I'm back folks.  No apologies from me for the absence.  I went for a hike, did some grocery shopping, secured a storage unit for my Harley, put away my awesome leftovers, and now it's time to finish this doctor's office visit blog entry.  I swear, only I can turn a 45 minute appointment into a 3 day event. Oh, well.  I yam what I yam.

Now, when last I left you this morning, I had just acquired my domain names and was feverishly strategizing with my advisors.  (Advisors being code for: The Myriad Voices in my Head...) Of course, this means that my mind is racing one hundred miles an hour and I've got ideas leaping from every pore.  Now is the time to harness that energy.  Stay tuned, I have no idea what's coming next!


Now, back to Dr. Ruckle's office.  I arrived, peed in the cup - they weren't sure they needed a sample, but better safe than sorry.  I sat in the lobby and filled out the forms.  "Do you have now, or have you ever had a headache?"  Yeah.  Pretty much everybody would say 'Yes' to that, right?

So, (after they have to call my doctor and request the records since they didn't have them: See Monday, traffic accident; best laid plans, etc....)  the doctor comes in and he is immediately likable - self deprecating and self-assured all at the same time.  Cool.  Then we get down to the brass tacks.  Why am I here?  Well, I'm kind of hoping that you'll treat my cancer.  Okay.  Sure.  (Remember I am paraphrasing...)

Here are the treatment options:

1. Watchful Waiting 

The least invasive method of addressing prostate cancer is the laissez-faire approach - do nothing.  Keep up regular intervals of biopsies, PSA tests, tracking growth (PSA doubling time), and checking for enlargement with regular digital exams and ultrasound techniques.

The premise is that prostate cancer is a slow-growing cancer, and the condition may warrant close watch until action is required.

Indicated for me?

In my case, the doctor told me that I was not a good candidate for Watchful Waiting because of my elevated PSA score of 16.2. My biopsy shows the presence of cancer in 10%of the organ, bilaterally (both sides).

Bottom Line

I did Watchful Waiting for about 4 years - while my PSA readings progressed from 8.21 to it's present level. [A note here: I think I covered this before, but PSA stands for Prostate Specific Antigen, and it is a marker for prostate cancer.  The higher the PSA reading, the higher the likelihood of cancer.]

The time for waiting is over - now it is time to attack!

2. Proton-beam radiation

Loma Linda is a pioneer in the use of this extremely focused beam of radiation. This is an external radiation; since the beam is shot from outside the body onto targets tattooed on the skin which locate the tumorous areas.  The benefits of the proton beam are less collateral damage to the surrounding tissues.

The radiation treatments last 5 days a week for 8 weeks.

2a. Radioactive seed implantation.  

Long needles are used to insert radioactive cancer-killing seeds into the prostate.  The needles are inserted into the prostate through the perineum - the space between the rectum and the scrotum.  Instead of the almost daily trips to the radiology lab, the seeds biodegrade in the body, killing the cancer cells in their proximity.

Indicated for me?

The doctor felt like these options were risky for a number of reasons.  Foremost again was my high PSA again, combined with the small size of my prostate.  This was interesting news to me.  He indicated that my prostate was small compared to most cancerous prostate.  Combined with the stage (T2C), and the high PSA, he did not feel this was the best course of treatment.  (Plus I wouldn't be able to hold Stella for the duration...)

Bottom Line

The clincher for me - as before - with this approach is the ability to pursue surgical options later if the cancer returns.  The doctor said this wasn't 'entirely true' as they then could do what he described as 'salvage' surgery, but that was not optimal.  Not only that, but the damage caused by the radiation to the adjacent tissues presented a problem for future surgery not just in the prostate, but the surrounding areas as well.

Lastly, radiation therapy for prostate cancer, is linked to a 1.75 times increase in other cancers in the colo-rectal region, such as colon cancer, rectal cancer, testicular cancer, bladder cancer...

No bueno.

3.  Surgery

The current state of the art surgical technique for prostate cancer is the robotically-assisted radical prostatectomy.  In this method, the doctor removes the entire prostate capsule and the seminal vesicle.  The urethra is then reconnected and a catheter is placed in the newly repaired urethra.  The procedure lasts about 2 and half hours and is performed via 5 incisions in the abdomen.  There is a one night stay in the hospital.

In some cases, such as mine, the lymph nodes in the abdomen are also harvested, as this is the usual site of initial metastases from the prostate cancer.  Typical recovery time from this surgery is 6 weeks (since when have I been typical, though?).  We shall see.

Indicated for me?

My thinking on this topic has not changed since I was first diagnosed.  Dr. Wolfson described surgery as "The gold standard" of prostate cancer treatment.

I want to be here for a long time, so bottom line: Surgery for me in mid-May.

I'll spare you the details of the romantic exchange with me bent over the examining room table.  I will say that Dr. Ruckle has a wonderful bedside manner, and a first class sense of humor.

Let's hope he's got mad skills in the operating room, too.

Oh, by the way, assisting Dr. Ruckle is some wizened veteran named Leonardo Da Vinci.  Hmmm...

(The DaVinci robot is used to help close the incisions and to perform precise stitching which would be too involved and fatiguing for the surgeon.)

I think that's all I've got in me after this long and very productive day...

Julian Bueno, take us out:

"Mr. P

I want to sincerely thank you for the most fun and interesting math class of my life.  I can also safely say your the best teacher and most coolest dude on campus. I'm really going to miss you next year, and I hope our paths cross in the future."

I'm happy to say that Julian has made the effort to keep in touch, and I appreciate his friendship and support.

Thank you, Julian. I love you.

Good night, all.  I will respond to your excellent comments tomorrow...