Decision Time

Following my prostate biopsy in late August, ‘t was results time in mid-September. The truth came as no real surprise to me, my prostate was misbehaving and had developed a touch of cancer. 14 samples had been taken. One sample showed 10% cancer cells, another showed 1% cancer cells, the remaining 12 were clear. The malignant samples were said to be “average” in terms of aggression. The aggression rating rejoices under the name of a Gleason score, mine being 7 (3+4, I think). If I understand this correctly, the score designates the aggressiveness, from 1 to 5, of the most common cancer cells seen followed by a similar 1 to 5 rating for the second most common cancer cells seen. The two scores are added together to form a total, so 2 (1+1) would be the lowest (least aggressive) and 10 (5+5) the highest (most aggressive).

The good news (I hoped) was that, since I’d been having PSA checks for 5 years, the consultant was very hopeful that we’d caught it early enough for there to be several treatment options open to me. I guess it must’ve been early ‘cos one option, not offered to too many, was the first one below. [Ed: in this day and age, we should probably be referring to these options as prostate cancer solutions.]

Watchful Waiting

(Or some such medical mumbo-jumbo.) Basically that means it ain’t urgent so do nothing but continue to monitor PSA levels, ultimately having another biopsy – another set of 14 holes being punched through your rectum wall – in 18 months time to see how things have developed.

Radiotherapy

Computer-targeted X-ray beams sauté the offending organ and serve it over a fresh green salad with a little dressing of your choice. “And for your main course, sir?”

Hormone therapy

This is kicked off by a dose of Radiotherapy, in this area, apparently. Prostate cancer cells feed on testosterone and injections of female hormones put the brakes on their feeding – and probably enable one to get further insights as to how the other half lives.

Radical Prostatectomy.

Surgery – rip the troublesome gland out. Why “radical”, I wonder? I mean, I guess ripping out someone’s prostate is pretty radical but why highlight that in the name of the procedure?

I had arrived at a crossroads on a journey that I’d rather not have embarked upon in the first place but, hey, that’s life, and at least things sounded reasonably hopeful.

Watchful waiting seemed to be prevaricating or burying my head in the sand, even though this seemed to be the medical team’s favoured option. (I’m a cynic and think they were trying to save the NHS money.) Their thinking officially was that the cancer may not continue developing and that treatment may not become necessary. Right! That’s not my belief. My PSA stayed fairly even for a couple of years but over the last two years had risen steadily (3.5 – 4.1 – 5.1). I saw no reason to suspect that it would miraculously decide to stop rising. The alligator that was already biting me in the arse would still be in the swamp.

I didn’t fancy radiotherapy for a couple of reasons. Firstly, this option comes complete with warnings of potential collateral damage, American military style, to bladder lining and rectum. Not appealing. The main factor, though, was that radiotherapy generally negates the surgical option at a later date. (I don’t know why, unless the effect of radio beams on tissue makes a surgical repair resemble trying to sew together a roast chicken. Anyway …) Too many bridges burnt.

Hormone therapy seemed a reasonable candidate and I now know a man who is being successfully treated that way. I’m already enough of a girlie, though. The last thing I need is even larger man-boobs. Besides, hormone therapy remains an option if other attempts don’t work as well as hoped. Reassuringly, if any prostate cancer cells escape to other parts of my body, hormone therapy still treats them effectively, I was told.

I’ve elected for surgery, the so-called radical prostatectomy. My personal belief is that any suggested cancer clear-up rates that are touted are largely made up of the type of cancer that can be excised. Why keep an unnecessary prostate? It’s the sort of organ that can get one into bags of trouble even when it’s healthy, for Darwin’s sake. Now it has the potential to do some serious harm. If we’ve truly caught it early enough and the cancer cells are completely localized, let’s maximize the benefit of that fortune and remove it entirely. This is the only prostate cancer solution that speaks about the possibility of a cure as opposed to containment.

I informed the medical team of our decision and would be receiving an appointment with the wielder of scalpels.