The Aggressiveness Factor

After robot-assisted radical prostate surgery three years ago, my pathology report contained good news: clean margins, no lymph node involvement (pT2N0). But there was bad news: primary tumor was Gleason 4+5. That fact alone reduced my prospects for surviving 5 years from 98-99 percent to about 80 percent.

A year and a half later, my PSA started rising rapidly. PMSA scan was negative. PSA never exceeded .18, but with aggressive cancer I agreed to 33 sessions of radiation and 6 months of ADT. (Still haven't told my partner. She's a retired nurse, and she urged against it in the strongest possible terms.)

The side-effects peaked a couple of months after the end of treatments: hot flashes (warm flushes), crushing fatigue, depression (negative outlook, preoccupation with imminent death, emotional volatility, etc.), and weight gain ("low testosterone belly"😉. To my longstanding (lol) ED I added total loss of sexual interest.

I'm convinced my Gleason 9 is a death sentence. I feel certain it will recur, again, in 1-3 years. The next course of treatment will be chemo of some sort. If it "works," then I'll have a couple of years before, inevitably, it comes back and I move on to the next body-wrecking and soul-destroying form of deliberate poisoning. I think this is called "living with cancer"...

I think a lot about my late uncle, who at 82 was diagnosed with kidney cancer. After one session (not round) of chemo, he said, "To hell with this. I'm not going to endure it just to gain another year of life." So he quit, and six months later, he died. I feel I'm following my uncle's script.

We all have to go sometime, and I've been luckier than many. But I've never learned to "be in the moment" and "live for today." I've always looked ahead. Now, I have a very foreshortened future.

Terminal illness is very isolating. I feel like I'm watching the entire universe recede in my rear-view mirror as the runaway vehicle I'm confined to is entering a pitch black tunnel.