A. Cystourethroscopy of the bladder, also called "cystoscopy" or "endoscopy", —** Usually the X-rays do not show with complete clarity problems of urethra and bladder. This procedure is done in the doctor's office normally with local anesthesia and takes about a half hour. It is very fast and does not require previous preparation except to evacuate the urine minutes before the procedure. Cystourethroscopy is the introduction through the penis' urethra of an instrument called an endoscope that is a stiff and thin pipe with a camera in the tip that is connected a monitor/screen for the doctor to evaluate the conditions of the patient and to detect if has cancer in the bladder or the urethra. The doctor will prescribes medicine to avoid infection after the procedure. The cystoscopy is not only utilized for patients with cancer. It is also used for patients with different problems in the urinary system, to remove bladder stones, to take samples of tissue, to remove tumors, study the urethra and for other procedures.

**B. Kidney ultrasound or "renal ultrasound."—** This is a fast procedure that will take about thirty minutes. There is no risk, and the procedure is painlessly done at the doctor's office without need of preparation or anesthesia. The results can be analyzed by the physician immediately. The technician will place a warm and transparent gel on the area of the kidneys. This gel helps to transmit the sound's waves. The technician will then rub a small manual instrument, called a transducer on the skin over the kidneys. The transducer emits high frequency sound waves, and a computer measures what the waves find and bounce off of in the body. The computer transforms those sound waves into images that can be analyzed for the doctor. The renal ultrasound can show the size of the kidneys, anomalies, calculations, wounds, infections, harmful cysts and benign tumors.

C. Bone Scan of Bone

It is a painless procedure, but it takes several delay hours. It is an almost one-half day program. You must fast before the scan. During the procedure, the technician injects a small quantity of radioactive material into the vein in the arm. The patient needs to wait two to three hours for the chemical to circulate all through the body. Then he is passed very slowly thru a tunnel-like machine. The machine will detect every irregularity in the bone system, like fractures not detected by X-rays, bone infections, cancer in the bones and other diseases.

Development stages of the cancer

The step (or stage) is the size and location of the cancer. It can be derived through the combination of: the digital rectal examination, the ultrasound and the number of samples in each biopsy needle that contain cancer cells. The classification systems of the stages of prostate cancer are usually A, B, C, D or T,N,M, (Tumor, Node, Metastasis) or I - II - III - IV (1 - 4).

**A1 - A2 or T1a - T1b**. This stage means that the cancerous tumor can only be detected by a pathologist who examines prostate tissue obtained during surgery. If the cancer affects more than five percent of tissue, it is considered to be **T1b**.

**T1c**. This means the cancerous tumor cannot be felt or seen on the ultrasound but is detected by a prostate biopsy performed because of a rise in PSA.

**B0 - B2** or **T2a - T2c**. This means the cancerous tumor is palpable but appears to be confined to one or both lobes of the prostate.

The Cancer in the stages of **A1 - B2 (or T1a - T2c)** is "local."

**C1 - C2** or **T3a - N0**. The cancerous tumor appears to extend beyond the prostate (extra capsular). It is possible that the cancer has begun to invade the lymph nodes.

**D1** or **N1 - M0**. The cancer has reached the lymph nodes. This is called a "regional cancer."

**D2** or **M1**. The cancer has spread to other parts of the body. This is a "systemic cancer" (or metastatic).

Stage **I** is equal to **A1** , **II-A2** - **B2** ; **III** **C** and **IV D**.

According to the National Cancer Society the first five year survival rates for local and regional cancer is almost one hundred percent. Undoubtedly, in many cases, patients live many more years.

Currently many research investigations are taking place to deepen the study of prostate cancer, especially in genetics and chemical and research on the behavior of cancer with relation to the physical condition of patients—that is, the influence of weight and eating habits to determine the aggressiveness of the different types of cancer.

Given that the main research and discovery of new techniques to fight cancer are relatively new, only in the last twenty-five years, there is disagreement among the various organizations working on the control of prostate cancer. This is most noticeable in regard to prevention and use of clinical procedures. Therefore, it is advisable to get a surgeon specialist with a good reputation and extensive experience in the field.
Chapter 16

Types of Treatment Available

First, the patient must ask questions to the doctor because he should be fully informed of his condition and the types of treatment available. If the patient does not find satisfactory answers, you should seek a second opinion. If the patient does not have absolute faith in his physician it is likely he will not be cured from the illness.

What should I ask my doctor?

If the physician has adequate experience in handling the problem, as was my case with Dr. Annaloro, most likely he will present all of the information about your "newlife" so that there is little room for questions. As for me, once the diagnosis was given and explained to me, I only had two questions: "When I can be operated on? and "When can I return to cycling?"

These are the main questions that the physician should answer:

What kind of cancer do I have?

Has the cancer spread to other organs of my body?

What other tests are required and why?

What is my clinical Gleason factor?

What does this factor mean?

What are the best choices, given my current situation?

What option do you recommend?

What are the side effects of this option?

What is the next step I should take?

How is my health in general?

What are my probabilities for a full recovery?

If the physician's recommendation is for surgery/radical prostatectomy, it is advisable to know the answers to these questions:

What are the odds of suffering from erectile dysfunction and urinary incontinence after the surgery?

If your doctor tells you emphatically that these conditions will be permanent, personally I recommend that you get a second opinion from a doctor with considerable experience with the procedure. I have the case of my brother, Rubén. The first physician answered that definitely he will have problems. I recommended he get a second opinion with a more experienced doctor who did the procedure with excellent results.

What are the clinical procedures recommended for the cure?

Today, there has been much research on alternatives for the treatment of prostate cancer. It is the type of cancer that offers the most options to the patient. There are about ten procedures available to treat this disease. Of the ten procedures available, there are five standard types supported by research, experience and historical statistics that allow the physician and patient to proceed with more security and confidence knowing the consequences and side effects. These are:

1. Watchful and supervised wait

It is the careful observation and supervision of the patient's condition by the specialist. Medical treatment is not provided until the symptoms change. Commonly used with:

a) Patients with prostate cancer at very early or doubtful stage

b) Very old patients when the probability to die by natural conditions is higher than dying by the cancer.

c) Patients with other health problems that do not allow treatment

d) Patients who voluntarily choose not to follow any treatment

Most prostate cancers grow very slowly and often, given the advanced age of the patient (older than eighty years, for example), it is best not to intervene when the cancer is not very severe. This cancer is monitored using PSA, digital rectal examination and sometimes by biopsy.

These are the possible risks of this procedure:

Cancer can worsen quickly and become untreatable

The exact moment when the cancer will become critical is unknown

The risk the cancer spreads beyond the gland and there are complications because of the process of metastasis.

2. Radical surgery or Prostatectomy

Because this was the procedure selected by me for the treatment and ultimate cure of cancer and taking into account its success I decided to devote a chapter solely to radical surgery or prostatectomy, taking into account its positive and negative side effect.

3. Chemotherapy

There are two types of chemotherapy, and its use depends on the type and stage of cancer being treated.

**a. General chemotherapy** is the use of drugs to stop cancer cell growth, either by killing or stopping these cells from dividing. It is administered orally or injected intravenously or intramuscularly. The drugs enter the bloodstream and can reach cancer cells throughout the body.

**b. Regional chemotherapy—** In this case, the chemical or medicine is placed directly into the spinal column or into an organ or body cavity such as the abdomen. The drugs mainly affect cancer cells in those areas. Sometimes chemotherapy is used if the prostate cancer spread outside the prostate gland and the hormone treatment does not help. During "systemic chemotherapy drugs are administered intravenously or orally, which enter the bloodstream and reach all parts of the body. This treatment is potentially effective in cancers that have metastasized.

The drugs used in chemotherapy kill cancer cells and some normal cells as well causing various side effects that depend on the drug type, the amount and duration of treatment and condition of the patient. These include:

Nausea or vomiting.

Loss of appetite.

Loss of hair.

