IADT3since2000
12-27-2007, 01:10 PM
This is another significant day for me, and in the joy of the Christmas season of 2007, feeling great and with my prostate cancer reasonably under control, I vividly remember December 27 of 2000.
It had only been about three weeks since my fateful first-ever PSA result of 113.6 that I received out of the blue on Pearl Harbor Day 1999, and events had moved quickly since that afternoon. (I doubt that the Pearl Harbor defenders had been more surprised, stunned and shocked than I and my wife had been. :confused:)
By evening I had arranged an emergency appointment for the first thing the next morning with a urologist recommended by the internal medicine doctor I had seen for my expected "routine physical" - the doctor who had told me he did not think I needed a PSA, but who had yielded at my insistance. The urologist did my first DRE, describing the prostate as "rock hard throughout," and followed with a biopsy a few days later, after I had squeezed in a business trip, which actually was a most welcome distraction. (I still remember much of what I did on that trip, including seeing a football game on the big screen projection TV at the motel, details that are far clearer than for any other of the many business trips I have taken.) I had also decided to tell my boss and upper management about my situation and did so after the urologist's exam. But no one else at work knew.
That biopsy revealed a GS 3+4=7 cancer, later changed by an expert pathologist to 4+3=7, with all cores positive, most 100% cancer, and perineural invasion. That's a terrible biopsy result, but I would learn later that it could have been worse.
On December 16th I called my brother-in-law's father, a urologist who had just retired. He was generally reassuring and empathetic, but he also told me he never heard of a PSA as high as mine! Yeah, that was not so reassuring! :(That's also the day I slipped on the two lowest stairs coming to the first floor for breakfast and jammed my shoulder, spraining a ligament, which would take months for recovery. But the day had gotten better as my boss had given me an encouraging mid-year review and our office had held a pleasant Christmas party.
On December 20th, while the first doctor was on vacation without leaving clear instructions about me with his staff, :( I arranged an appointment with a more senior associate, who squeezed me into his schedule, and had a bone scan, a CT scan (both of which turned out negative), and got my first Lupron shot. That was done because the doctors and I suspected a fast moving cancer and we figured the Lupron would give me a chance to catch my breath so to speak and set the cancer back on its heels for a while. (Also, a relative with prostate cancer was telling me that I would be crazy not to get a Lupron shot!) I was grateful that this doctor said he thought hormonal blockade might help me a lot. I also noticed that the doctor's peers had rated him one of the best urologists in the city, as reported by the Washingtonian Magazine. But neither he nor any other doctor to this point had really spent much time going over my prospects and options with me. Still, I didn't realize that I needed that, and I felt energized and in charge on that day.
What a difference a day makes! December 21 was the rottenest day I can remember. It was my last day at work before our vacation, and I was struggling to make essential progress before leaving, while realizing I was catching a cold. I had to integrate several complex Word documents to produce a complicated and urgently needed procurement request. By late afternoon I had it nearly finished, at which point my computer crashed! You can imagine the deleted expletives and panic! :( Fortunately, my deputy branch head had come to my rescue, saying she could get out the document if I could just reconstruct a few key parts. :angel: I was surprised how quickly I was able to do that, thank her from the bottom of my heart, and go home.
We finished packing so we could fly across the country to see our son and brother-in-law's family in the LA area. My wife was extremely worried, and I agreed to try to get a consultation with a doctor at a well known cancer institution just north and east of LA that my brother-in-law's family knew well. A respected urologist agreed to see me after Christmas.
I remain so grateful for the two hours he spent on December 27 with me, my wife and son in an informative and profoundly compassionate consultation. :angel: He went over what the results all meant for me, including my PSA, the DRE, the biopsy, and the bone and CT scans, which helped clarify what I had learned from fine material I had received from the American Cancer Society. He confirmed the DRE, but thought the PSA might be a lab error because it was so extraordinarily high for a newly diagnosed patient and ordered another one. He gave me advice on seeking a doctor to manage my case, noting that the doctor who had done my biopsy was not a board certified urologist and expressing some doubt about his management of my case, reinforcing a growing skepticism on my part. He reviewed options, including surgery, brachytherapy, cryo ("too experimental"), external beam radiation, and a combination of therapies. He recommended a few doctors he knew of back on the East Coast and in the Washington area, stressing that my case needed expert handling.
