Saturday, October 8, 2011

First Anniversary

Today is the day. This is the date. My first anniversary. Let’s celebrate! Bring on the cake and candles … well … candle. That’s right, it was on this date, one year ago, that I began counting. What am I talking about? Why I’m talking about cancer — the “C” word; Big “C”; scary; dangerous; deadly. Hopeless? I hope not.

Cancer is a disease where your own body’s cells run amok. All cancer patients know the date when those misbehaving cells were destroyed. Either removed or zapped with radiation or poisoned with chemicals. You are never really cured of cancer. All cancer patients are on the watch for “reoccurrence.” It can happen. Books full of statistics have calculated the ways and means. Life goes on, but for how long? That is the question. To be or not to be — it’s not just for Shakespeare any more. That’s why we celebrate each additional year of life. This is just like counting birthdays, only you celebrate a little more intensely. I’ve been cancer free for one year — I hope. Whoopee!

There are many different cancers, and there are many different causes. Some cancers, we know, are caused by a virus, some by environmental causes, some are hereditary, some go with old age, and some we just don’t know what causes them. My personal strain of the Big C is Prostate Cancer. This particular disease is found uniquely in men, since only men have prostates. It is a disease of aging. You gotta live long enough to get it. It is the most common cancer among men.

Prostate cancer is unknown before the age of 45 and over half the cases are in men over 55. (See the National Cancer Institute’s Surveillance Epidemiology and End Results or SEER database for more factual tidbits.)

No-one is really certain what causes prostate cancer. I’ve been told that if we lived long enough, all men would get prostate cancer. Something about testosterone, the male hormone. Us men and our football-lovin’, beer-guzzlin’, girlie-learin’, testosterone-packin’ bodies, we have this to look forward to in our old age. Now I feel like that Home Improvement star, Tim Allen: more power, arr arr.

I’ve also heard that the prostate is a gland usually found in herbivores. It seems that carnivores have a different gland to perform the same function. Are humans the only species that eats meat AND has a prostate? I think so. So this is the fate I endure to pay for all those Big Macs? Could be.

Now I was just thinking that, in some ways, prostate cancer is complementary to women’s breast cancer. That’s “complementary” as in making up each other’s lack rather than “complimentary,” as in “you look good in that hat.” Prostate cancer seems like the brother to our sister’s common cancer concern, only no-one is marching for a cure, and I’m not sure what color our ribbon is. (Just a little joke there. Don’t take me too seriously.)

Breast cancer is one of the leading causes of death for women. The average woman has one chance in eight (or about 12 percent) of developing breast cancer during her lifetime. It is the most common type of cancer among American women. So keep up those regular breast exams ladies Just thank Dr. Mickey for that wonderful thought.

So, this march for Prostate Cancer, what color ribbon do we get? Do I get a t-shirt? (Come on! I’m just joking.)

Most know that older men should get regular tests for prostate cancer. There is a digital exam, I mean literally a digit exam, and I don’t mean it involves one’s and zero’s. There is also a blood test for the Prostate Specific Antigen or PSA. A normal prostate produces a certain level of PSA in the blood, but an enlarged prostate will cause elevated levels. There are many reasons for a prostate gland to become enlarged, and not all of them are as dangerous as cancer.

Now, in my case, we had noticed an increase in my PSA a few years ago. My PSA was not over the level that doctors become concerned about, but the increase in itself, known as an “acceleration,” can also be a sign of cancer. After the first PSA that was elevated, I visited a specialist called a urologist, but his advice (and it was sound medical advise) was to wait and see. The increase was small and the next step would be to perform a needle biopsy to determine if the cause of the PSA increase was cancer. The doctor didn’t want me to have the uncomfortable procedure with such little evidence. I was quick to agree that I didn’t want the uncomfortable procedure either.

This wait and see is called “watchful waiting” in the cancer business. The slow growth rate of prostate cancer justifies some amount of just waiting around to see what develops. I repeated the blood test a year later and the PSA level actually declined. Good news. It was the third year that the test result was up again and over the minimum threshold too (earlier it was just the increase that was cause for concern), so my specialist decided I should have a needle biopsy. They take samples of the prostate tissue and examine them under a microscope.

This is a very routine procedure done in a doctor’s office. It is basically the same as an alien probe you heard about on The X-Files, only the aliens don’t have a nurse watching it all on the telly and the aliens don’t charge your medical insurance. This procedure was performed on me in March of 2010.

A week or so later I went back to the doctor’s office to get my results. They put me in one of those exam rooms with the little bed covered in paper and a couple of magazines from the last decade to read. Did you know that Barack Obama might defeat Hillary Clinton for the nomination? Good to keep up with the current events.

