On Halloween my wife, Jodie, my Mom, and I went to UCSD Moores Cancer Society to get a third second opinion. Jodie, being Jodie insisted that since it was Halloween that we should wear our costumes. When Dr. Tyler Stewart walked in to greet us he immediately started laughing. It was the perfect ice breaker. He then proceeded to spend over an hour talking with us, drawing diagrams, and discussing treatment options.
He started by explaining that prostate cancer requires a team of doctors. The team consists of a radiation oncologist, a urological oncologist, and a medical oncologist. Each plays a part in the treatment. Furthermore, at least at UCSD each case is reviewed weekly at a “tumor board”. I quickly imagined a bunch of doctors sitting at a table looking at radiology reports announcing in their best Schwarzenegger impersonation, “It’s NOT a tuma.” “It IS a tuma.” Kindergarten Cop ( 1990 ), anyone?
As the medical oncologist Dr. Stewart referred to himself as the “quarterback”, or the one that would be directly managing my care with the team.
He then dove into the various treatments that were available and how the treatment would vary based upon if and where the cancer had spread. There’s radiation for localized cancer, or cancer that is confined to a particular area. Surgery is another option, especially if the cancer is contained within the prostate. There’s hormone therapy for depriving the cancer of testosterone. Prostate cancer as it turns out feeds off testosterone; by medically lowering testosterone you can starve and kill the cancer cells. Chemotherapy is another option that is reserved for cancer that has spread. He didn’t delve into the topic of clinical trials nor immunotherapy. My understanding is that the later is reserved as a treatment of last resort when conventional treatments stop working.
Basically, there is a treatment for everything. But every treatment has nasty side effects.
He said that if were to stage my cancer he would give it a 4a since it has likely spread to at least one lymph node. However, he told me that he was still treating it as “cureable” based upon favorable results from additional scans that he wanted to run.
There are scans for everything, too
Dr. Stewart then ordered another CT Scan that would include my chest as well as an MRI Scan to determine the size and shape of my prostate. By verifying that the cancer is localized and has not spread too far he could start me on radiation and hormone therapy. Ideally, the hormone therapy will keep my cancer in check while the radiation wipes it out. The downside of hormone therapy is that prostate cancer eventually becomes resistant to it.
Dr. Stewart would like to run some additional advanced scans as well. In my prior post I also talked about the Ga-PSMA PET CT Scan. Well, there’s another slightly-less-advanced scan called an Axumin Scan that delivers similar results through a completely different process. Both scans can pinpoint where prostate cancer has metastasized. An Axumin Scan does this through a radioactive tracer absorbed by the prostate cancer cells. A PSMA Scan does the same thing by detecting a protein produced by the cancer cells. A PSMA scan is more accurate and from what I read it can be used for “targeted” therapy. Aside from the technical differences the Axumin Scan is the only one of the two that is likely covered by insurance and is available at UCSD. The PSMA Scan is only available at 5 locations nationwide and the soonest availability is a month out at UCLA. Phew. Information overload, right?
Be aware that scans are not cheap and there are no customer loyalty programs or repeat discounts.
My second CT Scan was only prescribed because my first one only covered my groin area. My first CT Scan was performed just a couple of weeks ago, too. Sigh. Supposedly, limiting a scan to a particular area is standard protocol however if I knew better at the time I might have avoided some unnecessary costs and trouble.
As our conversation wound down Dr. Stewart said he wanted to do a quick examination. Instinctively, I reached for my belt buckle and was about to drop trough when he said, “No worries, I already know what’s going on down there. I just want to listen to your breathing and check your lymph nodes.” With a deep sigh of relief I asked him if he’d take a picture with a couple of nerds. He agreed.
Before we left UCSD Dr. Stewart had me go get blood work done at the lab in the Moores Cancer Society lab. He wanted to check my testosterone, PSA level, and blood cell counts. He also was able to expedite a genetics test. It was kind of surreal walking into that building, looking around, and realizing that the majority of the people there had cancer. There was a lot of people. The majority of them looked healthy, too. That was reassuring. The best part? The lab staff was dressed up in costumes as – vampires! So yes, I had my blood drawn by a vampire on Halloween.
Dr. Stewart called me the next day to check-in. He told me that his goal was for me to look back on all of this forty years from now as just a “blip” in my life. That’s exactly what I needed to hear.
The third time [ opinion ] is the charm. I found a good quarterback and I’m not even a football fan.
Last but not least, everyone keeps asking me how I’m doing. The truth is I have a lot more good days than bad ones. I’m in a little pain but I’ve been managing it without medication. I could do without the urinary problems but I’ve learned to “take a seat” when using the bathroom. For now I’m not letting the cancer diagnoses slow me down. And when I do start feeling down one thing that cheers me back up is knowing that my family and friends have my back.
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