ANOTHER ROLLER COASTER RIDE

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…

CONFUSION ABOUNDED

So we thought we were ready to embark on the radiation pathway. Yep, I thought a one time procedure of pellet implantation was very desirable over 40 external beam treatments. This would be much less disruptive to my schedule.

Furthermore, I had a conversation with at least two people who either had external beam or pellets with external beam. But before I committed to any type of treatment, I was still confused about what I had heard at one of my urologist appointments regarding my Gleason 7 score. This was confusing to me. But after doing some research, it seems that even if most of the core specimens are 3+3 and only one is staged at 3+4=7, the person is staged according to the higher number.

So the Gleason system is based on the assumption that the higher number is representative of what’s actually occurring. Here I am thinking that sine most of the core biopsies were a Gleason 6, that’s what was representative of the cancer. Oops, I guess NOT!

Oh well. I had to stay on track. I had to keep moving forward. So next stop on this train was an appointment with the oncologist at the cancer center. I was ready. My wife and I had discussed this and made up our minds on the treatment plan and was ready to go and get this radiation thing scheduled and started. But I could not have been less prepared for what came next.

Continued….

THE RECONNAISSANCE MISSION

After having heard about my treatment options, I was determined to speak to someone who had been through radiation. However, my quest was more specific than just anyone. I was on a mission to hear from someone around my own age who had been through radiation treatment.

So through a friend, I was able to speak to a gentleman who had a history a higher Gleason score and went through both brachytherapy and external beam treatment. And he was doing well with minor side effects. So after this conversation I was encouraged and ready to go forward. So I thought.

After this conversation, my wife and I met a couple who were nutritional vendors promoting a vegan lifestyle. The gentleman had a significant history of prostate cancer, however, his had metastasized. He underwent both surgery, testosterone suppression therapy and radiation. He shared research information about how a diet free of animal products and low in saturated fats, was known to protect against prostate cancer and actually reverse the process.

The name that stuck out the most during our conversation was Dr. Dean Ornish. He authored a study in the Journal of Urology, which detailed the effects of an “intensive lifestyle change” on men with early, low grade prostate cancer. The study showed that the PSA revealed a 4% decrease on the experimental group versus a 6% increase in the control group. Furthermore, there was an decrease in the growth of cancer cells of up to 8 times as much in the control group.

This sounded groundbreaking! But was it truly real science? This may not be mainstream, I thought, but certainly worth some attention. Furthermore, Dr. Ornish may not be a cardiologist or nutritionist, but even the American Cancer Society recommends a reduction of saturated fats and reducing red meats.

Although this gentleman had some side effects, his claim was that they were improved with a vegan diet. Although I was not totally ready to bet the farm on these claims, it was clear that there were at least anecdotal evidence. So we did research on a vegan diet and decided to adopt this practice. I had nothing to lose. And my wife, in a demonstration of love and support, decided to adopt this lifestyle with me. (Mostly because she’d be doing the cooking anyway. LOL)

Our hope and prayer was that God would use this change in diet in conjunction with the upcoming radiation treatments to give me good outcomes. But wasn’t totally sure if this was my treatment option for sure. I still had a consult with the Cancer Center.

THE TREATMENT PLAN

Now that we are well versed on the Gleason system, I’ll continue my story.

So with all the pieces of the puzzle together, now came time to break out the National Comprehensive Cancer Guidelines (NCCN) to develop a treatment plan. The NCCN is a comprehensive set of guidelines developed through extensive review of clinical trials and existing treatment protocol along with expert medical judgment and recommendations by physician panels made up from Member Institutions. These guidelines cover 97 percent of all cancers affecting patients in the United States and are updated on a continual basis.

According to the NCCN flowchart, interventions or treatment protocols are based on age and life expectancy. This means that the younger the patient, the more aggressive the intervention. Conversely, the older the patient, the more conservative the approach. For example, a 75 year old male diagnosed with a Gleason 7 prostate cancer would more than likely undergo radiation rather than surgery.

Well, from what I remembered, my Gleason score was 6. According to the NCCN Guidelines, the recommendation was prostatectomy (removal of the prostate), brachytherapy (radioactive pellets placed into the prostate gland) or external beam radiation. And with the radiation, I would have to decide if I wanted to have androgen deprivation therapy (ADT), which are basically injections to decrease testosterone, which is known to promote prostate cancer growth.

So, again, my Gleason score was repeated as a 6. And now I had to decide on which type of radiation I wanted as treatment and if I wanted to go through with ADT. Well, nothing sounded extremely attractive about pellets being inserted into my prostate or ADT. So I decided against those and surgery and opted for external beam radiation, which I know from others who had it or were having it, that it was 40 treatments.

