Thursday, November 10, 2011

A Journal Entry From 2006

Two days after Christmas, in 2006, I started keeping a journal.  Here is an excerpt from that day:

Story so far--PSA rising after surgery. Diagnosed February 2006, surgery in April.  First PSA undetectable, second 0.2.  December PSA 0.6.  I think I'm in big trouble.  Meeting with a radiation oncologist and a medical oncologist January 9.  I will try radiation, I think, even though the cancer is probably distant rather than local, since PSA rose so quickly.  I imagine hormones and chemo are in the works before long.  Worried about how long I will live, but more importantly, what that life will be like, with all the effects hormone therapy causes.  Lots of thoughts passing through my mind, so figured it's a good time to start journaling.  Waking up at 4 am with anxiety, but doing okay during the day.  Read a part of Walsh's book yesterday--a study where a subset of men had PSA rise within one year.  Only 1 of 16 got any benefit (from radiation) and his PSA started to rise three years later. Worried about _____ growing up without me.  Everything is different now.  Should I bother putting anything into my career?  Should _______and I plan a romantic trip now, in case HT is going to destroy that part of life?  Should I start getting into pictures and videotapes more now so that in the future, ____________ can see me as I was, not sick?  Should we bank some family experiences now?  I think I have a 74% chance of surviving three years but only a 15% chance of ten years.  That's a pessimistic view (looking at "Risk of Prostate Cancer-Specific Mortality etc." from JAMA 2005; 294: 433-439.  
It was actually an overly pessimistic view.  I had thought, based on what my surgeon told me and the yellow Post-It attached to the record he sent the radiation oncologist, that my surgical margins were negative.  But when the oncologist read the file, he found that actually, my margins were positive.  Positive surgical margins mean that cancer was present right up to the very cut edge of the removed tissue, meaning that it's likely some bits of cancer were left behind in the region of the prostate.  And those cancerous leftovers were a likely culprit for my rising PSA.  Since their location could be approximated (the prostate "bed", or fossa), radiation was more likely to effect a cure, than if the margins had been negative.

I had salvage radiation in early 2007.  Within a few months, my PSA fell back below 0.1, where it has remained.  Am I cured?  It's too soon to tell.  It may always be too soon to tell.  But I'll take what I can get.

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