CANCER = INDECISIVENESS

“In any moment of decision, the best thing you can do is the right thing. The worst thing you can do is nothing.” 
― Theodore Roosevelt

I have always been taught that being decisive is a great leadership trait.  I have been decisive pretty much all my life.  Quick decisions.  Decide, and then move on to the next task.  But today I find myself completely INDECISIVE.  I'm not sure what to do with myself.

Cancer is a new experience for me.  Cancer is a HUGE deal.  Cancer is LIFE OR DEATH.  The decisions we make now regarding my treatment can SAVE my life, or JEOPARDIZE it!  These decisions are likely some of the most important decisions we will make in my life.

And I am PARALYZED!  Paralyzed because there are so many options and so many treatments and so many people who have answers and so many people that THINK they have the answers.  And yet, most don't know.

I have resigned to surviving it by taking it one day at a time.  And by making one decision at a time.  I've never been good at chess because I can only come up with the next move, not the next five or ten.  That is a comfort now.  One decision at a time.

We visited with my Urologist this past week to go over the options.  More information.  More options.  More paralysis.

Here we go...........These are the options my Urologist has given me.

OPTION 1:  ACTIVE SURVEILLANCE
We decide not to do any treatment at all.  Biopsies and PSA tests are performed regularly, probably every six months, and the cancer is watched closely.  If it becomes more aggressive, then we treat it.  If not, then we just keep watching it.  At this point, my cancer appears to be very slow growing and low risk. (Technical Terms here:  4 of the 12 core samples had cancer.  The most any of them were cancerous was 35%.  My Gleason Score is a 6.  My PSA is 7.  Treatment would kick in at 6 cores, 50%, or a 7).  (You almost need to have a medical degree to know what all of that means.  I've done so much reading and studying and asking questions the past few weeks, that my head is about to explode from being so full of new acronyms, statistics, and treatments for cancer.)

Pros:  33% of men in my Gleason 6 category never need treatment.  They die from other causes.  This option prolongs quality of life which treatment appears to destroy.

Cons:  Fear.  Really.  Who wants to live with even one freakin' cancer cell in their midst??!!  Biopsies.  (Go to my prior blog post to see why that is a con.  They seriously jam a stick up your butt and root around for cancer with a pick.  Seriously.)  (And there is no anesthesia or sedative as they do it.  Believe me, I asked for at least some laughing gas and the nurse said "NO!")  25% of the time, the biopsy does not detect the most serious cancer cells and the cancer is more aggressive than thought.  And it spreads to other parts of the body between biopsies.  Just the thought of that cause FEAR.  In 67% of men, the cancer does grow and treatment will be necessary.  Health may decline during the surveillance making the treatment more difficult.

OPTION 2:  RADICAL PROSTATECTOMY
Yes, radical is a good word for it.  They basically cut you open and dig out the prostate while trying not to damage anything else that is in that area of the body.  This includes nerves that create erections, muscles that hold the urine in the bladder, and the bowels which store poop.  The surgery is quite invasive no matter how it is performed (robotic, laparoscopic, or traditional) and has up to a two-year recovery from it all in some cases.

Pros:  When caught early, like in my apparent case, the surgery has a 95% rate of success.  Cancer is gone forever.  If it for some reason doesn't work, you can still do radiation and several other treatments.

Cons:  There are so many side-effects and possible complications.  Impotence (25%), Incontinence (5%), damage to bowels, infection, blood loss, and yes, even DEATH.  I have discussed this with dozens of victims of cancer surgery on-line and while they are alive, I have only met one who did not struggle with impotence and none who don't struggle with incontinence to some degree.  It apparently changes your standard of living permanently.  Picture going from a strong man who hikes a lot to an old man that shuffles, within a matter of weeks.

OPTION 3:  RADIATION
They beam the prostate with radiation.  Or, my favorite, they insert radioactive seeds into the prostate.  Either way, the radiation kills the cancer cells and everything around them.

Pros:  It does kill the cancer.

Cons: You are using something that CAUSES CANCER to KILL CANCER.  Many times it causes problems to nearby organs.  Impotence.  Incontinence.  Sigh...........  And the scar tissue from it is so bad that surgery and many other treatments are nearly impossible if the radiation does not work.  So if it doesn't work, you are screwed.

Our Urologist is recommending Option 1.  But he is also excited about and very good at Option 2.  We have ruled out Option 3.

If you have made it this far into this blog, no doubt you are FEELING MY FRUSTRATION.

The options appear to be: risk death vs voluntarily giving up my quality of life.  THAT EXPLAINS MY INDECISIVENESS!!!  Worst decision of my life.

