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I Have Cancer: Now What? Deciding On My Treatment Plan

Moving forward and leaving behind the negative is the best means to being healthy both mentally and physically.

I would really rather be doing this with my son than trying to decide how to deal with this cancer crap.

I would really rather be doing this with my son than trying to decide how to deal with this cancer crap.

If it's on the Internet, it must be true.

I begin my research into the different treatments that are options for me. When I read my Pathology Report from the biopsy, it states that there are two areas which indicate cancer:

"Prostate, lesion 13, needle biopsy: - Adenocarcinoma, Gleason score 6 (3+3), grade group 1, involving 1 fragment and comprising approximately 10% of tissue."

"Prostate, left apex, random 3, 5, 6 near lesion, needle biopsy: - Adenocarcinoma, Gleason score 6 (3+3), grade group 1, involving 1 core and comprising approximately 13% of tissue."

First, a Gleason Score. This is a combination score of two indicators. Mine came back 3+3, which means most of my prostate's tumor is made up of medium grade cancer cells, while the rest of the cells are made up of medium grade cancer cells. As both are Grade 3 (medium) grade that means my tumor is equally cancerous throughout. A score of 7 (3+4) would mean a lessor portion of the cells are of a higher grade of cancer. A Gleason 6 is kind of middle of the road, low grade cancer which is good for me. That indicates the cancer has not spread and is not currently beyond my prostate. So treatment has a good chance of being successful and I can live a reasonably normal life with proper care.

Option 1: Brachytherapy

Brachytherapy it is called. What it means is radioactive bits, or seeds are implanted in a very specific area in order to destroy the cancerous cells. They use Iridium-192 as the radiation treatment and this can be accomplished in as few as five treatments. This is a means of destroying cancer which may minimize damage to the surrounding tissues. May minimize.

Side effects of this treatment may include bowel issues, incontinence and sexual functions. So, I may pee myself uncontrollably, have diarrhea and loose bowels, and not be able to make love to my wife. Great.

These may be short lived side effects, but some of these may last longer than others. Loose and bloody bowel movements are a higher probablity than other treatments but urinary and sexual side effects are less, so a trade off seems to be offered: Crap yourself more, loose and bloody craps, and have more control (maybe) of my sexual functions.

However, surgery offers more side effects than this, and these can be long lasting.

  • Brachytherapy - Mayo Clinic
    During brachytherapy cancer treatment, radioactive material is placed inside your body. Find out how brachytherapy is done and who it's for.

Option 2: Radical Prostatectomy

Surgery, real surgery. An incision in my abdomen in order to remove my prostate completely, thus ridding me of the cancer contained within it. The preferred method is the daVinci Surgical System, which is a robotic procedure that allows the surgeon greater dexterity and control in order to minimize the risks.

And this method has its side effects as well. Possibly severe incontinence and sexual issues accompany the likelihood of not having the cancer in me any longer.

So, the choice seems to be to either have possible bowel issues that range in length from six months to life but have better ability to control my bladder and sexual functions, or lose control of my bladder and sexual functions and maintain control of my bowels.

What a great choice.

More good news

If I have it removed, I will be using a catheter for weeks, maybe months. Complicating this is the fact that our son and I will be alone in Branson while my wife cares for the pets two hours away. I will not have her to depend on, to care for me in my convalescence, or to care for our son while I am laid up. That's not good.

Having the seeds implanted has a different problem associated with it: I will not be able to be around my grandchildren while undergoing this treatment. I guess the radiation is high enough to possibly be deadly to a young child. So, that means no bouncing grand-babies on my knee for who knows how long. Will the treatment be five sessions; ten; more? Will they be weekly, monthly? Could this stretch out for months, maybe not seeing them until summer? That is not good either.


PSA Readings over the last four years

DatePSA levelAcceptable LevelAge

November 2, 2017

5.5

<=3.99

57

September 6, 2018

5.05

<=3.99

58

July 15, 2019

4.61

<=3.99

59

June 4, 2021

5.64

<=3.99

61

July 7, 2021

5.08

<=3.99

61

Tuesday, December 7, 2021: Dr. Anderson

I met with a surgeon to speak about removing the prostate completely on Tuesday afternoon. He began by asking what he could do for me. I told him I was referred to him by another doctor to speak about surgery and the options associated with it, along with the side effects. We had a long discussion, me asking questions and he answering them.