Pain in the mouth.

Reduced blood cell count.

Risk of infection.

Bleeding from cuts or scrapes.

Fatigue.

Each drug can have its own effects and medications to alleviate them.

**4. Radiation—** This treatment uses X-rays or other type of radiation to kill cancer cells or to control their growth. There are two types of radiation:

**a. External radiation therapy** —It uses a machine outside the body to emit radiation to the affected area.

**b. Internal radiation therapy** uses a radioactive substance sealed in needles, or catheters, that are placed inside or near the prostate close to the cancer. This procedure is known as "radioactive seed implant," perhaps because the needles are the size of a grain of rice. The type and stage of cancer determines which of the two procedures must be followed.

Radiation treats cancer with low grade of severity that is confined to the prostate or has only invaded the surrounding tissue. The chances of a cure through the use of radiation are similar to those obtained with surgery or radical prostatectomy. If the disease is more advanced, radiation may be used to shrink the tumor and provide relief but not a complete cure. Traditionally, this procedure is reserved for the treatment of first-rate cancer in men between the ages of seventy and eighty years old with health problems that impede the surgery of the prostate.

Radiation therapy creates a high risk of bladder cancer or intestinal rectal cancer. Furthermore, you may still experience impotence or urinary problems. Without a doubt, one of the most delicate effects of this treatment is that after the procedure, there is no alternative for surgery because the tissues have been burned by the radiation and therefore have no capacity to heal.

Radiation therapy can have side effects. Some of these problems may improve over time and others can be for life.

Digestive problems, diarrhea and loss of rectal sphincter control

Possible cancer in the bladder or rectum

Loss of bladder control (incontinence)

Blood in the urine and burning while urinating

Impotence

Tiredness and exhaustion are not overcome even months after completing treatment.

Accumulation of fluid in the legs and testicles

**5. Hormone therapy** is a treatment that removes hormones or blocks their action and stops the growth of malignant cells. The glands of the body produce substances called hormones that flow throughout the body via the circulatory system. In the case of prostate cancer, male sex hormones can cause the cancer to grow. In other words, the cancer feeds on these hormones. With the use of drugs, surgery or other hormones, the production of male hormones can be reduced or prevented.

Hormone therapy may have the following possible side effects:

Diarrhea

Hot flashes

Nausea

Pruritus (itching when urinating)

Decrease or loss of sexual desire

Weakness in the bones

Loss of muscle mass

Weight gain or loss

Significant fatigue

Increased cholesterol

Depression

What are the procedures in clinical trial process?

The following five procedures continue to undergo clinical trials and therefore contain positive and negative risks that the reader can easily indentify. When it is proven that any of these treatments is at least as effective as traditional treatments, it undergoes a period of ten to fifteen years before becoming a standard or clinically reliable procedure.

**1. Cryosurgery—** This treatment involves using a metal probe to freeze and destroy prostate cancer cells. This procedure is also known as cryotherapy. These are some of possible side effects:

Freezing damages the nerves near the prostate and causes impotence in most cases.

Freezing can damage the bladder and intestines. It can cause pain and a burning sensation. It generates a need to empty the bladder and rectum frequently.

Loss of bladder control

Most urologists do not recommend it as first choice

**2. Biological Therapy—** This treatment uses the patient's immune system to fight cancer. Substances produced by the same body or produced in the laboratory are used to improve or restore the body's natural defenses against cancer. This type of treatment is also called biotherapy or immunotherapy.

**3. High-intensity focused ultrasound** is a treatment that uses ultrasound or high intensity sound waves to destroy existing cancer cells in the prostate. To carry out this treatment, an endorrectal probe that generates sound waves is used.

**4. Proton beam radiation therapy** is a type of high energy radiotherapy that directs streams of protons into the tumors. Protons are small particles with positive radioactive charge. This type of radiation therapy is undergoing research for the treatment of prostate cancer.

**5. Clinical trials** take place before, during and after different treatments and should be chosen by patients who consider that their decision will be a contribution to the common good of humanity in the search for a cure for cancer in the future.

Experimental clinical trials are conducted in many parts of the country, and options can be found online at the website of the National Cancer Institute (NCI).

What should I consider when making the decision to undergo surgery?

The age and life expectancy of the patient

The general state of physical and mental health: weight, heart, blood, tissue, bone, diseases

Physical features, severity and conditions of the tumor

Patient's personal preferences regarding treatment and its side effects.

What was the experience of my father, Mario, with prostate cancer?

One example that shows that age is crucial when determining the appropriate procedure is the story of my father, Mario, who at age ninety was attacked by the illness. His physical and mental health was not appropriate for radical surgery or any other standard treatment, such as radiation, chemotherapy etc. My father had a pacemaker.

We based our decision on the slow development of the cancer. The urologist correctly diagnosed that my father would die from something other than prostate cancer, as indeed happened four years later. He died from multiple causes associated with the overall decline in the health of his body. The doctor recommended an intermediate procedure to give him a better quality of life. Prostate cancer feeds especially off the testosterone produced by the testicles. The doctors considered that by castrating him, that is, removing the testicles, the development of the cancer would diminish.

My father jokingly agreed to the procedure, normal behavior in this wonderful man. During the medical consult to make the decision, the physician could hardly find the words to voice his recommendation to my father. My father, who was undergoing speech difficulties, interrupted him and said, "Let's face it, doctor, what you mean is that you want to castrate me?

"Yes, Mr. Mario."

"So go ahead and do it. Much better, because they won't be able to call me "viejo güevón" (Old man with big testicles – a Spanish insult) on the street anymore.

What is the best treatment option?

For cancer that has not spread outside the prostate gland to other organs, these are the procedures recommended:

Active monitored surveillance

Internal and external radiation therapy

3. Radical surgery or prostatectomy
Chapter 17

Radical Surgery

_NOTE:_ _Before making any decision, the reader should consult with his doctor. This chapter reflects only the experiences and personal opinions of the author, a patient who has triumphed against the scourge of prostate cancer by making the decisions to have a radical surgery._

What is radical prostatectomy or surgery?

It is the search for a cure for cancer based on the complete removal of the prostate gland and some surrounding tissue. Typically, the surgeon removes the lymph nodes surrounding the prostate to check for the spread of cancer under the microscope. If the nodes contain malignant cells, it is possible that the cancer has metastasized.

There are various interpretations about the side effects of radical surgery due to the fact that the prostate is located near organs vital for urinary, digestive and sexual functions.

Why does radical surgery cause infertility?

The testicles produce sperm and prostate fluid to transport semen through the urethra. By removing the prostate, the tubes connecting the testicles to the urethra are cut leaving the patient sterile and unable to procreate.

Consequently, a patient that has undergone a proper surgery will still be able to have erections and orgasms. These kinds of orgasms are called "dry ejaculations," i.e. without any emission of liquid. The pleasure experienced during this type of orgasm does not change.

For these reasons, some young patients wishing to have children should consider saving their sperm in a sperm bank before undergoing the surgery.

Why recommend surgery or radical prostatectomy?

It has been five years since I had surgery or radical prostatectomy to eradicate the monster called "prostate cancer." All I can say is that my life has been transformed in a great spiritual and physical way that is almost unimaginable and indescribable. Therefore, I am a firm believer of radical surgery, and I want, with all my heart, to share my experience so that thousands and thousands of people will benefit from my testimony. The goals that I want to achieve with this book are two:

**a.** Save lives by promoting prevention based on appropriate checkups so that cancer cells are detected before leaving the prostate gland and prior to metastasis.

**b.** Bring peace and tranquility for patients, families and friends by showing them that if they decide on the appropriate treatment, not only will their lives go back to normal, but it will significantly improve in a spiritual and material way.

To achieve these goals, only one thing is required from the patient, possibly with the support of his doctor and his family: Determining the appropriate treatment for cancer."

