[Leica] Prostate Cancer

[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