by Hugh Gilmore
My wife quietly beside me, I parked my car on a warm afternoon and walked across the medical building parking lot toward my cancer doctor’s office. I was braced for bad news, for the probability that neither the radical surgery of 2016, nor the 37 rounds of follow-up radiation I’d endured in 2018, had been sufficient to evict an unruly bunch of prostate cancer cells from their campsites in my abdomen. My domain, their domicile. Possibly my damnation.
In the elevator on the way up to the office I opened my mind and took out the folder labeled “Next.” In the world of prostate cancer men talk like baseball statisticians: Stage Three. Gleason Score 7 – “But is it 4/3? or 3/4?” One gets tested quarterly and fights queasiness as one awaits the numbers. Then: “The envelope, please.” Hopes, plans, and beads of slow sweat fall when numbers rise. Doubts and suspicion rise when numbers fall. Is the enemy merely pausing, before renewing the attack?
Off the elevator and into the waiting room, a too large, sunny room with a TV in a corner. So many people here. Does every one of these guys here have prostate or bladder or scrotal or penile cancer? There are lots of men’s magazines on the end tables, but nearly everybody is doing face time with a device screen.
In an ideal world, surgery and radiation alone would kill cancer. Afterward, when a man goes for his follow-up PSA (prostate-specific antigen) test, the numbers should be lowered, sometimes almost to zero. Mine was high (15) before I agreed to a radical da Vinci (a robotic surgical device) prostatectomy. The operation’s mission is to excise every last morsel of prostate tissue, down to the last cell. Afterward, my PSA was microscopic. “Hurrah!” I said naively back then.
I signed in early for my 2:40 appointment. I people-watched for a while. None of the men seemed to have been able to arrange for a support-animal, so they sat with spouses or friends. I thought a few of the people looked kind of worried, as though this was their first rodeo. This was perhaps my eighth visit. Usually nothing good had ever happened here.
Prostate cancer supposedly doubles every four years on average. Mine, post surgery, lowered to.018 to start with, but doubled after three months. And doubled again. Probably an “aggressive” cancer, they said. Two more tests showed the same rate of growth. I was advised to consider radiation therapy. I agreed and had that last year.
Today, a half-hour’s wait in the reception room slow-waltzed by like two hours. I still hadn’t turned on my Kindle. I remembered the radiation therapy as not painful, or even uncomfortable, and actually interesting to experience – since I was allowed to bring my own music and themed it to the weirdness of pretending I was at zero gravity in outer space while the mother module circled me.
But now, here I was in the waiting room, about to have a conference with my urological oncologist about what to do next, since the radiation has done nothing much to slow my microscopic prostate cancer. If anything, the Big Beamer’s rays had irritated everything they burst through in my lower belly on their way out my back. Especially the cancer cells, which seemed nowadays to be running at me like a horde of enraged Vikings. My PSA moved from 0.18 to 0.63 between last July and September. I asked for another three-month interval and a retest. Perhaps there’d been a hanging chad left over from surgery. In six months, at that rate I’d be over 2.00, one of those magical points at which everyone rolls up their sleeves and reaches for the hammer and tongs.
Yeah, sure, see you in January, my doc said. And so in mid-January, 2019, I’d sat in this same office watching the endless supply of other urological cases step off the elevators, sign in and sit waiting to go backstage with the doc. Not much good it did me. The gloomy news: PSA 2.80. Doubled twice in three months. Too much eggnog over Christmas?
My name was called and I was brought back to see my doctor. Whom I respect and trust. He said it might be time to go see a medical oncologist. I’d been surgi-fied and radiation-ified, and now it might be time to drink the Drano. Medical oncologists treat with “medicines” – a euphemism for chemicals that suppress, strangle, hypnotize, bypass and sometimes murder cancer cells along with anything else they brush against as they barrel through your system.
In the case of the prostate, it is widely believed that that awful, awful hormone that makes men so awful, namely testosterone, is the fuel that feeds the prostate cancer cells. The answer: cut the fuel. Castration is offered in two basic flavors: physical or chemical, with lots of variations.
Some studies say it is perhaps only 50% effective. And usually the effect wears off after a while (though the orchids plucked in an orchidectomy 100% do not grow back). And for every chemical introduced to the body, other chemicals are needed to offset their nasty side-effects. And, oh yes, a man’s body might feminize, his strength might ebb, he may experience fuzziness when doing calculus and he might lose his libido.
“Doctor,” I said, “could we try the PSA test again? Perhaps in May? And do some imaging?” He said yes, but I should expect that my PSA might be between 5.0 and 6.0 by that time. Action might be called for.
And now: it was May. I’d had a full-body MRI, and a lower body CT-Scan to check for metastasis, and another PSA.
My name was called. The shape of my coming summer, and perhaps my whole life, was about to be revealed.
See you all next week. Thank you for reading.
Author and columnist Hugh Gilmore has been writing this column for the Local for 13 years.