For me,, it was a very simple decision. I think it took me no more than five minutes given that Dr. Annaloro presented the situation in an honest, concise, neutral, objective and most importantly in a compassionate manner.

How did I determine which treatment to take?

To determine the appropriate treatment, the first thing to do is to know the magnitude of the illness and to clarify one question. Is the cancer located only in the prostate or has it affected other organs?

What tests are done to check that the cancer has not come out of the gland or that it has metastasized?

My cancer gave a Gleason reading of six, which made it unclear. There was no certainty of a possible metastasis. Therefore, the following tests were required:

**1. Cystourethroscopy of the bladder, commonly called cystoscopy or bladder endoscopy--** It involves inserting a tube through the urethra. The instrument is called a rigid cystoscope. It is equipped with a light, and it takes samples of tissue to examine under a microscope to check for cancer in the bladder or urethra.

This procedure is done in the urologist's office and can take half an hour. There is no need to fast or undergo special preparation; it is only necessary to empty the bladder. The patient lies on his back with the knees bent, separated and high in the air, the same position for women in labor. Before the procedure, the nurse washes the urethra and applies an anesthetic to the skin on the inside. After the procedure, it is possible to see blood in the urine and feel a strong burning sensation when evacuating.

To me, it was the most painful procedure. I described it as brutal, as I had the urethra almost blocked due to my enlarged prostate. This made the passage of the cystoscope very difficult. Basically, the anesthesia did not work.

After the surgery, due to the bleedings that I narrate about later, I had to undergo two more endoscopies. These procedures were completely painless.

**2. Ultrasound of the kidneys or renal ultrasound—** a test that uses sound waves to study the renal system, including the kidneys, bladder and urethra. It is used to detect, among other things, changes in the bladder wall, changes in the size or structure of the kidney and circulatory system, foreign bodies, etc. This test requires no preparation.

This procedure can be done in the urologist's office. The patient lies on a stretcher and the radiologist applies a sound conducting gel on the abdomen over the bladder and kidneys. The device is passed slowly over the areas where the gel was applied. The transducer sends sound waves into the body. The waves bounce off internal organs and echo back to the transducer. The echoes are converted into images displayed on a screen. The doctor then examines the images on the screen. A picture is probably taken for a more detailed assessment.

This procedure does not require anesthesia, is painless and takes between thirty and forty-five minutes. The doctor can immediately see the results. There is no need to fast or any other special preparation. Obesity can make this test more difficult to perform and less accurate. If an abnormality is detected, additional tests are ordered, such as biopsies, to determine the exact problem and cause.

**3. Bone Scan—** The purpose of this exam is to ensure that cancer has not spread through the skeletal system. This procedure is painless, requires no anesthesia and takes a total of approximately four hours. There is no need to fast or do special preparation. The results are not immediate because the doctor requires additional time for analysis.

First, the radiologist injects a radioactive tracer into the vein of the arm. You have to wait two hours for this substance to circulate throughout the body. I recommend not staying in the lab during this time. It is healthier to distract the mind in another activity. Subsequently, the patient lies comfortably on his back and wears earplugs so he will not hear the thousands of pulses of the machine (tunnel).

Who are possible candidates for surgery?

Those who have not metastasized

• Those who are in good health, determined by doctor

• Those whose cancer is in stage T1 or T2

• Traditionally, patients younger than seventy

• Those cases where the cancer has metastasized, doctors recommend surgery to relieve pain or difficulties and to slow the progress of the disease.

What types of prostatectomy are there?

There are several types of radical surgery:

**1. Retro-pubic prostatectomy** is a manual surgery performed to remove the entire prostate through a cut made in the abdominal wall, from the bottom of the navel to the base of the penis. The cut is about seven inches or twenty centimeters. At the same time, the surgeon can remove nearby lymph nodes and seminal vesicles. This procedure is the most widely used and was used as my surgery.

**2. Perineal prostatectomy** is the manual surgical procedure used to remove the entire prostate through a cut in the perineum (area between the scrotum and anus). Lymph nodes cannot be removed through this procedure but can be removed through another incision in the abdomen. This procedure does not distress the nerve of erections. This operation takes less time and is usually used when there are clinical cases in which the retro pubic prostatectomy cannot be performed.

**3. Robotic radical prostatectomy—** Using a robot called DaVinci, the removal of the prostate is achieved. This procedure has been used in the United States since 2003 and is estimated to have been used to perform about one hundred thousand operations. There is estimated of eight hundred robots in the world designed for this purpose.

**4. Transurethral resection of the prostate** is a surgical procedure used to remove tissue from the prostate using a resectoscope. It is a thin tube with light and a cutting instrument that is inserted through the urethra (penis). This procedure is sometimes performed to relieve symptoms caused by a tumor. It is performed before administering any other treatment for prostate cancer. This procedure is also recommended for men who, because of special circumstances age or illness, cannot undergo a standard radical prostatectomy.

What are the disadvantages of radical surgery?

Before going into this issue, we must start from the premise that the patient has selected the appropriate physician with the knowledge and experience required to perform radical surgery successfully. These are the main risks and consequences:

**a. Incontinence—** During prostatectomy, the bladder is pulled to where the prostate was to connect it to the urethra. If the sphincter, the muscle or valve that closes the bladder, is damaged during surgery or radiation, there will be a problem of incontinence or partial or total loss of urinary control.

**b. Bowel function—** The excrements of the body move slowly through the intestine and become stool. Then, through a voluntary movement, this matter is expelled through the anus but controlled by the sphincter. Radiation damage and sometimes prostate surgery can affect the sphincter and create problems of bleeding, diarrhea or control of the disposal.

**c. Sexual function, erectile dysfunction—** The erectile nerve runs through the side of the prostate. If it is damaged in the process, damage that was standard until the mid 1980s, the ability to have an erection is lost. This nerve can also be damaged by radiation. The conditions of the cancer, the patient and the surgeon's skills will determine the retention or loss of this function.

In my opinion, these are the requirements for success in radical surgery:

1. The **patient** should have the necessary physical conditions, including age and health; and mental conditions that include courage, determination, faith, will, perseverance and optimism.

2. The **doctor** must have knowledge, experience, compassion and faith.

An article was published recently by a well known urological organization, which stated that according to some studies, in order for a surgeon to successfully perform a prostatectomy, a minimum experience of two thousand surgeries was required. I believe in the results of that study. Unfortunately, I did not save copy of the article, so I cannot remember the name of the organization.
Chapter 18

Why I Opted for Radical Surgery

I had chosen radical prostatectomy on the day when Dr. Annaloro informed me that I had the "monster" and explained the situation and my options. It took me only a few minutes because for me it was a situation that did not require any thought, even though I had never really worried about this type of cancer. I only knew what my great friends who had lost their lives to this illness had told me. The professional, honest and sensitive way in which the doctor explained my case to me, coupled with the use of logical terms, made the decision very clear. It was a no-brainer.

I believe the natural law of cause and effect is what governs our lives, and these are the reasons why I made my decision:

I had a selection of ten alternatives for quick analyses. Five of them were traditional, standard procedures tested through the years. The chances and side effects of these procedures were known. But I also had five other alternatives, which were considered clinical trials with fewer than ten to fifteen years of statistics to prove their merit. Given my nature, I did not consider it appropriate to submit to any of these five treatments. Therefore, I only had the first five options.

I am a man of action, a man who makes decisions, solves problems and does take like to delay the inevitable. I love to take risks that have good results. I am also aware that a risk will have a cost I must be willing to pay. My life has been guided by the motto, "Nothing is Impossible." Therefore, the first alternative of waiting to see what happens was instantly dismissed.

I had to decide between one of these four options: radiation therapy, chemotherapy, hormone therapy or radical surgery. This was my rational when deciding:

In English, there is an expression that states, "No pain, no gain." It is very similar the one in Spanish, "He who wants something has to pay the cost" If the patient wants to be free of cancer, he has to pay a price. Undoubtedly, the price is high and mortifying—undergoing general anesthesia, the opening of the abdomen by almost twenty centimeters, spending several days in a hospital, having to use a catheter for several weeks, losing blood, and then going a good number of weeks struggling to recover.

