Decision Time!

The “bomb” had been dropped, and if you’re like I was then, you are in disbelief. Cancer wasn’t going to strike me, and now I was facing life, death, and quality of life decisions.

First, because prostate and bladder cancers generally metastasize to the bones, my urologist sent me for a whole body bone scan, which was done a few mornings later. A few hours after the scan, which was a piece of cake, I got a call from the facility that had done the scan, and the pathologist couldn’t tell whether I had cancer throughout my lumbar spine or a lot of osteoarthritis. So in a very concerned state, I went back down for an x-ray of the lumbar spine. Not many people are happy to hear they have severe osteoarthritis in their spine, but that was welcome news considering prostate cancer (PC) was the alternative.

And then the numbers

As a side note, my father died in 1987 from bladder cancer that had metastasized to the bones, and I was his decision maker at the end. Bottom line is it was pure hell for him, and I knew I would do everything possible to conquer the PC before it conquered me, i.e., the battle was on.

Next, with a Gleason 8, while I could have argued for radiation instead of a prostatectomy, it really wasn’t a choice in my mind—I knew the odds of survival were in my favor with my prostate gone. But earlier this year (2017) a friend called me for advice on PC as he’d been diagnosed with a Gleason 7, but it was a 3 + 4. Ironically when my urologist and I were discussing my PC and the options available to me, during the conversation he said there is a big difference between a 4 + 3 versus a 3 + 4 as you don’t want a grade 4 or 5 primary PC.

Sex and other decisions

And here lies a concern I’ve had with a lot of guys making this life or death decision—“I’m not giving up my sex life” is guiding their decision making. First, you will give up your sex life if the cancer kills you--guaranteed. As I said in my previous blog, I’d rather take my chances on seeing what I could do when I’m alive than if I’m dead. (More on what happened to me with my prostate gone in a future article, but the medical community has come a long way in helping us keep our “sexual potency” as they call it.)

My friend mentioned above with the 3 + 4 studied his options more than anyone I’ve ever met. He had already seen a surgeon and a radiation specialist, and he wasn’t happy with the surgeon’s cavalier attitude. I suggested he talk to my surgeon at Penn, which he did. My friend said to the surgeon that he had read there’s no difference in survival rates between radiation and surgery, to which my surgeon, who was promoted to Chief of Urology at Penn this year, said that’s true for the first ten years, but after that the advantage is all in favor of surgery. He had a prostatectomy about 3 months ago and is doing very well.

My decision to make

So my prostatectomy, which was to be done robotically, was scheduled for 6/5/13, 5 days before my 69th birthday.