Whatever happened to The Notorious Dr. R.P. ?

Surprise solution to a nearly 13-year mystery

By Howard Wolinsky

Nearly 13 years ago, as a newly diagnosed patient with low-risk prostate “cancer,” I reviewed the medical literature on management and treatment approaches, comparing active surveillance (AS), radical prostatectomies, and radiation therapy.

I saw that the longevity was the same at 10 years no matter what you did. So I cast my lot with AS to avoid the potential side effects of treatment, such as impotence and incontinence.

It’s a slow-growing disease, and AS would provide me with a distant early warning system should things start to head south with plenty of time to launch an offensive operation.

I never looked back.

Well, almost never.

From time to time, I wondered about whatever happened to the urologist, one of the more prominent doctors in my small burb outside Chicago, who diagnosed my “cancer.”

The Notorious Dr. R.P.

I refer to this urologist as “The Notorious Dr. R.P.”, not only because he felt that an RP (radical prostatectomy) was my best path forward, but also because those are his actual initials. The notorious part relates to his position then on AS, where he would’ve sent me for unnecessary surgery and its risks.

In December 2010, Dr. R.P. called me on a Friday night and in an extremely serious voice announced a biopsy had found I had “CANCER!!” He asked that we meet the following Tuesday. Gulp. Anxiety level rising.

When my wife Judi and I consulted with him in his windowless office, he said again he had “bad news” for me: “You have cancer.” (He didn’t emphasize that it was low-risk.)

Then, he offered me “good news”: He had an opening the next Tuesday in his OR, where he could “cure” my so-called cancer.

(Why do I say “so-called cancer” and use quotation marks around “cancer” or call it a generic lesion? Some experts today—and even a decade ago--question whether what I have is actually cancer since it doesn’t act like one. It is not known to kill or spread.)

I’m sure that R.P.’s good news-bad news bit was his shtick.

AS unsupported

I asked about AS. “I don’t support that modality,” he said with a dismissive gesture.

To be fair, R.P. wasn’t alone. Back then, only a handful of urologists supported AS, and few patients knew to ask about it. AS was urology’s best-kept secret.

As a medical and investigative reporter at the Chicago Sun-Times, I may have had a jump on finding alternatives to the treatment of prostate cancer.

At that moment, when R.P. did not offer AS as an option, I felt as though the hunter had ensnared me in his surgical trap with no hope of escape.

This experience would motivate me, an objective journalist, uncharacteristically, to become an activist and advocate for AS and others diagnosed with low-risk prostate “cancer.”

I wanted to spare other patients like me from the same claustrophobic experience of being diagnosed with a harmless condition without being provided a full menu of options—AS or aggressive treatment—so they could decide what was best for them.

I politely declined Dr. R.P.’s offer and got a second opinion.

Still, I wondered, from time to time, if the first urologist was still hard-selling surgery with the risk of impotence and urinary incontinence to unsuspecting patients with low-risk Gleason 6 lesions. Or had he changed his tune?

“The Poster Boy”

Dr. Scott Eggener, of UChicago, a prominent AS proponent, rendered a second opinion and declared me the “poster boy for AS.” Is that an actual diagnosis?

I have remained untreated on AS as I approach my “pros mitzvah” year.

(My prostate-specific antigen (PSA) blood levels once spiked to as high as 9, but for years it has settled at about 4.5. Plus “the cancer”—less than one millimeter—was only seen once in a single biopsy in 2010 and never seen again in five other biopsies in five years. I haven’t been biopsied in almost seven years, and monitor the “cancer” with a type of PSA.)

On my 10th anniversary on AS, my former urologist, Eggener, told me he was happy he had saved me from surgery but wished he could have spared me all of the biopsies.

Meanwhile, I figured I would never know if R.P. had changed his ways even as AS became increasingly common. I accepted that this would remain one of my life’s unsolved mysteries. I could live with it.

I assumed I would never encounter Dr. R.P. again. In fact, if I saw him, I expected to cross the street to avoid him, just as I had avoided his scalpel.

But fate had something else in store.

My ‘silent’ partner

A CT exam–which I underwent for other reasons–revealed that I had a tiny silent kidney stone. After a few months, the stone revealed itself, kicking me like a mule in the lower back.

I recognized the pain. I had a stone about five years ago and underwent a procedure to extract it at UChicago.

(Side note: Following stone removal and despite antibiotics, I ended up with a high fever, dizziness, nausea, and muscle pain. It was early sepsis. So I can relate to the concerns prostate cancer patients have about the small risk of sepsis they face from transrectal biopsies.)

This time around, my UC family doctor in a suburban outpost referred me to a urologist much closer to home.

Returning to the scene of the crime

The urologist? None other than The Notorious Dr. R.P.

I shuddered at the thought. But I learned he had a young partner–who received high marks from a cancer nurse and also some other staffers I know at the local hospital.

I decided to spin the wheel, take my chances and see Dr. C. I had to wait over a month to see the urologist. I bided my time drinking loads more water than usual to try to coax the stone to make an exit.

C. said the stone was poised to leave but urged me to undergo a stone-removal procedure. He warned that this tiny stone potentially could shut down my kidney. I understood the problem but still hoped that gravity and a flood of water would flush the tiny particle of calcium oxalate pain out of my system.

I suggested we slow down. C. agreed that I first have another CT to determine if by chance the stone passed without my knowledge. A guy can hope, right? 

Whatever happened to Dr. R.P.?

Finally, I got up my nerve and asked him about his partner and AS.

He had read my medical history, where I checked off having prostate cancer. He took that as past tense and was shocked to hear I still had a prostate gland and was still on AS.

I told him about my experience in 2010 with his partner. I asked whether he and Dr. R.P. offer active surveillance.

In those dark days 13 years ago, 94% of men like me with low-risk lesions underwent aggressive treatment that most likely was unnecessary. Today, 40% of this group in the U.S. nationwide still opt for surgery or radiation–an improvement, but at the same time scandalously higher than the 6% rate in Sweden and 9% in Michigan.

Dr. C. told me his partner had moved with the times and now offers AS as an option though he (C.) suspects he recommends AS more often than his senior partner does.

This was welcome news. It was cathartic. I was thrilled to hear my neighbors now have a chance of being presented with a more complete menu of options to manage their disease than I had in 2010.

Last Friday, I had a follow-up CT to see if by chance the tiny kidney stone had left. Stay tuned.

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Two don't-miss free webinars featuring AS visionaries: Drs. Klotz and Scholz

ASPI presents the latest episode in the cliff-hanging AS 101 video series, featuring Dr. Laurence Klotz, “father of AS.” Active Surveillance Patients International (ASPI) will premier the AS 101 Episode 3 video on Saturday, Jan. 28, 2023, at 12 p.m. Eastern/5 p.m. London. To register, click https://bit.ly/3k7xuPT

AnCan features Dr. Mark Scholz, author of the groundbreaking “Invasion of the Prostate Snatchers” at 8 p.m. Eastern/1 a.m. London Jan. 30.

Scholz’s program is entitled, "Invasion of the Prostate Snatchers: The return 13 years later. An evening with Dr. Mark Scholz." To register, click https://bit.ly/3Xf4nbm