On the other hand, it is easier and uncomplicated to expose the body to an X-ray machine for a few seconds a few times. But the difference is that radical surgery seeks a "definite cure," while any alternative treatment seeks "remission," which does not indicate a complete cure.

There is a misunderstanding of the statement, Cancer is in remission." This does not mean that the cancer has been cured, and the patient is finally free from it. The American Cancer Society defines cancer remission as a "period in which the cancer is responding to treatment or is under control." And cancer in full remission means that the symptoms of the disease have disappeared, but it takes several years to be considered cured.

It was not difficult to rule out the option of chemotherapy radiotherapy or hormone treatment because during the initial conversation with Dr. Annaloro, he warned me that these two procedures were risky because statistics showed that radiation and chemotherapy lasted from eight to ten years in most cases, as cells eventually became resistant. But at the same time, he said, the procedure may be successful. His words echoed in my mind as I remembered two of my best friends, the physician, Vinicio Echeverri, and Gerardo Cuartas. I had lost them to prostate cancer about eight years after they had been diagnosed with the illness.

Also, my national and regional cycling activity in the senior category had enabled me to meet men who are as athletic as I am, men who have the illness and chose these procedures. They are doing well but have lived for several years in constant fear, monitoring the development of their "remission" because they chose radiation or hormone therapy. I decided to exclude these two procedures. First, I did not want to take the risk, and secondly, I did not want to live the rest of life with that permanent concern. I like to solve problems for good.

Analyzing the side effects, especially bladder control, incontinence and erectile dysfunction, I concluded that virtually the same effects could occur with the other procedures. On the other hand, the effects could be minimized with radical surgery if the surgeon was skilled and the appropriate conditions were present. A surgeon who has performed thousands of surgeries can perform the operation, preserve the nerves that control erection and prevent damage to the sphincter that controls the bladder and the rectum. If the patient is in optimum condition for the procedure, it is more likely that these problems will not arise after radical surgery because they will be more controlled. Some conditions, such as tumor size, have a lot to do with the process of saving the nervous system of the penis. Therefore, my circumstances were optimal for surgery.

With regard to incontinence, there are three types:

**a. Stress incontinence—** This is the most common and occurs after surgery. This incontinence can be tightly controlled through the use of exercises. It is a leakage of urine when coughing, when a lot of effort is performed, when tired or after extreme exercise. Also, it can be a side effect of drinking liquor.

**b. Flow incontinence or leakage—** This means that it takes a long time to urinate. The flow is very slow.

**c. Urge incontinence** is a sudden and unexpected urgency to urinate. Regaining control of urination and erection can take several days to several months. The doctor cannot determine this. Each body reacts differently. I am aware of cases almost identical to mine in terms of prognosis and surgery. Two friends of mine went through the same procedure. One regained bladder control immediately after the catheter was removed, and the other two years later. I regained control approximately three months after surgery.

The conversation with Dr. Annaloro motivated me to make the decision. He had told me that despite my age, I was in excellent physical conditions and was a good candidate to have surgery and return smoothly to a normal life.

Another powerful factor in making the decision for surgery was that in the event of a recurrence, all other treatment options would still be open, even the possibility of another surgery. This is not the case with the majority of the other treatments.

One thing that greatly impacted me was that when Dr. Annaloro told me that if I selected radiation treatment, he would not be able to perform surgery afterwards. The radiation burns good and bad tissue, therefore, the area burned by the X-ray loses the property of healing. For all the reasons above, I only had the option of undergoing radical surgery.

I had to determine what type of surgery I was going to submit to—conventional or robotic. These were the factors that led me to dismiss the DaVinci robot:

1. This is considered an experimental surgery. The DaVinci robot, despite being very popular at the moment, does not have enough statistics supporting it, as it is a relatively new procedure. The robot has been used in the United States for treatment of prostate cancer since 2003. Despite the successes during other surgical procedures, such as those of the brain and heart, there has not been sufficient time to prove the statistics. But there is no doubt that medicine is going in that direction.

2. Frankly, I wanted Dr. Annaloro to be my surgeon, and the robotic procedure was not available in the area. I wanted to be near my family during the procedure.

In conclusion, I opted for radical surgery knowing I would pay a price for my freedom. I am a blessed man because I have returned to a normal life, full of energy and dreams and have no concerns about the side effects of this illness. I do not even think about its return. Simply, the prostate, the organ that threatened me, has been incinerated and not even the memories are left in my body.

What happens after surgery?

Bear in mind that the process of recovery is very slow. There are countless microscopic blood vessels and nerves that are still struggling to reconnect. This can take years. If three or more years later, you feel sharp pains it is not necessarily because the illness has returned. On the contrary, blood vessels and nerves that control bladder and erectile function continue to improve and reconnect, increasing their efficiency as time goes by. Nevertheless, if the symptoms are severe and very frequent you should consult a doctor.

In previous chapters, I have discussed the details of what occurred after surgery. Now I refer to what happens several years later. Unfortunately, doctor's appointments begin to dwindle to every two, three or four months and then every six months. I say "unfortunately" because a close friendship has been established with all the medical personnel throughout this ordeal. Seeing them twice a year is too little. The visits are more part of a protocol than anything else. The bad thing for me is that very soon, five years after my surgery, they will only be annual visits.

During the annual visit, blood and urine samples are taken to verify that there are no infections and that the PSA factor is zero.
Chapter 19

Kegel Exercises  
The Key to Success against Incontinence

A common ailment for some women who give birth is incontinence. The American gynecologist, Arnold Kegel, invented the method of Kegel exercises to control the bladder in 1948. Subsequently, the benefit of these exercises for men after prostate surgery or for men who suffer from fecal incontinence was discovered. These scourges are common in some elderly people of both genders, even without undergoing surgery. For this reason, these exercises are recommended for the elderly regardless of their health status.

What are Kegel exercises?

They are a series of movements to reactivate the sphincter muscles that control the bladder and the anus. These muscles are in the base of the pelvis and may be affected by the surgery. The exercises facilitate and improve urethral and rectal functions of the patient. The success of these exercises depends on the physical condition of the patient and the strict adherence to the program and its technique. It is the most effective treatment for incontinence without the use of medication.

How to identify the muscles of the base of the pelvis?

They are the ones that we open and close to empty the bladder or bowel. They are also identified as those that we use to ejaculate. The easiest way to identify them is by tightening them after urinating or defecating but without tightening the stomach muscles or legs and without holding your breath.

When should I do the exercises, and what is the procedure?

You should never do the exercises when the catheter is installed or with a full bladder.

The exercise typically lasts about fifteen minutes and should be done three times a day as follows:

1. Empty the bladder

Keep the sphincter muscles tight and count—one thousand ten, two thousand ten, and three thousand ten until you reach ten thousand ten.

Relax the muscles completely and remain relaxed, counting in the same way up to ten.

Do ten exercises, three times a day in the morning, afternoon and evening.

Never skip exercising, especially at the beginning. You can do them anywhere, anytime, standing or sitting.

Your success depends on your discipline. An improvement should be noticed four to eight weeks later, although it could take several months to a year, which I have seen in some of my friends. It requires patience. Be very careful not to overdo it. If the exercises are performed in amounts greater than recommended, the problem of incontinence is aggravated because the muscles become fatigued and worsen rather than improve. If you feel discomfort in your back or stomach pain, it means that the exercises are being performed incorrectly.

What was my experience with Kegel exercises?

I narrated in other parts of the book my difficulties with incontinence. Here are my main experiences:

**a.** The muscles become weak and the challenge is to keep them exercised to avoid any mishaps. If you neglect regular exercises, incontinence will return.

