The summary: recurrent prostate cancer
In short, I've agreed to start with two standard therapies for recurrent prostate cancer – eight weeks of pelvic radiation (five times a week) – and six months of hormonal therapy (i.e., testosterone suppression). Several more tests are scheduled, so the start date will likely be early May.
The detail (probably mostly for myself so feel free to skip): 😏
Last week's PET scan and MRI delivered for me the most common result — no tumors large enough to be detected by today's technology.
According to MSK Radiation Oncologist, Daniel Shasha, my PSA recurrence most likely means prostate cells in pelvic lymph nodes. Twelve lymph nodes had been removed and examined as part of my January 31, 2019, laparoscopic prostatectomy, with no sign of prostate cancer. Unfortunately, there are actually many lymph nodes in the pelvis, which is why it is a common area where recurrence takes place without initial detection.. Fortunately, as he reminded me, my Gleason score – originally thought to be an aggressive 8 – was actually determined to be 7, meaning somewhat less aggressive than originally diagnosed.
With no therapy, 35% of guys in my condition will have metastatic prostate cancer within a decade – and, yes, standard therapies greatly reduce such odds. However, if I was 83 rather than 73 – or if I had a family history of early death due to anything other than prostate cancer – I might consider taking my chance with no treatment.
Given my family's history of relatively long lives, however, it seems worthwhile for me to put up with 6-8 months of unpleasant side effects.
The six months of hormone therapy is simple. Two shots in the rear, each lasting for three months, during which time I will become very aware of what many women experience as menopause. Simple, but certainly not very enjoyable.😒
The eight weeks of radiation therapy means increasing physical and emotional fatigue, coupled with some (hopefully mild) temporary issues with the organs in the pelvis – bladder, bowels, etc. This on top of the menopause experience! If therapy begins in early May, that probably means June and early July will be a very challenging period for me. 😕
In the meantime, I plan to make the most of every day, which becomes easier as we move into spring. It helps that city vaccinations continue increasing and local restaurant constraints continue decreasing. 👍