Tuesday, July 31, 2012

Confronting the Cancer Demon....Full Speed Ahead!

 Being taken through the ins and outs of a prostate biopsy result, clinical all the way, is a weird experience. Weird because for the first time, in living color, you're coming "face to face" with what is growing - otherwise unseen - inside you. Something that if left to itself, will surely kill you and as totally, painfully and miserably as almost any other cancer.....maybe just short of the misery of pancreatic cancer. But there it was, one photo-micrograph specimen of two 'cores' (in glaring reddish stain, with menacing looking, ragged cell borders)  bearing Gleason scores (3 +4 = 7) . The two most malignant "fragments" occupied the mid lobe and apex, respectively and with 20% extent meaning the tumors in those areas are now 6mm (or a quarter inch wide) and growing.

(Aside: Btw, the nurse gave the Gleason scores incorrectly: There were actually SIX of twelve sample cores with abnormal cell manifestation, and five identified as malignant. Two samples had 3 + 3 = 6 Gleason total, and the other two (noted above) had 3 + 4s. )

When I asked the urologist if there was any option for "watchful waiting" he said that based on his 20 years experience, including at Johns Hopkins and Mayo Clinic, no. The tumor doubling time for a 20% volume wasn't known for certain but he didn't leave out a potential of once every six months in which case the whole prostate might be occupied by tumor in 2 years and might break out to the lymph nodes and bones in three. In other words, discomfiting or not, it was a damned good thing I did get the biopsy done and didn't hesitate any longer.

I was also frankly amazed that when I mentioned my preferred choice of treatment (HDR monotherapy) the urologist didn't express dismay. As he put it: "Unlike some docs who get their noses out of joint because a patient chooses a treatment outside their own specialty, I don't!" That was very satisfying, also when he volunteered his assistance in case any problem arose in the aftermath.

By the way, the use of "seeds" is not where the UC- San Fran. monotherapy is at. They now have a method of HDR treatment planning in which nothing - no seed - is left inside ....for its radiation to decay. Instead, the needles are themselves radioactive - each bearing a designated, pre-computed dose - and are inserted into the affected areas of the gland (through the perineum) then removed daily. The treatment for needle insertion is generally done over 3 sessions, occupying two -three days depending on one's tolerance for the pain, discomfort. (You are also given control of the pain, according to wifey, by being allowed to squeeze a morphine drip to get relief any time needed. I've never taken morphine before but be assured if I need it I will use it! I ain't worried about "addictions" like so many are in this country and why many drs. are pain amelioration averse.)

The urologist will be sending all the biopsy results and slide histology over to SF today or tomorrow, and on calling my Medicare Supplement insurance company - found out they are A-ok with going out of state for treatment. So, depending on how soon the clinical assessment is done, and the availability of seats (using accumulated  free miles), we will be on our way. I always wanted to see the Redwood forests and Golden Gate Bridge....as well as Haight-Ashbury!

More than likely this won't happen before September, maybe the first or second week. We will probably miss the start of the NFL football season for our teams (Ravens and Packers) but hey, that's what DVRs are for.

Am I looking forward to it? Not all of it, but then you gotta do what you gotta do. Guys, here's another object lesson for you: When wifey nags you to go in for that PSA test or biopsy do not fob her off. She has your best interests at heart. Yeah, the biopsy was bloody uncomfortable in parts, but tolerable and no where as bad as the outcome had cancer taken over everything.

Do what you have to do!

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