**b.** I created a system that has become automatic. Whenever I go to the bathroom, even if it is only to urinate, I sit on the toilet and always do the exercises. Also, I do them before I go to sleep and right after I wake up. This routine has become automatic, and the problem has disappeared.

**c.** Liquor, some drugs and excessive exercise can worsen incontinence.

**d.** I'm sorry I learned about the exercises after surgery. I recommended that my great friends, Tommy Moffit and Anthony J. "Jay" Traina, do these exercises a month before the surgery, just a few days after the diagnosis. They did them and when the catheter was removed after surgery, they box of diapers was left unopened because they never had to use them.

**e.** Exercise has influence on continence. I can be on the bike for four hours and have no problem with urinary control. However, if I walk for more than an hour, the problem begins again. I think that being on the bike seat, the sphincter muscles do not have to work as hard because the weight of fluid from the bladder is resting on the seat. On the contrary, walking puts the weight on the sphincter. Dr. Annaloro advised me to take frequent breaks during long walks. This has yielded excellent results.
Chapter 20

Statistics

What are the statistics about prostate cancer in the United States?

Prostate cancer is called, "The Silent Killer," for its characteristics. Generally, it camouflages minor symptoms, such as increased frequency and slow urine flow, prostatitis, etc. Cancer is very slow to develop. Usually, it takes up to ten years to appear.

Today prostate cancer is the number two men killer in the United States after skin cancer.

The American Cancer Society (ACS) estimates that 217,730 new cases will be diagnosed in 2010

Approximately 32,050 will die in 2010

Approximately eighty-eight people die daily from this disease and is the number of people who will die while you read this book.

Every fifteen minutes a man dies from prostate cancer. The sad thing about these statistics is that not even one of these lives should be sacrificed because of this illness. This facts discussed in this book prove this.

In autopsies of men over eighty years old, seven to nine out of ten men have died with prostate cancer, without even knowing it, hence the silent killer. Prostate cancer is the most common cancer in men, excluding skin cancer.

One in six men will be diagnosed with prostate cancer during their lifetime.

One in thirty-two dies of cancer.

Of all men diagnosed with prostate cancer, ninety-seven percent are alive five years after diagnosis, seventy-nine percent ten years after. These figures include all states and grades of prostate cancer.

At diagnosis, of all cases of prostate cancer, approximately seventy percent have not metastasized to other organs.

The mortality rate for this cancer has declined in the United States. This has been attributed to earlier diagnosis and increased awareness and knowledge. Patients diagnosed early have probably been given better prognosis than those diagnosed at an advanced stage. The other cause for this decline is the advancement in diagnostic techniques and treatments.

The incidence of prostate cancer has increased over more than one hundred percent in the last ten years. Among the possible factors are:

Aging population

Longer life of men

Decrease in other causes of death

Improved diagnostic techniques: transrectal biopsy, MRI and determination of prostate specific antigen levels in blood.

Early detection programs

Increased education and awareness of the population

Great increase in surgical procedures performed on benign prostate diseases, such as benign prostatic hyperplasia that increase the incidental diagnosis of early stage cancer.

The likelihood of having prostate cancer increases rapidly after the age of fifty. More than seventy percent of cases are diagnosed in men over fifty years old.

Prostate cancer occurs about seventy percent more often in African American men than in white men. Asian men or inhabitants of the islands of the Pacific have the lowest rates of incidence and mortality.

The highest risk of prostate cancer occurs in Sweden. There is an intermediate risk in North America and Europe of seventeen percent, and the lowest risks are present in rural China, which has a two percent risk.

When the Chinese move from rural to urban areas, the statistic increases.

Age is the greatest risk for getting prostate cancer.

The possibility of cancer rises as soon as a man turns fifty. Two out of three cases of prostate cancer are found in men older than sixty-five.

In ten thousand men, one under forty is diagnosed with this cancer.

One in thirty-eight is diagnosed between forty and fifty years old.

One in fifteen is diagnosed at age sixty to sixty-nine.

Sixty-five percent of prostate cancer is diagnosed in men over sixty-five.

The average age for cancer diagnosis is sixty-nine years—my age at my diagnosis.

Nine out of ten cases of cancer are found in stage I and II (less severe).

Currently, an estimated two million men in the United States who had prostate cancer at some time are still alive.

Dr. Annaloro told me when the illness was diagnosed that I was very lucky to have detected cancer at sixty-nine when I was in excellent physical condition. He informed me that one in three men after fifty were diagnosed with prostate cancer. At age sixty, the probability was sixty percent. At seventy, the probability was seventy percent and ninety, ninety per cent, so on. Then he added, "Any man who does not die from other causes will eventually die of prostate cancer." His prophetic words reminded me of my father's death at age ninety-four. He had prostate cancer.
Chapter 21

Cancer Prevention

This chapter does not apply exclusively to patients with prostate cancer. It is dedicated to all those who want better health conditions and subsequently a better lifestyle. Those who want to prevent catastrophic illnesses, such any type of cancer, heart problems, circulatory diseases or other problems like diabetes, etc. In my opinion, no one person should die from prostate cancer. One is too many. The best strategies to prevent and reduce mortality rate from prostate cancer are:

a. Prevention

b. Early diagnosis

c. Adequate procedures and treatments today available

d. Investment in research and development of new procedures

Progress in these areas has saved many lives, but not enough. Having cancer indicates that a person has multiple deficiencies. These may be genetic, environmental, nutritional, lifestyle and even mental behavior.

Can you prevent prostate cancer?

Prostate cancer **cannot be prevented** because the causes of it are unknown, but there are several ways to minimize the risk. Unfortunately, despite significant research done in the last twenty years, the goal of detecting the cause has not been reached. Age, genetic and environmental causes have been identified, but the evidence is not definitive.

Today, there are talks indicating there are ways to cure cancer other than chemotherapy, radiation or surgery.

We all have malignant cells, but a strong and immune system destroys and prevents from spreading.

We must start from the principle that chemotherapy involves poisoning the cancer cells, but this means that healthy cells in the bone marrow or the intestinal tract, among others, are also poisoned. Chemotherapy can also cause damage to organs like the liver, kidneys, heart, or lungs, etc.

Radiation destroys cancer cells, but also burns, scars and damages healthy cells, tissues and organs. Therefore, prolonged use of these treatments involves other serious side effects due to the toxic changes that affect the patient's immune system. Also, there is the possibility that the cancer cells will become resistant or immune to this treatment. With surgery there is also a risk that malignant cells will spread to other sites.

However, there are alternatives to help prevent the disease:

1. Diet

One of the best ways to help prevent cancer and catastrophic illness is to strengthen the immune system based on an appropriate diet and supplements in order to reinforce it and help it destroy malignant cells.

It has been concluded that a diet rich in red meat, dairy and fat leads to greater risk of getting cancer. On the other hand, a diet based on fruits, vegetables and white meats reinforce the immune system. A clear influence of diet on the recovery process for the treatments above has also been identified. These are some of the recommendations from the John Hopkins Hospital in Baltimore:

A. One way to combat cancer is to have cancer cells starve to death by not feeding them with the food necessary to multiply.

B. Sugar is a cancer-feeder. Cutting sugar shuts off one important food supply for cancer. Sugar substitutes like NutraSweet or Equal, for example, are made with Aspartame, which is harmful. A better natural substitute would be honey but in a small amounts. Table salt contains chemicals that make it white. A better alternative is sea salt.

C. Milk causes the body to produce mucus, especially in the gastro-intestinal tract. Cancer feeds on mucus. By cutting off milk and substituting it with unsweetened soy milk, cancer cells begin to die of hunger.

D. Cancer cells thrive in acidic environments. A meat-based diet is high in acid. It is best to eat fish and some chicken than to eat beef or pork. Meat also contains livestock antibiotics, growth hormones and parasites, which are all harmful, especially for people with cancer.

