Friday, August 12, 2005

Prostate Cancer Update

This week has been a test of my self-discipline. I’ve been attending college this summer and this week was finals week. I’ve had to concentrate on my exams and temporarily put thinking about my cancer on the back-burner. I’ve worked too hard this summer to throw away good grades. Now that finals are over, I can concentrate on beating this thing.

I met with my proctologist, a surgeon, early last week and a Radiation Oncologist today. It seems I have several options;

1) Watchful waiting (i.e. do nothing for the time being). Prostate cancer is, historically speaking, one of the slowest growing cancers.

2) Hormone therapy. Removing or dampening the male hormone, testosterone, slows the growth of Prostate Cancer.

3) Radiation therapy. This works by damaging or killing all of the tissues, both healthy and cancerous. Once the radiation treatment is stopped, the healthy tissues grow back somewhat, but the cancerous ones are unable to reproduce themselves. There are two types of Radiation Therapy I can consider, External Beam and Seed Implantation.

4) Surgery. The prostate and seminal vessels are removed. No more prostate gland, no more prostate cancer (theoretically).

Each option has its pluses and minuses, of course.

• Watchful waiting means life goes on, essentially, as before. My PSA gets checked regularly and I can look forward to fairly frequent prostate biopsies. Leaving this disease alone sounds, on the surface, insane, but prostate cancer is normally very slow growing. If I was diagnosed with this at age 75 rather than at 55, this would be a real option. But at my age it’s not.

• Hormone therapy means either my testicles get removed (they are what generate the testosterone) or else I have to take drugs to suppress my testosterone. Having my balls cut off doesn’t sound very attractive, but if it would result in my beating this cancer, it would be an option I’d consider. But the lack of testosterone only slows down the growth, it doesn’t stop it. The same negative applies with taking suppression drugs – I’d still have the cancer, it just would be growing slower.

• Radiation therapy is a real option as the odds are strongly in favor of a total cure of the disease, not just a slowing down of it. But there are real side effects. 20-25% of men who undergo this lose their sexual functions. Approximately the same percentage also experience incontinence, both urinary and rectal. The real downside to this option is that if it is unsuccessful, it makes surgery much more risky. The healthy tissues are also damaged by radiation therapy and just don’t take surgery as well as normal tissues do.

• Surgery is also a real option as it, too, has an excellent chance of completely curing me of prostate cancer. But it’s not totally guaranteed. If any of the cancer cells have spread from my prostate into the surrounding tissues or lymph nodes, then it will eventually regenerate itself. However, at that point I do have a second option, radiation therapy. You can follow surgery with radiation therapy, if necessary, but not vice-versa. There are downsides to surgery, too. They include urinary incontinence and loss of sexual function in a small percentage (less than 10%) of the cases.

So these are my options. At this point, I’m leaning towards surgery, but will spend this weekend doing additional web research on the issue. I need to make up my mind quickly. Every day I wait is another day the cancer grows unchecked.

I will keep everyone posted…

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