When the doctor came in, I noticed he had a brochure in his hand. “Now why would he need a brochure to tell me the test was negative,” I thought. “Mr. Cheatham. We have bad news. You have cancer.” Now that is a direct method of sharing. “Gulp,” said I.

“Now don’t worry,” he said. “Prostate cancer is very slow growing and we have caught it in time. There are several treatment options available, and I want you to think about them.” He gave me the brochure.

He went on to explain that my cancer was graded on the Gleason scale (which goes from 2 to 10) as a 6. That is pretty mild. Less than 6 and they would not do anything but watch. Of course, 10 is not good. The examination also indicated a large involvement with over 70% of my prostate “infected” and both sides of the gland were cancerous. That was a little surprising to the doctor. That level of infection is not typical at an early stage.

He went on to tell me that right after the biopsy the gland would need to heal up from the dozen needle pokes, and it would be about six months before we could schedule surgery. So I had lots of time to contemplate and decide on a course of treatment.

Now let me give you some background. I am and always have been a great Frank Zappa fan. His combination of musical talent, irreverence, and playful sense of humor really touched me. Also, I liked it when he chewed out a particular senator’s wife for being a nosy busybody. But I also knew he died of prostate cancer at a young age — well, younger than I am any way. I don’t know for sure, but I heard that he spent several years going to doctors trying to find out what was wrong, and by the time they determined it was prostate cancer, it was too late to treat.

So now the fact I didn’t have a biopsy two years earlier was poking me in my mind’s eye. I went immediately to the internet and read all I could find about prostate cancer. While on the internet I visited Amazon and ordered several scholarly medical texts about prostate cancer too. One of those, Dr. Patrick Walsh's, “Guide to Surviving Prostate Cancer,” proved to be especially useful in my decision making process.

It is good to have some time to make important decisions, and I used all of that time to explore options. I talked to my personal care physician, a trusted friend. I also spoke with Linda’s brother’s physician in Alaska — another trusted friend. I contacted one of the leading experts on prostate cancer at the University of California and made an appointment to get his informed opinion at $500 an hour.

If I don't confess that I canceled that appointment, they will suspend my artistic license.

I considered surgery, several kinds, radiation treatment, again several kinds, as well as exotic methods like cryosurgery and ultrasound, as well as hormonal and chemical treatments. Pretty much the gamut of choices that most cancer patients go through.

Finally I decided on the surgical option using a robot to perform the operation through several small incisions. I sought out the best robotic surgeon in Colorado. (Part of the advice was against surgery in another state, only to return home for recovery. If there are complications it is, well, … complicated.)

I chose surgery over radiation treatment for many reasons, not least of which was if radiation was needed later it was still an option. If you treat prostate cancer initially with radiation, then it can’t be used again. So surgery allows for a back-up plan B if plan A fails.

There were other treatments under consideration including “watchful waiting” which is based on the slow growth of this cancer and the usual age of patients. Prostate cancer in an 80 year old man will likely not be fatal because something else will probably happen sooner. However, since I was only 63, and hoped for another twenty years or more, I chose a more invasive method. Use your best James Cagney voice to say, "Let’s put a hit on this cancer and show him we mean business, yeah."

On October 8, 2010, I checked into the Medial Center of the Rockies, a new hospital located east of Loveland, although really a Ft. Collins facility. This state-of-the-art building housed an exceptional staff and equipment. The surgery went exceedingly well. In just two days I was home and never really suffered from any pain. I only took aspirin for what little discomfort I had, and it was as pleasant as such an experience can possibly be.

One reason I chose surgery is the removed prostate gland can be examined more thoroughly. With radiation, you can’t do that. They took the gland, froze it, sliced it into thin slices, and viewed it under the microscope.

Now for the bad news. This biopsy showed the cancer was much worse than the needle biopsy had indicated. They raised my Gleason score to 7, still not too bad. But the real bad news was that the cancer had spread beyond the prostate itself. They say it “penetrated the capsule.” This changed the classification of my disease from a lowly stage one cancer, highly curable, to stage three, not so highly curable.

There was good news. Since surgeons always take out more than just the prostate gland, they had removed the tissue around the gland too. That is called the “margins.” It appeared that they had removed all of the cancer. Whatever had escaped the prostate was in the margins and was removed — at least that is what we all hoped. As my doctor explained, cancer cells aren’t purple and don’t blink on and off, so you can’t really tell them from ordinary cells during the operation.