Then he dropped a bombshell on me. He preferred I didn't have my prostate removed. And asked why I thought I needed it out.

I told him the other doctor had made me feel this was a serious situation, going from PSA test in September to MRI in October to biopsy in November to consultation in December. I was seriously scared and worried and needed to know how best to proceed. He then dropped another bombshell: the reason I was here was due to the doctor who did the MRI and biopsy. He explained that this particular doctor had decided that every man who came in who had elevated PSA was going to have an MRI; then they would have the biopsy. No exceptions, every single one. I told him that something this doctor had said to me at the time had concerned me. This doctor had told me after the biopsy results that he was a "broker" for other doctors; this sounded, well strange. The doctor laughed and said yeah, that was a strange way to put it. But that doctor had decided he was going to be "that person", who pushed people in a particular direction.

The bottom line was, I could proceed with the surgery and have it removed, then deal with the side effects for six weeks to life, or I could have the radiation seeds implanted and deal with those side effects; or I could do what he felt was best for my particular situation: wait and observe; watchful surveillance he called it. Have a PSA test every few months to see if the levels rise and if they do, have another MRI. According to him, I have an 85% chance of being alive in ten years by doing this.

Then he gave me another option: have my cancer cells analyzed in something called a Prolaris test to see if they are actually likely to metastasize. If they are, then we act sooner; if not, then we can safely wait and see what happens. This was new, a genetic DNA test on the cells which will give even more information about what might be happening and when it might happen.

I spoke with my wife, and I think we are going to pursue this course if my insurance will cover it. I will be contacting them today to see and if they do, I will call this doctor and have him go ahead and send the samples off.

UPDATE: I contacted the insurance company and they confirmed it is covered, so we are proceeding in that direction now.

However, I am keeping my appointment tomorrow with the radiation specialist to determine if this is a better alternative to surgery.

So, for now, I have the option of DNA testing, radiation seeds, or surgery. Hormone treatment only delays the cancer, which can eventually overcome the treatment and continue to spread; evidently it doesn't cure it or kill it.

  • Prolaris | Prolaris
    The Prolaris test is designed to assess prostate cancer aggressiveness. It is the only test that measures how fast prostate cancer tumor is growing.

And still more options come to light

Thursday I met with the radiation therapy doctor who was very positive and upbeat. We discussed my situation and the other options I had received along with the diagnosis and the speed of which this had come about. He agreed that surgery could be put off for the time being, and explained the seed implantation method along with the positives and negatives associated with both methods. He also agreed that hormones were a less desirable method for me at this point.

Then he mentioned external radiation. Honestly, this was the least desirable option I had researched, yet when he described what he could offer I was intrigued. However, it is not without its negatives as well. Basically, any treatment has some negatives associated with them you just have to weigh them against your particular situation. There is a slim possibility (1 out of 1,000) that I end up with a colostomy bag.

Low dosage radiation daily, five days a week for two months. Each treatment is only 20 minutes, but I currently live an hour away. I probably won't lose my hair (not that I am concerned with that; wouldn't mind not having haircuts or shaving for a while, although my upper lip hasn't seen the light of day since January 1980, and my chin since the 1990's) and I can have my grandbabies sit on my lap without worrying about their health. So for two full months I would have to drive, alone, an hour there; undergo the treatment, then drive another hour back to where my son and I are living.

He agreed to get with the other doctor and pursue the genetic information then let me know how that develops before beginning treatment. One thing he is concerned with on me is the size of my prostate. Normally, it is walnut sized; mine is apple sized. He is surprised I am not having more trouble with my urination than I am, and it could become an issue moving forward if it continues to grow. So, regardless, I might have to have it removed. So many options!

One final twist...

My former employer is contesting my unemployment. Even though they decided we were no longer desirable and they wanted "out of the employee business" by the end of the year, they are fighting me and the others who resigned based upon their decision. So, income will be an issue. I spoke with the SSA today and as I am 62 can take early retirement now. Then, I learned I might be able to take disability SSA as I will be undergoing treatment and that could/will affect my ability to work or even have a good quality of life, depending upon what I have to do.

For now, I am going to wait until I hear back on the genetic testing before making any decision. That could be two weeks or less. Stay tuned.

This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.

© 2021 Mr Archer

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