Jodie was enthusiastic when I exited the bathroom a couple of weeks ago.
“Hey, that was a good pee! It sounded like it was coming out fast!”, she said.
“Uh, thanks. I’ve been feeling a lot better…”, I replied.
I was inclined to give her a fist bump, but quickly withdrew when I realized I hadn’t yet washed my hands. Honestly, I don’t know if this is a new high in our relationship, or a new low.
The day after our rendezvous I received the first of my bi-weekly PSA tests since starting hormone therapy. It was 10.70. To put in perspective, the last time I had my PSA measured was on Halloween, and it came back at 103. As of my appointment with my oncologist earlier this week, my score was 3.85. PSA scores under 4 are typically considered “normal”. The hormone therapy is working, at least for now ( more on that in a bit ).
This week I had my third appointment with my oncologist, Dr. Stewart.
Since my last appointment I had a full-body MRI as part of a research study. I was eagerly awaiting the results of this as well as the results of the genetic testing performed on my biopsy. As with my last two appointments, Jodie and my mom joined me in a small exam room.
The MRI results showed no more metastasis other than the sole lymph node that “lit up” in my prior scans. The good news is that the lymph node had actually shrunk from 18mm to 11mm. Normal is less than 10mm. Awesome! More evidence that the hormone therapy is working.
So what is a lymph node? Lymph nodes collect fluid, waste material, and other things (like viruses and bacteria) that are in the body tissues, outside the bloodstream. There are about 600 lymph nodes in the human body. They are spread throughout our body and interconnected by a series of lymphatic vessels. If cancer metastasizes to a nearby lymph node, it can traverse the lymphatic vessels like a highway and spread elsewhere.
My genetic screening results are still not in. There is only one prostate biopsy, and three different labs have been vying for it. Everyone wants a piece of me. The genetic screening lab, being last in queue, is still waiting. Dr. Stewart did however, tell me that there were no tumors detected in the blood of my biopsy.
Then we started discussing my future treatment.
My prostate cancer, due to it having spread to a lymph node, is an early Stage 4. This usually means treatable, but not curable. Dr. Stewart told me that he believes that there is a tiny chance that he might be able to cure me. In my prior appointments he told me that due to my age and general good health that he wants to be very aggressive in treating my cancer. At this appointment he was more specific as to what those treatments might be.
The thing about cancer treatments is that they have to be carefully orchestrated. Some treatments can only be performed once. Others can adversely affect future treatments. A friend of mine who is also fighting prostate cancer referred to treatments as arrows in a quiver. You only have so many arrows to shoot, so make each one count.
My treatment is to span roughly 2 years. During that time I will continue hormone therapy.
Hormone therapy, as I have mentioned in prior posts, starves the prostate cancer of testosterone which prevents it from metastasizing. Hormone therapy is also referred to as “chemical castration” as it blocks the production of testosterone in the ( cough cough ) testicles. Hormone therapy works well, but after a couple years the prostate cancer can start to adapt and either becomes more adept at slurping minute amounts of testosterone or, starts producing it on its own. At this point the cancer is referred to as Castration Resistant Prostate Cancer (CRPC). Hormone therapy is not entirely a single-shot “arrow”, but it’s close. It’s performed through a variety of medications and when one medication fails, another might still work.
Three months in I will start Chemotherapy.
The chemotherapy will be performed in 6 cycles over 18 weeks using a medication called Docetaxel which, from what I have been told, is generally well tolerated. While undergoing chemotherapy my hormone therapy might be reduced by eliminating Zytiga, which is rough on the liver. Chemotherapy is a systemic treatment in that it affects the entire body. It is administered through the bloodstream and kills cells that are undergoing mitosis, or cell division. Cancer cells tend to divide much faster than normal cells, so they are the most susceptible to the treatment. That’s not to say that healthy cells aren’t affected as well. Hair cells, among others, divide quickly as well.
“So am I going to lose my hair?”, I asked.
“You will only lose the hair you want to keep.”, Dr. Stewart replied with just the hint of a smile.
“Seriously?”. I replied, chuckling.
Humor, I imagine, is a fine line for medical professionals when dealing with cancer patients. I am fortunate that Dr. Stewart knows how to walk that line with skill. The truth be told, most men can pull off bald heads; no one can pull off the lack of eyebrows or eyelashes. That’s not to say my daughter Kaylee, isn’t looking forward to it. Nightly, I get asked the same question from her …
“Yes?”, I replied.
“Are you going to have chemotherapy?”
