Thursday, April 24, 2008

What to do - The Decision

The Decision
The medical crowd give you a leaflet and send you off to make the decision. Between when Mr. L., gave us the bad news and our return two week later, I asked D. what she thought L. expected would happen next. She replied “He wants you to tell him what you want to do.” I said “That’s exactly what I thought.”
I reckon I’m pretty good at research. A lot of what I do for a living involves researching. My interest in genealogy is similar. Anytime I come across some theory or fact, I ask the question “How came we confirm or corroborate that?” So I’d done a lot of research on the net and come across a lot of good advice and info. Came across a lot of wacky stuff too. That’s the main thing; get to know when you’re dealing with crap and cut it out.

Watchful Waiting
For God’s sake, I’m just short of 55 and in excellent health and fitness – except for this ugly little “walnut” inside me. ..and the cancer appears to be a pretty aggressive bugger. Except for the cancer, I’d have a life expectancy of 35 years. Watchful waiting is for slow-growing cancers in people whose life expectancy is less than their mortality period for PC. No chance. Not for me.

Several people recommended this but I wasn’t convinced. You’re estimating the size of the prostate from ultrasound and trying to place radioactive pellets inside the gland. Apparently the pellets have a two mm “sphere of influence”. That’s fine if it works. There are plenty of stories about it not working, i.e. “It came back!” When I had the first consultation and DRE, I was told that I’d got “quite a large prostate”. After the first TRUS biopsy, it was “quite small”, and after the second TRUS, it was “on the larger size.” So….you expect to place pellets, 2 to 4 mm apart, throughout the gland and get full coverage. No chance.

External Beam
For a while EBRT looked like being the only show in town. Thankfully the MRI came back clear, so it’s still an option – one I don’t intend to take, but an option nevertheless. Btw, the fact that the MRI came back clear doesn’t mean that there is no cancer there, just that there is no gross malignancy.
I rejected EBRT for several reasons:
No pathology – can’t tell what Stage or Grade you have.
Extent – can’t tell if all of it has been eradicated.
Surgery – If you have EBRT, you can’t subsequently have surgery. Actually you can, but they don’t recommend doing it. Apparently it “bonds” the flesh in the region. Because of this, I reckon EBRT is too risky – you never know when, or for what reason, you’ll need surgery in the nether regions.
Long term side effects – Colon problems, painful and bleeding piles. Apparently the side-effects of radiation creep up on you. In my running experience, anything that creeps up on you is likely to be both chronic, have more side-issues and probably worse than the things that happen suddenly. As a medical advisor put it “The sins of surgery are upfront”.

When it appeared that surgery wasn’t possible, I started exploring what options were available for radiation. IMRT was pioneered in the Tyndall centre in Cork, however it isn’t available for patients in Cork. The nearest centre is in Waterford.
IMRT, Intensity Modulated Radiation Treatment, is a more focussed form and can therefore be better targeted, resulting in less damage to surrounding tissue.

[i'll add more here later]

Radical prostatectomy
The thought of this scares the shite out of me. I really don’t want to go there. I’m fit and healthy. Why bring this on me? Maybe I should emigrate to the South Seas and live happily ever after in permanent sunshine. Dream on!
I want this gone. I want to live a full life. My father, mother and elder brother were deprived of this.
For many years I’ve planned my retirement. I had planned retirement for sometime in the next three to four years, and it was to be an active and fulfilling retirement. The idea behind early retirement was to travel and do things while D & I both had our health. Two things have upset these plans; the economic climate has put a big damper on our pension fund and my cancer is the other. Both are outside my control to a large extent.
The market will return. The immediate thing is the cancer, and the pension won’t matter a damn if I don’t get it sorted. I might even be collecting life insurance – and where would we be then?

So the surgery: Why?
It will be gone, gone, gone – I hope. Mr. Q says he will be taking the Prostate and seminal vessicles and may be taking the lymph glands. I’m not clear but I think he’ll only take the Lymph glands if he feels, during the surgery, that they’re affected. I presume that they’re going to do path on biopsies immediately, otherwise how are they going to know? Whatever is taken, I will have the path three weeks later, when I go back to get the catherer out. One of the main benefits of surgery is that the surgeon can see what he’s dealing with and will take more than the gland, if he feels/sees that it is warranted.
Sure, I don’t want to be pissing my pants and I’d rather be having sex until I’m in the box, but if I don’t get this done, I may be in a box in 10 years or so anyway – and I probably won’t be in great shape leading up to my demise.

Incontinence & Erectile Dysfunction
These are very real prospects. Mr. Q made no bones about it “You will be incontinent and impotent.” “Don’t think you’ll be the first to be fully functional.” I know I’ll be both incontinent and impotent – Full Stop! I’m going for nerve-sparing on one side – the other is almost certainly gone – and research shows that nerve-sparing offers the best prospects for both incontinence and E.D.

I’m hoping that my fitness and general health will stand to me and that I’ll recover a relatively degree of bladder control within the convalescence period. I understand that the best I can probably hope for is “female level of bladder control”, i.e. that I will have stress incontinence – a little leakage when I cough, sneeze or laugh. I can live with that – the operative word being live – maybe I’ll feel differently when the op. is over and I’m home with the catherer out.

According to my G.P., Dr. C., a lot of the erectile function hinges on psychological well-being. He says that any problems prior to surgery will be magnified afterwards. Hopefully this is the case. I also understand, from research, that early intervention following surgery, is warranted, particularly in the form of drugs, e.g. Viagra, Cialis and Sildenafil, along with any/all other forms of stimulus.

No comments: