The post-operative pathology report is done and the news is good. You may remember we wanted clean margins, nothing in the vesicles, and nothing in the lymph nodes. That's exactly what they found. Other good news was the Gleason score didn't increase and they found that only 5% of the prostate was cancerous. Usually, once the prostate is removed, sliced, and examined they find more - and more dangerous - cancer than could be seen from the extremely small biopsy cores. In my case, one of those cores was 100% moderately agressive cancer. We were warned to expect the post-op report would look worse than the biopsy. Now it appears the biopsy doctor just had remarkably good aim.
The most immediate implication of this report is no follow-up radiation appears to be needed. After all, where would they aim the thing?
This new has let us relax a lot. Of course there is still cause for concern. For one thing the peri-neural invasion meant those dangerous grade 4 cells had blood vessels available to ride out of the prostate. So we're in a similar position to the one we face when we find a door to our house has been left open. Did one of the cats get out? The only way to know for sure is to search the house counting ears (we look for exactly eight). You can almost never find all the cats at the same time, though, so we end up having to wait and hope we see each of them soon.
The test for escaped cancer cells will be the follow-up PSA tests. The first one is in about three weeks. I'm fairly confident the first couple of tests will show very low or undetectable PSA. Any new cancer cell colonies would probably be microscopic at this point. Most important is that over time we don't want to see the PSA rise at all, which would indicate that microscopic colonies of prostate cancer cells were turning into real tumors. At that point the long-term prognosis would not be good.
Another risk factor is my age. Conventional wisdom has it that cancer in "young" guys like me tends to be more agressive. I don't know that there's much data to support that, though.
Finally, the rate at which my PSA was rising (the "velocity") before diagnosis was alarming. I don't put as much stock in velocity as I do in the post-op pathology, though. The pathology data is much more concrete.
So if my age, perineural invasion, and velocity are not taken into account then the nomograms show a chance of recurrance that is a little less than 10%. I'm guessing those extra factors put the odds somewhere over 10%. That's still much better than the odds we thought we were facing just a few weeks ago and it's enough to let me plan a future for my family that still includes me.
Oh, and while I don't want to be overconfident about it, it appears side effects aren't going to be a significant issue at all. I feel a little guilty saying that because so many men struggle for months or even years. Being diagnosed with an older man's cancer at age 43 has sucked, but one consolation is my recovery seems to be taking only days.
Ironically, the removal of my final tube was delayed this week because I was too continent. Apparently the internal plumbing, which is severed and reattached during surgery, was still a little swollen. They left the catheter in so I didn't fill up like a water balloon while we waited for the tubes to open up. It's scheduled to come out today.
So what's next as I acclimate to the lower-grade stress of follow-up PSA tests? Making my body as inhospitable as I can to any cancer cells that may be trying to set up new homes. I've already been losing weight and excercising and I'll keep that up. I'm also making even more significant dietary changes, pretty much eliminating red meat, limiting meat in general, and eating foods that have been shown (in actual peer-reviewed research) to be associated with lower incidence of cancer. Unfortunately that means pretty much a complete reversal of my farm based meat-and-potatoes diet. Fortunately, one of the recommended foods is cooked tomatos. Tomato sauce is one of my favorite foods. I could literally eat it every night of the week.
And fortuately that will start tonight, when the Orwigs go out for pizza to celebrate. The Twinlets still won't be able to sit on my lap at Cottage Inn due to Daddy's "boo-boo", and I'll have to be careful of my fluid intake. But that's fine for now. I'll take it.