Posted 5/1/2015 1:02 AM (GMT 0)
I've been reading lots of posts here for the past few weeks, and figure it's time to jump in and add to the mix by contributing my situation. The posts have been great. They have served, along with a close friend of mine, to get me to slow down, collect data and information, analyze, collect more data, and try to focus more on facts and less on emotion.
I'm age 57 now, and have been actively surveilling my prostate drama since 2008 just after I turned age 50 and had my first PSA at 1.3. The numbers have been rising ever since at what turns out to be a closely fitting exponential curve. In June 2012 my first biopsy was benign/clear although the PSA had risen to 6.1. In October 2013 my first MRI with and without contrast was also clear while the PSA rose further to 9.6. By my last test in September 2014, the PSA had risen to 12.7.
This year I switched urologists because I left my job mid-2014, and switched to CoveredCalifornia Silver to start 2015. I was focused on keeping my opthamologist and picked the carrier that he accepted. I didn't check beforehand on my urologist, and learned the hard way that she wasn't in the same plan. I wasn't totally fond of my urologist anyway. In September when I reported that my PSA was rising faster and now at 12.7, she asked what I wanted to do next -- another PSA test, an MRI or a biopsy. I'm all for patients owning their decisions, but shouldn't the doctor be advising on this step, I thought. My new guy was the opposite. In late January, at my first appointment he looked at my PSA trend graph I brought along, and said well if you don't have cancer yet, get ready for it sooner or later because you most likely will, and you're going in immediately for an MRI to scope things out.
So, February's one hour MRI prostate exam was performed at Rolling Oaks Radiology in Thousand Oaks CA. Luckily it was in my insurance plan. The exam involved an endorectal coil without and with contrast, with 3.0 Tesla equipment and T2 imaging, etc. It showed a 10x5 mm smudge in the left ventral transition zone in the mid gland that needed to be biopsied. Maybe the best news was no signs of spread.
In March, the same place performed a two-core MRI guided biopsy. While I understood zeroing in on the smudge area, I asked why there weren't additional cores taken to evaluate possible spread within the prostate. The answer was that if cancer was confirmed then there was no further need to identify more of it. Frankly, this didn't seem like a logical answer to me. The biopsy result was Gleason 3+3= 6/10 from from both cores. The tumor site was the left anterior mid gland, and its size was .75x.75mm and 9% of total core volume.
My close friend is a smart and analytic guy, and unfortunately both his parents had gone through various cancers including prostate. His main advice was to slow down and get educated, and told me that luckily in one sense, prostate cancer is slow growing so a person doesn't usually have to rush hastily into life changing decisions. I discovered this site as part of my research which has been a god-send.
As a result of all the inputs and the cancer confirmation, in mid-April I made consultation appointments with Dr Desai, a 2,000+ prostate robotic surgeon at USC, Dr Ballas of Oncology at USC, Dr Paul Miller of Coast Oncology in Thousand Oaks closer to home, and Dr Scholz at Prostate Oncology Specialists in Marina Del Rey.
Last week based on how the appointments lined up I saw Dr Desai, the prostate surgeon. As expected, he feels I am an excellent candidate for surgery and believes that my best option is complete removal via surgery. He feels that based on my data, removing the gland and two lymph nodes should fully eliminate the cancer. I mentioned that I hadn't had a PSA test in six months, so he agreed to prescribe one. Last Friday I received the number and unfortunately, it has risen to 16.8. His associate doctor called me and said I should still check out radiation to satisfy myself, but he thinks brachytherapy is out due to my intermediate risk classification and the rate of growth in PSA. Also that they'll need to do a bone scan to check for spread, and surgery still seems to be the best option. Their warning to do a bone scan is probably the most fear-inducing statement I've received out of this whole saga. Hope it hasn't spread, of course.
My next appointment is with Dr Scholz, although the office just called and he's not available for over a month and suggests seeing Dr Turner in the same practice instead. I told them I didn't want to wait a month so I'll see Dr Turner. These doctors don't do surgery or radiation, just consult and support patients in watchful waiting. So I'm looking forward to this appointment to get advice from an expert with maybe a bit less conflict of interest in the choice of advice.
The more I read, the more I consider radiation instead of prostatectomy. There are many articulate posts here that highlight the positives of both. I'm envisioning 25+ years of living with the results of the upcoming procedures but trying not to add more pressure to the decision process. It seems therapeutic to talk especially to my friend about this subject, and now to write about it even if no one reads it. So, thanks to Healing Well for letting me air this out, and any thoughts and comments would be appreciated. Thanks in advance.