E. A diet made of eighty percent fresh vegetables and juice, whole grains, seeds, nuts and fruit help put the body in an alkaline environment. The remaining twenty percent can be supplemented with cooked food, including beans. Fresh vegetable juice provides live enzymes that are rapidly absorbed and reach down to cell levels within fifteen minutes. They nourish and enhance growth of healthy cells.

F. To obtain live enzymes to build healthy cells try to drink fresh vegetable juice and eat some raw vegetables two or three times each day. Enzymes are destroyed at temperatures of forty degrees Celsius.

G. Avoid coffee, tea and chocolate that contains too much caffeine. Green tea is a better alternative and has properties that act against cancer. Drink purified or filtered water. Tap water contains toxic heavy metals. Distilled water is acidic. Avoid it.

H. Meat protein is difficult to digest and requires a lot of digestive enzymes. Undigested meat remains in the intestines and rots, thereby becoming more toxic residues.

I. Cancer cells cannot thrive in an oxygenated environment. Exercising daily and deep breathing help carry oxygen to the cells. Oxygen therapy is another way to combat cancer cells.

J. John Hopkins Hospital makes the following recommendations:

Do not use plastic containers in the microwave.

Do not place plastic bottles with water in the freezer.

Do not use plastic wrap on containers in the microwave. By heating the plastic in the microwave or putting it in the freezer, dioxins are released. Dioxin is a chemical that causes cancer, especially breast cancer. Dioxin poisons the cells in our body.

This information has been circulated by the Walter Reed Army Medical Center. Recently, Dr. Edward Fujimoto, wellness program manager at Castle Hospital, was on a television program where they explained the risks of dioxin to our health. He talked about dioxins and how bad they are for our body. He said that we should not be heating our food in the microwave using plastic containers. This especially applies to foods that contain fat. He said the combination of fat, high heat and plastic releases dioxin into the food, which then enters our body. Dr. Fujimoto recommends using glass, such as Corning Ware or Pyrex or ceramic containers for heating food. You get the same results, only without the dioxin. Foods that appear on television, such as instant soups or Maruchan, Ramen, etc., should be removed from the plastic containers and heated in glass containers. Fujimoto said that the paper is not bad, but it is hard to tell what is in the paper. It is best to use tempered glass. Long ago in some fast food restaurants, dry ice containers (foam) were replaced with paper. This was because of the dioxin problems. He noted that plastic containers are also dangerous when placed over foods to be heated in the microwave. High temperatures cause the toxins to actually melt the plastic and fall into the food. Doctors recommend using paper towels instead.

2. Obesity

The vast majority of scientific studies have found that obesity is not an important indicator or indication of an increased risk of prostate cancer. However, studies have shown that obesity increases the risk that upon the discovery of cancer it will be in a more advanced state. Similarly, obesity may be a determining factor in deciding which treatment to follow or make it more difficult; therefore, it can affect the chances of survival.

3. Exercise and health

Most studies show that exercise does not reduce the risk of prostate cancer. However, studies have shown that oxygen limits the growth and reproduction of malignant cells and that the person in good physical conditions is better able to withstand the selected treatment and speed up the recovery process. Awareness in society about the seriousness of prostate cancer is relatively recent. Further research is needed on the impact of diet, certain vitamins, obesity and exercise.

Prostate cancer is more likely to be present among older people, and studies show that exercise and physical activity in these men reduced the likelihood of advanced cancer. Thus, the overall physical and mental health, or the presence of heart and circulatory problems or diseases like diabetes or being overweight, are determining factors in the healing process.

4. Occupations and habits

The following occupations have a higher risk of prostate cancer, according to research:

Workers in the industries that use metal, including cadmium used in batteries, solder and cigarettes appear more likely to develop prostate cancer. Cadmium disrupts the natural process of cellular DNA repair and may allow uncontrolled proliferation of malignant tumors.

Painters

Workers rubber, tires, hoses and plastics industries

Consumers of tobacco. Cigarette smoking increases the production of male hormones that stimulate cell growth and is a risk factor for prostate cancer, according to recent studies. The cadmium content of cigarettes is another risk factor.
Chapter 22

My Wishes

If only one life is saved by writing this book, all of the effort will have been justified. One life is a great loss. Hundreds of thousands can be saved if we do two things: be aware and be responsible. I was consciously irresponsible because at first I was dominated by fear. After five years of experience and research I think that no one life should be lost because this disease.

Fortunately, I received a blessing. Now I long for my past experience to be useful and save many lives all over the world. That is why I have decided to donate the proceeds of this book to the Prostate Cancer Foundation.

My message is the following: Prostate cancer is not terminal, and it is not something extraordinary or severe, provided that it is diagnosed promptly and the right decisions are made. After all, it is the patient who decides on the procedure for healing.

Most men could save their lives from prostate cancer if they are able to do the following:

a. Become responsible for their lives and the happiness of their families by yearly monitoring of the prostate gland and by adopting an appropriate lifestyle.

b. Choose the appropriate clinical procedure in an analytical and confident manner.

c. Place themselves in the hands of professional experts with medical knowledge and experience.

Doctor Annaloro commented on one occasion how painful it was for him to see some patients chose to undergo procedures that, in his opinion, would lead them to a premature death. He, however, had to respect the will of the patient.

I want patients who are diagnosed with this disease not to be embarrassed or suffer because if they act quickly and accurately, they will have a normal life, possible a better life because it will be full of gratitude and generosity. Everything around them will be different because after cancer you simply start a "newlife."

I would also like for patients to share their positive experiences with those who have been diagnosed with the illness. That way, they will instill the peace of mind they need to make the right decision that will lead to a successful recovery.

I long for patients, relatives and friends to have faith, to work hard together and not let the illness attack their minds. I pray they will not suffer with fear or excess anxiety. Success lies in using the imagination for good and not evil. We must remember that a mental and emotional recovery is required first for the physical part follow the same course. Our thoughts govern our body. We must be aware that no two cases are clinically identical and that no one on earth can predict our end.

A young priest from our parish, Rev. Joseph Vu Ngoc Than, fifty-one, who suffers from a delicate lung cancer without having smoked, told us, "I did not ask the doctor how serious the lung cancer was, nor how much longer I have, because God controls my time and no one else but Him knows how much longer I have." This truth is applicable to all living things including animals.

This reminds me of Dulce, my son, Carlos Mario, and his wife, Richarda's, beautiful Doberman. She had terminal cancer and several specialists gave her about forty-five days to live. Three years later, we were enjoying her company, and the same specialists who had declared her hopeless were now investigating her case. No one knows the day we will cross the finish line. This is why we must always do our best every day.

Not all patients diagnosed with prostate cancer are operable through radical surgery. Only a urologist can determine that, but the primary requirement for this surgery is that the cancer cells have not left the prostate gland. This comes only with responsible behavior and a timely diagnosis.

While it is true that in medical circles this surgery is called, "radical," because of the complete removal of the gland, I prefer to interpret, "radical," as the final eradication of this cancer once and for all. Any other procedure involves further agony, constantly monitoring of the evolution of the illness based on blood tests, medical appointments and more concerns.

With radical surgery there is more pain, blood loss, more time in the hospital, more suffering, but there is a greater prize...freedom, a freedom that becomes the real prize of courage.

Throughout this book, I have discussed my "newlife," but I haven't talked much about what a "newlife" really means for me and for most people who have survived cancer. "Newlife" is the most wonderful state of being a person can experience. It involves a greater appreciation of life, of the years we are given on this earth and of the people who have blessed us with their love.

"Newlife" is a new awareness of the smell of a freshly cut lawn, the first flowers in spring, the laughter of a child. It is the feeling when a smile is exchanged, when a hug is savored. It is the kiss of a loved one.

"Newlife" is watching the vegetables growing in my garden and knowing that I will still be here to pick them when they are ripe.

"Newlife" is treasuring the ability to hold my beloved wife in my arms each night and fully enjoying and appreciating the love and warmth with which she has surrounded me for so many years.

"Newlife" is watching my grandchildren, Alek and Lucas, grow to become strong and

happy young men and being able to share with them the lessons of my life.

