Austinite gets another shot at life
New prostate cancer surgery gave him hope when there was none

BYLINE: Rachna Sheth, AMERICAN-STATESMAN STAFF
DATE: October 11, 2004
PUBLICATION: Austin American-Statesman (TX)
SECTION: Metro/State

Leibel Harelik said six doctors had given up on him, each agreeing that his prostate cancer was beyond hope or cure.

Surgery and radiation, they all said, would not be enough to improve his remaining months of life.

But his heart whispered the contrary, Harelik said. So the 55-year-old Austinite searched for a physician who would give him hope and found Dr. Randy Fagin, the only urological surgeon in Central Texas to specialize in a procedure called laparoscopic prostatectomy.

Two French physicians, Bertrand Guillonneau and Guy Vallancien, developed the procedure in 1998. Instead of conventional surgery, in which a large incision is made, laparoscopic prostatectomy uses small incisions and small instruments to remove the prostate.

It's rapidly gaining popularity, said Fagin, who trained with the two surgeons in Paris during his residency to master the difficult procedure. A steep learning curve, he said, accounts for the small number of urological surgeons able to perform the surgery in the United States.

Fewer than half a dozen surgeons perform this surgery on a regular basis in Texas, said Dr. Herbert Watkins, president of the Texas Urology Society and a urologist at the Kelsey-Seybold Clinic in Houston.

For months after his 2002 diagnosis, Harelik (pronounced HAR-lick) said he had been on medication that lowered his testosterone to a "near castration" level because it caused the cancer to expand. The side effects made his life intolerable, he said.

"I would have hot and cold flashes, severe depression," Harelik said. "It saps your bones. It causes real pain in your back and hips -- you're not your regular self."

According to the National Cancer Institute, a governmental cancer research and training agency, the majority of men diagnosed with prostate cancer do not die from the disease. But Harelik's cancer had advanced to stage four, where the cancer cells spread to the lymph nodes.

Harelik decided to allow Fagin, who practices at St. David's Medical Center, to operate on him.

For the procedure, a surgeon makes five incisions about 5 millimeters long and pumps a gas, such as carbon dioxide, into the body cavity. A tiny camera -- a laparoscope -- is inserted through one of the incisions, giving the surgeon a magnified view on a monitor as he or she uses microtools to discern the prostate from the urethra, bladder and rectum. Once the prostate is removed, the urethra must be reattached to the bladder to resume urinary function.

A laparoscopic surgery poses the same risks, such as infection, as conventional surgery, Watkins said. It also takes longer than conventional surgery, which typically involves a large incision, but recovery time is much shorter, he said.

Most patients, Fagin said, stay in the hospital less than 48 hours after the procedure and resume normal activity within three to six weeks.

Austinite Tom Ussery, 53, said he is still amazed at how quickly he came home after the surgery.

"I went on a Monday morning, and I was home by Tuesday at lunchtime," Ussery said. "I talked to so many people who had the procedure done the old way, or the conventional method. The pain and discomfort they experienced, I never experienced any of it."

Nine months after Harelik's operation, he said he is virtually cancer free. He still has to have blood work done to make sure the cancer has not returned in another organ or in his blood, but the cancerous cells in his body are under control.

"Thank God I'm doing great, and I feel great," Harelik said.

Fagin said the procedure also causes less nerve damage than conventional surgery, which helps reduce loss of sexual function. Loss of bladder control, which typically lasts six to nine months after conventional surgery, is usually gone within six weeks of laparoscopic surgery.

"But all that means nothing unless you do a good cancer operation," Fagin said. "We're seeing that we are able to do an even better job from a cancer point of view than from an open surgery. We're able to achieve equal if not better results."

Harelik and his wife, Debb Deitch-Harelik, said the surgery gave them a new lease on life. They were married after his diagnosis.

Harelik grew up in Waco, where he was involved in city politics and managed his family business, a men's clothing shop, until it closed in 1985. Looking for a new direction, Harelik said he went to Israel, where he attended rabbinical school and trained as a kosher chef.

After working as a chef for years, Harelik said he returned to Waco in 1999 to care for his elderly parents, three years before his cancer diagnosis.

Now, Harelik has become a full-time advocate for prostate cancer awareness. He serves on every cancer advocacy group he can, including prostate cancer support organization Us Too International. He said he is particularly interested in helping black, Hispanic and other underserved communities.

"I want to do everything I can to get them treatment," he said.

Harelik is also in talks with the city about building a cancer survivor's park in Austin.

"I feel like God didn't punish me by giving me cancer," Harelik said. "He gave it to me so I could help other people survive."

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