At my insistence, he reluctantly gave me a prognosis. At this point, still stunned by my extraordinarily high PSA, my wife and I thought I might have only months or a year or two to live. So when he said I probably had about five years - three good years and two declining years, that was actually a relief and sounded good! That estimate of five years was based on doing all I could to combat the cancer.
I still have high respect for this doctor, and I noticed that he was a presenter at the recent National Conference on Prostate Cancer 2007, which was held this year in LA. But I don't recall that he reviewed hormonal blockade in detail with me, and I gradually learned that many urologists are not very familiar with that therapy, and no doubt were much less familiar with it at the start of 2000. However, he did say that Lupron should give me two to three years of good quality of life. As it turned out, a later ProstaScint scan indicated there was no detectable soft tissue metastasis, and intermittent triple blockade with maintenance has been a godsend for me. I am now enjoying an excellent quality of life at the eight year point and look forward optimistically to many more years. Ironically, I later learned that most of the leading experts on hormonal blockade are located right there in LA, and one of them was an adjunct professor at the very same institution where we held the consultation.
About that PSA he had ordered - I had to call several times over two weeks trying to get the result, getting the old run-around, and finally they said they thought their analyzer was broken. Actually, it wasn't. Finally the doctor intervened, and broke loose the result: 125, higher than my initial 113.6. The unusual magnitude of the score in a newly diagnosed patient and the increase from the original PSA had led the technicians to suspect a broken machine. Great. Just great! :( The doctor reassured me that the increase was almost certainly due to "flare" from the early days of the Lupron shot, and that the PSA would shortly plunge. That proved true, to our great relief! :)
As it has turned out, I am now doing fine, with the cancer incurable with current technology but in decent control, and I'm enjoying an excellent quality of life. :angel: I expect I will have to have another round of blockade in a few months, but I'm fairly confident that blockade will again work as well as it has in the past. :)
Jim
It had only been about three weeks since my fateful first-ever PSA result of 113.6 that I received out of the blue on Pearl Harbor Day 1999, and events had moved quickly since that afternoon. (I doubt that the Pearl Harbor defenders had been more surprised, stunned and shocked than I and my wife had been. :confused:)
By evening I had arranged an emergency appointment for the first thing the next morning with a urologist recommended by the internal medicine doctor I had seen for my expected "routine physical" - the doctor who had told me he did not think I needed a PSA, but who had yielded at my insistance. The urologist did my first DRE, describing the prostate as "rock hard throughout," and followed with a biopsy a few days later, after I had squeezed in a business trip, which actually was a most welcome distraction. (I still remember much of what I did on that trip, including seeing a football game on the big screen projection TV at the motel, details that are far clearer than for any other of the many business trips I have taken.) I had also decided to tell my boss and upper management about my situation and did so after the urologist's exam. But no one else at work knew.
That biopsy revealed a GS 3+4=7 cancer, later changed by an expert pathologist to 4+3=7, with all cores positive, most 100% cancer, and perineural invasion. That's a terrible biopsy result, but I would learn later that it could have been worse.
On December 16th I called my brother-in-law's father, a urologist who had just retired. He was generally reassuring and empathetic, but he also told me he never heard of a PSA as high as mine! Yeah, that was not so reassuring! :(That's also the day I slipped on the two lowest stairs coming to the first floor for breakfast and jammed my shoulder, spraining a ligament, which would take months for recovery. But the day had gotten better as my boss had given me an encouraging mid-year review and our office had held a pleasant Christmas party.
