Monday, November 05, 2012

I've had a lot on my mind...

"All twelve samples are positive for prostate cancer."  Dr. Miller was matter-of-fact and calm.  He'd done this many times.

I was remarkably calm too...for the moment.  Unlike the movies, there had been no ominous music building in the background as Dr. Miller entered the room.  In an odd way, finally knowing that I had cancer was a relief.  The doubt that began back in August was finally resolved.  It was a problem that could be overcome.  The doctors caught it very early, so there's an excellent chance of a full recovery.

Let's start at the beginning.


When I visited my doctor for a checkup back in August, blood tests indicated that my PSA was over 4.  Normal should be under 2.  He scheduled me for a meeting with a urologist, Dr. Miller, who did another exam and more thorough blood work.

My PSA increased more than a point in one month.  It's now over 5.  When the nurse called with the results, she immediately scheduled a prostate biopsy.  In the meantime, I'm not supposed to have any aspirin or other blood thinner.  I have to report an hour early for the biopsy so they can give me an antibiotic, and of course, I have to use a fleet enema to clear the way.

Fun, fun.

Sure, there's a slim chance that I can develop a serious cancer or a complication from the procedure.  That's a remote possibility, but one that exists nonetheless.  I'm a little nervous about this.


I had the biopsy on Tuesday last week.  On Monday, Dr. Miller told me that 12 of 12 samples were positive for prostate cancer.  I've been reading more about it since then, and I've learned that by the time we reach 80, half of all men will have it.  That's a 50/50 chance over a lifetime.  Even so, most men will die of something else before the cancer gets them.  When it's detected early, the success rate is nearly 100%. 

Treatment options include: surgery, chemotherapy, cryotherapy, hormone therapy, radiation, and surveillance.  Each treatment has several approaches, so treatment can be tailored to the individual depending on his age, general heath, and type of cancer.  I'm presently reading the National Cancer Institute's "Treatment Choices for Men with Early-Stage Prostate Cancer" (NIH pub. no. 11-4659) and it's riveting stuff...if you're an insomniac.  It's informative, though, and some of the material could be fodder for immature and slightly off-color satire.  Not that I'd yield to that nefarious temptation, of course.  Not me.

Here's something weird, though.  Some of the people around me have been far more freaked out over this diagnosis than I am.  Honestly, Monday afternoon I walked around thinking, "I have cancer."  But there was almost no emotional impact to that thought.  I didn't get depressed or angry.  It was like being told that a bad tooth would have to be extracted.  It's just something to get through. 

A few people reacted as if I were about to keel over any minute.  Maybe that comes from seeing others decline and die of cancer, or maybe it comes from a simple lack of knowledge.  Then there's fear of the unknown.  Put them all together and you get shocked people.  As I already know a couple of men who have been through treatment or are entering it, I asked questions and read about it, knowing that by acquiring information I can overcome my own fear.

On Friday, I see Dr. Miller to discuss treatment. I'll try very hard to keep from telling him my fears of radiation therapy leading to a 50 foot penis attacking Tokyo.  He's probably already considered it.

(I resisted for nearly three paragraphs!  That's a really long time!)


We saw Dr. Miller on Friday, and by "we" I mean Mary, Lyndsay, and me.  Jordan wanted to go along too, but found his pillow far more attractive.

At the office, we were ushered into a conference room where Dr. Miller explained the various treatment options.  My Gleason score is a six, or as I understand it, a slightly aggressive form of cancer that can be treated in a number of ways.  They include: surgery, radiation therapy, chemotherapy, hormone therapy, or simply "watchful waiting."  Dr. Miller did not recommend the latter.  Several surgical options are available, but the most promising from my point of view is the laproscopic robot surgery.  The other option I'm considering is radioactive seeding.  Right now, I'm leaning more toward surgery because the radiation technique may allow the cancer to recur in 10 years or so.  I don't want to be 70 years old and facing surgery.

