[Leica] Prostate Cancer

[oliverbryk at comcast.net (Bryk Oliver)]

I was born in 1928; the older I get the less wisdom I have to impart. I am, 
however, willing to share my experience as a prostate cancer patient.

At the insistence of my family physician, a doctor of the old school who 
treats the whole patient although he is a cardiologist, I started seeing a 
urologist once a year when I turned 60.

DRE and PSA were normal until I was about 70 when PSA levels began to rise 
slightly but were not yet of concern to this very conservative urologist.

My family physician had always done his own DRE and continued to do so. At 
some point - I guess I was about 75 - he said that he had felt some nodules 
and recommended a biopsy.

The urologist performed the biopsy and subsequently reported a small growth. 
He said that we now go into a mode called, "watchful waiting".

The urologist and I had several conversations about the probability of 
malignant prostate cancer. He reviewed the statistics from the perspective 
of populations, a view that is appropriate for physicians.

I consistently maintained that I was aware of the conditional probability 
that I had malignant prostate cancer, given the population statistics, but 
that my probability was binary, i.e., I either had malignant prostate cancer 
or I did not. I insisted on pursuing a "worst case" course of action. 

I began to see my urologist twice a year. PSA levels were rising. Another 
biopsy in the fall of 2013 indicated aggressive growth. My urologist 
recommended a combination of hormone therapy and radiation treatment. A 
radical prostatectomy was not an option because of my age. My pacemaker 
precludes an MRI.

I asked my family physician to refer me to an oncologist with prostate 
cancer experience for a second opinion. The oncologist ordered a whole body 
bone scan to look for indications of metastasis, i.e., whether the cancer 
had "gone to the bone". After reviewing the results he concurred with the 
recommendation of my urologist.

I should note that my wife accompanied me to the candid conversation with 
the oncologist and to all subsequent appointments. The purpose of the 
hormone therapy is to suppress the male body's normal production of 
testosterone in order to starve the cancer cells. The lack of testosterone 
has many unwelcome consequences.

We went to see the radiation oncologist in charge of the treatment facility 
that serves only prostate cancer patients. He explained the process (45 
treatments) and discussed typical recommendations such as diet. In 
retrospect he should have been far more explicit about the euphemistically 
named "side effects". I could have been much better prepared for them.

I won't go into details about the sometimes painful complications that 
necessitated more diagnostic procedures. Preliminary tests indicated a 
possibility that I had a rare variant of prostate cancer that does not 
respond to the typical treatment regimen. 

With the full support of my urologist and oncologist I transferred my 
oncological care to the University of California Medical School which has a 
research department devoted to urinary oncology. I had several diagnostic 
procedures to test this hypothesis, repeated at certain intervals, as well 
as a bone biopsy.

During this period I saw my urinary oncologist once a month. When he was 
satisfied that my cancer had stabilized he changed my tests and office 
visits to a three month interval (coming up next month). I still get my 
Lupron (hormone treatment) shots every three months. 

If my cancer remains under control for at least a year I may get a "Lupron 
holiday".

Oliver