It's cancer. I got the dreaded call on Tuesday and have been in anxiety/panic mode ever since. The urologist who did the biopsy called me and told me this is a "garden variety" prostate cancer, moderately aggressive, and the kind they treat and even cure regularly. I asked if he could tell anything from the biopsy about the chances the cancer had spread, and he said no but statistically it was unlikely. Now as I have read the odds since (they actually have something called the Partin Tables that break the odds down by PSA and Gleason score) it's not that unlikely to have spread. In fact, the Partin tables say there is a significant chance it has gotten out of the prostate capsule, although even in that case a skilled surgeon can sometimes get it all or it can (maybe) be cleaned up with radiation.
The doctor said I should explore all my options, but at my age and with this more aggressive form of the disease (Gleason 7) he would advise that I:
- Treat it. With the least aggressive prostate cancers (Gleason 6) and older men, sometimes the patient can make a choice just to "keep a close eye on it". The odds of it actually spreading to the point of being life threatening before the man dies of other more-typical things are low enough that it's not worth risking surgery, radiation, or the side effects of either. But that's not true for a 43 year-old with a Gleason 7. The doc said that untreated, the chances of it "causing me problems" in my lifetime are quite good. In other words: It will likely kill me if I don't do something.
- Get the prostate removed. I'm learning this is something of a religious debate in the prostate cancer world. There are those who strongly prefer surgery (the "get this out of me now!" crowd - of which I am currently a member) and those who prefer radiation for various reasons (lower risk of side effects, similar outcomes, etc), and those in-between. There is also androgen-blocking therapy (drugs that limit the production of testosterone can limit prostate cancer cell growth and maybe even kill early cells in some cases), and chemotherapy, which is really only useful against the most aggressive types of prostate cancer. This doctor said I should explore my options and the decision was up to me, but his advice was to have the prostatectomy.
I've since had advice to do the prostatectomy from two other doctors we know socially. I haven't really given the radiation oncology advocates equal time yet but I will.
On Friday afternoon I visited the U of M Hospital records area (basically a nice woman with a web browser and a printer) and got my actual pathology report. The good news is my Gleason 7 (moderately aggressive) is made up more of less-aggressive 3 cells than of more-aggressive 4 cells. So I initially felt better on reading the results. But the results also show that one of the twelve cores is actually pretty scary in a few ways. Cancer is in a nerve area, which can be a route for it to spread. It also suggests a tumor that goes right to the surface and maybe beyond. And it appears to be mostly in the apex of the prostate, which is where positive margins most often occur.
Fortunately, last week I was able to get an appointment for Monday the 31st (23 hours from now) with an excellent surgeon at Henry Ford's Vattikuti Urology Institute. I'm really looking forward to hearing what he has to say. My hope is he'll be able to soothe our anxieties, but I don't know. We'll see.
Calm is of course a relative term for me now (and probably for the rest of my life). The best survival outcomes, for biopsies better than mine, are in the 90% range projected over years. As cancers get more aggressive and if the surgery leaves some behind those numbers drop sharply. So this is very scary.
I'm looking forward to asking my questions tomorrow . . .