Operation Scheduled

I met with my surgeon Dr. Vincent Laudone today and scheduled my prostatectomy for October 20th. I have an MRI on October 11th in preparation for that and hopefully indications will be that the cancer is contained. If my cancer is contained to the prostate, then after the surgery my treatment is finished, I'm done.

Dr. Laudone said people are typically out of work four to six weeks after the surgery, which surprised me, though some people go back in their second week. Melanie and I are leaving on November 28th for a trip to India so I'm hoping I'll be in good shape for that, and though it will be close, it looks like I should be doing well by then.

Dr. Laudone is the guy you want for this operation, he's at the top of the game and is personable and easy to talk to. I'm very comfortable with him doing the work, and he's got a great track record. He said as long as the cancer is contained to my prostate, I can expect to have the same life expectancy after the surgery as if I'd never had the cancer. So much for my plan to die young and leave a beautiful corpse...

My big fear, obviously, is the cancer is not contained to my prostate. The MRI will tell more, but the results won't be definitive even if they look good. During the surgery they'll sample a lot of the surrounding tissue and test it for cancer later, so it's not until I know those results we'll know the full story of what I'm dealing with. Of course I hope the MRI looks good, I don't want it to find anything suspicious, but the definitive results won't come until after the surgery.

So fingers crossed the cancer is contained. Dr. Laudone characterized this as an aggressive cancer, but I guess it's all in how you interpret it. He said my PSA was low at this stage of the game so that was good. They look at "Gleason" scores which run between six and ten and mine was an eight, right in the middle of the scale. So I'm halfway between "wait-and-see" and "very aggressive." It's serious enough they'll do the surgery before my trip to India instead of later, which is what I want, I wouldn't be able to enjoy myself with the operation hanging over me.

It feels good to have this scheduled. Now I hope everything goes well with no surprises.

(I'd love to hear from you.  Feel free to leave a comment.)

Michael Chabon Book Signing

http://en.wikipedia.org/wiki/Michael_Chabon

My man Alain & I were in the Union Square Barnes & Noble last night to hear Michael Chabon read from his latest novel "Telegraph Avenue" (we share mutual Michael Chabon man-crushes). Thanks go to Alain's beautiful bride Kacie who spotted the appearance. Following the reading, Michael signed copies of his book.

The way it worked was, you bought the book on the main floor, then brought it and the receipt up to the 4th floor (it's a big bookstore) for the reading and signing. The receipt was your entry ticket. Michael would sign any book you brought so long as he wrote it, and sure enough, there were people who seemed to have stacks of every book he’d ever touched. (We were told someone at the previous signing wanted him to sign a copy of "Moby Dick" for some reason. New Yorkers, don't ask.)

Alain and I were both surprised by the sound of Chabon's voice. I don't know what I’d expected - I wasn't aware I had any expectations at all - but what I heard surprised me, a slightly higher-pitched soft tenor-y voice as opposed to the commanding baritone I must have imagined. Maybe I expected to hear the narrator in those Hollywood blockbuster trailers: "IN A WORLD WITHOUT HOPE, ONE MAN STANDS ON THE BRINK OF ETERNITY!!!"

I don't follow too many contemporary writers, but Michael Chabon has interested me for a long time. I became aware of him after seeing a movie based on his book "Wonder Boys." The film shares the title and stars Michael Douglas, Toby McGuire, and a pre-sobriety Robert Downey Jr., and is fantastic, I LOVE this movie. I picked up the book and was even more impressed. I haven’t responded like that to a new writer in a long time. Later, in 2001, Chabon won the Pulitzer Prize for Fiction for his novel "The Amazing Adventures of Kavalier & Clay" about the early days of the comic book industry. This new one, "Telegraph Avenue," is about a used record store in 2004. Not only is Chabon a brilliant writer, he writes about the geeky things I love.

Chabon read the beginning of the book, then took questions from the audience. He was relaxed and conversational answering questions and came off likeable and genuine. After that he signed easily hundreds of autographs for people. Alain and I were near the back of the line but we got to shake his hand and get our books signed. Very cool night.

Springsteen: "Born To Run" & "The Rising"

I've never seen Bruce Springsteen in concert and I don't know if I'd call myself a fan. I love some of his stuff and I have maybe half of his albums. On the other hand, I buy a lot of albums, so… I'm aware of what he's doing at any given time, but I'm more of an interested outsider than a fan.

Then there's the album "Born To Run."

