Friday, December 14, 2007

Radiation Likely in my Future

Lessons learned..

If you have any qualms or reservations on how your medical treatment is going, do not hesitate to get a second opinion.

And..when seeking a second opinion (that is in the nature of a consultation) have your questions written down. Your doctor will spend the necessary time with you if your questions are written.

Yesterday, I had a second opinion with a radiation oncologist. What I learned was..

Given my stage of cancer, there really are no best practices. There just are not enough data points to formulate best practices for stage 3a prostate cancer with a very low (but not undetectable) PSA level.

Still, given my PSA level and trends, it is probable that a PSA 0.1 is indicative of some ongoing cancer left after the surgery. However there is no way of confirming whether this is actually the case.

Furthermore, given my gleason (3+4), slow rate of PSA rise, and post-op pathology report, there is a good chance that whatever cancer is left is confined to the prostate bed. Of course there are no guarantees this is the case. Furthermore there is no reliable test that can be used to determine whether the cancer has moved (bone scans generally read negative anyway for very low PSA levels).

So I could conceivably have radiation therapy when (a) there is no cancer in which case it is a waste and I would be risking the side effects of radiation for no reason (b) the cancer has already moved, in which case it makes no sense because the radiation will not cure it.

However, since radiation represents my last hope for cure, these are chances I am willing to take. Remember that prostate cancer is way down there on my list of preferred deaths (my #1 preferred death is being assumed into heaven like Elijah (and Mary if you are Catholic) were but my wife is skeptical on whether my life has been on par with Elijah (or Mary). So assuming my #1 preferred death will not happen, my #2 preferred death is dying in my sleep at age 95. Actually the idea of being raptured sounds pretty good also, but I personally find most end-times theology very highly speculative (for grins and giggles read the 1970s version of the Late Great Planet Earth sometime).

Note: I'm not Catholic, but I also have no particular angst against Catholicism. Regarding the assumption of Mary, I can't say for sure she wasn't assumed (God has not recorded everything He ever did in the Bible). All I know is that God hasn't definitely shown it to us through the Bible, and therefore I am under no obligation to believe it. So as much as I know, the assumption of Mary is one of those nice extra-Biblical stories (the idea of Mary being assumed to heaven does sound nice) that may or may not be true. But anyway forgive my theological digressions here..

The net is that since radiation represents my last hope of being cured of this disease (everything after that point is about extending your life a few years in hopes that you die of something else), I would prefer to err on being overly aggressive.

I asked the doctor what he would do if he were me. He said to wait and have one more PSA test. If it rises to 0.2, by all means he would have the radiation therapy. If it stays at 0.1, to him it would be borderline, but since this is the last curative treatment available, he would still have the radiation. He would only put it off if it falls to 0.0.

I think the doctor's reasoning is sound and that will be the course of action I will take.

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