Thursday, January 18, 2007

How I got to this point

A little backstory:

Several years ago I realized I was getting up more and more at night to go to the bathroom. I eventually asked my primary care doc about it. He performed a DRE (digital rectal examination) and said it felt a little "boggy." He ordered a PSA test. It came back just over 4, as I remember. That's high for someone my age--late 30's at the time. So off I went to the urologist.

The urologist examined me but didn't find anything unusual (nothing palpable). He tried antibiotics and anti-inflammatories, but nothing really seemed to do the trick with my PSA. And it rose a bit. So--biopsy time. Now at that time, local anesthesia was not widely used in prostate biopsies. Prostate biopsies are the kind of thing doctors classify as "uncomfortable" while the rest of us compare the experience to being poked with knitting needles. (These days, don't worry--your uro can give you a shot of lidocaine right in the area of the prostate and the biopsy will be tolerable, although still not a lot of fun).

The biopsy came back negative for cancer. Everything looked normal.

So we tried some more monitoring and as I recall, more drugs to try to see if it was something entirely benign. But eventually the PSA rose up again (I don't recall that score) and we went for another biopsy. This time, high grade PIN cells were found. In a large percentage of men with high grade PIN, cancer is found on subsequent biopsies. But--I was still negative for cancer. So we tried Avodart, a drug that would shrink the prostate and just maybe, have some chemoprevention properties. My PSA dropped more than 50%, to just over 2.0, and stayed there for a couple of exams.

And then it doubled in 6 months.

My uro checked me out with another DRE and found a palpable nodule. Now I went to the hospital, under general anesthesia, for a saturation biopsy. Lots of samples. And 20% were cancerous.

At this point my official PSA was 4.8, but since Avodart was cutting my PSA in half, my "real" PSA was more like 9.6.

I had a Da Vinci prostatectomy in late Spring 2006. Recovery wasn't bad, except that I wasn't psychologically prepared for the catheter--it took some getting used to (2 weeks after surgery it was out--and it wasn't bad coming out, either. Glad to be rid of it.)

The surgical results: positive margins, negative seminal invasion, Gleason 3+4. Both lobes involved, cancer found throughout the gland.

I continued to recover just fine from surgery. Incontinence was only a problem for a few weeks. ED has been a problem but it's getting better all the time.

My first PSA after surgery was less than 0.1. 3 months later, it was 0.2--worrisome but probably no reason to act yet. 4 months later, it had tripled to 0.6. My urologist referred me to a radiation oncologist and a medical oncologist.

I was very anxious and depressed--but I didn't have the right information. I thought I had NEGATIVE margins, in which case I would have been more likely to have distant rather than local disease. At 44, I was looking at hormones, chemo, and a very premature departure from the planet.

But the oncologists--both of them--saw that the pathology report actually said that the margins were positive. Both of them agreed--no hormones, just try IMRT. There's a good chance it will kill the remaining cancer cells, provided they haven't left the area where the prostate used to be. So that's what I'm doing.

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