“More than likely.”, I replied.
“Why are you so excited?”, I asked.
“Because I don’t like your scratchy beard!”
Chemotherapy typically becomes less effective the more it is used. Similar to hormone therapy, the cancer cells adapt to it. However, like hormone therapy, chemotherapy is not necessarily a single-shot “arrow” either, as there are a variety of different medications that can be used.
After chemotherapy Dr. Stewart plans to run additional CT Scans on me to see how my prostate cancer has responded to the treatments. The CT scans will also prepare the surgeon for yup, you guessed it …
Six months into my treatment I will have my prostate removed through a radical prostatectomy.
Originally, Dr. Stewart was torn between surgery or radiation therapy. I asked him why and he told me that the “standard of care” dictates that surgery is typically not recommended for prostate cancer that has metastasized to a lymph node if the lymph node has exceeded 20mm. If you remember from earlier, my lymph node at its worst was on the cusp at 18mm.
For now Dr. Stewart has chosen to leave the radiation therapy “arrow” in the quiver and I agree, wholeheartedly. If radiation therapy is performed prior to surgery it can make surgery more complicated or not possible because of scar tissue/tissue damage. Radiation therapy is also typically a single-shot “arrow”; it can also be performed only once on a particular area. Leaving it in the quiver preserves a very effective treatment if the other treatments fail.
I have an appointment scheduled with a urological surgeon early next year to discuss what, exactly, surgery entails. Until then I’ll leave you with two words : incontinence and impotence. In a weird twist of irony, my kids will be carrying a diaper bag for me for once. Fortunately, from what I have read, both are usually temporary conditions.
If I seem a little cavalier about having my prostate removed, I have my reasons. From a purely psychological perspective it’d be reassuring to have the “bag of disease” removed from my body even though I am well aware that the cancer has metastasized outside of it. There are also physical issues as well. As I have mentioned in prior posts, my prostate has also caused numerous urination problems ranging from pain, to urgency, to a weak stream.
And that, in a nutshell, is my treatment plan. Piece of cake, right?
But that’s not all…
Next, Dr. Stewart had me sit on the exam table and breathe while he probed me with his stethoscope. He then he had me pull up my shirt and lay down while he palpated my abdomen.
“Your hands are freeeeezing”, I yelped.
“It’s the alcohol .”, he replied.
“Uh, you drink at work?”, I asked.
He just laughed at me. I laughed back, confused.
“Hand sanitizer!”, Jodie added.
“Oh…”, I said, sheepishly. Okay, so maybe the hormone therapy is dulling my mind a little.
“Originally, I started you on Degarelix, or Firmagon, because I was concerned about a testosterone spike making your symptoms worse. Now, I want to start you on Leuprolide, or Lupron. It’s administered as a single shot every three months instead of monthly.”, Dr. Stewart told me.
“And where is this shot administered?”, I asked.
Before Dr. Stewart could answer, his nurse materialized in the doorway, blocking my escape route.
“Drop your pants a little and put your hands on the exam table.”, the nurse told me.
“Ohhhhhhh….”, I replied.
“Uh, I’ll talk to you guys later…”, my mom said as she squeezed past the nurse and made a hasty escape out the door.
“And, you’re staying for this?”, I asked Jodie.
“Sure!”, Jodie replied, a little too enthusiastically.
I shot a glance over my shoulder at the nurse, who was now wearing what looked like a hazmat suit and gloves. She held a transparent bag marked with a biohazard symbol that contained a syringe full of what I imagined, was Lupron.
“Wow! I honestly didn’t think it was possible to make syringes where the needle is bigger than the barrel.”, I told the nurse, “Be gentle, or I’ll kick like a mule.”
The nurse was fantastic. I barely felt a thing, well, not until later on that day anyway.
“Have you ever been tempted to slap on a cute pink heart-shaped bandaid back there while no one was looking.”, I asked the nurse while pulling up my pants, “That’s what I’d do…”
“No, but maybe next time!”, she replied with a smile.
By the time I got home it felt like someone had kicked me in the ass where the shot was administered. Oh, well. It’s still far better than two shots to the belly.
So, that’s all for this year, folks!
2020 is going to be rough year for me, and to be honest, I’m scared. I’ve been feeling the best I have felt in months, and now with these new upcoming treatments, I am worried about relapsing. Fortunately, I have my family and friends. Their love and support have helped me more than they could possibly imagine. Thank you, it’s the best gift I could receive.
Have a Merry Christmas and a healthy, happy New Year.
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