<http://www.boston.com/news/local/new_hampshire/articles/2005/08/20/cancer_doctor
_becomes_cancer_patient/>

By Holly Ramer, Associated Press Writer  |  August 20, 2005

CONCORD, N.H. --When Jack Evjy was diagnosed with prostate cancer last
year, the disease spread quickly -- from his professional life to his
personal life.

"What I have is right smack in the middle of what I do," said Evjy, an
oncologist for 30 years who has treated thousands of patients, many with
the same diagnosis. Becoming a patient himself gave him deeper insight
into the choices he once presented to others, and made him realize how
much his patients had taught him.

"Running away doesn't help," he said. "It's far better to try to do
whatever you can do -- not put your face in the sand -- and face it."

Evjy, 70, stopped seeing patients three years ago but still helps run
Commonwealth Hematology-Oncology Group, a network of specialists
stretching from Quincy, Mass., into southern New Hampshire. In April 2004,
he was enjoying semi-retirement -- traveling, building a new house in
Bedford and preparing for his daughter's wedding -- when he squeezed in a
visit to his family doctor.

"Life was pretty darn good," he said. "Everything was going all fine."

Then his doctor did a routine examination of Evjy's prostate gland.

"Jack," the doctor said. "This gland does not feel the same way it did a
year ago.'"

"That was the bursting of the bubble of equanimity," Evjy said.

A blood test for a protein called PSA, indicating an inflamed prostate,
came back normal. But tissue from one of 10 biopsy sites came back
positive for cancer and the pathology report showed the tumor was growing
at a moderately aggressive pace.

Doctors often recommend "watchful waiting" for men over 70, because in
many cases, the tumor grows so slowly the patient dies of something else.
Two types of radiation therapy to kill the tumor were options, but Evjy
decided surgical removal of the gland was the best approach, if only to
find out what he was up against.

"The thinking has been that if the PSA isn't sky-high and you're a
youngster like me who at that time was approaching 70 and was otherwise
healthy, do you want to just watch and wait?" he said. "My feeling was
that what can really hurt you is what you don't know, so I made a decision
to pursue it rather than just sit and wait."

That opened up a new array of choices. Instead of conventional surgery,
his involved a three-armed robot fitted with a tiny camera, magnifying
lens and surgical tools. Sitting at a console, a surgeon used handgrips
and footpedals to manipulate the robotic arms, which entered his body
through quarter-sized incisions.

Evjy had read about the technique a few years ago when the military began
exploring equipment that would allow a surgeon in the United States to
operate on a soldier in a war zone using video imaging and robotic hands.

"I wasn't thinking I might be at war with cancer myself," he said.

The flexibility of the robotic hands and the enhanced view provided by the
camera allow the surgeon to be more precise in removing a tumor while
sparing nerve bundles, said Dr. John Munoz, who performed Evjy's surgery
using the $1.2 million da Vinci surgical system. Preliminary data suggests
the procedure is less likely to result in impotence and has shortened the
duration of post-surgical incontinence, he said.

Smaller incisions also mean less bleeding during surgery and less pain
afterward, shorter hospital stays and quicker recoveries. Patients are
told to limit their activity for about two weeks instead of four to six.

Within days, Evjy was going up and down the stairs of his new home,
unpacking and moving things around. But the final pathology report showed
that the tumor, though confined to the prostate, had been more aggressive
than originally believed. That meant he was at high risk for a recurrence
and had another decision to make.

Evjy, a former president of the Massachusetts Medical Society, consulted
experts at the Dana Farber Cancer Center in Boston and his colleagues
before choosing to undergo further treatment in New Hampshire.

"I felt that I should be cared for by oncologists who were not part of my
own group because if things didn't go right, it would just be such a
struggle on them," he said.

He endured six months of chemotherapy and a course of radiation and is now
taking hormone therapy to suppress testosterone, which feeds the growth of
prostate tumors. Aside some from hot flashes, Evjy says he feels 100
percent.

He urges men not to rely exclusively on PSA tests, have biopsies if
there's any doubt and consider new techniques like the robot-assisted
surgery so they know what they're facing.

"You may find that there's a whole boatload of people whose lives can be
saved," he said. "Maybe I'll be one of them, maybe not. But I'd much
rather sit here today or five years from now or 10 years from now feeling
as though I hadn't just watched, that I'd done everything I can."

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On the Net:

National Cancer Institute general information about prostate cancer:
http://www.cancer.gov/cancertopics/pdq/treatment/prostate/patient/

Da Vinci Surgical System: http://www.davinciprostatectomy.com/