The prostate is a walnut sized organ in men,that sits just under the bladder in front of the rectum and wraps around the urethra where urine and semen flow into the outside of the body. Its main job is to store the seminal fluid that lubricates and maintains integrity of the sperm. It receives seminal fluid from two sacs on either side called seminal vesicles. It is made active by masculinizing hormones called androgens, the most important of which are testosterone and dihydrotestosterone. They also stimulate prostate cancer growth.
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| Image from American Cancer Society |
Statistics from the American Cancer Society March 2015:
Prostate cancer is a very slow growing cancer usually found in older men and rarely in men under 40. The average age at diagnosis is at 66 years. It is the second most common cancer in American men next only to skin cancer and the second leading cause of cancer death next to lung cancer. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime and 1 man of 38 will die of this disease, (27,540 deaths from prostate cancer in the US in2015.)
Although a very serious disease, the fact that it is a slow growing cancer, usually diagnosed in late life, most men with the disorder die of other causes such as heart disease or complications of diabetes. More than 2.9 million men diagnosed with prostate cancer in the US are still alive today and in autopsies of men who died of other causes, a good number showed asymptomatic and undiagnosed prostate cancer.
Dr. Perry outlines treatment options. In the past year the treatment has mainly been active surveillance meaning watching and monitoring the growth with prostate specific antigen (PSA) levels, a surveillance blood test run on men over 40 (much like women get routine mammograms), digital rectal examinations (DRE) and prostate biopsy. He tells us that since this biopsy result showed cancer cells 3 times more than the last one, the cancer has moved from a Gleason 6 to a Gleason 7 staging and 7 is not good. (Gleason scoring is a microscopic scoring indicating the degree of aberration of prostate gland cells and is used with other parameters to determine the aggressiveness of the cancer.)
It is time to move towards more aggressive treatments. These include surgical removal of the prostate, radiation therapy, androgen hormone blocking or a combination. Dr. Perry says, "I am a surgeon but if I get prostate cancer at age 74, no way will I let anyone operate on me." With that emphatic non-endorsement, surgery is ruled out. Thank goodness because it is frought with complications such as bladder incontinence, erectile dysfunction, etc. etc. He recommends radiation therapy possibly with hormone blocking therapy, still with side effects especially those related to testosterone loss but much less invasive.
Dr. Perry refers Luis to the radiology oncologist and off to the radiation center for a next stop. He will receive the hormone blocking therapy followed by 9 weeks of radiation. Essentially radiation is a massive concentration of sunlight, killing the tumor by sunburn so to speak. The technology has become so precise that my radiology technician once told me she could zap a fly off the wall without chipping the paint. (That is not what my radiology oncologist told me since he had to read off all the possible complications including benign effects such as third degree sunburn to death.)
Luis starts hormone chemotherapy next week and radiation therapy in April. The doctors give their usual 5 year survival prediction which usually does not mean anything other than if you are cancer free after 5 years you have better odds of not dying from cancer for many more years. Once you have cancer, you are never cancer free. It is only undetectable, lurking in some place, waiting to create havoc if you live long enough.
This five year time table on life is at the same time limiting and liberating. Everyone believes that they will be alive tomorrow, a contemporary yogi once said. Being given some kind of time table puts you on notice of the finiteness of earth life and time. At the same moment, you are free to do whatever you think you want in life, to make amends, to fulfill your bucket list or to simply keep on with what you are already doing with your life. You already know you are not getting out of it alive anyway.
Dying has a different implication for Luis than it does for me. My children are 40 something. They now worry about and sometimes take care of me. I live in the present. I enjoy each and every moment and dying for me is nothing more than another phase of living. Healthy time is very important to Luis because he still has teenage children to raise and mentor. He has six sons and they have always been the most important people in his life. He will live for as long as he can for them. He is a wonderful person that way and I have always admired him for that.
Luis and I got married 3 months ago. On the way home from the doctor, he gets very pensive and says, "Five good years is all I can give you. (As if anyone can guarantee time.) Is that all right with you?" I remind him, 5 years is the same odds my oncologist gave me after breast cancer therapy. It is not quite that long but I am still here. He does not realize, of course, that when you get married at 73, your odds of having very many years together are very very slim. So 3 years, 5 years, 10 years, what's the big deal? Gratefully, we are already living on bonus time. And while we cannot say how many years we yet have together, we already promised ourselves and each other that they will be the very best years of our lives.
