By Mary Beth Hislop

This is the second in a two-part series of articles on prostate cancer.

One in six men will develop prostate cancer some time in his life. This is a harsh statistical reality for men.

“There’s a joke among urologists,” said San Jose resident Chris Dettner, diagnosed with prostate cancer last September. “They say, ‘If it doesn’t kill you, you’ll die with it.’”

The data from the American Cancer Society may be daunting, but with early detection, there are successful treatments that can eradicate the cancer with minimal side effects. The problem: prostate cancer has no symptoms in its early stages.

For this reason, the American Foundation for Urologic Disease recommends annual prostate checkups for men over 40, which includes a digital rectal examination and a prostate-specific antigen (PSA), a blood test that measures prostate proteins in blood. If the proteins are elevated, prostate cancer is more likely.

The prostate is a male sex gland that produces about one-third of the fluid that carries sperm through the urethra out of the penis during orgasm. Located in front of the rectum canal and directly below the bladder, a doctor can insert a gloved finger in the rectum to detect any changes in size or growths on the prostate. Once considered the best option for detecting prostate cancer, the PSA blood results can detect prostate cancers earlier than a manual exam.

Dr. Frank Lai, a urologist at El Camino Hospital, said PSAs are instrumental in detecting prostate cancer.

“Prostate cancer is pretty prevalent,” Lai said. “In the PSA era, now we’re finding them earlier.”

Interestingly, it wasn’t PSA results that warranted additional tests for prostate cancer.

Dettner, 52, has had an annual prostate checkup since 1999. Though he missed his 2006 appointment, his 3.6ng/mL PSA (nanograms per milliliter of blood) last August didn’t necessarily raise a red flag – 2.6 to 10ng/mL is considered slightly elevated PSA, while 20+ng/mL is significantly elevated – it was the digital rectal exam and family history that spurred a referral to specialist Lai.

Dettner’s doctor felt enlargement on one side of the prostate, and his father was diagnosed with prostate cancer at age 75.

Lai recommended a biopsy and Dettner underwent the procedure. He wasn’t prepared for Lai’s call at the end of September.

“He said, ‘You’ve got a little bit of cancer, Chris,’” Dettner said. “I was like, ‘Wham.’ There is no way to describe how that feels.”

Julian Cervantes had a similar experience. After 30 years of annual prostate exams and then 60 years old, the Los Altos resident was immediately sent next door to Lai’s office after his internist felt a little growth on his prostate. He remembers the date – Dec. 23 – “the day before Christmas Eve.”

With a low PSA of .09ng/mL but that lump still there, Lai recommended and Cervantes underwent a biopsy shortly after Christmas. A few days later, a call from Lai left Cervantes in the same dreamlike stupor Dettner would experience months later.

“I was at the carwash when Lai called,” Cervantes said. “He said, ‘I’ve got some bad news, Julian. You’ve got prostate cancer.’”

Cervantes thanked Lai for the information, got in his car and headed home.

“I pulled off the freeway, thinking, ‘What did he say?’” Cervantes said.

After cancer is discovered, Lai said the question becomes what the patient should do about it.

“There are options,” Lai said. “It’s not going to be one perfect treatment for anybody.”

Lai said the cancer is assigned a Gleason score, which gauges how aggressive the cancer is. Tumor cells that look normal are usually slower-growth cancers, while randomly distributed cells with rough edges are more likely to spread rapidly, according to a fall 1998 FDA Consumer article, “Prostate Cancer: No One Answer for Testing or Treatment.”

Two numbers, each from one to five, are assigned to the tumor.

“The higher the numbers when the two are added, the more aggressive the tumor is likely to be,” wrote John Henkel in the FDA magazine.

Lai said a score of “2” is of the least concern and “10” is the highest.

“When cancers are assigned a “6” or higher, that’s when patients need to examine their options for treatment,” Lai said.

Cervantes’ Gleason score was 7.3 and Dettner’s was 7. Something had to be done, for both men.

Nine months ahead of Dettner, Cervantes started researching his options, from surfing the Internet to one-on-one interviews with urologists. Plastered on page after page on the Internet, he discovered the wonders of the da Vinci robot, a surgical system that gives surgeons a magnified, three-dimensional view of the operating area.

It was all about the nerves around the prostate. If these are damaged, a man could face a life of incontinence or impotence.

“We don’t talk too much about it,” Cervantes said of men in general. “Our egos are involved here. But I knew I had a better chance of success in 3-D – that makes the difference.”

Cervantes went as far as visiting Intuitive Surgical Inc., located in Sunnyvale, which manufactures the $1.5 million laparoscopic robot. Cervantes said he was surprised to learn El Camino Hospital would be purchasing a robot soon.

More than five months after learning he had prostrate cancer, Lai operated on Cervantes using the da Vinci robot on May 15, 2007.

“I was the first guinea pig,” Cervantes said of the hospital’s initial da Vinci operation. For Dettner, fear the cancer had metastasized sent him back to the hospital for additional testing – an MRI and bone scan.

“I’d never even been in a hospital my whole life – never,” Dettner said. “The worst thing was waiting.”

Dettner also visited cancer Web sites to research his options, talked with a friend who is a radiologist and learned that Lai was also a laparoscopic surgeon who worked with the da Vinci.

“Dr. Lai is really good – he’s a straight shooter,” Dettner said.

When tests came back indicating his cancer was contained in the prostate, Lai suggested radioactive seeds to treat the cancer, a nonsurgical option. Besides the da Vinci surgery, traditional prostatectomies, radiation and hormonal therapies, patients will want to consider the choices, which often depends on age. For the elderly, surgery might be more dangerous than the cancer itself.

Another option is doing nothing at all.

“Doctors call it watchful waiting, and it is best suited for men with a 10-year life expectancy or less who have a low Gleason number and whose tumor has not spread beyond the prostate,” Henkel wrote in the FDA article. “The idea is that in these men, the cancer is growing so slowly they likely won’t die from it.”

“I just wanted it out,” Dettner said of the cancer.

On Nov. 12, Dettner underwent a prostatectomy with Lai operating the da Vinci.

“I went home the next day,” Dettner said, albeit a little awkward and uncomfortable. “Nothing was worse than what I thought it would be.”

Both Cervantes and Dettner will undergo occasional prostate examinations to be sure all the cancer was removed.

In the meantime, Dettner tells all his friends to get PSAs. At age 45, Dettner’s brother recently went in for his first prostate exam.

Cervantes recently taped an interview for El Camino Hospital that is currently airing on KMVT, channel 15, talking about his experience with prostate cancer and the da Vinci robot surgery. He said he tells all the women he knows to “talk to their men,” whether they’re life partners, brothers or fathers, to encourage them to get an annual prostate checkup.

Cervantes hopes his interview helps people understand the prevalence of prostate cancer and preventative measures men can take.

“It’s not an obsession, but I think it’s a really good thing to do,” he said.

Contact Mary Beth Hislop at marybethh@latc.com.