We have found other "what we feel are" valid options.

HIFU
It stands for High Intensity Focused Ultrasound.  They take an ultrasound wand (just like in Harry Potter) and jam it up your butt and a crystal in the wand shoots out ultrasonic waves at the prostate.  The waves heat up the cells to around 200 degrees and this kills that part of the prostate and the cancer cells.  (Don't worry, they use a general anesthesia.) This is OUTPATIENT surgery.  You are free to consume a diet of cheeseburgers and pizza that very night!  In front of your own TV set!  While used for years in Europe, it was just approved by the FDA in late 2017.

Pros:  I have talked to half a dozen or so men who have used this.  Not one struggles with impotence or incontinence or other bazaar side effects.  It is nonevasive.  No incisions.  No stitches.  It does not close the door to other treatments if the cancer reoccurs, including doing HIFU again.

Cons:  A lot of doctors, especially prostate robotic docs, are very leery of it.  While it appears to have a great 10-year success rate for eradicating the cancer, there are no credible studies that go beyond ten years.

(It seriously sounds like a no-brainer to me.  But we are still studying..........)

MRI BIOPSY
New technology in which an MRI is done on the prostate which identifies exactly where the cancer is.  The MRI scan then is used to perform the biopsy and the biopsy is thus much more accurate.  No 20 - 25% oops rate that I mentioned above.

(Another no-brainer, right??)

GENOMIC TESTING
Some highly trained pathologist with specialized advanced training studies the genetic makeup of the cancer cells and provides a report as to how aggressive they likely will be.  You are given statistics like likelihood of death from cancer within ten years.  Likelihood of moving to other parts of your body in ten years.  And chance that your biopsy is incorrect and the cancer is more aggressive than your Gleason score.  And then it categorizes you into Very Low, Low, Intermediate, or High Risk.

(Seems like yet another no-brainer, right??)

SEE MY HEAD EXPLODE!!!  Indecisiveness!!!

Now that we've meticulously studied each medical treatment option, let me get funny and make a list of the "other" advise we have been given.  (These are all actual quotes, but I'm too lazy to put up the quote signs.  Please use your quote sign imaginations...........)

A diet of carrot and celery juice will cure the cancer.

Sugar feeds the cancer.  (When I was told that, I went home and ate every piece of candy in my home just to make sure it was gone. I'm safe now!)

Your diet will have no impact on the cancer.  (Although please eat healthy so you don't die of a heart attack when this is all over.)

 Cannaboids, if taken for 90 days as a suppository, will cure the cancer.

I have done pot for 30 years and still got cancer.

Too much sex causes the cancer.

Not enough sex causes the cancer.

The cancer is genetic.

There is no evidence that this cancer is genetic.

MRIs have no place in prostate cancer.

An MRI could save your life.

Biopsies make the cancer worse.

Biopsies are totally safe.

A plant-only diet will cure you.

A Pescetarian Diet will cure you.  (I had to google it.........fish diet.  I kind of do like fish and chips a lot........is that what they are talking about?)

The OMAD diet will cure you.  (One Meal a Day.)  (I'd rather just die.........)

A protein diet will cure you.  (Let's hear it for bacon-wrapped beef steak!!)

You should move to Japan, it is the country with the lowest risk of cancer among industrialized nations.  (not sure if it is the food, air or water..........)

You need to live off the grid and eat only organic foods.

You should never have drank the water in Clearlake.  (I love it when the locals there can laugh at their own situation.....we love you guys!)

Radical Prostatectomy (I really hate trying to spell medical terms correctly) will NOT reduce your quality of life.

You should go on Active Surveillance to prolong your quality of life.

You won't be able to wear shorts ever again because of the incontinence pee bag that hangs on your calf.

OK.  I'll stop.  I'm trying to amuse myself.  Laughter kills cancer, remember?  But, seriously, the above are all ACTUAL QUOTES.  Some from DOCTORS even.  MY HEAD IS EXPLODING!!!

So what have we decided?  1.  This week we will embark on an adventure to talk to a second Urologist and an Oncologist.   2.  I will not give up.  (Did you know that suicide among men who are diagnosed with prostate cancer is 400% higher than other men?  That's a whole other blog post.  Don't get me started on that topic.  Emotional help is apparently NONEXISTENT for this in most places in this country).  3. I will take care of myself.  (yet another future blog).

That's enough medical terminology and laughter at my situation for tonight.  I think I'll go drink some carrot and celery juice, eat some deep-fried fish, and then indulge in some Snicker Doodle Flavored Hot Chocolate - the only true blue proven cure for prostate cancer.