"Born To Run" is in my Top Ten albums of all time; no, my Top Five. It was released when I was in high school and I borrowed it from my friend Mitch (some of you might know Mitch as Captin Krunch) and recorded it to my father's reel-to-reel tape recorder. I gave the LP back to Mitch and listened to the tape over the next week or two, and I was so blown away by the lyrics (I'd never paid much attention to lyrics before) I borrowed the record again so I could type the words out on my mother's old manual typewriter. (Do you remember that, Mitch?)

It was the first time I'd related to what a rock album had to say. Bruce sings about the Jersey shore on this record and I KNEW those people, I'd SEEN them. I lived in the suburbs, but I'd go to the shore and this album talked about something familiar. I was blown away. A rock album made me consider the world in a way I hadn't before. It was the first time I saw popular music as art I guess, or as something that could move me and change my perceptions and experiences, or maybe affirm them; I don't know, it's a complicated thing when art moves you.

I followed Bruce's career after that. I got "Darkness On The Edge Of Town" released an agonizingly long three years later. The wait was caused by Bruce's legal dispute with his previous manager. I remember first hearing "Darkness" on an FM station at night, they played an advanced copy in its entirety, and I'd expected it to be "Born To Run - Part II." But of course it wasn't, it isn't. "Darkness" is an album by an older artist exploring different themes. I wasn't ready for that, and I was disappointed.

I followed Bruce's stuff over the years. I was in the Air Force when "Born In The USA" was released and became the monster hit of his career with all those top-ten songs. But just as the hit single "Born To Run" never grabbed me much, the album "Born In The USA" didn't do much for me. It was good, but it didn't match the greatness of the "Born To Run" album; nothing did.

I kept buying maybe every-other Bruce album over the years and was always a little disappointed.

Then 9/11 happened and the things that were important before took a back seat to the fears of the world. A few pop music artists released albums and songs responding to this event - Neil Young for one - but nothing registered for me.

Then Bruce released "The Rising."

I cry like a baby every time I put "The Rising" on. That's why I'll never listen to it in front of you, I can't. "The Rising" did for the country what "Born To Run" did for New Jersey. It brought to vivid life a people in a place at a time with magical artistry in a way no one else did or maybe could do.

And it does so much more.

"The Rising" is tender, loving, and tries to understand. "The Rising" isn't judgmental, it doesn't point fingers, and it doesn't accuse. It comes from a place of humanity. It knows people all have the same needs and concerns, and it tries to make sense of the tragedy of 9/11 in a way that leaves me in utter awe. I'm not kidding when I say I cry every time I put this CD on.

What an achievement this record is. It articulates the depth of absence, something we usually never consider.

This album is as great as the best work of any popular artist living in their time; da Vinci, Mozart, Twain, Pollack, Kerouac, Beatles, Dylan… and Bruce. All popular artists of their day who remain inspiring and influential. It's hard to appreciate a prophet in his home town, and we - especially in America - dismiss our own easily. But this album is one of the best.

If you haven't heard "The Rising," listen to it. Keep in mind when you do this was released ten months after 9/11 and is a direct response to it. Though not all the songs were written after 9/11, they were included for the way they reflect on that tragedy. Be aware of that, and think about how this album is about the permanence of absence. I like to think this record makes us better people.


(I'd love to hear from you. Feel free to comment.)

http://en.wikipedia.org/wiki/Born_to_run
http://en.wikipedia.org/wiki/The_Rising_(album)

Waiting To Talk To The Surgeon

This Thursday at 11:00 I talk with the surgeon who will probably do my prostatectomy. I'm going with the robotic surgery which has the same long-term outcome as traditional surgery but is less invasive, is possibly more accurate, and has a shorter recovery time. I've seen the device in action and I'm impressed. To me, it's a no-brainer.

A bit more info on the findings of my prostate biopsy. The doctors said they only take into account Gleason scores between six and ten, with a six indicating a possibly slow-growing and benign cancer for which they take a wait-and-see approach, and a ten indicating an aggressive cancer that needs to be treated. They took fourteen samples of my prostate during the biopsy and six were positive for cancer. My highest Gleason score was an eight and the next highest sample - or core - was a seven I think. That put me somewhere between wait-and-see and treat it now. With my family history - my father died of prostate cancer when he was 70 - and my relative youth, I think it'd be a mistake to let this go untreated. All things being equal, I could be around another 30 years or so; that's a long time for an existing cancer to branch out and become problematic. Plus, I don't like the idea of living day-to-day wondering if the cancer is spreading yet.

