The Doctor Lays it Out

The weekend following the telephone conversation when my urologist informed me that I had cancer of the prostate went fairly well. My wife was involved in a local volunteer archeological activity for most of Saturday. We jokingly call it “washing rocks” as she and other clean the bits of stuff collected from historic sites to see whether they are indeed rocks, or, perhaps, shards of pottery or some other remnant of the time around the birth of the American nation. She loves this stuff and is a real history buff. I’m glad she has that kind of thing to do.

That left me free to pursue one of my hobbies, geocaching. This game involves hunting for containers hidden by other people using a GPS receiver. The fun comes from matching minds with the hider and finding the cache that he or she has hidden. These objects can be as large as a half-gallon milk carton, or as small as a half a cigarette. Or smaller. The GPS receiver gets you only so close. The rest of the actual find depends on looking in likely spots where you think some devious person might put a small object. The finding can be challenging.

On this particular weekend, by hunting for caches near my home, I was able to use my bicycle to get to the places where the caches were hidden. I had not ridden the bike since the biopsy. I wanted the bleeding to stop before I did any riding, and the bleeding was gone. I figured it was time to risk bouncing along on a bicycle seat. I enjoy both riding and caching, as it’s called, and was giving myself some time to relax and enjoy things.

I was able to find three of a group of five hidden containers by searching in the areas described. In this case, each was located in a small park maintained by the city. Part of the fun of caching is that it takes you to places you might not otherwise visit. I enjoy the discovery of new things, and these were little parks that I’d never seen before, even though I’ve lived in this area for nearly two years.

I was frustrated that I had not been able to find the fourth cache. It was supposed to be located in a very small park, and the neighbors who live adjoining this park have become sort of used to having strangers show up and hunt intensely near a particular spot. In fact, one such neighbor hailed me as I was hunting and asked if I was looking for the cache. I said yes, and that I’d been unsuccessful so far. He assured me that it was still there, and near where I was looking. He asked if I wanted him to tell me where it was. I told him that I appreciated knowing it was nearby, but that I did not want to be told exactly where. He smiled, wished me well, and returned to his house.

Nevertheless, despite hunting high and low, I simply did not find it, and had to leave empty-handed. Until I found the fourth cache I would not be able to find the fifth. That was because, although not all caches have this feature, the group I was hunting had an extra treasure hunt feature. The were four caches, when you found them, each had a log book inside (or log scroll, in these cases, because they were quite small and there was little room for anything). You sign the log to show you found the item. In these cases, however, the log scroll in each of the first four caches also contained a couple of clues. When you have found all of the first four caches of this group of five you have all the information you need to learn the coordinates of the fifth cache. Clearly that last one would have to wait for my success with number four.

I called a friend I know who is a rabid geocaching enthusiast. Over the past 3 years he has managed to locate over 9,000 caches around the country. There are over a million of these things hidden world-wide. I have found 80 of them. This other guy is a fiend. I knew he had found the one that I was missing some months ago, but, unfortunately, he could not recall this particular cache so he was unable to give me a hint. No surprise. When you’ve found over 9,000 of these things, I expect they blur a bit in memory.

Nevertheless, the day was pleasant, and my wife and I went about life as usual. One strange thing, however. I started having blood in my urine again, but not fresh blood. Instead sort of rusty colored stuff that must be clots that were slowly dissolving. No pain. I was not concerned.

Sunday, my wife went off to some classes and I looked again for the fourth cache. Found it this time. I’d actually looked at the place where it was hidden, but not carefully enough. Great. Got the missing clues, hunted down the fifth cache, and completed the set. A pleasant feeling of accomplishment. And an enjoyable time outdoors in great weather and some bicycle riding as well. Great to be outside.

Monday passed without incident, although the rusty blood continued to appear at the beginning of each piss episode. I was even able to sleep well on Monday night. I was sort of getting used to the concept that I have cancer.

Then it was Tuesday morning. My wife and I drove together to the urologist’s office and I was very grateful for her presence. It made things feel shared, sort of, and I really enjoyed having someone close to share with. The doc was on time and we met in his consulting office. I looked around on the walls. The new thing I learned was that he had been elected to Alpha Omega Alpha in medical school. That’s a high scholastic achievement award, kind of like Phi Betta Kappa in undergraduate school. Yet one more indication that he has excellent training.

The purpose of today's visit was to get the big picture for what's next. The doc went into a sort of lecture mode and provide a mostly broad brush view of the situation with few details. I really could not expect much more because, at this point, all that is possible is educated speculation based on the biopsy results alone.

