Wednesday, November 10, 2010
So, I have Cancer
Unless you want to, there is no reason for you to walk this path with me. If you are going to quit reading now and you are a man over age 40, let me just say that you should have your PSA tested at least each year; if you are a woman, have your man get his PSA tested. If you are a man between 35 and 40, get your PSA tested to establish a baseline of data for comparisons later.
OKAY, for those who don’t want to walk this path with me, now is the time to quit reading this blog. There may be too many details for you; I am holding nothing back here.
Last September it was time to get my prescriptions renewed, but I needed a new prescription for them so I went for my twice a year checkup. They always draw blood for a liver function test because I take statins for my cholesterol, and it’s the liver that metabolizes statins like Crestor and Lipitor (I had hepatitis 28 years ago). On a whim I asked the phlebotomist to add a PSA test to the screen of tests they were doing this time around. About a week later the doctor’s office called me to schedule a visit with the urologist because my PSA numbers were elevated.
PSA (Prostate Specific Antigen) is an indicator for possible prostate cancer, but is not diagnostic; several things can make the PSA elevated, including recent sexual activity. For a man my age (58) the PSA should have been about a 2, mine was 4.6, double what it should have been. The urologist checked me with a DRE (Digital Rectal Examination, isn’t it neat how everything has an acronym/ euphemism?), sticking his gloved and lubricated (KY Jelly) fingers where the sun never shines, twisting and poking as hard as he could in order to feel as much of my prostate as he could reach. When the DRE was complete, he gave me a box of tissues to clean myself off with, said that he would give me some privacy (after a DRE!), and told me he would meet me in his office in a few minutes.
He said that my prostate was somewhat enlarged, and he wanted to do a new PSA test anyway, so his phlebotomist drew some blood just for that test. About a week later, his office called to say that my PSA was still elevated at 4.1, and that the doctor would like to do an ultrasound, could I come in for that at 10:00 on Oct the 6th?
I bought a bottle of Fleets to clean out my colon as instructed, and my wife and I checked into a motel in town for the night before the “ultrasound.” At 09:00 I administered the Fleets to myself, and took care of that business just before going to the doctor’s office.
In the exam room, the nurse told me to take off all my clothes from the waist down, and to sit on the table, and to put this flimsy faux paper blanket over me, and she would be right back. Well, the paper blanket was a ruse: it was not to keep me warm in the chilled doctor’s office, and it was not for my modesty or hers, because when she came back in, she told me to lie on the table. Then she said to scoot my butt down to the lower right hand table corner, and to lie on my left side with my butt in the corner of the table, and to draw my knees into a full fetal position. Then she lifted the blanket to see if my bare butt was properly positioned in the corner. Perfect! Then the doctor came in.
The probe they used was slightly larger than the diameter of my thumb; feature something the size of a broom handle, if you will. This probe had the ultra sound system in the tip, with the biopsy equipment inside of it. I was thinking that the ultrasound was something to tell them if they needed to do a biopsy, but no, it’s the guidance system for the needle biopsy. The doctor inserted the probe, twisted it around into position so he could see which part of the prostate he was on for the sample. I thought I was getting an ultrasound; I did not know I was getting the needle biopsy!
Another thing they did not tell me was that this test was going to really hurt, and hurt bad. I am not talking “discomfort,” but genuine pain. I was given no pain medication, no analgesic, not even Valium to take the edge off, nothing.
Imagine a grid, three wide and four high, then imagine that grid overlaid on an internal organ the size of a walnut, below the bladder (which is full, “for a better image on the ultrasound”) and resting on the rectum. “This is going to sting just a bit,” and ZAP, the biopsy needle is shot into the prostate through the wall of the rectum, removing a tissue sample with it. He took twelve samples, but I could only count the first six. He twisted and pushed that broom handle inside me to reposition the probe for each fresh sample. I think he missed one position for the probe: inserted fully, and turned sideways. When he was done, he came and took my hand and said, “I had to kind beat you up pretty good there, but it’s over for now.” For now!?! I was a quivering bowl of Jell-o laying there on the table when the nurse gave me a shot of antibiotics in my right hip, and replaced the faux paper blanket over my nakedness. This is how much my needle biopsy hurt: I will never consent to have another one.
“You should get up now Mr. Mills,” she said. I was barely conscious. I leaned up on my left elbow. “Are you feeling dizzy or something?” she asked. I said “I just don’t want to pass out cold.” When I stood up to put my clothes on, there was blood on the pad they had put under me. I went into a bathroom to pee, but could not, even though my bladder was tight; it was over two hours before I could successfully void. As I walked out of the treatment area into the waiting room, I held out the car keys to my bride. I could barely shuffle to the elevator.