Besides having a 50 foot tall penis, the radioactive approach might cause fogging on my photographic film.  I hate that.  I'll probably have to do a couple of glow-in-the-dark jokes too.


Mary and Lyndsay talked to me about the possible treatments.  Both were thinking that removing my prostate would be the best course, an option that I had already decided was best.  I called Dr. Miller's office today, telling his nurse that I wanted to do the laparoscopic surgery.  "Dr. Miller doesn't perform those", she said, "so I'll set up an appointment with Dr. Milsten."  Indeed, Dr. Miller told us on Friday that he did the traditional surgery, not laparoscopy, so this was not a problem.  I'm seeing Dr. Milsten on November first at 11 AM.

Lyndsay accompanied me to meet Dr. Milsten.  He's younger than Dr. Miller, and at one point, said that he didn't do prostate surgery the "old-fashioned" way.  I can't decide if that was a dig or not.  But he was focused and professional, probably from doing this spiel hundreds of times. He said my prostate would be removed intact so the pathologist can study it.  I had the impression that finding widespread cancer cells in a prostate that hadn't started to enlarge was slightly unusual. 

He asked what I thought of the process so far, so I told him of my initial trepidation and how it was alleviated by experience and more knowledge.  I told him of my reasoning at reaching the decision to go the surgical route.  Radiation therapy may work, but if it doesn't, a later surgery is less effective, and in the case of radioactive seeding, it's simply not possible.  I don't want to be another 10 years older and facing surgery.

Meanwhile, I'll have another ultrasound so Dr. Milsten can plan his surgery, and sometime before the 26th, I'll have a meeting at the hospital, probably with the anesthesiologist.  I have a set of instructions to follow prior to surgery.  Mary and Lyndsay will be eagle-eyed seeing that I stick to it.

Here are the next steps.  On November 16th, Dr. Milsten will do another ultrasound to map out the position of my prostate.  The surgery is scheduled for November 26th.  I can have only clear fluids the day before the surgery, and I'm NPO after midnight.  All blood thinners are forbidden 14 days prior, and that includes aspirin, ibuprofen, vitamins and supplements.

Now for the icky stuff, and I forgive you if you want to skip this paragraph. Dr. Milsten said the outcomes are very good given my present good health and the progress of this cancer.  He said that there's a chance it can recur anyway if they miss any of the cells, but that radiation is a fall back position if that happens.  There's one aspect that is problematic.  In order to preserve erectile function, the usual approach is to peel back the nerves surrounding the prostate, yet that also may allow some cancer cells to remain.  Removing the nerves entirely is the nuclear option.  Eliminating the nerves greatly reduces the chance of recurrence.  This will require some careful thought. Mr. Happy and I have been together for a very long time.  The other concern is incontinence.  Eighty percent of all prostate surgery patients recover without problems.  Most of the other 20% have occasional problems, like if they strain to lift something, laugh, or sneeze, they may experience some leakage.  In a very small percentage, that problem is far worse if sphincter control is lost.  That's mainly a problem with the open prostate removal, or, as Dr. Milsten said, the "old fashioned" way.  Still, the surgery is preferable to radiation because the side effects of radiation therapy can include ED, incontinence, and loss of bowel control.  I don't want to go there.


Blogger PM Summer said...

You're on my "list" now, Ed.

I understand some of this, having walked a similar path a bit more than 15 years ago, but not the same path.

10:33 PM  
Blogger Pete said...

My Dad had his prostate removed with the da Vinci robotic machine about 3 years ago, and it went really well. I'm not sure if this is the same procedure you're describing, but I hope all goes well for you regardless.

7:04 AM  
Blogger lemmiwinks said...

All the best Ed. After "not dying", preserving the tall timber would be right up there (pardon the pun) on my list.

4:20 PM  
Blogger Steve A said...

One of my coworkers recently went through this. I pray your experience matches his. Well, actually, it might be 30 years before we know who lasted longest...

7:00 PM  

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