My name is Nicholas Mosca, and in my 50s I was going to a primary care provider for the annual physical. He would check my prostate gland, placing the finger up the rectum and feeling it, and I would get a blood test called a PSA, prostate specific antigen. He noted that the level of that test was high compared to normal and started to monitor me. At one point, he suggested I go to see a urologist and have a biopsy of the prostate gland, which I did. This was in 2012 and it was negative. So over the years, I would have the PSA test drawn and tested, and the PSA test kept going up, and so they recommended another biopsy. And then at that biopsy I was found to have cancer. I believe at the time, I didn't know what specific cancer. I just knew it was prostate cancer, but I didn't know the medical term for it.

At the time I went to see a specialist in radiation therapy and a surgeon who did prostatectomies and decided that, for me, I needed to have a provider that I felt was staying current with science. I thought that if I went to a place where there was an educational component where medical students and residents were trained, that would mean that they were reading journals and not just going to CE every six months. I wanted to find a provider that was comfortable in the deep end of the pool, not the shallow end. That's how I thought about it. So I decided to go to Tulane Medical Center. A friend said that they had a prostate cancer center, and the experience I had was different than when I was seeing the private providers. First of all, I saw the private providers separately, different appointments, and to have everybody come in and talk to you at the same time or in sequence was valuable.

I was able to ask questions. So the first person was the internal medicine or the oncologist, and he told me what the options would be in that people who specialized in those procedures would be coming into the exam room and talking about it. I think the first was the urologist. I was really impressed that the surgical technique used was robotics. I was a little concerned about the traditional surgery because of the longer healing and the higher risk for infection and so forth. Next was the radiation therapist. She was very smart. I was impressed, but I also will have to say that I didn't quite understand everything at the moment, but I still felt like she was reading the journal, staying on top of the latest science, and that she was using critical thinking. So I felt really comfortable, but then I opted to have the surgery, mainly because I feel that if you have abnormal cells and they can grow, better to get rid of the source, I just thought that was the way to go.

You have to weigh the benefits and the disadvantages. So things like impotency and incontinence and some of the side effects that can happen. The risk of getting an infection is higher with surgery, obviously, probably than with radiation therapy. But that was the decision I made and I'm glad I did make it. The surgery went well. I recovered quickly. It was good. But I guess I would just end by saying that it's still a difficult situation because it's hard for most people to understand the medical science, and so you have to be able to feel trust in the people that you're seeing to move forward on decision making. Do you learn to use the muscles? I think they call it the kegel reflex or something like that, where you have to learn. It takes a few months. I was wearing pads.

However, as I was coming back for my follow-up visits, over time, my PSA started to elevate again.

And so I was then seeing Dr. Berata. I then opted to move forward on the salvage radiation therapy, and that started in... Well, first I had a medication, I think it was called Lupron, but COVID started. So my radiation started at the end of January. I got the Lupron at the beginning of January, 2020, and by March, New Orleans was in lockdown. So it was interesting to go into my treatments when people were afraid of spreading a viral infection, respiratory viral infection. In fact, some of my radiation therapists were at risk, and I think one or two had to stay home as a result. And I finished radiation, as I said, at the end of March. And until now, I've been undetectable. Even the little scar above the naval is starting to shrink, but I have not had any. In fact, I think my surgeon was real concerned about damaging the nerves that can cause an erection, and I can say that I'm okay there, and I appreciate his approach.

So that was really helpful. I have no regrets. I'm glad that I was doctor shopping. I guess, the clearest term for that, trying to find folks I felt would swim in the deep end of the pool. And I think Tulane Medical Center did an excellent job.

The challenge is to understand the therapies and to feel as if you're making the decision and that you can stand by the decision you make as opposed to second guessing or feeling that somebody's doing something and then later you feel, why do they do that? Why did I listen? That kind of thing. So I believe it's important for people to learn through the experience, and if they feel that they don't understand what the individual's saying or if they feel like they're just being told to do it, I would doctor shop.

I mean, I would look around, ask friends. Who do you know? Did you ever have this? I know the more I ask people, I find out people did have prostate surgery, too. I met three or four people who had prostate surgery that I would never have known. And so I think getting advice is really valuable.