Pro Gnosis

The source of all the trouble.

Previously on MondoBlahBlah...

I had the consult with the NIH multidisciplinary team on Wednesday. In (very) short, the prognosis is quite good, though they want to treat aggressively. The cancer is still encapsulated in the prostate, and of very low volume, so they feel that given my relatively young age, there is an extremely good chance that this can be nipped in the bud so I can go on to live long enough to have my heart kill me. They have a way with encouragement, these guys.

They have laid out two recommended courses of action (Christ, do they actually call them “modalities”?) I do not yet comprehend all the details, but am rapidly coming up to speed. They are, not in any particular order:

Radiation/Hormone Therapy
Eight weeks of radiation and two years of hormone therapy, basically ridding the body of testosterone which effectively starves any cancer that survives the blast of radiation.

Surgery
Laparoscopic radical prostatectomy using a device called a daVinci robot. This is just what it sounds like – chop it out. If I read the NIH team accurately, this is their preferred approach, though that may just be because when you have a da Vinci robot, everything looks like a prostatectomy.

Both approaches have been pitched as equally effective and ultimately curative. Each has its own set of risks and potential side effects. The hormone therapy would turn me into Bruce Jenner for about three years and the surgery is, well surgery. Both promise the possibility of sexual and urinary “lifestyle adaptations” meaning I could potentially become an impotent bed-wetter, but they assure me that most men of my age who go through the procedures go on to live fairly normal lives with only comparatively modest accommodation (e.g., boner pills, etc.).

So, I'm now in the process of compiling a list of questions and I’m making arrangements to meet with my urologist, whose opinion I have come to trust, to get his take on it. The NIH team assures me that there is no urgency to decide on what treatment I prefer, and have encouraged me strongly to seek other opinions and carefully consider the options. On the whole I am very pleased with the NIH team’s manner – I had five doctors from the Urology Oncology Branch, the Radiation Oncology Branch, the Medical Oncology Branch, the Department of Molecular Imaging and Radiology, and the Department of Pathology spend nearly two hours talking to me about the details of my case and answering questions about the recommended treatment options. I was genuinely surprised to have such attention lavished on me, but then you’ve got to remember, these are federal government doctors, not for profit doctors; so they’re probably not under the same kind of pressure to turn over the table, so to speak.
 
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