Random thoughts from flyover country

Tuesday, March 20

Cancer diagnosis and treatment

After several months of rising PSA (prostate specific antigen) levels followed by a biopsy, I was diagnosed with prostate cancer in January. I sat with my wife rather stoically, somewhat stunned, as the urologist detailed my options. Options. You've just been told you have cancer, and you're expected to listen to options. Well,...yeah. What else are you going to do? One thing to consider, according to the doctor, was that the cancer was detected very early. My Gleason Score was 6, and pathologists couldn't diagnose prostate cancer below that level.

The options were: 1) wait and watch; 2) radiation: a) implantation of radioactive seeds in the prostate, b) external radiation, c) proton beam therapy; 3) hormone therapy in conjunction with radiation; 4) radical prostatectomy: a) robotic, b) traditional. After hearing the options, I went home with the doctor's instructions to read everything I could about all the options in order to make an informed decision; he wasn't going to insist on any one of them because I was the one who had to live with my decision.

Option 1, watch and wait, might have been appropriate if I was older, 75 or so, because the odds are that something else would kill me before the prostate cancer did. My urologist described this as not my best option.

Option 2, radiation in its various forms, would have a number of debilitating, uncomfortable, and downright inconvenient side effects. Radiation poisoning of the cancer cells inside the prostate means that you will suffer from radiation poisoning since there is no way to keep from radiating parts of your body other than the cancer cells. Damage to the colon, bladder, and urethra can cause problems long after the cancer has been destroyed. I'm told proton beam therapy might minimize those side effects, but it is terribly expensive and not proven to be more effective than traditional radiation.

Option 3, hormone therapy with radiation adds chemical castration to radiation milieu. Yeah, that sounds good.

Option 4, prostatectomy, removes the prostate (at a minimum) with the associated cancer and can have long term side effects like most of the other options above. There are the possibilities of incontinence in various degrees of severity and of sexual side effects. Disadvantages include a hospital stay and recovery from major surgery. In my case there was an additional risk due to previous abdominal surgery that even if I chose robotic surgery that the doctor would have to open me up to deal with scar tissue and adhesions.

My wife and I did our research and discussed all the options. Her bottom line was, "The important thing to me is that you stay around. Anything else I can deal with." I decided that the robotic radical prostatectomy would give me the best result: remove the cancer, minimize the time of treatment and recovery, and lessen the chance of long-term debilitation.

I had the surgery two weeks ago (It took 5 hours because the urologist worked through the scar tissue and adhesion issues using the robot.), and I'm feeling great. The pathology report indicated that less than 1% of the prostate was cancerous and that the cancer was confined to the interior of the prostate. Can't get much better result.

Today I went to the hospital for X-rays which showed no problems. Tomorrow I go back to the urologist and have every expectation that I'll be free of the catheter in the evening. Long term side effects will take a little longer to determine, but for right now I'll be happy to sit comfortably.