I am glad that my bride was there to drive me home after the biopsy, because there was no possible way I could have driven myself home afterwards. I guess that if I had come alone, I would have had to call a cab to drive me to a hotel for the rest of the day, sleep over, and drive home the next day. But my bride was wholly unsympathetic, telling me I had a low tolerance for pain; and how bad could it really have been? I never knew the road home had so many bumps and potholes in it. I stayed home to recover the day after the biopsy. In fairness to her, she did not know; until, that is, she made contacts through her nurse friends who had contact with an oncology nurse who said the needle biopsy is one of the more painful procedures and she could not believe that it was done sans analgesic. I spent the entire next day recovering from the effects of the “test.” Two days later, I began passing blood in my bowl movements, it felt like diarrhea as the blood passed, thickly turning the water in the toilet bowl deep crimson. That lasted for three days and scared me so bad that I called the doctor’s office to inform them of it, but they did not seem concerned.
A week later I called the doctor’s office to find out the results, but the receptionist said that the doctor was not available, but would call me back. I could hear the concern in her voice; she knew something she was not telling me. Later that day my urologist called to say that one of the samples taken did have a “microscopic amount of cancer cells in it,” and that another one had pre-cancerous lesions, not cancer yet, but they would become cancerous. Well, of course the amount of cancerous cells is microscopic; a microscope is what has to be used to look at the tissue at the cellular level to find or eliminate the diagnosis of cancer! He meant that there was a small amount of cells in one sample which were cancerous. Having a little bit of cancer is like being a little bit pregnant: it’s only going to blossom. The doctor asked me to come in for an office consultation on Oct 22nd, so he could talk to me about my diagnosis and to answer questions I may have.
Did I mention that Oct 16th was our 39th wedding anniversary? We’ve been married for 39 blessed years. I hope we have 39 more blessed years together!
Oct 22nd was a bright and cool day. My bride and I went together to the doctor’s office, she waited while I went in with the doctor; she had told me that I am in charge of my health and my decisions about treatment will rule. After talking to the doctor for what seemed to me to be forever, I asked him to have her come in so she could ask questions of her own that I might not think to ask. The doctor gave us a book, “One Hundred Questions and Answers about Prostate Cancer.”
Given my age (58), a PSA score of 4.6, a Gleason Score of 6, and prostate cancer stage of T-1, 95-97% of men in my situation survive ten years or more after treatment.
There are several possible options for treatment:
- Watchful waiting; that is, do nothing, but monitor the PSA and retest with a needle biopsy when necessary. In men that are 10-15 years older than me, that can be a viable option: they are more likely to die of anything other than prostate cancer!
- Cryo-freezing: Insert needles into the cancerous parts of the prostate and freeze the cancer cells so that they die. Again with the needles! And it would have to be repeated when new cancer cells were found; again with more needles where the sun don’t shine.
- Seed therapy: plant (again with the needles) radioactive pellets into the prostate where the cancer cells are located. And again with the needles! And it would have to be repeated when new cancer cells were found; again and again with more needles where the sun don’t ever shine.
- Radiation therapy: irradiate the prostate for 5 days a week for 7 weeks, resulting in killing the prostate without removing it, with the accompanying radiation sickness.
- Traditional surgery: cut me open like the famous Caesarian Section for delivering babies. Basically cut from the navel to the base of the penis, and use pries and clamps to hold the incision open for the removal of the prostate and the examination of the lymph nodes. Time in the Operating Room is less, but recovery takes 8 weeks.
- Laparoscopic surgery: make five or six holes in the abdomen, and enter using computers and robotic controls to see and remove the prostate, and examine the lymph nodes. This means longer in the OR, but recovery is significantly shorter.
Side effects: There are two main side effects that may (or may not) happen with removal of the prostate, these are the same for each of the five active treatments.
- ED: There are two bundles of nerves and blood vessels that run alongside the prostate. These supply the feeling and blood supply which make an erection possible. The surgeon may or may not be able to save these, 25% of men do suffer ED as a side effect of the surgery. It may be possible to save one of the bundles, if not both; in which case Viagra may help.
- Incontinence: The urethra runs from the man’s bladder through the prostate, to the penis for urination. In about 25% of the men who have the prostate removed, there is a problem with incontinence afterward. Almost in a subcategory of this, because the urethra inside the prostate must be removed with the prostate, the patient must have a Foley catheter for ten days to two weeks after the surgery. A major problem with Foley catheters is that they have a tendency to contribute to urinary tract infections (UTI, more acronyms/ euphemisms). You can see “Foley catheter” for yourself in Wikipedia, complete with color illustrations. If the cancer is near the sphincter valve of the bladder, that must be removed as well and that patient WILL have incontinence and must keep a catheter installed all the time.
Of course, if either of these conditions happens to a particular patient (me), that patient is not effected 25% of the time, or has 75% of his function; for that patient, the side effect is 100%. These side effects are the same for all of the treatments except “Watchful Waiting.”
October 29 I called my doctor to tell him we have decided on the Laparoscopic surgery. The next day I called back to the office to ask about it, and was told that the receptionist had put my file on his desk and that she will put a gentle reminder with it because he is not in the office today. Hmm.
So we received an appointment with the surgeon on Nov 22nd in Little Rock. The package his office sent me today said to be sure to bring the CT scan DVD with me. Hmm, I have not had a CT scan done, I must check with my doctor’s office about that in the morning.
I will post more when I know more!