Elizabeth Kavaler is a urologist, surgeon and medical director at Total Urology Care of New York. She’s also married to Gary Rosen, who was recently diagnosed with prostate cancer. What did she tell him about his treatment — not in the exam room but at home, off the clock, just one spouse to another?
We asked, and she shared.
“You’re not going to die.”
Hearing “you’ve got cancer” is enough to make most guys freak out. But the first thing Kavaler assured her husband was, “The odds are in your favor.”
The five-year survival rate for prostate cancer, according to the American Cancer Society, is 90 percent.
“It used to be a death sentence,” she says. “Once you were diagnosed with it, you basically had maybe four months left.” But that’s changed over the past few decades, thanks to prostate-specific antigen (PSA) testing, which has “completely revolutionized the way we identify prostate cancer,” says Kavaler.
“Increasingly, prostate cancer is a disease that a man will die with rather than one that he’ll die from.”
“Yes, we will still have sex.”
“Sex is not a problem before, during or after prostate cancer treatment,” Kavaler says. The only exception is if you have surgery, which requires around three months of recovery before you get back full urinary control and erectile function.
It’s not all good news. “Post-surgery, the penis can feel smaller,” Kavaler says. “Ejaculation will be dry — no fluid will come out of the tip of the penis because the seminal vesicles are removed, which are located at the base of the prostate.”
So you’ll still have orgasms, just without the sperm finale.
“Let’s think small.”
It makes sense for a man to think, Cancer? Get it out of me!
“We used to do tons of prostate surgeries,” Kavaler says. “An elevated PSA would sound the alert, a biopsy would follow and, if it was positive, the prostate would come out.”
It saved their lives, but “many of these men were rendered incontinent, impotent and miserable,” she says.
That calculus has changed in recent years. A less aggressive tumor can be treated with target radiation, “like cryotherapy, which is freezing the tumor,” Kavaler says. “You could do what’s called radiofrequency ablation, which is where a needle is put into the tumor, but it doesn’t affect the whole gland.” These noninvasive techniques — known collectively as “focal therapy” — aren’t always considered, say Kavaler.
“It really comes down to more patients saying, ‘Wait a minute, why am I getting surgery when I have a very low-risk disease?’ ”
“Say hello to your little friend.”
“We’re still getting used to the idea that cancer can often be something you manage rather than something you eradicate,” says Kavaler.
Gary’s prognosis is good, Kavaler assures us. And that’s not just something she’s said to her husband so he won’t be alarmed. “His tumor is confined to one focal area with favorable genomics,” she says. “We’re currently deciding between focal therapy and watchful waiting”— that is, doing nothing at all.
It’s something more men are opting for. “Gradually, we’re learning to reframe prostate cancer and accept that there’s going to be a certain population of men who live with it,” says Kavaler. “You still monitor it, but it’s something that can be managed.”
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