Well ... I asked for it!

After a lengthy discussion with my Radiation Oncologist, I finally arrived at the 'unmitigated truth'. Call me crazy, but I prefer to know the 'whole' truth; rather than be kept in the dark - regardless of my care-givers good intentions! At least when you are aware of your true condition, you can begin the process of preparing for the various steps needed to address each challenge as it presents.

To be honest I was more than a little 'peeved' by my previous medicos (plural) attempts to 'gild the lilly' [aka withholding necessary information / lying] ... as though I couldn't handle the truth. At best, this falls under the category of 'misplaced good intentions'! Worse however, it is patronising and condescending; worse still it disempowers the patient and robs them of their ability to make the best choice and denies the whole process of 'informed consent'!

The truth is ...

1. There remains some concern as to whether the LHRH implant (Zoladex) is as effective as could expected; as my PSA reading should have been closer to '0' by now. It is worth noting in this context, that LHRH implants only block the testosterone produced in the testes; and this accounts for approximately: 90-95%. I recently had a further blood test to determine my current PSA level and also my Testosterone levels. This will be an aid to determining whether the current LHRH is effective.


2. Because the PSA level has not declined at a faster rate, it has been decided to introduce an anti-agonist (Anandron ie Nilutamide) as well. Anti-agonists act to block the testosterone produced by the adrenal glands thus affecting a 100% blockade of testosterone in the body. This will continue for some time, concurrent with the LHRH Implant, and is known as Combined Androgen Blockade (CAB).


3. I have been scheduled for an outpatient procedure to be performed at one of Sydney's premier Hospitals, in which the Radiologist will insert three (24 carat) 'gold seeds' into the prostate. This procedure is performed under a general anaesthetic in a 'day procedure' in similar fashion to the TRUS. An ultrasound-guided instrument is positioned via the rectum to implant the gold seeds into carefully selected regions in the Prostate.


4. Following this, there will be a recovery period of 24 hours and then a 'planning week' in which the Radiotherapy treatment is discussed and mapped out carefully. This involves several scans, computer mapping and precise targetting. It is vital that this process is precise as the likely outcome otherwise would mean damage to healthy tissue and organs causing long term [unwanted] side effects.


5. I will most likely continue on the Hormone Treatment for at least 2 to 3 years. This then gives rise to the possibility of 'bone thinning' [oesteoporosis) and so I have commenced a daily regime of Calcium and Vitamin D supplements.


6. The Radiotherapy will consist of a precisely targetted (thanks to the gold seeds), high dosage of radiation being applied to the prostate. A lower dosage of radiation will also be applied to certain bones and organs within the pelvic region. During the process the patient is restrained using various devices to ensure that NO movement occurs that can adversely effect the outcome.


7. My original PSA [84.8] coupled with a very high Gleason Score [9] along with the results of the CT Scan, indicate that it is very likely that the cancer has metastisised to other organs or bones. This makes a 'cure' much less likely. It is hoped that if such metastises exist they are only microscopic and can be eliminated by selectively targetting the most likely 'culprits' with radiation as part of the overall IMRT procedure during the next 8 weeks. The best option moving forward seems to be ... to address the primary cancer and to review my recovery by way of ongoing PSA tests.


8. While the prognosis of 5 years is still 'on the table' it is impossible to predict - see below.

As the Radiologist pointed out: "we only get one shot at this and so we will plan to maximise our chances of a successful outcome".


Clinical prognostic factors

The most important clinical prognostic indicators of disease outcome in prostate cancer are pre-therapy PSA level and Gleason score.

Patients with localised prostate cancer who have pre-therapy PSA levels of less than 4ng/ml and pre-therapy Gleason scores of less than 4 have an excellent post-treatment prognosis, with a disease–free survival of greater than 90% following either radical prostatectomy or radiation therapy.

In contrast, patients with pre-therapy PSA levels of greater than 20ng/ml [mine was 84.8] and Gleason scores of more than 8 [mine is 9] have a poor prognosis (less than 50% disease-free survival).

Survival rates for patients diagnosed with a prostate cancer that has breached the prostatic capsule is poor and patients with metastatic disease have the lowest predicted survival rates of all. One estimate shows that, on average, 46% of patients with metastatic disease die about 22 months after diagnosis, and approximately 70% of all patients diagnosed with metastatic disease die within 5 years.

Well ... I asked for it!!