Urologist Visit

Today, I took myself off to the Urologist's surgery; armed with a page full of questions. The questions looked something like this:

1. What if anything, can be done about the fatigue?
2. Should I be concerned about the 'shortness of breath'?
3. What about the dizziness?
4. Should we consider addressing the cholesterol level at this time?
5. What about the ... 'blood in the ejaculate'?
6. What can I do about the 'hot flushes'?
7. Um ... ah ... what about ... um ... 'breast tenderness'?
8. Is the weight gain something to concern myself about at this time?
9. And the blood in the ejaculate?
   
   

Well ... during the course of the consultation, the doctor managed to:

1. Answer some of the above.
2. Avoid some of the above ("I wouldn't worry about that").
3. Delegate the responsibility (to answer) the remaining questions to a colleague - "You can talk to the Radiation Oncologist about that.

Don't you just love it when doctors are able put your mind at ease!


Radiotherapy

The upshot of the visit was, that we now move into a new phase of treatment - 'Radiotherapy' (RT) as an adjunct to the Hormone Therapy (HT). The latter will most likely continue for approximately 18 to 24 months. However, there is a possiblity that I could be on HT for the remainder of my life; dependent upon the success of the radiation treatment.

[It has also been decided at this stage, to rule out surgery; because of the likely complications; both during and after the operation].

Radiation Therapy will entail daily radiation treatment, 5 days a week for approximately 6 weeks; (with Saturday and Sunday ... 'off for good behaviour').

Unfortunately this will also involve short stays in hospital for each subsequent treatment; thus further complicating my desire to lead as normal a life as possible e.g. juggling work committments, cancer therapies and home and social life etc.


LHRH Implant

Of course, the main purpose for my visit was to receive another injection of a luteinising hormone-releasing hormone (LHRH)- specifically a 'Goserelin acetate implant' (the generic name) or Zoladex (the product name).

Don't ask me why, but ... I asked to be able to inject myself on this occasion, not sure why now; but it seemed like a good idea at the time! Well according to witnesses (the doctor and my wife) I was a real 'pro' (professional).

The instructions were simple: "Grab a good fistful of excess skin ... (to the left of the 'belly button') ... and in one swift downward motion plunge the syringe into the abdomen right up to the hilt! Then depress the plunger and this will release the implant."

Well I must admit, in some strange way, I actually enjoyed the experience!

Perhaps it was because I was 'in control'; for the first time since the cancer was discovered. Perhaps it was the release of adrenalin, associated with the whole procedure; I'm not sure.

However, afterwards I do recall the doctor stating: "Very well done ... but ... I'm still charging you for the procedure, even though you administered the implant yourself"!

The success of this treatment (in my case Goserelin 10.8mg every 3 months) will continue to be be monitored by regular blood tests which look specifically at the Prostate Specific Antigen (PSA) readings.


Summary

In what follows, I'll attempt to summarise my position at this stage. I must add, that most of what follows has been determined by the research that I have undertaken on my own behalf.

While I have been priveliged to have the services of some very good professionals available to me throughout this ordeal; none of them (including my GP who is only new to me) has assumed the role of case manager and walked me through the necessary (often daunting) steps.

This I believe is often a serious flaw in the current treatment of cancer patients. Even though my Urologist has a clinical nurse assigned to liaise with his cancer patients, she has been unable to answer my questions, on at least 3 occasions and was away at a 'course' (yeah you guessed it - the course entitled 'How to Comfort Cancer patients') on the fourth occasion. Suffice to say: 'I wasn't all that comforted'!


As to life expectency:

We still have 3 to 5 years 'on the table', with the qualifier ... it could be a few years longer!

The PSA level is "coming down very nicely" but at 4.8 (normal being 0 to 3.5) and with a Gleason score or 9 (out of 10) there is still the possibility that the tumour has breached the boundaries of the capsule (Prostate Gland). If so, it is hoped that the Radiation Therapy (in combination with the HT) will effectively deal with such a breach.

NOTE: There is currently NO cure for Prostate Cancer once it has spread beyond the capsule. Current therapies can only 'buy some time'.


