For your listening pleasure....
He had an appointment with a nurse yesterday to go over the test results and options available.
He has prostate cancer. His PSA (prostate serum antigen) count has been higher than normal for a few years now, from the first time it was taken. We were frustrated with our current insurance company at the time, trying to get a better rate for life insurance for Brian. One of the companies came out and took blood and that's when we found out there may be a problem. He was turned down for the insurance, but he started having it tested every year. It had been hanging between 3.5 and 4, but on his test last October, it was 7.4. A big, concerning jump.
We were aware that there was a concern, because they called and wanted him to come in. Eleven days later, the result had risen. It was now 8.2. We didn't find out the actual results until yesterday.
Because of the results of that colon cancer home screening kit, they wanted Brian to have a colonoscopy. That was scheduled for October 30th. (Polyps removed, tested, benign.) He got a call from another department about the PSA results (we still didn't know what they were) about the same time and he made an appointment to speak with a doctor on October 31st. And the doctor advised the prostate biopsy. After Thanksgiving, he finally got the call to schedule the biopsy. It was scheduled for December 13th.
The doctor called with the results on December 22nd. The Friday before Christmas. Brian has cancer. Now, the question is how bad is it and what are the options. And we're back to waiting.
They called Brian last week and scheduled two appointments. One with the nurse (yesterday) and one with his oncologist (the 25th). We got a packet in the mail. Brian didn't open it right away and when he did, he tried to absorb the content, but just had a hard time with it. He asked me to look at it.
I finally said something on Facebook about it and got some input from others who had someone close who had prostate cancer and their treatments. Brian was all set to have the prostate removed, but it's not as easy as taking it out, then going back to work in a couple of days. It isn't a weekend recovery. More than one person shared that seeding (brachytherapy) was done with pretty good results. I kept this in mind as I read the material.
I compared what Brian had said about his experiences to what I was reading. His Gleason scores were two sevens and one six. The DRE (digital rectal exam, where the doc puts his fingers up the butt and feels the prostate, anyone who's had a cervical done will be familiar with this type of procedure) was normal, the doctor didn't feel any thing out of the ordinary, i.e. no lumps. So, that's a good thing. So, based on the few things I knew, I figured the cancer was stage 1. And that's a pretty good thing. Those sevens mean that watching and waiting is off of the table for options. (And the watching and waiting doesn't mean doing nothing, there would be doctor appointments and blood tests every three months.)
I tried to grasp the Gleason scores, but didn't find anything that explained it so that I completely understood it. I knew that a Gleason score of 7, that was 3+4 was a better score of a 7 with a 4+3 base. I didn't understand why. But the nurse cleared that up yesterday. Now I understand.
Yesterday, we got to see the results of both the PSA tests and the biopsy. And she sent copies of the results as well.
The prostate is an organ about the size of a walnut. Brian's was a third larger than that. Just to give you an idea of how small it is. They took twelve samples. Two each from six different locations. A, B, C, D, E and F. Three on the left, three on the right.
Each one of these samples is given a score, from one (normal) to five (most mutated), depending on the appearance of the cancer. (There is a graphic here that shows the varying degrees of the cancer mutations; I wish I'd found this earlier.)
The first number of the score is the more prevalent cancer cells, the second number is the smaller amount. So, 3 + 4 is better because there are more of the less mutated cells. If the 4 was first, that means there are more more mutated cells than less mutated cells. I hope I explained that right.
Anyway, from Brian's results of the twelve samples taken, four showed cancer. Two of the areas only showed cancer in one sample (D and F) and one area showed cancer in both samples (B). And the most that was present in any of the samples was 20% (B). So, that seems pretty decent, it could be a lot worse than it was.
Anyway, we pretty much ruled out the surgical removal because of downtime. A three to four day hospital stay, at least two weeks at home with a catheter and limited physical movement, with gradually increasing. There were a couple of radiation options, one being high beam radiation therapy where he'd have to go in for treatment on a daily basis for five to nine weeks. Where he'd have to go is about fifteen to twenty miles from home. They do have evening appointments. But, once again, it comes down to time. And then there's the seeding. An outpatient surgery. Like the biopsy. Minimal downtime.
From the research I've done, the seeding seems to have as good of results as the surgery. The only problem with the radiation therapy (any of the therapies) is scar tissue. Should the cancer return, the presence of scar tissue would put surgery out of the picture.
We'll find out what the doctor recommends when we see him on the 25th.
Brian still hasn't told his brother, but now that we know more, he's more comfortable sharing this. Things like this really upset his brother, which is why he's put off telling him. But he has to tell him because now it's family medical history.