Cause for celebration

    Harrison man cured of prostate cancer

     By Matt Kerner

After delaying his yearly Prostate Specific Antigen (PSA) test for almost year, an accidental meeting between Pat Angarano’s wife, Ada, and his urologist, Dr. Sol Usher, ended up saving his life. “The fact of having cancer was devastating to me,” said Pat. “It’s an ugly word,” the 55 year old recalled.

Angarano, who works in Human Resources for the New York Power Author­ity in White Plains, had put off his annual PSA test due to his recovery from another knee surgery on Aug. 2, 2004. In July 2005, Ada Angarano, his wife of 34 years, bumped into his Usher at White Plains Hospital, where she was taking her father for cancer treatment. Usher informed her that her husband had missed his appointment in June, and urged her to have him come in as soon as possible.  That same day Pat received a call from Ushe’s office to schedule an appointment for a PSA test.

“We didn’t think anything of it,” said Ada. “In 2002 and 2003, his PSA tests came back normal, there were no signs anything, we were walking three miles a This rating is determined by examining happening, and that before I knew it the day, everything was fine.

Angarano then went to Usher for his PSA test, which yielded PSA level of 4.1 PSA test yielding a result of 2.5. -3.0 or higher are considered elevated levels. The PSA level of 4.1. indicated that  Pat had an enlarged prostate that he would need to have a biopsy performed on.

“We were all just so worried at that point,”said Ada, Pat’s wife. “I really thought to myself that I was going to be a widow. We were worried about what our options were, and then Dr. Usher recommended another doctor who he thought could help us.” Pat took his doctor’s advice and went to see Dr. David Samadi, Director of Robotic Laparscopic Surgery and Urologic Oncology at New York’s Columbia Presbyterian Medical Center, but only after postponing the appointment for a week to celebrate his wedding anniversary with his wife.

On Sept.23, Pat went to Samadi to have a biopsy. The results were on Sept. 26 and revealed a Gleason rating of six out of 10. This rating is determined by examining to how aggressively the cancer is growing amongst the cells in the prostate. A rating between one and four means the cancer is in the beginning stages, and seven to 10 indicate more advanced stages.

“I felt very comfortable with Dr. Samadi from when I first met him. I just felt that he knew exactly what he was talking about: he understood what I was going through and that made me trust him.

He  eased my worries about incontinence and impotence, which was something that I was concerned about as a man.

Pat was informed that Samadi couldn’t schedule him for surgery until Dec.16 which caused Pat to assume he had time to think about the rapid chain of events that unfolded over the past two weeks.  However, Ada called Samadi and explained their situation, and got her husband’s surgery moved to Oct.17 at 10:30 a.m.

“It was somewhat resistant to undergo the procedure at first”, said Pat. “I had expected to have time to take in what was happening, and that before I knew it the day had come. I remember being in the pre-op room waiting a long time. The surgery that was taking place before mine was taking longer than expected, and I didn’t end up going into the operation room until 1:30 p.m. I wasn’t bother by delay because I knew I would want the doctor to take as long as he had to if that was me, so I understood what that person was going through.

Pat awoke from the surgery about five hours later and was told that the procedure lasted for about two and half hours. Pat come home from the hospital the next day  and said that he was able to walk around the neighborhood the day after that. “I experienced a degree of discomfort, but I was not in an enormous   amount of pain”, said Pat. “I was worried about a sudden reaction causing leaking, but I didn’t experienced it anywhere near as much I expected and never at night. I could have gone back to work in two or three weeks, but I opted to be safe and take the full four weeks.”

Samadi, who is one of the few urologic surgeons in the U.S. trained in both oncol­ogy and laparoscopy, performed the first robotic laparoscopic radical prostatectomy in 2001 at Columbia Presbyterian and is one of the leaders in this advanced field and is extremely committed to his patients and passionate about his work.

Radical prostatectomy is one of the most common treatments for prostate cancer. It involves the surgical removal of the prostate gland, and traditionally requires a large 8-10 inch incision. However, open surgery commonly results in substantial blood loss, possible infection, a lengthy recovery and the risk of impotence and incontinence. Most patients also have to carry a catheter for a period of two to three weeks.

Laparoscopic radical prostatectomy, also known as da Vinci Prostatectomy, is a minimally invasive approach, which allows for the removal of the prostate through five small “key hole” incisions across the abdomen of the patient. In this procedure, there is a much lower risk of bleeding and transfusion, decreased catheterization time and of postoperative pain medication.

It incorporates a state-of-the-art surgical system that enables the surgeon to see vital anatomical structures three-dimensionally and in 10-15 times higher magnifications. The surgeon’s hand movement are scaled, filtered and trans­lated into precise move­ments of micro-instruments within the operative site, which is about five feet away from the patient.

The da Vinci System enhances surgical capabili­ties by enabling the perfor­mance of complex surgeries through tiny surgical open­ings. The System cannot be programmed nor can it make decisions on its own. It requires every surgical maneuver be performed with direct input from the surgeon.

“I think that this is the most exciting procedure in urology, people are coming from all over the country to have this procedure done,” said Samadi. “What most people don’t know is that just because you remove the prostate, it doesn’t mean it’s a successful cancer operation, you need to have the experi­ence. There’s no result better than patient testimony.”

Over their lifetime, men have a one in six chance of developing prostate cancer, which is second only to lung cancer in the number of cancer-related deaths among men. The American Cancer society estimates there will be 232,090 cases of prostate cancer in 2005, and 30,350 deaths.

Samadi has performed well-over 300 of these procedures with great success and stresses the need for more surgeons experienced in this area. “People don’t have to die, you catch them early and take out all the risks of open surgery,” said Samadi. “There’s a whole family involved, a whole emotional aspect of it, it’s a very stressful time in everyone’s life, there are no symptoms for prostate cancer until it’s already too late. There is a learning curve for these cases, and it takes a surgeon at least 50-100 times just to get comfortable. You don’t give anyone false hope, but you want to keep the patient fully continent, sexu­ally functional and cured.”

Pat is now cancer-free and had a PSA test that resulted in a score of zero on Nov. 17. He will now undergo a PSA test every three months for the next year, then every six months for the next year and then back to just once a year, which is what is recommended for males over the age of 40. “Today, there is no sign that my husband had cancer just weeks ago,” said Ada. I just thank God for both of these doctors, Usher and Samadi.”

Pat is relieved to be able to get back to his job and four children and live a normal life again. “The thing that amazes me is that I had surgery just six weeks ago,” said Pat. “I just couldn’t imagine being incontinent for the rest of my life. If I were to exert myself and leak, I would get angry with myself, because I was brought up believing that men don’t do that. I don’t think I could have survived. Dr. Samadi turned what I thought was a mountain of a problem and turned it into a bump in the road.”