Disclaimer: I am not a doctor, nor is any of the information in this blog a substitute for informed medical opinion or treatment. If you have questions, talk to a doctor. If you still have questions, talk to another doctor. The information below may or may not be accurate today or in the future when you read this.
Well, I’ve had an interesting last few days.
I thought long and hard about whether to share this information on the internet. In the end, I decided that there are lots and lots of men who will be going through what I’ll be going through over the next weeks, months and years. So if you find yourself in my position and are doing research for what’s in store for you, I hope these blog entries prove helpful. This is my journey.
To set the stage: I went in for my annual urology exam a couple of weeks ago. I had no complaints and no particular issues. It’s just something that I’ve done for a few years due to my genetic history: my father was diagnosed and successfully treated for prostate cancer back in the 1980′s, so I’ve known for many years that I was at risk for developing the disease as well. A lot of men do: 1 in 6 American males will be diagnosed with prostate cancer in their lifetimes; even more older men have it and never know it before they die of something else. It is the second most common cancer in American men after skin cancer. And if you have a family history of prostate cancer, your chances of being diagnosed with it are even higher.
So knowing that was a possibility, I’ve been careful to get annual checkups since I hit my 50s. My PSA (prostate-specific antigen, measured with a simple blood test) has been running at about 0.7, which is quite low and a very good indication that there isn’t anything going on with the prostate. This year, however, it doubled to 1.4. Now, usually a PSA below 4 is considered normal and is not cause for alarm. However, given my family history, my urologist strongly suggested that I undergo a biopsy just to make sure there wasn’t anything to worry about. He told me that there was about a 70% chance that the biopsy wouldn’t detect anything abnormal and only a 30% chance that they would find cancer.
Unfortunately, I came out on the short end of those odds. Of the 14 samples they took in the biopsy, 2 came back with a small amount of cancer (one contained 4% cancer cells, the other 10%). My Gleason score was 6(3+3) out of a possible 10 (which is considered low-grade).
So the bad news (which was not entirely unexpected): I have developed prostate cancer. I’ve assumed for a long time that I probably would at some point in my life–I was hoping that it would be later rather than sooner, however. The good news: it’s been caught at a very, very early stage and is 1) not immediately life-threatening in any way, and 2) highly treatable.
Now if I were a few years older, one of the recommended actions is today called “active surveillance”–which is basically to do nothing except keep a watchful eye on your PSA. If it stays below about 10 (your mileage will vary) then don’t bother treating the prostate cancer at all. After all, if you are 85 years old, why bother treating a slow-growing, low-grade cancer when you are probably going to die from something else before your prostate cancer becomes life threatening? Given my family history and the fact that my PSA had doubled in the last year, that isn’t really an option for me at age 58. Although, if there was some promising new treatment on the horizon that wasn’t quite yet approved and accepted, I’d *probably* be safe in doing nothing for a few years until the new treatment was available. My urologist suggested that if I did nothing, in 10 years there was only about a 30% chance that the cancer would kill me (hmmm…I’ve heard those odds before somewhere…).
Since there doesn’t seem to be anything like a pill that I can take that has a 100% cure rate on the horizon anytime soon, I have several options to rid myself of the cancer before it becomes a problem.
First is surgery. Ugh. Even though my surgical options today are far more attractive than when my father had his surgery in the late 80′s (minimally invasive robotic surgery vs. the traditional surgery), it is still surgery and it still has risks: chief among them being incontinence and impotence for at least several weeks, perhaps months, and possibly forever (unlikely at my age, but so far in this journey I haven’t exactly fared all well with the odds). The benefit of course is that the cancer is quickly removed (a couple of weeks to schedule the surgery, an hour or two for the surgery). Zip, snip, gone. A night in the hospital, a few days off work, a few weeks (normally) for a full recovery, and a high success rate: in excess of 95% for my stage cancer and my age group.
The other major option is radiation. Until a few years ago, radiation was considered a poor option compared to surgery (and still is for some patients, but for mostly different reasons than before). Radiation treatment uses ionizing radiation (x-rays, in the treatment I considered, but there are other options) to damage the DNA of the cancer cells so severely that they cannot reproduce. Unfortunately, it does the same thing to normal, healthy cells–which used to be a common and unavoidable side-effect of radiation treatment. So the trick in using radiation to treat cancer is to target the radiation accurately enough so that the cancer cells are disrupted, but do so in a way such that as little normal tissue surrounding the cancer is harmed as is possible. As you can imagine, there are a lot of very important structures *near* the prostate that you don’t want damaged (see “incontinence” and “impotence” for starters). Fortunately for me, radiation treatment via x-rays has become much more targeted in recent years and has a very good success rate of treating the cancer without overly damaging the surrounding tissue (feel free to read up on RapidARC if you are interested). Today, the success rate for this type of radiation treatment is approximately equal to that of surgery: both north of 95%. And the radiation treatment has far fewer side effects: flareups of hemorrhoids if you have them, possible diarrhea, and possible difficulty urinating if the urethra becomes irritated during treatment: all of which are treatable and subside once the radiation treatment is concluded. Unlike surgery, there’s no hospitalization, no time off required (other than the 10 minutes of so per day of treatment–8 of which is prepping for the actual radiation treatment–5 days a week for 9 weeks), no recovery time, and minimal of side effects risks (other than one big one I’ll tell you about shortly) other than those I’ve already mentioned. And in my case, the treatment center closest to my home is less than 2 miles away.
The one big side effect to be aware of isn’t really a issue for someone my age, but would be if I was much younger: the treatment itself can *cause* other cancers (why do you think radiologists step behind lead shields when operating x-ray machines). I was told by my doctor that I’ll have about a 1% chance of contracting some other cancer from the treatment in the next 30 years. Well, in 30 years (assuming I don’t get run over by a bus before then) I’ll be 88, and who knows what cancer treatments will look like by then. So it’s not something I’m going to lose sleep over.
There are other treatment options, of course. Some approved and some you have to travel to other countries to receive. If I had a late-stage aggressive cancer where neither surgery or radiation had a high success rate, I’d certainly be giving some of them my attention. Since I don’t, I’ve decided to go with the radiation treatment. Approximately equal success rates for curing the cancer, and far fewer risks and side effects as far as I’m concerned. For me, it seems like an easy decision.
I start treatments next week, and I’ll keep you posted as to how it goes.