Turning Point - 005
Seven weeks passed since my surgery and it was time to return to the surgeon for my first post-operative PSA results. My sweet Mom, who was 91 at the time, asked my sister to bring her to Florida to be with me when I got the results. Even though I was 53 at the time, she still thought of me as her little boy. My sister was happy to do it and I picked them up at the airport. The following morning, Mike drove us all to Celebration to meet with the surgeon. By this point, I wasn’t dreading the results even if it showed the PSA level was detectable, which would indicate the surgery wasn’t curative. I just wanted to receive the information and get that part over so I could plan what to do next.
The urology fellow came in and gave us the results. My PSA was 4.8. My stomach sank and I partially left my body again. I was starting to get used to bad news so each time was slightly less impactful. Or at least that’s what I told myself.
It’s funny how people hear what they want to hear when under a lot of stress. When the fellow left the room, my husband turned to me and said “So you’re cured.” I didn’t have the heart right then to tell him that I wasn’t. I just told him, “It means I need more treatment.” The surgeon quickly followed, reiterated the results, and said the PSA level wasn’t surprising given my surgical pathology results. He told me that he recommends I see an oncologist as soon as possible and that I need to begin androgen deprivation therapy and radiation.
As we walked out of the doctor’s office into the hallway, my sister started crying and hugged me. My Mom and husband joined in with a big group hug. I eventually had to break us up because we were literally blocking the door and preventing another patient from leaving. We went to a restaurant for lunch and talked about what it all meant. I really don’t even remember much of our conversation because I was still partly out of my body trying to keep from emotionally breaking down. I just remember everyone staying very positive.
My biggest fear since learning I have prostate cancer is not of dying. My spiritual belief is that we go home from where we came from and that it’s full of unconditional love. My biggest fear just after hearing the PSA results was thinking about having to start androgen deprivation therapy (ADT). ADT typically involves the use of different types of medications to lower your testosterone level, preferably to less than 20, with a normal level between 240 and 950. Some physicians talk their patients into having their testicles removed, known as castration. When drugs are used, it’s called chemical castration. Yes, the same chemical castration used as punishment for sex offenders.
Many people don’t know that Alan Turing, the British computer genius, was convicted of homosexuality and sentenced to chemical castration. They did this to him despite his pivotal role in cracking the German Enigma code, leading to an early end of World War II. It is reported that he committed suicide with cyanide two years after being chemically castrated.
I was afraid of ADT because of the long list of side effects: loss of sex drive, fatigue, osteoporosis, anemia, hot flashes, emotional lability, gynecomastia (man boobs), muscle loss, and increased risk for stroke and heart attack. A few studies have shown ADT causes cognitive decline as well as dementia. I can’t have cognitive decline and do my job as a physician. I can’t be significantly fatigued and work nine-hour days.
Other studies show a common side effect of ADT is depression. What if it throws me into such a deep dark depression that my immune system fails and lets the cancer rapidly take over? I had recently read a study that showed depressed prostate cancer patients die much faster than those who are not depressed. These are the thoughts that go through your head. This is why I was dreading hearing that I should start ADT.
While prolonging the lives of some men with advanced prostate cancer, it significantly worsens their quality of life. ADT and its modern derivatives remain the mainstay of treatment for men with advanced prostate cancer even after eighty years. That’s a reflection of how little the treatment for advanced prostate cancer has progressed compared to other cancers.
ADT drugs aren't considered curative in men with advanced prostate cancer. They just give you a little time. But at what cost? In addition, resistance to the drugs’ effects develops rather rapidly, an average of about eighteen months for first-generation ADT drugs. And what I call prostate cancer’s dirty little secret is that treatment with these drugs creates pressures at the cellular level, which mutates prostate cancer cells into aggressive tumor types that are more likely to metastasize. I go into more detail about exactly how this happens in another newsletter.
Soon I’ll have a shocking experience with two radiation oncologists who personified exactly how not to treat patients. Their behavior was quite disturbing, especially knowing they only treat cancer patients.