Because I was stage three and very prone to reoccurrence of cancer, my surgeon recommended I immediately undergo radiation treatments of the area where the prostate was removed. Again I sought more expert opinions. I found the leading cancer doctor in Colorado at the University Hospital and took my case to him. After several consultations he confirmed the biopsy and agreed with my surgeon that the best chance was immediate radiation treatment. However, he agreed that, considering the risks of radiation, including it causing a cancer by itself, I was not a complete nut to forego that treatment. At first my surgeon objected, but finally admitted that, if it was him, he would do the same thing.

You see folks, life is full of decisions (and medicines) that have good results and bad results. It is always a mixture. Every wonder drug has bad side effects. You have to do the entire “risk / benefit analysis.” I did that, and chose to take the slightly larger risk of watchful waiting before undertaking radiation treatments.

Now there are several good things about prostate cancer, if you can ever describe this disease with any positive comment. First is the fact it is typically very slow growing. It can take 10 to 15 years for untreated prostate cancer to actually kill you. Second, prostate cancer does not metastasize to another kind of cancer. Lung cancer can spread to your head and become brain cancer. Prostate cancer is always prostate cancer.

Now it can migrate to your bladder — and then you may have to have that removed — imagine life without a bladder — still it is life. Or it can spread to the large bones of the hip and legs. That is really difficult to treat. But, in any case, the continued PSA tests act as an early warning.

As a man who has no prostate, my PSA should be zero. If some of the cancerous cells escaped and start to grow, that would show up in a PSA test. Four times a year I take a sensitive version of that blood test, and for the last nine months the result has been a PSA of 0.00. And that folks, is the best grade I’ve ever gotten on a test.

On the other hand, I was warned by the expert at University of Colorado that, if my PSA starts to increase, don’t walk, run to the hospital for radiation treatments.

In August I had another PSA test. The result was 0.02. Uh, oh. Well, maybe not. That is considered practically zero and it may be what we engineers call “noise.” My family doctor recommended another PSA in one month just to be sure.

Last Thursday I had that blood test. I am waiting for the results. Wednesday I will meet with my surgeon and will learn my score. If the PSA is increasing, then I’ll pursue radiation treatments. The odds are that 70% of people with stage three prostate cancer have a reoccurrence in three years. So the statistics aren’t good. Plus, from some of the evidence it appears my prostate cancer may not be so slow growing. Everyone was surprised at the level of the cancer aggressiveness when the surgery was performed. Just my luck that my cancer would be atypical.

So there you have it. Today is the one year anniversary of my surgery. I hope to say that I am now one year cancer free. All cancer patients count the days. There is no cure. Only watchful waiting.

Some have been cured more than once. Some were given ten or more years of useful life by the actions of doctors. My hero and mentor, Richard Feynman, lasted ten years longer than the doctors predicted thanks to very drastic surgery that he had. His doctor said he liked to cut out tissue until he can see the operating bed underneath the patient. That drastic surgery was credited by the nobel prize winning physicist as giving him many more years of life.

Another hero, Steve Jobs, lost his life just this week after an eight year battle with pancreatic cancer. He even had a liver transplant in an attempt for a cure. He had a rare form of pancreatic cancer, and got the best treatment that money can buy. I’m sure it prolonged his life too. On the other hand, prostate cancer is not as dangerous or deadly as either pancreatic cancer or the intestinal cancer that Feynman had. So I hope for a better prognosis.

My plan is to continue seeking medical advice and treatment. My hope is for a healthy and long life with many anniversaries of the surgery finding me cancer free. I planned to write this a few months ago. I expected to write about a one year cancer free anniversary. Now I am not quite so sure. If I need further treatment, then that is what I’ll do.

If I’m anything, I’m a “glass half full” guy. I feel certain the results of the last blood test will show no reoccurrence of the cancer, but if it does, then radiation and chemical treatments will retard the cancer.

Wait, wait … I’ve got to tell this. I want to die in my sleep like grandpa. Not screaming and yelling like the other people in his car. Hardy, har, har.

So, what should you all do. Well, pray for me, and pray for Linda that being married to me will continue to be a positive adventure. (Our 35th wedding anniversary is later this year.) I always appreciate prayers and know first hand how effective they can be. But, if it is God’s plan that I join him sooner rather than later, that’s OK too. I’ve had close friends demonstrate for me how to face your end with the help of God’s grace. So I know how to do that. But I would much rather stick around here on this earthly orb for a few more years just enjoying all of your company and trying to accomplish a few more goals. Who knows, if I live long enough, people might actually start reading this.

I live to be a blessing to others and would like to continue that path. Meanwhile, nothing is wiping this smile off my face. After all, it makes people wonder what I’ve been up to. Now bring on the cake. I have a candle I need to blow out.

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