So, on our last post we discussed the biopsy process. We discussed that your Urologist likes the TRUS approach. You agreed to it and had it done. The results show that you have Prostate cancer. It is now important to learn things like the extent of your cancer and what your Gleason Score is as that will determine what treatment options you have!
Let’s follow the discussion you will have with your Urologist when he meets with you to discuss options. The Urologist says she has sone news “we” need to discuss, and can you be at her office tomorrow at 10? Of course, I can hardly wait as this should be a barrel of monkeys, right? Obviously, I jest, as there is nothing fun with this discussion. But it is like paying taxes or getting a root canal. It does not have to be fun, but it must happen. No time like the present
Your Urologist explains at your appointment that the biopsy has come back positive and this positive is not a good positive. This positive says the biopsy shows cancer in one of the twelve zones of your Prostate or in multiple zones. Again, I will use personal results to help in this discussion. The Urologist says the Pathologist sees cancer in 9 of 12 zones. However, the good news is that the cancer is completely contained in your prostate and has not metastasized to the lymph nodes or adjacent structures. Trust me, at this point you will take any positives you can get.
The Urologist will also share with you Where the cancer is and what it may mean. Based on the distribution of your Prostate cancer, you get a Gleason Score of 3 + 4 for a 7. This puts you in an Intermediate category and at least it is better than a Gleason of 4 + 3 for a 7. And it is much better than a Gleason Score of 8-10. But it is not as good as if you had a 3 + 3 or 6 Gleason Score. Clear as mud, right!?
If you had a Gleason score of 6, then the prognosis would be to wait and watch for a few years and hope it does not change. Since you had a 7, we need to take action. Further, we need this action to be taken within the next few months! The doctor says your options are a Prostatectomy to simply remove your prostate and eliminate the gland all together. No more cancer then, hopefully, ever! The other option is to do radiation to remove the cancerous cells and spare the rest of your Prostate. Thus, with radiation you still have a Prostate. Lastly the Urologist is going to suggest that you meet with the surgeon that does all their Prostatectomies and the Radiologist that runs their location that houses the External Beam Radiation machine. If you choose radiation this is the doctor that will manage your treatment.
I am going to speak in a personal voice for a minute as I think that is the best way to get the important details to you. I followed the Urologist’s advice and set up 2 appointments. First, I met with the surgeon and had a very constructive discussion around his use of a robot and the fact that he was trained on a robot and does every case with the robot. He also took the time to explain to me how using the robot, as opposed to the 100+ open Prostatectomies I had seen, are now much easier on the patient and the side effects are greatly reduced. Unfortunately he could not give me a 100% assurance that I would not end up impotent or wearing an adult diaper. Two real fears I have when looking at this procedure.
I then met with the Radiologist that runs (or ran, as he has moved to Miami recently) the Radiation Clinic. Another exceptionally good discussion and I came away from it with a good feel for what it would mean to do radiation. He also explained that if I chose radiation, he would prefer to do 48 treatments, but the insurance company may only approve 28 treatments. Thus, the treatment is dependent on what the Insurance company will approve.
Now we have covered this issue from the first PSA test that comes back “Abnormal.” We conclude with you being at the point that a decision has to be made. What are you going to do, radiation or a Prostatectomy. It is a very sobering thought process, but it is critical to your health and well-being as you get beyond this issue. I cannot tell you what to do. I can only outline what I did and how I am recovering. I truly hope it can be helpful if you are ever at the point of facing this monster.
In my next series of posts, we are going to look at Prostatectomy versus Radiation. I always want to keep this site and blog relevant and honest. With that said, I will deliver to you a “patient’s” perspective of what having Radiation meant. Since I have never experienced a Prostatectomy, I am going to introduce you to a dear friend of mine who has had a Prostatectomy. He will walk you through, from a “patient’s” perspective, what this procedure means for your long-term health. Hopefully between the 2 of us we can help you see what it is like to have a Prostatectomy or do Radiation. Of course the decision is yours and we are trying to add perspective to your decision.
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