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…

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