Of course, as with any discussion of a surgical procedure or medical treatment, came the discussion or “informed consent.” “Everyone is different and not everyone has these effects, but some of the side effects of radiation are urinary incontinence, blood in the urine, painful urination, diarrhea and erectile dysfunction. These are mostly temporary and medications can be given for erectile problems.” (Sorry, I have to keep it real). Just what I wanted to hear- feasible ways in which I could help keep the prescription drug industry viable! (insert sarcasm face). Well, this was starting to sound less attractive

I left that appointment determined to do more research in terms of pros and cons of radiation therapy. I knew I need to find people who had been through this type of treatment and glean from their experiences. To be continued…

As we continue to raise awareness for prostate cancer, please remember: Although there may not be a hard rule for screening, talk to your doctor about a PSA test if you’re between 45 and 55 years old. Screening should be done at 40-45 years of age for African Americans, Latinos or if there’s a strong family history.

THE BIOPSY

“Next stop, Biopsy,” said the conductor as the train pushed forward. Then the Tran came to an abrupt stop. As I de board, I enter into the urologist’s office for my biopsy appointment. This would be what’s called a core needle biopsy. For this procedure, the doctor uses a probe with a somewhat of a spring-loaded, thin, hollow needle to obtain specimens from the prostate gland. (I won’t go into all details).

When the trigger is pulled, the needle retrieves a small cylinder of prostate tissue called a core. This is repeated about 12 times to get several samples from different areas of the prostate. Yes, there’s local anesthesia involved. Besides some discomfort, it wasn’t horrible. I wouldn’t sign up for it again though!

Well, we were all set to go on vacation in three days and here I am, waiting on biopsy results! I didn’t really know if I wanted my results before or after our vacation. But in a way, I wanted to know what I was up against so that I could have some time away from the hustle and bustle to gather myself and get mentally prepared for what was coming up. After moments of contemplation, I decided to bite the bullet and call for my results two days before our trip. Well, when I called, I was transferred to the doctor’s assistant. “Hi Mr Araujo,” said the nice assistant. Her voice was friendly and chipper. This could only be good news, right? Could this be a sign for optimism? I didn’t find out because I was told the doctor would have to call me in the morning. Ugh!!!!

So I get a call in the morning. Not only was I told the results, but I was also e-mailed the report. In a matter of seconds I felt like had just entered the twilight zone! I don’t remember anything else that was said but I could probably reel off what the pathology report read. What I remember most vividly, was the word “adenocarcinoma.” Adenocarcinoma is the type of cancer that develops in gland cells and is the most common type of cancer found in the prostate gland.

50% of the biopsy specimens were positive for adenocarcinoma. There were numbers

associated with each biopsy specimen that appeared in the following manner: 3+3=6 which were most of the core specimens. One however, had the numbers 3+4=7. The others were labeled with what became my favorite word, “benign.” I was also told, as I would’ve expected, that I would need to have a bone scan and MRI to check for possible spread. Yes, I had now entered into the cancer world. The only question was, how deep?

Wow! This was a lot to take in right before a vacation! But I just needed to know so that I could at least use a few days off to process this information.

To be continued…

Understanding Differences Between Men and Women

So this past Mother’s Day, I tried to do more stuff around the house so that that my wife, and mother of our kids, could just relax. While my wife enjoyed her cards, flowers and lunch, she also had arranged her empty Clinique products on the bathroom counter for full display. “I don’t ask much, just for some observation,” she said as she swept her right hand as to uncover a prize.

At that moment, I felt like I was three days late for the prom! So I went into “fix it mode,” because that’s what men do, right? I told her that I would get new products but she told me not to bother, that she would do it.

This incident portrays a stark difference between men and women: women want men to notice things they need whereas men want to be told what women want or need.

A woman’s desire would be for her husband to be observant and proactive in both noticing and fulfilling some wants. This lets the woman know that she is being thought of. Unfortunately, most men aren’t wired this way. Most men would be happy to fill a need once they are asked.

Knowing and understanding these differences is of vital importance in a marriage. It prevents misunderstandings, unrealistic expectations and disappointments. It is also important to be able to discuss these differences with grace, patience and without setting ultimatums. This allows for healthy communication and may also help each person to be more sensitive to each other’s needs.

So how did this play out? Well, she never did go to get her Clinique products. So I assured her that I would take care of it and I did! Now she’s all set…and I’ll try to be more intentional on being observant.

Encouraging Love

I wanted to share a story about encouragement in our marriage. But what does this word mean? What does it entail? Well the dictionary definition of encouragement is “the action of giving someone support, confidence or hope.”

Well, as an example of this I’ll share our experience over the past year or so. Recently, my wife changed her work hours to where she has Fridays off. She also has engaged in personal development, which I think is great! In addition to this, I am two years into opening a business.

Now marriage is hard enough without adding some stressors and twists. But when we decided to push forward with these changes we also made a decision to support and encourage each other. How did we do this? By giving each other space when needed, telling each other we believed in one another, picking up the slack for each other, just being attentive and by praying for each other. The more we did this for each other, the stronger became our intimacy, confidence and prayer life.

So as we found, again, a little encouragement went a long way in the long term investment of our marriage.

What are some ways you encourage your spouse?