The biopsy showed five of 12 cores with cancer. One core had a Gleason score of 4+3=7, and another had a score of 3+4=7. Gleason was a pathologist who was trying to help urologists make accurate predictions about the extend of spread of prostate cancer depending on what was seen in the specimens under the microscope. The scores are sums of two numbers. The numbers are based on the two kinds of cancer there are the most of in each core sample. The first number is the degree of aggressiveness of the cancer there was the most of in a sample, the second number is the aggressiveness of the cancer there was next most of. The individual scores run from 0 to 5, with 5 being most aggressive. The sums run from 0 to 10. In my case, two of my cores were a mix of 3 and 4. In Gleason score terms, one was 4+3=7, the other was 3+4=7. The way its been described, 3 is like an early cancer and 4 is a definite cancer while 5 is cancer that might be out of control. So I figure, these totals of 7 are not the worst possible. Maybe not the best, but not horrible.

The urologist was less optimistic. He said that the 4+3=7 sample indicated that there was a bad actor in there somewhere. He said that the score predicted that the cancer might have already extended outside my prostate and might be invading other normal tissue nearby. Or it could have already gotten into the blood stream and be growing somewhere far away from the postate, particularly in bone. He would not know until he had done a number of diagnostic tests to see if there were signs of spread beyond the prostate. Ok. I’m getting it. But at least it’s not the worst possible.

The urologist laid out options for surgery, extended field radiation, chemotherapy, and a few approaches not yet approved for treatment of prostate cancer. Which he would recommend depended both on what the diagnostic tests he had planned showed, and what he found on surgery. No real question in his mind that surgery was appropriate, if for no other reason than to understand the extent of spread within the prostate.

He did a great job in his explanation. He answered all the questions my wife and I had. He did not speculate about what treatment would be most appropriate or what the outcome might be. Instead, with a sense of urgency he restated his recommendation that I get this series of tests done. Then we could discuss next steps. He also suggested that an evaluation by a multi-disciplinary panel at the National Institutes of Health that could offer treatment recommendations. He said he’d let them know that I was a candidate for their evaluation. And with that my wife and I thanked him, and returned to the car.

From that early morning appointment, my wife and i each went to our respective jobs. We both felt the doc had done an excellent job of being objective and providing clear answers. He had not pushed a particular approach. He seemed to want the best for me. And he was very definite about suggesting we have a panel of unrelated physicians review the biopsy results and make some recommendations of their own, after the other diagnostic tests were done. I felt that was a very pretty open and confident position, and I appreciated it.

By the time I got off work, there was a message from the NIH asking me to make arrangements for an evaluation. The next morning I was set up for the addition studies recommended. Things were getting more concrete, at least. My wife and I both felt like things were happening. Progress was being made. We were not just sitting still waiting for the next event. It made us both feel good. The additional tests will be done next Wednesday. And the visit to NIH will be done the week after that. There’s even some final testing to be done a month or so later. Hey – maybe there’s time for a vacation in here, before surgery!

Next big task: find out just what I've got.

Comments

Wow. I am impressed with your ability to describe all this almost as if you are speaking about another person. Calm, reasoned, objective. Not only listening to the information provided, but also hearing it. Good approach I think, and certainly best wishes as you move forward. Wish I could give you a big hug.
 
I have seen some men GeoCaching at the local park! I was glad when one told us moms that the object would be labeled so a person would know it was not garbage. We tend to pick everything up and toss it out as we walk the trails and parks. Cool hobby I had no idea until then it existed, and that it is a global game.
Happy your doctor is so top notch! That is so rare these days you have to appreciate how lucky you are in that respect. The fact someone called you right away for the evaluation shocked me. Wish we had your doctor in my city, I would sign my husband right up with him.
 
My thoughts are with you as you embark upon this journey. It so great that your wife is in this with you!
Good luck!!!!!!!!!
 
Great to hear from you all...

Tamuning -- I hope I'm not being too objective and unemotional here. I readily admit to sometimes feeling scared and as though my life is suddenly at an end. Writing, however, lets me see the whole thing more clearly, so maybe that's why it seems like I'm talking about someone else. Just be assured that I feel very much like it's ME that is going along this path.

SweetLovesVick -- cool that you know about geocaching. I'm going to be trying to find another set of five this weekend. As for my doc -- I'm thrilled that I was referred to him and I feel he is very strong. I expect I'll be needing to rely on that sort of strength.

gunit -- my wife is a great support here. she's going to push me to get the very best, most effective treatment. She wants to keep me around. I'm very pleased.
 

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