Cancer – back to battle stations.

From prostatecancer.ca

Cancer is no stranger to the Murray household. My wife successfully battled two versions of non-Hodgkin’s lymphoma, the first arriving in 2001 and the second in 2013. Thanks to an alert (and superb) family doctor and the world class expertise of Sunnybrook’s Odette Cancer Centre, she has made a complete recovery and leads a full life.

Imagine my annoyance and indignation to find that I too have cancer.

It started with a routine suggestion from my doctor to have a PSA test. This is a test that measures something called prostate-specific antigen. As men age, prostate antigen levels become higher. Cancer raises PSA levels too. I had resisted getting tested in the past because – well I just had. Put it down to boundless confidence in my immortality, some doubts about the test and yes, ignorance. About 12% of white men will be diagnosed with prostate cancer in their lifetimes. For black men, the incidence is considerably higher while it’s lower for Asian men. The good news is that most men die with the disease rather than from it. The bad news is that it’s an unpleasant way to die. As some wit once said, “I’m not afraid of dying, I just don’t want to be there when it happens”.

From Ontario Ministry of Health and Long Term Care.

Anyway, in response to my mild concern that something might be happening ‘down there’, the doctor suggested and I agreed to the test. The result was double the normal level for my age and the follow-up specialist recommended a biopsy. Prostate tissue samples can confirm but can’t eliminate a cancer diagnosis as the samples may not be from an affected area of the prostate.

The biopsy was done a week later in the specialist’s office. Without getting into the gory details, I was bent over a bench and it felt like an electric stapler barging around and firing inside my body. Definitely a moment requiring a stiff upper lip! Thankfully it was done quickly and efficiently. I waited three weeks for the results, expecting the ‘all clear’ and wasn’t particularly concerned.

The news was broken matter of factly in the specialist’s busy premises, “Out of the twelve samples we took, ten were cancerous”. I sat in a daze while he handed me a pamphlet and talked about a ‘Gleason Score’ (lower is better; my score was 7, indicating a moderate involvement – maximum is 10) along with probabilities and options for treatment. Luckily my wife was there and asked some pertinent questions.

Treatments for prostate cancer depend on how far it has progressed with options narrowing if the cancer has spread beyond the prostate. Basically the major options are:

  • Active surveillance if the involvement is low and / or the patient is older.
  • A radical  or partial prostatectomy (Removal of the prostate) if the cancer has not spread elsewhere.
  • Hormone treatment to suppress the body’s testosterone production. (Prostate cancer grows a lot slower in the absence of testosterone.)
  • Various radiation options to attack the cancer cells.
  • Chemotherapy (These last three treatments can be used in combination.)
  • Palliative care -if the cancer is incurable.

Surgery is ineffective if the cancer has spread much beyond the prostate.

To determine treatment options, bone and soft tissue CAT scans were ordered. This was deja vu for my wife and brought back vivid memories of her own long agonizing hours spent in treatment and waiting for test results. After her first diagnosis she had radiation and in 2013, six chemotherapy treatments (every three weeks) with accompanying hair loss.

My CAT scans were clear indicating that the cancer hasn’t spread. What now? Luckily, I have the option to have the damned thing removed. This will likely eliminate the need for radiation and hormone treatments. The surgeon has ordered an MRI of the region so that he can plan his attack and the operation should take place in the next few weeks.

In the meantime, I’m 99% symptom free and a few weeks after the operation should be able to return to a ‘normal’ existence. I’m lucky that I have a loving wife to take care of me and access to a health care system that is second to none.

Note to men over 40: it’s probably a good idea to get a PSA test done so that a baseline reading can be established. The test isn’t totally reliable – see the diagram above – but it’s a useful diagnostic tool.

If members of your family have had prostate cancer you may be at increased risk. Early detection improves your chances and treatment options.

For more information go here.