Decisions, Decisions

As I wrote at the end of my first article, “C Day: The Day I Learned I Had Prostate Cancer,” more will be revealed. On the day I received the diagnosis, my doctor explained my biopsy results and my Gleason score. I had cancer in all six lobes, in 10 out of 12 cores. My highest percentage of cancer in any one core was 12%, then down to 7%, then two 5% and two 3%. My Gleason score, an estimation of the aggressiveness of my cancer, was a 3+3=6 on a scale of 2 to 10. So while knowing I had any cancer at all was shocking, the aggressiveness of the cancer found was low to moderate, somewhat of a relief.

Following my diagnosis, I had a full body bone scan and a CT abdominal scan to find out if the cancer had spread beyond my prostate. Fortunately, the results for both of those tests were negative. With my PSA score, biopsy results, Gleason score and scan results, my doctor and I were now able to discuss treatment options. Here is part of my journal entry for March 29th, 2017: “Good news today. My cancer is contained in my prostate. Many options outlined, but the two that make the most sense are active surveillance or surgery to remove my prostate.”

Trials of aging vs. getting old

I have a friend who likes to say that he doesn’t mind aging, he just doesn’t want to get old. At sixty-nine, I completely understand his point of view. It’s one thing to accept that I can’t run a six-minute mile anymore, not to mention the sub-five miles I ran in high school and college, another thing altogether to accept the health challenges I’ve faced in the last ten years, including my prostate cancer diagnosis, as serious evidence of aging and inching up on getting old.

I’ve never been someone who others would describe as a health nut, but I’ve always been physically active and fit. I ran for decades, including a couple of sub three-hour-and-thirty-minute marathons. I hike, play golf (no cart), backpack in the Sierras in the summer, and, at sixty-seven, I took up rock climbing. I’ve never had high blood pressure, never been overweight or had high cholesterol. Since retiring from a career in secondary education, the last nine years in a high-stress job as a high school principal, I’ve lost fifteen pounds, back to my weight as a middle-distance runner in college.

My first unexpected and most serious health challenge, up to that time, came in 2007. After doing some yard and garden work on a Saturday afternoon, I was eating a salad and watching a college basketball game when I felt a cramp in my lower back, the kind you feel when you have a sudden need to go to the bathroom. The cramp accelerated at light speed until I found myself curled in a ball on the floor, pinned down by pain that felt like some kind of cosmic laser beam, the worst pain I’d ever felt by an exponent of ten. Broken bones? Torn ligaments? Dislocations? Forget about it. Tens had become ones. I was experiencing a whole new definition of pain.

By now you’ve guessed it: kidney stone. A month of horror followed that sunny Saturday in California. Unable to pass the stone, past the stage of blasting it apart, surgery was my only choice. When the surgeon found the stone stuck in my ureter between my kidney and my bladder, it was, he said, “embedded like a tick on a hound’s back,” surrounded by infection. I’m a fan of metaphor, and I have to admit that the surgeon’s was a damn good one, despite how miserable I was feeling at the time. Complications followed the surgery. It was a nightmare, the first time in my life I felt depleted by a health-related experience.

Another challenge

I felt tired and sluggish near the end of the 2009-2010 school year, my eighth as principal, a year defined by extraordinary and difficult events. I couldn’t complete my usual runs. Sometimes I had to stop and catch my breath halfway up a stairway. Serious fatigue, I thought. Summer will fix that. In early July, while attending a convention in San Antonio, a group of friends and I were strolling along the Riverwalk to the Alamo Dome, climbing a short flight of stairs, when, suddenly, I couldn’t catch my breath and felt like I was going to pass out.

The wife of one of my friends was the head nurse at a highly rated cardiac care hospital in our town. My friend called her on the spot and she said, “If it happens again, go straight to an ER. Otherwise, see your primary care doctor as soon as you get home,” which is what I did. After an EKG, he had a look on his face I’ve never seen during a doctor’s visit. “We have a problem,” he said. I had taken the first steps on my journey with coronary artery disease. An angiogram found two blocked arteries, one of them being the Left Anterior Descending, also known as the widow maker due to the high incidence of men suddenly dropping dead as a result of blockage in that artery. A stent was inserted and I started taking a statin, baby aspirin, and medication to prevent a blood clot.

In 2012 I was again with a group of friends on a Saturday morning when I felt a sudden pressure in my chest, arms and shoulders like someone was standing behind me and giving me a bear hug. I soon found myself at the ER and tests showed that I’d had a “mild” heart attack. Another angioplasty located blockage in my circumflex artery and another stent was installed. I’ve had no problems since, even on long backpacking trips at high altitudes. I take one 80 mg statin per day and one 81 mg baby aspirin. My blood pressure is never higher than 130 over 70, and my resting pulse rate is 54.

Active surveillance or surgery?

Now, in March of 2017, I’m sitting in the office of my urologist discussing prostate cancer treatment options. Prior to this visit I did some research and spoke to a number of friends who had already traveled down the path I was on. Three friends, in their fifties and sixties at the time of diagnosis, chose radical prostatectomy, the complete removal of the prostate, as their treatment. All of them, in either the short or long run, dealt with the common side effects of surgery: incontinence and impotence. None of them has had a reoccurrence of cancer. Two friends, in their mid-seventies when diagnosed, chose radiation therapy. Both are doing fine, but for one of them, the treatment has been an ordeal lasting long after completion of the radiation.

My personal research, in books and on the internet, suggested that, given all of my test results, I was a candidate for one of two treatments: surgery or active surveillance. My doctor offered both of those options but favored surgery. It was then that cognitive dissonance, the conflict between thinking of myself as “aging” as opposed to “getting old,” really kicked in. Choose active surveillance and live with cancer in my body? Or have surgery and risk irreversible collateral damage, crossing the border between aging and getting old?

In my next article, I’ll discuss the turmoil in my mind and the treatment option I chose.