As to the side effects:

Hot flushes, Cholesterol, fatigue, shortness of breath and dizziness can all be managed by medication; according to my own research.

Weight gain is amenible to exercise, but some may be inevitable.

Blood in the ejaculate? To quote the Urologist: "We don't need to worry about that; it's quite common for blood to be still present in the semen at the 3 month mark. But that's something you can ask T... ('Dr. T' - Radiation Oncologist) about as well".

And finally, with regard to 'breast tenderness, a short zap with 'radiation' (while undergoing RT) can deal with this once and for all!

Grave News...

I'll be blunt, Mr Purcell, it's not good news. I am really sorry that I don't have better news for you, but there are still some things we can try ..."

I was not completely shocked by the news, I had known for sometime that something was wrong; a sort of 'gut feeling' if you like.

But circumstances in my life had been pretty chaotic for quite some time and had not permitted an investigation into my 'gut feelings' - until now.

My mind had already begun to race ahead exploring the many different scenarios, until ... suddenly the Urologist was speaking again.

"... there are a number of tests we need to do right away. I'll schedule a CT scan followed by a Bone scan for early next week. We'll know more then, and can begin to develop a plan of attack."

"Doctor let me be blunt, I need to know ... should I start getting my afffairs in order? I have a daughter and two young grand children in Chile; the youngest one is only 6 weeks old and I've never seen her".

"If I were you, I would be planning to spend as much quality time with them as possible; why wait and take the chance that your health might deteriorate more rapidly then expected. I would go and see them"!

"Thankyou, I appreciate your honesty, I've got a lot to think about".

My wife and I just looked at each other - stunned! I had earlier warned her to expect bad news, but even I wasn't prepared for the prognosis:

"At best you have 3 to 5 years; at worst ... a little over 12 months!


All I heard for the next hour or so, repeated like a tape recorder resounding relentlessly in my head, was that last phrase ...


"... a little over 12 months"


It was then I realised I had a terminal illness, and fear came flooding in! As I looked at my wife while we made our way to the car, I could see that she was sobbing and shaking and the colour had drained from her face. I felt so helpless, realising that I was ONCE AGAIN the cause of her pain - only this time I could see no obvious way to make it up to her?

Urologist

I attended my first appointment with the Urologist/Surgeon today in his Monavale surgery. After some intial discussion, I then underwent ... a 'digital rectal examination'. Now this is not as painful as it sounds, but it certainly is a little embarrassing; as the process involved a gloved finger penetrating my anus!

As I recall that moment now, I can't help but smile broadly. The Urologist had asked me to climb up on the 'bed', which was located against the far wall. As I approached the 'bed' I received a new command: "drop everything from the waist down, climb up; then lie down and face the wall - in a foetal position".

Now everyone knows that doctors are well respected and to be obeyed - to the letter. And so I did as requested. Now imagine, a 56 year old (proud Aussie) male, with his dignity only just intact ... his trousers and underpants around his ankles ... trying to climb onto a 'bed' one metre high!

"Hey 'doc' don't you think it would have been much easier to climb up here, if I didn't have my 'dacs' down around my ankles? Come on fair go!"

The doctor simply laughed (I suspect a snicker was present too) and explained that most of the men he sees; can't undress that easily once on the table. Hence the 'dacs down first routine! So much for trusting in authority figures. Next time I'll ask for a second opinion!

Now, this could not have been a pretty sight!

I was (almost) glad that my wife had been asked to leave the room for the duration of the procedure.

Imagine what she would have had to endure, the poor thing; watching while her husband - whom she had previously viewed as: strong, self-reliant, a pillar of strenth type - was anything but a picture of strength and calm. The image she would have had burned into her psyche would have been that of a:

'A half naked middle-aged man, lying helplessly in a 'foetal position' (which speaks of vulnerabilty, dependence upon others) 'facing the wall', as though in disgrace; and then letting out a pathetic wimper, as a gloved finger was thrust into his nether-regions!

Oh, the indignities we men have to endure!