0.1

Well then number came in two days ago: 0.1.

It was not the 0.0 I had hoped for, but at least it was better than the 0.2 I feared.

What is this number? It is my PSA level following the removal of my prostate one year ago this month.

At the time of the operation, my PSA level was 4.7 and my Gleason score (a grade for the severity of the cancer was a not bad 6). The doctor was confident that given my stage that he thought was at worst T2 and Gleason grade, the cancer was organ confined and the operation would be curative.

However, following the operation, the pathology report found that the stage was T3a (positive margins..cancer found on the outside of the prostate) and the Gleason grade was upgraded to a slightly worse 7 (but a 3+4 seven which is better than a 4+3 seven).

Stage T3a cancer is one of these in between stages. There is a prostate cancer forum that I sometimes participate in. There are men there much worse than myself on this forum and my heart goes out to them and their families. On the other hand, there are men who have had post surgery 0.0 for years following their operation (my father being one of them). Furthermore, from what I have read in the literature, treatment for stage T3a prostate cancer is debatable. The standard is to wait until the PSA rises till at least 0.2 until follow on treatment is recommended. However, there are some doctors who recommend more aggressive treatment of stage T3a cancer on the logic that the sooner the treatment, the more likely it is curative.

Since it seems to me that the treatment for this stage of prostate cancer is debatable, I have scheduled a second opinion meeting with a radiation oncologist this December. We shall see.

Anyway, what is the prognosis for stage T3a prostate cancer? Technically I am in remission and will be until if and when my PSA rises to 0.2 (which is the standard for biochemical recurrence in the literature I have read ). However the chance of my operation having been curative is less than had the cancer been found to be organ confined.

However, the longer that it remains under 0.2, the more likely the cancer remains confined to the prostate bed and has not metastasized (moved away). This means that I still have a decent chance of being cured through what is called salvage radiation. Should the cancer metastasize, there are still a number of treatments available, but these are not considered curative. However, they could extend my life long enough (prostate cancer is a very slowly developing disease) that I could very well end up dying of something else.

But that is all down the line anyway. I am philosophical about this; even if I am cured of prostate cancer, it only means that I die of something else a little later. Still if I had my choice of deaths, #1 would be gently in my sleep at age 95 or so. Prostate cancer would be significantly lower on my list. But the choice is not mine to make.

Anyway, no matter what happens, I still have a lot of living left in me and refuse to be obsessed with stuff that I really can't control.