"Newlife" is being able to spend time with my children and their loves one, cherishing the love and friendship we have nurtured throughout the years. It is being proud of their accomplishments and feeling confident that I have left them a legacy of which they can be proud.

"Newlife" is being able to continue to build the St. Jude Dream Home every year to raise money for cancer research for children. It is sharing my fortune with others and knowing that I have indeed made a difference with my life.

"Newlife" is being able to write this book in the hope of helping even more people who will be stricken with cancer. It is sharing my experience with prostate cancer so that others will be able to see the benefits of radical surgery.

"Newlife" is life—life with cancer, life free of cancer. It is a mindset, an appreciation, a gift from God. It is to be born again.

Every day, I am thankful for my "newlife," and I sincerely hope that everyone diagnosed with prostate cancer will make the right decision and be able to enjoy his own "newlife" as fully as I am enjoying mine.

Finally, to me, "newlife" means that God has allowed me to live another day to show my family how much I love them. For that, I am eternally grateful.
Chapter 23

Testimonies of Survivors

Dear brother Jairo:

I would like to contribute to your book by sharing my personal experience with prostate cancer.

Since the early nineties, when I was less than fifty years old, I began having difficulty urinating, especially at night. After consulting with a general practitioner, he performed a digital examination on my prostate. The PSA and blood tests were omitted. The doctor informed me that everything was normal.

The problem continued. In 2004, I visited an urologist, who, after digital and PSA examinations, proceeded to order a biopsy. It was concluded that only the prostate was enlarged, and nothing was malignant. My family history of our father who had prostate cancer was a concern. I proceeded to undergo the routine annual examinations.

My PSA readings continued to gradually rise but never reached critical levels to become a concern for the physician. Finally, in 2008, the PSA level became doubtful. After the doctor learned that you had recently been diagnosed with prostate cancer, he recommended a repeat biopsy that tested positive for prostate cancer. My urologist presented me with the following alternatives:

a. Do nothing and have the prostate "in surveillance"

b. Implant the prostate with radioactive "seeds." With this procedure, the doctor warned me I could not be near a pregnant woman or sit a child on my lap.

c. Undergo radical surgery for the complete removal of the prostate gland

d. Begin a radiation therapy treatment for a period of several months

These alternatives had me very confused. I talked with friends, read and sometimes I thought that the first option could be the best option because this way I would be buying time and I thought that in four or five years there would be a better option than radical surgery. Fear generated in me countless excuses not to confront the situation.

That's when you, Jairo, played an important role in making me see that keeping the cancer under surveillance was not appropriate given the immense risk involved. My current physical conditions due to age and my health created the time to grab the monster by the horns. Options "b" and "d" were ways to postpone the battle that I had to deal with anyway. Later in my life I would have less chances of winning. The other alternatives did not eradicate illness, they only postponed it.

I wanted to get a second opinion from Dr. Wheller, an urologist at the St. Joseph Hospital in Hamilton, Ontario. Upon analyzing my records and family history he replied immediately, saying that the "prostate has to be removed." He gave me two options for surgery:

1. Robotic surgery based micro instruments and a monitor for the surgeon. It was the least invasive procedure with a quicker recovery.

2. Conventional Radical Surgery. I opted for conventional surgery because I think looking at the internal organs on a monitor is not the same as looking directly at them. The surgery took place in November 2008.

I am very happy with the decision of doing a radical surgery. I am a free man. My cancer has been cremated and is not "in remission" as would have occurred with the other procedures available. My routine reviews are excellent, and the PSA indicates that I am completely free of cancer. This is just history. I recently retired, and I am adjusting to a new way of life. I still have trouble with sleep and the Kegel exercises for the sphincter have been essential for improvement of incontinence.

In short, this is my experience. I wish to tell all the men in the world that if they have the dilemma that I had, opt for radical surgery if the doctor considers it as an alternative. Otherwise, what you don't face today you will have to face tomorrow perhaps in more adverse conditions that may cost you your life!

Thank you for everything you did for me, for your good counsel and support and that of Anita. I wish much success with this book because you will save many lives.

Cordially,

Rubén Álvarez-Botero, younger brother of author

* * *

Dear Jairo:

Congratulations on your continuing desire to help others. That makes me very proud as a relative and fellow countryman.

I am seventy-eight years old, and my cancer was diagnosed when I was sixty-six. Its discovery was attributed to a miracle. I've always hated the advertising material on the windshield, but one day I passed by a hematology laboratory and they placed a flyer on my car. The lab announced a new procedure, at that time, for the prostate exam. It consisted of a blood test, that is, the prostate-specific antigen.

Honestly, since I became older, the prostate topic preoccupied me, However, the exam at that time was very invasive and bothersome; it was what they called "rectal sensing." I subjected myself to the examination but very irregularly. When I found out about the Prostate Specific Antigen, (PSA) I ran to take the test and, indeed, I had prostate cancer. Until then, I had not felt any discomfort, pain, incontinence or bleeding, nothing at all.

What to do? The first thing was to seek the medical advice of someone reliable and experienced. A doctor referred me to Dr. Pérez-Flórez. I also read about the disease and various treatments. The doctor explained everything with honesty, and advised me to undergo radical surgery or prostatectomy. I knew I would be left impotent, but I would live several more years because the cancer did not show any other compromise besides the prostate. One could say that evil was encapsulated.

It is difficult to know what would have happened if I had chosen a different procedure. All I can say is that I am very pleased with the decision I made. I had the operation twelve years ago, and I am in great condition.

I recommend to the readers of your wonderful book that they get routine exams before and after the illness. In other words, while they are healthy and then after the illness. That way, they will be aware of any metastasis.

Jairo, I hope your book will be successful and that through the revenue that it generates you will be able to help continue your wonderful work.

Ignacio Álvarez-Ángel, cousin of the author

\---

Dear Mr. Álvarez:

I want to express my gratitude for everything you did for me during the cure and healing of my prostate cancer that was diagnosed two years ago. Frankly, I have no words to express it.

I admire your goal of saving lives, not only in America but worldwide. I commend you for that work.

I want to contribute to your book by describing my own testimony, as I am aware that today there is much ignorance and many myths about prostate cancer. Nearly a quarter of a million people suffer from this illness annually. Of that group, nearly thirty-five thousand people die in the United States every year.

Currently I am sixty years old, and my prostate cancer was diagnosed when I was fifty-eight. I remember I was about thirteen or fourteen years old when one day during school while walking from the cafeteria to the classroom I felt a sharp pain in the lower genital area. I was very young and do not remember the details, but since then it was recommended that I perform a prostate exam every year. I performed this test dutifully.

When I was fifty-seven, I traveled with my wife to Brazil. At that time, I had a very active sex life. It was during those days that I started experiencing severe pain in the prostate immediately after sex. The pain was very similar to what I had felt when I was young. I did not worry because just two months earlier my general physician had performed a digital rectal examination and had informed me that the prostate was in good health.

But seeing that the pain persisted every time I had sex, I decided to revisit the same doctor, who ordered the biopsy. This visit was very painful. I was shocked when I was informed that I had prostate cancer. Shortly after, I was attacked by a bladder infection and prostate infection that caused a very high fever, and I was hospitalized for three days. From that moment, my health deteriorated dramatically since my doctor usually took several weeks before seeing me. Fortunately, you, Mr. Álvarez, referred me to the urologist Angelo Annaloro.

After discussing my situation with Dr. Annaloro and considering the various alternatives that he presented, I immediately decided to undergo radical surgery or prostatectomy.

Undoubtedly, the most important decision I ever made was to save my life by deciding on radical surgery. If I had not done this, honestly, I would be dead. Considering my temperament, I would not have been able to withstand another treatment that would have given me so much freedom and happiness for the rest of my life.

