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 Tales from real life |
| Well, if they're not true, they oughta be! |
| Part 2 - Decisions "The Blue Ribbon (part 1)"  Sadly, cancer is big business these days with a much too large customer base. Halvorson Cancer Center is just one part of the cancer complex in the west wing of Evergreen hospital. Itâs a modern facility that opened in 2012, with wide corridors, pleasant dĂŠcor, and the latest equipment for cancer diagnosis and treatment. Virtual Tour: https://www.youtube.com/watch?v=sbYjQFEXYoI Thatâs where I went to meet with the radiation oncologist. Debbie went with me to offer her support. The self-described âconciergeâ who checked me in for my appointment with Dr. Taylor is a nice guy with a friendly smile. He welcomed me to the oncology âfamilyâ and insisted on taking my picture. âSo everyone will recognize you and know your name,â he said. âSure, thanks,â I replied with an automatic smile. No, I donât want this, I objected silently in my head. I donât want to join your stupid family. Iâm going to get this thing cut out and be done with it. I donât belong here and I wonât be back! I wasnât in a receptive frame of mind, but I held my tongue and listened politely as Dr. Taylor shook hands and launched into a detailed explanation of my particular case. He covered a lot of the same ground as my urologist, Dr. Dai, but Iâd been too shaken up at my meeting with her to take it all in. He also revealed that he was a cancer survivor himself, having undergone prostate removal twenty years earlier. Dr. Taylor explained that the tissue samples from each cancerous area are evaluated and given whatâs called a Gleason score. The numbers range from one to ten and higher numbers are worse. Mine were mostly sixes and sevens. That meant my case was, in fact, serious. Based on my Gleason score, physical exams, PSA level, and various scans, I was given an overall cancer stage of T2a. Or, in simpler terms, unfavorable intermediate risk. My face must have shown dismay at the word unfavorable. âDonât panic,â Doctor Taylor told me. âItâs not as bad as it sounds. You donât need to put your affairs in order just yet. Your cancer is still very treatable. Your outlook is a matter of years rather than months.â Somehow, the word years wasnât very comforting. We all expect to have a long, vague number of years. Hearing the word months was disheartening. It made the end seem a lot more specific. But I still had a decision to make about how my cancer treatment would affect those years. Dr. Taylor showed us projected outcomes based on thousands of case histories of similar patients. Thereâs a progression of cancer treatments, beginning with a surgical removal of the tumor. If that isnât successful, the next option is radiation therapy. And the final option, for metastatic cancers, is chemotherapy. The data from similar patients showed that even with immediate surgery, I would have a 76% chance of needing radiation therapy in the next ten years. And there was a 91% chance that cancerous cells were already beginning to invade the surrounding tissues. That wasnât what Iâd hoped to hear, so I had to pause and rethink my options. Dr. Taylor gave us a description of intensity-modulated radiation therapy (IMRT). It combines a CT scanner and a radiation beam powerful enough to damage cancer cells. The damaged cancer cells are unable to reproduce and can then be broken down by the bodyâs natural healing processes. The IMRT machine scans as it rotates the beam around the patient. That allows the beam to precisely target the prostate gland and a computer program varies the power as it moves. The radiation beam is always focused on the prostate, but the angle of the beam varies as it rotates to minimize damage to the surrounding tissues. Healthy cells can recover from radiation damage if it isnât too severe. That can preserve at least partial prostate function. Even so, side effects of radiation therapy can include fatigue, urinary distress, abdominal pain, and diarrhea. Dr. Taylor explained that IMRT therapy can treat cancerous cells around the prostate gland as well as those within. Another advantage of IMRT is that the side effects are usually less severe than surgery and certainly less immediate. With IMRT, I could spare myself the trauma of an invasive surgery, enjoy a more normal life in the short term, and possibly in the long term as well. Suddenly, being in the oncology family didnât seem so bad. I felt like I should go back and apologize to our concierge. Deb and I met a second time with Dr. Dai to give her a chance to offer a rebuttal. She looked at the projected outcomes and agreed that Dr. Taylorâs numbers were valid. She also conceded that surgery couldnât guarantee removal of all the cancerous tissue, and it would put an end to my prostate function. One common reason to opt for surgery, relief of urinary problems caused by an enlarged prostate, wasnât a factor for me. Dr. Dai did point out that surgery isnât done following radiation therapy, so I couldnât change my mind later. But when I asked directly for a recommendation, she demurred Dr. Taylor hadnât given a recommendation either. My case resides in that anxious gray area of who knows? If my cancer was less aggressive or less advanced, then surgery would be the best choice for a cure. Get it out and get on with my life. That had worked out well for Dr. Taylor. If my cancer was more advanced, then radiation or chemotherapy would be the only choices. Managing the disease more so than curing it. But I was in between with my unfavorable intermediate risk. Surgery might be successful for me, but the odds werenât great. In addition, the numbers showed that my fifteen-year survival outlook would be almost the same with either treatment option. In the end, I chose to avoid surgery and go for a better quality of life in the short term. And I can still hope that my prostate function returns over time while the cancer doesnât. So, I embraced my oncology family and asked Dr. Taylor to schedule me for radiation therapy. I was ready to get started right away, but it turned into a case of hurry up and wait. The first step was yet another scan on November 27th. This time it was a CT scan to get a more accurate map of my prostate gland and my pelvic bones. The scan confirmed that my prostate was enlarged (53 cc). It also showed that my pubic arch is high enough to make me a candidate for Brachytherapy. There are two methods for irradiating prostate cancer. IMRT is external and Brachytherapy is internal. IMRT requires 15-minute sessions at the hospital five days a week for six to ten weeks, while Brachytherapy is a one-time outpatient procedure. Brachytherapy involves implanting radioactive seeds within the prostate gland to deliver radiation directly to the cancer cells. A needle is used to place the seeds, and they're inserted through the pelvic opening. Women have a wide pelvis with a high pubic arch to accommodate childbirth. Men have a narrower pelvis and the pubic arch may be too low to allow access for Brachytherapy. For those cases, a full 10 weeks of IMRT is required to deliver the desired radiation dosage. DDr. Taylor used all of my diagnostic data to prepare a customized treatment plan and presented it to the oncology review board the first week of December. I was approved for 6 weeks of IMRT followed by Brachytherapy. The IMRT sessions would treat the cancerous cells in and around my prostate from the outside in. Then the radioactive seeds would finish the treatment from the inside out. For me, the combination of the two therapies would be more effective than either alone. But I still wasnât quite ready for irradiation. I learned that thereâs a less obvious fourth therapy for prostate cancer and I would actually be starting with that one first. It seems that prostate cancer cells feed on testosterone, and they also need it to reproduce and spread. Using an androgen blocker prevents a manâs body from producing that testosterone fuel. That starves the cancer and shrinks the prostate gland. And a smaller prostate enhances the effectiveness of the radiation treatment and reduces the impact on surrounding tissue. So, on December 4th I got my first dose of hormone therapy. It comes with its own set of side effects, similar to menopause, including fatigue, irritability, and hot flashes. There are many supplements advertised on TV for low-T. Well, Iâm operating on no-T. Itâs frustrating to deal with, but it might save my life. I struggle with my usual yard work and some days I just nap all afternoon. And the hormone therapy also causes smug comments from the women in my life, "Now you know what we go through." The hormone treatment is effective though, my prostate volume shrank by half, to 24 cc, over the next three months. By March of 2025 I was already showing real improvement, even though I still hadn't received any radiation. |
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