Playwright, 83, thanks mother and doctor for life-saving surgery

 

 

By Donald H. Harrison

SAN DIEGO–Although a precedent-setting prostate surgery occurred in New York City, the setting for much of the story is San Diego, where the doctor grew up and the mother of the patient resides.

The doctor is Herbert Lepor who on October 31, 2011, performed a radical prostatectomy–the removal of the entire prostate gland– on Mayo Simon, a former Hollywood screenwriter now working as a playwright in New York City.  Simon is 83 years old, and so far as anyone knows, is the oldest patient to undergo this surgery, which is frequently utilized to help younger men battle cancer.  Until this procedure, such surgeries on men over 70 were generally discouraged.

Dr. Lepor is the head of the urology department at the Tisch Hospital at the New York University Lagone Medical Center. Of interest is the fact that Lepor grew up in San Diego where his parents were members of Beth Jacob Congregation and later Congregation Beth Tefilah.   When he was at Crawford High School, the future surgeon played saxophone, was a member of the debate team, and spent as much time as he could at the beach.  His younger brother, Norman, had one of the first open heart surgeries ever performed at Children’s Hospital.  His older brother, Philip, a dentist, continues to live in San Diego.

But the more relevant San Diego angle to this story is the fact that Mayo Simon’s mother, Laura, resides in San Diego.   He’s 83, so figure it out, she’s older than most mothers ever get to be.  She is 106, still quite healthy, and locally famed as the author of I’m Still Here, published when she was 100 years old.  She recently received a letter from the Library of Congress telling her that she was the oldest living author whose book is in that national library’s collection.

It was because of Laura Simon’s longevity that Dr. Lepor agreed to operate on Mayo.   As Lepor tells the story, with Mayo’s full permission, his 83-year-old patient was diagnosed with an aggressive form of prostate cancer.  “In many, but not all cases, prostate cancer is slow growing and therefore aggressive treatment is typically not recommended for octogenarians. ”

He explained that “in older men with ‘slow-growing’ cancers, the risks outweigh the benefits of radical prostatectomy.”  This is because the surgery may complicate other dangerous conditions an older man may have such as heart and lung disease.

In other words, surgery might cure the elderly patient’s prostate cancer but hasten his death from other causes.  Along with the faster growing cancer, Mayo had a history of heart disease and under ordinary circumstances that could have been another reason for a surgeon to be reluctant about performing the radical surgery.

Recalled Lepor:  “I spent 11 years of my medical and surgical training at Johns Hopkins.  My mentor, Patrick Walsh, often stated that one should not offer radical prostatectomy to someone over 70 years of age ‘unless a parent is available to witness the surgical consent.’

“The inference was that longevity has a tendency to run in families.  When I made this comment to Mayo, he quickly responded that his 106 year old mother would have trouble coming to New York to sign the consent but she would provide verbal approval.   The fact that Mayo’s mother at 106 and his two aunts were alive and well reaffirmed my clinical assessment of Mayo’s long life expectancy.”

Mayo’s surgery went well and he was discharged the following day, which Lepor said, “is testimony to his mental and physical well being.”  The Martin Spatz Chair of Urology since 1993, Lepor has performed a prostatectomy over 4,000 times, making him one of the most experienced surgeons for this procedure in the world.

“Mayo is the oldest patient for whom I have performed the surgery,” Lepor said.  “Mayo’s case emphasizes that one must individualize medical decision making, relying on sound clinical judgment and understanding the patient’s preferences and priorities. ”

He added: “Few surgeons would be willing to offer Mayo a surgical cure of his disease simply because of his age.  I had confidence in my surgical skills.  I also felt there was compelling evidence that the benefits of surgery outweighed the risks.  Finally, Mayo wanted to be cured and was willing to accept risks to achieve that cure.  Hindsight is 20:20.  Both Mayo and I would do this all over again.”

Mayo commented that “my alternatives were to do nothing — my life expectancy at 83 with already one cancer and one heart condition was no more than 5 years and (another doctor) thought the cancer would kill me in 4 years.”  The other doctor was concerned that Mayo would suffer incontinence if he had the surgery, so he  instead recommended radiation.  “But if you have radiation you cannot then go on to surgery,” Mayo said. “If you have surgery, you can have radiation.  So I decided to look further and see someone who had perhaps more experience with really old guys.”

He found Dr. Lepor, who said if other doctors agreed that Mayo was otherwise in good health, he would do the surgery. Mayo said that since the surgery,  he has not had any trouble with incontinence.  “Sexual functioning is a work in progress, as he (Lepor) said it would be,” Mayo added.  “I’ll be taking PSA tests for the rest of my life. Hopefully I’ll be cancer free for a very long time.”

“There is another issue here,” said Mayo.  “A presidential commission has recommended no PSA tests, no biopsies and no treatment.”  The reason is that older guys typically will “die of something else, so why bother with the expense and the anxiety and the difficulty of surgery?  I don’t fit this profile.  I think Dr. Lepor feels that there is still room for an experienced doctor to make good judgments about individual patients without resorting to statistics to make decisions for him.”

A month after the surgery Mayo flew to San Diego to attend his mother’s 106th birthday party at the Patrician senior residential home.  Lepor disclosed that “when I agreed to perform Mayo’s surgery, I made one simple request….he send me a picture from the party together with his mother.  About six weeks after surgery the photo arrived. It is displayed proudly on my wall in my office. It reminds me why I went into medicine and why after 25 years practicing urology there is tremendous personal satisfaction every day.”

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Harrison is editor of San Diego Jewish World.  He may be contacted at donald.harrison@sdjewishworld.com