On December 20th, while the first doctor was on vacation without leaving clear instructions about me with his staff, :( I arranged an appointment with a more senior associate, who squeezed me into his schedule, and had a bone scan, a CT scan (both of which turned out negative), and got my first Lupron shot. That was done because the doctors and I suspected a fast moving cancer and we figured the Lupron would give me a chance to catch my breath so to speak and set the cancer back on its heels for a while. (Also, a relative with prostate cancer was telling me that I would be crazy not to get a Lupron shot!) I was grateful that this doctor said he thought hormonal blockade might help me a lot. I also noticed that the doctor's peers had rated him one of the best urologists in the city, as reported by the Washingtonian Magazine. But neither he nor any other doctor to this point had really spent much time going over my prospects and options with me. Still, I didn't realize that I needed that, and I felt energized and in charge on that day.
What a difference a day makes! December 21 was the rottenest day I can remember. It was my last day at work before our vacation, and I was struggling to make essential progress before leaving, while realizing I was catching a cold. I had to integrate several complex Word documents to produce a complicated and urgently needed procurement request. By late afternoon I had it nearly finished, at which point my computer crashed! You can imagine the deleted expletives and panic! :( Fortunately, my deputy branch head had come to my rescue, saying she could get out the document if I could just reconstruct a few key parts. :angel: I was surprised how quickly I was able to do that, thank her from the bottom of my heart, and go home.
We finished packing so we could fly across the country to see our son and brother-in-law's family in the LA area. My wife was extremely worried, and I agreed to try to get a consultation with a doctor at a well known cancer institution just north and east of LA that my brother-in-law's family knew well. A respected urologist agreed to see me after Christmas.
I remain so grateful for the two hours he spent on December 27 with me, my wife and son in an informative and profoundly compassionate consultation. :angel: He went over what the results all meant for me, including my PSA, the DRE, the biopsy, and the bone and CT scans, which helped clarify what I had learned from fine material I had received from the American Cancer Society. He confirmed the DRE, but thought the PSA might be a lab error because it was so extraordinarily high for a newly diagnosed patient and ordered another one. He gave me advice on seeking a doctor to manage my case, noting that the doctor who had done my biopsy was not a board certified urologist and expressing some doubt about his management of my case, reinforcing a growing skepticism on my part. He reviewed options, including surgery, brachytherapy, cryo ("too experimental"), external beam radiation, and a combination of therapies. He recommended a few doctors he knew of back on the East Coast and in the Washington area, stressing that my case needed expert handling.
At my insistence, he reluctantly gave me a prognosis. At this point, still stunned by my extraordinarily high PSA, my wife and I thought I might have only months or a year or two to live. So when he said I probably had about five years - three good years and two declining years, that was actually a relief and sounded good! That estimate of five years was based on doing all I could to combat the cancer.
I still have high respect for this doctor, and I noticed that he was a presenter at the recent National Conference on Prostate Cancer 2007, which was held this year in LA. But I don't recall that he reviewed hormonal blockade in detail with me, and I gradually learned that many urologists are not very familiar with that therapy, and no doubt were much less familiar with it at the start of 2000. However, he did say that Lupron should give me two to three years of good quality of life. As it turned out, a later ProstaScint scan indicated there was no detectable soft tissue metastasis, and intermittent triple blockade with maintenance has been a godsend for me. I am now enjoying an excellent quality of life at the eight year point and look forward optimistically to many more years. Ironically, I later learned that most of the leading experts on hormonal blockade are located right there in LA, and one of them was an adjunct professor at the very same institution where we held the consultation.
About that PSA he had ordered - I had to call several times over two weeks trying to get the result, getting the old run-around, and finally they said they thought their analyzer was broken. Actually, it wasn't. Finally the doctor intervened, and broke loose the result: 125, higher than my initial 113.6. The unusual magnitude of the score in a newly diagnosed patient and the increase from the original PSA had led the technicians to suspect a broken machine. Great. Just great! :( The doctor reassured me that the increase was almost certainly due to "flare" from the early days of the Lupron shot, and that the PSA would shortly plunge. That proved true, to our great relief! :)
As it has turned out, I am now doing fine, with the cancer incurable with current technology but in decent control, and I'm enjoying an excellent quality of life. :angel: I expect I will have to have another round of blockade in a few months, but I'm fairly confident that blockade will again work as well as it has in the past. :)
Jim