I have been quite for a while as I recover. But I wanted to continue my story…
As we met with the oncologist, he thoroughly described my staging and reviewed the NCCN Guidelines. According to the Gleason score and high percentage volume involvement, of at least two specimens, my prostate cancer staging, according to the American Joint Committee on Cancer was the following:
pT2b or PT2c with most likely no node involvement (NO).
If this sounds confusing, it’s really not as long as you have a legend to follow. For reference, you can follow the attached diagram. But just as a quick explanation, the “p” along with the “T” refer to the pathologic staging of the primary tumor and how much of the organ is involved. This is designated with the prefix pT2-4 referring to the extent of the prostate gland involvement (minimal, one lobe, two lobes, whole organ and surrounding tissues).
The other letters refer to lymph nodes and distant metastasis, N and M, respectively. The N is staged from X-1, ranging from no lymph node sampling to node metastasis. The M is staged from 0-1C, indicating no metastasis to bone involvement.
As we heard about the staging, we felt some optimism. But then the doctor described percent success rates with and without androgen deprivation therapy. Wait, what? I had already decided on a course of treatment that I wanted. What was happening? Furthermore, I was now told that I would first have the radioactive pellets placed in the prostate and then four weeks later I’d have the external beam treatment.
We were also told about the precautions I would need to take with having the pellets in terms of holding babies. Mind you, I have a baby grandson (nine months old during this occurrence). When he told us that the pellets never stop giving off radiation, I was paralyzed. Although I had read that the pellets would not be a danger in terms of holding a baby, the radiation oncologist said that holding the baby on my lap for a long period would not be advisable for three to six months. To say I was shocked would be an understatement!
Then came the other bomb. We were told that because of the enlarged size of my prostate, it would be highly recommended that I have ADT first to decrease the size to allow for safer placement of the pellets. Now I became numb. How did I go from having a choice on the ADT to now it almost being required? Not only that, the percent survival at later years were also improved when adding this therapy. As with any treatment, there were several possible listed side effects from radiation and ADT.
My world was absolutely rocked! I felt like someone had pulled the carpet from underneath me! What I thought was an appointment to go over the treatment protocol and start scheduling sessions, became a bombardment of information that was overwhelming and surprising! However, given the intermediate, unfavorable category of my prostate cancer, made sense. It was just unexpected.
Well, the other option, which I had totally ruled out before this visit was surgery. However, we were told that obviously, we would have to make that decision. And obviously, there were also some side effects discussed with the surgery. We were told that although no medical professional could force me in any certain direction, given my age, surgery could be a viable option. I left this appointment with totally dejected. Needless to say, it was a very long night!
To be continued…