Confirmation And Schedule

As planned, I met with my radiation oncologist on June 27, discussed the details and the risks of the procedure, and signed the consent form. Twenty minutes later I went through the set up process on a specialized CT machine and got a couple of new tattoos for alignment purposes. The treatment dates are set (July 11, 12, 16, 17, 18). Now the game is to stay healthy and positive for the next 3 weeks. I'm in the groove and ready for it. Everything is good.

The Medical Oncologist Weighs In On The Treatment Plan

Yesterday I had a meeting with my medical oncologist to talk about the role of drugs in the treatment of prostate cancer. You can spend all the time you want reading peer reviewed research papers and listening to smart and accomplished people working in the PC world (and you should), but there is nothing like a face to face with a doctor who knows you. There are two big takeaways from our conversation. First, regarding treatment approaches, the doc said that there are a lot of data and a lot of protocols, but instead of applying them blindly it's better to form a plan for "the man in the room" based on that man's specific circumstances. Second, my desire to avoid androgen deprivation therapy (ADT) at this time is acceptable to him and he supports the treatment plan. He mentioned that newer technology like SBRT is showing tremendous value in individual cases, but it will take years to collect enough data to change the standard of care. I mentioned this in my book. Take survival statistics with a grain of salt, because to analyze something like  survival rates over ten years requires ten years worth of data. The best treatments for PC ten years ago have improved considerably. This is the same with many other cancers and diseases other than cancer. 

I feel good about the meeting because the doctor that I know and trust supports the plan, confirming that my choices are not mistakes. I also feel privileged to have such a solid team of doctors and healthcare professionals looking after me.

The Process Moves Forward; Consent and Set Up Session

I now have an appoint for June 27 to get the radiation treatment program started. At 10am I see the doc for a detailed explanation of the treatment and any Q&A. Then I sign the consent form, which I call the "death warrant." Pretty much every consent form ends with something like "up to and including death." It's good to read it because it may bring up a few more questions and the doc is right there to answer them. 

From there I head downstairs for the set up session, which includes a special type of CT scan designed to accurately locate the target. This will be the fourth time I've been through this and as I recall it's simple for me and non-invasive. Data gleaned from the scan is compatible with the planning software used by the doc, the physicists, and others. It's one big integrated system. I'm pretty sure the admin who handles scheduling is already working on treatment dates. I told her I wanted to start ASAP and prefer mid-morning. The actual treatment is five sessions with a day between sessions and the weekend off, so the whole thing is complete in less than two weeks. 

That's the nitty gritty, but underlying this is the fuzzy fear and anxiety about the whole damn thing. It's a lot of "what if?" questions. What if the cancer has already spread to other locations? Am I doomed? Can they be treated? What if my PSA continues to rise but the cancer can't be found? Will this treatment last, or will I be in trouble again by Thanksgiving? Does PC prove to be the assassin, emerging from the shady gang of other cancers? Is this going to fucking kill me? I could go on and on. I personally like to break it all down logically. I can do it my head, but making notes or writing about it can solidify things and help prevent backsliding to the fuzzy world. When I'm satisfied I compartmentalize it and just put it in a box. Fear and anxiety dissipate. I can re-visit the box whenever I need to, but it always goes back in the box. And no, I'm not talking about a literal paper box. This is a psychological technique.

Compartmentalization is a good way to maintain your physical and emotional health (which are completely intertwined) and to stay focused on the outcome that you want. I wrote about it in my book. You should take a look at it because it applies to many challenges you face in life.

Decision Made

My decision is to go forward with radiation treatment for the single lymph node that has been definitively invaded by prostate cancer. I'm hoping to get some additional information that will confirm the wisdom of this decision, but I don't want to wait too long and give the PC more time to spread. I contacted my radiation oncologist today using the hospital's internal messaging system. I hope to hear from them soon. Update: Heard from the doc last night. He answered some questions and will begin to setup the treatment.

Unrelated to PC: Today I saw an ophthalmologist who specializes in treating uveal melanoma. It's a rare form of malignant cancer that forms in the back of the eye and can be fatal. Patients who have a BAP1 mutation are especially susceptible to this disease as well as half a dozen other cancers. This single mutation is the reason I've had so many other cancers. I see this doctor annually and I'm happy to report that my eyes are normal. Great news! I'll take any win I can get.