One alternative to surgery is to have radiation pellets - or seeds - put directly into my prostate to keep the cancer at bay. However, the prognosis for that is messy. Over time the likelihood of incontinence and sexual dysfunction increases. There also seems to be a question about whether the seeds are a cure or simply keep the cancer in check, and if so, for how long. And the longer the radiation pellets stay in, the more damage they cause to the healthy tissue. Maybe for someone in their 70s it's a way to go, but I don't think it's an option for me. Another thing that makes surgery more attractive to me is with surgery, I remove all the cancer in one procedure and start the recovery and healing process right away and keep getting better over time.

So surgery it is. I'll have it done at Memorial Sloan-Kettering Cancer Center where I work and there's no better facility for something like this. We're truly cutting edge, real pioneers in this treatment. You can probably find care which is as good elsewhere, but I don't think you'll find better. In a way I'm lucky, I just happened to get a job here three years ago so I have access to this treatment. I feel very comfortable my care will be the best, period.

I'm a little worried though, of course. I'm concerned the cancer has spread. That seems very unlikely; all indications are this is an early detection and the cancer is contained. But a spread is a possibility, and so far I haven't been beating any of the odds. That's got me concerned.

Even the best case scenario is a little mixed. If they do remove all the cancer, I'll still be dealing with the effects of the prostatectomy for the rest of my life. The urinary incontinence should be mild and temporary; it won't be a loss of control so much as a loss of FULL control. For a short time. The possibility of sexual dysfunction, though, is scarier and varies from person to person. There seems to be very little risk of impotence. The best I can tell is, at my age and general health, I can expect to get about 90% of my sexual function back, maybe more. And the better your surgeons are and the more experienced they are, the better your chances of having a successful recovery there. Sex will never be the same as before the surgery because my anatomy will be different, but I should regain most of the ability and function. Clearly it's not the end of the world, and it's certainly preferable over death. But even with the best outcome I can't help but think of the punchline: "Aside from that, Mrs. Lincoln, how did you enjoy the show?"

I freak out a bit from time to time, but since I'm going to do this, I just want to get it over with, I hate thinking and waiting. I'm hoping the meeting goes well with the surgeon Thursday and I get this scheduled and feel reassured about the outcome.

To be continued. And continued. And continued. And con…

(I'd love to hear from you. Feel free to comment.)

The Mind Of A Cancer Owner

Fantasy Conversation Inside My Head Right Now

I'm freaking out a little bit.  Did my cancer spread?  I can deal with the surgery recovery shit if I have to, but did my cancer spread?  How bad is it?  Will it kill me?  Is this surgery, like my father's treatment, a waste of time?  Will this cancer kill me like it killed him?  Something will kill me some time eventually, but am I dealing with that eventuality now?  Will this cancer kill me?

Probably not.

Probably?  That's the best you can do?

Yes, it is.  There are no certainties in medicine, not today's medicine, only statistical probabilities. This cancer probably won't kill you.  It might, and it does kill some people in your situation, but it probably won't kill you.

Can you tell me something more positive?  More uplifting?

Yes.  You make bald look good.

.... Uhm....   Thanks?

(I'd love to hear from you. Feel free to comment.)

Prostate Cancer

I'm getting tired of getting cancer all the time!  (Four or five years ago I had Melanoma, which they removed from my back and no further treatment was needed.)

Today, 9/11 of all days, I found out I have prostate cancer.  These days the approach is often to do nothing, wait-and-see, because so many prostate cancers are relatively benign, slow growing or non-growing and unlikely to pose any risk.  But in my case, because of the amount they found and the density, they categorized it as between wait-and-see and aggressive.  They recommended taking care of it, and I have to agree.  Plus my father died from prostate cancer, so I don't want to take any chances.

All indications point to surgery taking care of the whole problem, there seems to be very little risk of it having spread at this point.  I work at Memorial Sloan-Kettering Cancer Center so I have access to the best cancer care you can get.  There's no doubt my doctors know what they're doing and will do the best job anyone can.  I may be dealing with something shitty, but I've got the best people in the field working on it.

I got over the Melanoma surgery fast, and I expect I'll get over this one relatively quickly too.  It will be a longer recovery obviously, but with my age and overall health - and the skill of the surgeons I have access to - my side effects should be on the smaller side and manageable.

It's an easy choice though.  I have dying on one hand, and living with an unpleasant recovery and some side effects I'm sure I can handle on the other.  Talk about a no brainer.  Plus I'm with Melanie now, so I'm planning on sticking around as long as I can.  It took me a while to find her and now that I have, I'm not planning on leaving anytime soon.

Oh shut up Cameron and get some sleep.  

OK, I think I will.  

Goodnight.