Surveillance and surgery: A prostate cancer journey

By Carol McPhail
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One month after Rhett Plash retired from his three-decade career as a civilian employee at a Navy research and development lab in Panama City, Florida, he received some bad news: He had prostate cancer.

Based on his prostate-specific antigen (PSA) score and the results of a biopsy, his doctor recommended that he have his prostate surgically removed. “It was a shock,” said Plash, then 56. He had always gotten regular health screenings, and the doctors had caught the cancer early. To him, surgery seemed like a drastic measure.

The Mobile native sought a second opinion from urologist Christopher Keel, D.O., FACS, of USA Health University Urology. The first office visit immediately put Plash’s mind at ease. “Dr. Keel was awesome the way he treated me and acted,” he recalled. “It made me feel very comfortable.”

What’s more, Keel offered a different treatment plan. He suggested active surveillance – that is, they would continue to monitor his PSA score and postpone surgery for as long as possible. For Plash, who was concerned that surgery would cause urinary incontinence or sexual dysfunction, the new plan was a godsend.

Keel also ordered germline testing, a type of genetic testing that is highly recommended for people diagnosed with certain cancers. The results showed Plash’s tumor genetics were “lower risk,” which supported the decision to pursue active surveillance.

“Mitigating patient side effects and matching that with their goals is the most important step in deciding treatment,” Keel said. “Prostate cancer is a heterogeneous disease that affects men of all ages and health statuses. Matching their treatment with age and health is an important part of the decision making.”  

As he continued with doctor visits, Plash pursued a new interest as a professional gig musician, playing his guitar and singing at local venues. He describes his playlist as classic rock, old country, new country and the blues – all based on influences such as Tom Petty, the Eagles, Bob Seger, Johnny Cash, Willie Nelson and Tyler Childers.  

It wasn’t until December 2023 that it became clear he needed surgery. Plash underwent a robotic prostatectomy at USA Health University Hospital and went home the same day. With active surveillance, “Dr. Keel bought me over four years,” he said.

The robot-assisted surgery was minimally invasive, resulting in two small scars near Plash’s navel. It also was “nerve sparing,” meaning that the team used athermal techniques to avoid branches of the pelvic nerves that supply innvervation, or nerve stimulation, to the muscles and penis to support continence and erections. “Sparing those nerves results in a better and quicker recovery,” Keel explained.

Plash’s recovery included some pain but was very successful. Seven days after surgery, a catheter was removed, and he began to feel better. It soon became clear that his worries about incontinence and sexual dysfunction were unfounded.

“It was miraculous how things improved,” he said. “Everybody will respond differently, but I was blessed with what my results were.”

Two years later, prostate cancer is no longer top of mind for Plash. “I don’t even think about it until I have to go back for a checkup,” he said.

That allows him to focus on spending time with Patty, his wife of 25 years, their adult children and two granddaughters.

Keel has since called on the gregarious musician to counsel other patients who are coping with a prostate cancer diagnosis, which can be scary and isolating. Plash has also played music at Pints for Prostates events, which raise awareness about prostate cancer and screening.

“What makes Rhett a good example is that he’s a charismatic guy who doesn’t mind talking about personal issues,” Keel said. “And he’s had a great, and expected, outcome.”