These have been the main benefits and effects of radical surgery:

I have acquired a clear conscience that allows me to take care of my health and self-esteem. I lost thirty-five pounds, I have improved my diet, and I have refrained from consuming alcohol in a social way.

My sex life is more active and enjoyable than before, and the orgasm is more delayed. I was surprised that three days after the catheter had been removed, I had a slight erection. Dr Annaloro had saved the nerves.

I have never had problems with incontinence because whenever I go to the bathroom, I sit on the toilet and perform the Kegel exercises for one or two minutes.

I simply wanted to give you my testimony. If the person diagnosed with prostate cancer can have the operation, I recommend radical surgery over other procedures. This way you will be able to lead a normal life full of happiness. You will be able to enjoy your family, spouse, children, grandchildren and friends. I ask the readers to have a great sense of responsibility to themselves and society. Therefore, I recommend the frequent examination of the prostate—not only digital examination as a precaution but be sure to perform the PSA check of the blood.

Again, thank you for what you did for my family and me.

Sincerely,

Sidney Sutton **,** independent contractor, Baton Rouge, Louisiana

Conversation with Anthony J. Traina, prostate cancer survivor.

Jay, as we call him affectionately in our industry, is a hard working carpet installer who four years ago, at age sixty-three, was diagnosed with prostate cancer. Today, at sixty-seven, he leads a "newlife" full of comfort and joy. He is devoted to his three passions: his family, work and tennis.

This is a conversation that I had with Jay recently:

How do you feel today?

I feel perfectly well, full of health and energy, as if nothing had happened to me. I am happy.

How did you find out you had prostate cancer?

I had always been disciplined about getting my annual physical. I do not know what happened. Possibly because I was feeling great, I neglected the physical for three years. I went to my family doctor, and he ordered a PSA of the blood. I was diagnosed with prostate cancer even though I did not have any symptoms. The doctor explained the alternatives but recommended radical surgery. Naturally, I was very confused and did not know what to do.

What led you to make the decision to undergo radical surgery?

When you, Mr. Álvarez, found out that I had been diagnosed with cancer and called me to tell me of your experiences, they were of invaluable help. You told me about your experience, and you made a recommendation. I immediately decided that they should completely remove the prostate so that I could be free from this illness for the rest of my life. I was very confused. Look at my arms, I get chills just thinking about it. I do not know how to thank you. It's the best decision I have ever made in my life.

Which of the recommendations that I gave you helped you the most?

You told me to start Kegel exercises before surgery to strengthen the muscles that control the bladder. I carefully did them for one month before surgery. Two weeks after the procedure, when they removed the catheter, I had normal bladder control and didn't even have to use diapers. I've never had problems with incontinence.

Jay, tell me about your sex life.

Normal. As if nothing had happened once I recovered from surgery.

What satisfaction do you feel today?

My thirty-seven-year-old son is aware of the genetic factor and has plans to begin his checkups at forty.

What message do you have for other men?

Be aware and stay conscious of your health through regular checkups in order to detect this illness on time and if you are diagnosed, do not hesitate to decide to completely remove the prostate if it is clinically possible.

How often do you see the urologist today?

I go every year for a routine visit.

Jay, what's the worst that can happen after a surgery?

Mr. Álvarez, life is more important than sex.

Conversation with Mr. Gustavo Gonzalez, prostate cancer survivor

How old are you, Gustavo?

I am forty-nine, and twelve months ago I was operated for cancer.

What are the statistics in your family for this illness?

None. Nobody in my family has suffered from this type of cancer before.

How did you discover you had cancer?

I've always been very conscious of my health. I visited the doctor annually. The doctor, unfortunately, only performed the digital exam of the prostate and not the blood exam. I went to a routine checkup, and the doctor ordered me a PSA test of the blood. The doctor later requested a biopsy and found that I had cancer in forty percent of the prostate. I never felt any symptoms. Definitely, this type of cancer is a silent killer.

Why did you decide on radical surgery rather than radiation or chemotherapy?

The doctor asked me about the age of my children. They were six and ten years old at the time. Then he told me that if did not decide on radical surgery, it was likely that I would not see them graduate from high school. Radiation or chemotherapy would cause further damage to other organs, the possibility that illness would return was significant and besides, I was a good candidate for surgery. If I wanted to rid myself of the problem once and for all, the doctor recommended radical surgery.

How has your body behaved after radical surgery?

Extremely well. I followed the instructions of the urologist carefully. After three months, I had complete control of the bladder and at six months, I had an erection without any problem. My life is as normal as it was before surgery.

What do you say to men in the world?

That my life was saved by the annual health check that included a PSA review of my blood. If their cancer is diagnosed early, do not think about small seeds or any other treatment than prostatectomy or total removal of the prostate.
Chapter 24

Support and Resources

Where I can find support and information about prostate cancer?

In Spanish and English:

1. American Cancer Society (ACS):

http://www.cancer.org/Espanol/index

Detailed guide in Spanish:

http://www.cancer.org/Espanol/cancer/Cancerdeprostata/Guiadetallada/index

Toll-free number: (800) 227-2345 or visit www.cancer.org.

2. National Cancer Institute (NCI):

http://www.cancer.gov/cancertopics/types/prostate

Toll-free number: (800) 4-CANCER - (800) 422-6237

Websites: English www.cancer.gov

Spanish: www.cancer.org/espanol/cancer/cancerdeprostata/

In English only:

3. ZERO - The Project to End Prostate Cancer

Toll-free number: (888) 245-9455

Web site: www.zerocancer.org

4. Prostate Cancer Foundation (PCF):

Toll-free number: (800) 757-2873 - (800) 757-CURE

Website: www.pcf.org
Glossary

For prostate patients:

**Active surveillance—** when no clinical treatment is performed. This treatment involves continuous monitoring of PSA, digital rectal examinations and biopsies.

**Aggressiveness** is the severity of the cancerous tumor inside and outside of the prostate.

**Anesthesia** is a substance, drug or gas that produces local or general loss of consciousness, including pain.

**Benign** is a tumor that does not spread to other parts of the body.

**Biopsy** is a procedure that involves taking small pieces of prostate tissue to then be examined in the laboratory.

**Bladder** is a muscular bag-ball in which urine is temporarily stored before being evacuated through the urethra.

**Catheter** is a thin clear plastic tube that is inserted through the penis into the urethra to the bladder to drain urine.

**Complications** are difficulties presented by medical treatment.

**Digital rectal exam** is the insertion of the index finger, covered with a lubricated glove into the rectum to feel for abnormalities of the prostate.

**Ejaculation** is the emission of semen from the penis during an orgasm.

**Erectile Dysfunction** is also called impotence. It is the inability to maintain a satisfactory erection to complete intercourse.

**Incontinence** is the loss of bladder and/or the digestive system control or accidental release of urine or stool.

**Life expectancy** is the measurement of time in months or years that a person is estimated and expected to live.

**Malignant** is cancerous growth that is likely to grow and spread through the body to cause disability or death.

**Metastasis is** the spread of cancer to other organs of the body.

**Pathologist** is a medical specialist who studies human tissues and diagnoses their condition.

**PSA** means Prostate Specific Antigen and is a protein produced only by the prostate gland.

**Radical prostatectomy** is a surgical procedure to remove the prostate completely.

**Rectum** is the bottom of the large intestine to the anus.

**Semen** is also known as seminal fluid. It is a thick white fluid that is produced by glands in the male reproductive system that carries the sperm through the urethra during ejaculation.

**Seminal vesicles, vesicular glands** are a pair of simple tubular glands located behind the bladder and prostate that secretes a significant proportion of the fluid that ultimately becomes semen.

**Sperm** are male reproductive cells produced by the testes.

**Testicles** are two egg-shaped glands located in a sac called the scrotum under the penis. These glands produce the hormone testosterone.

**Ultrasound** is a tool that uses sound waves to produce a picture of a human part.

**Urethra—** In men, it is a thin tube that goes from the bladder out through the penis. Semen to be ejaculated flows through the urethra.

