Monday, February 29, 2016

A Strategy

I was going to title this post, "A New Strategy," but I haven't really felt like there was one until yesterday. My oncologist's appointment was yesterday afternoon, and it was much more informative than I was expecting. There will be a lot of nerdy detail here, so hang in there.

My new doctor spelled out the whole diagnosis in a way that my urologist never did. He explained why my urologist staged me where he did, and why he's inclined to agree for now.

I won't bore you with all of the numbers, but one number in particular got their attention. My Gleason score. If you know someone who's had prostate cancer, you probably know about the Gleason score. It measures how aggressive prostate cancer is. One of my biopsy samples back in July had a Gleason score of 9, which indicates a very aggressive cancer. Most of my prostate is cancerous. The high Gleason score make it inoperable.

My oncologist does say that Lupron is the treatment of choice for what I have. My next shot is scheduled for March 1st. I'm dreading it already. My previous doctor, the urologist, said that Lupron only works for two years, but apparently that was an estimate based on my Gleason score. Some people can stay on it for a long time, and it keeps their cancer under control. But that only works for less aggressive cancers. The more aggressive the cancer, the less time you get from Lupron and other "systemic" treatments.

As I've mentioned before, Lupron is a hormone suppressant. Prostate cancer feeds on testosterone, and Lupron reduces your testosterone level, creating unfavorable conditions for cancer to grow. Some cancer cells, however, are resistant to Lupron and continue to reproduce without testosterone. So once Lupron is no longer effective, they'll try other treatments that may work on those cells.

The good news is, there are lots of those treatments available, and more are coming all the time. There may even be a prostate cancer vaccine available soon. Also, my otherwise good health and relative youth will help me stay strong so I can tolerate all of these treatments. My life expectancy is increased by the fact that all of my other numbers, the ones that don't relate to cancer, are all great. My cholesterol, my blood pressure, all of it's really good, except for this one thing. That will help me fight this.

The bad news is, because it seems that I do have a very aggressive cancer, it's likely that I'll burn through treatments pretty fast.

But here's the plan so far. It's so nice to be able to say that!

First, my oncologist is very intrigued by my case. He meets with a group of cancer experts each month to discuss various cases, and he's taking my case to this board next week. He'll get input from them and let me know what they said. He also wants me to meet with a radiation oncologist to talk about possible radiation strategies.

Radiation may not be a good option for me, given where I'm at with this. The cancer in the prostate area is very slow growing, and my prostate isn't causing me any problems in terms of physical function, so it might not be the best idea to radiate my crotch several times, especially considering the potential long-term side effects.

I appreciated the fact that my oncologist doesn't make any more money for recommending procedures, so he's more than willing to tell me I don't need one thing or another.

But he still wants me to talk to a radiation oncologist in his group, just to gather information. That appointment is February 24th. I'll go in for a blood draw a few days before my next Lupron shot, and when I go in for my shot on March 1st, my doctor and I will discuss everything we've learned, and decide which direction to go. He may order new tests and scans to see where we are, but he wants to talk to the board first, and wants me to talk to a radiation oncologist before we make any decisions.

So that's where we are. I'm encouraged just to have a strategy, and be a little more informed. I'm also glad to have some actual cancer news for you! Thanks so much for your love, concern, and support! It's an amazing thing to realize how many people I have going through this with me.

No comments:

Post a Comment