Health challenges

Posted in : Current Issues on by : Paul J. Fitzgerald Comments: 0

To all my current and previous clients and colleagues: I am letting you know that I was diagnosed just before the holidays with prostate cancer. I’m aware that confidentiality of health information is a very sensitive topic. But I feel like I don’t have any real reason to keep the information private: I am self-employed and don’t plan to apply for any jobs in the future. And if I apply for insurance, well, they’ll have access to that information anyway. Besides, I feel like this is a valuable lesson for me and worth sharing with others.

The first lesson is that we all need to keep up with our annual exams and periodic health screenings.

I admit that I missed my annual physical exam during COVID-19 (though I did keep in touch with my doctors for other problems that are being successfully treated). But the PSA test (Prostate-specific antigen) was put off; and when the results came back last summer, my PSA had risen from 2.5 to 5.4. Anything under 10 is not cause for immediate alarm, but doubling of the PSA always warrants further investigation. So I was referred to a urologist, and on the digital exam, he noted some firmness that warranted a biopsy. I had the biopsy in October and the results came back in November. Prostate cancer has been very systematically studied, and besides the Gleason score, the number of cores that were positive for cancer helps determine the stage and treatment options.

I had six of twelve cores that showed cancer, with four of them having a Gleason score of 7 (3+4 or 4+3). In addition, one was close to a nerve, which raises the risk a bit. But the cancer was entirely confined to the prostate, so the stage was considered “2a.” Another system classified it as “Intermediate unfavorable,” or “teal” in yet another classification.

So the good news was that I had choices. One choice is “active surveillance,” which is the new term for “watchful waiting.” Because prostate cancer is slow-growing as long as it is within the prostate, this may be a viable option for some men, especially those over 70. It involves frequent PSA tests and exams, with further treatment if necessary.

Another choice is surgery to remove the prostate and some surrounding stuctures. Nowadays this is usually done robotically. But because of my age, and since I had previous robotic surgery in that area, the surgeon did not think I was an ideal candidate. I have also found in my reading that surgery runs a slight risk of missing some cancer cells “in the margins.”

The third choice is radiation therapy. There are several types: One is brachytherapy, in which radioactive seeds are permanently implanted. My doctors did not recommend this type. The other types are external beam radiation, using either image-guided equipment and gold “fiducial markers” or the “Calypso” system using tiny radio transponders (no kidding! I could have been microchipped!). I spoke to a radiation oncologist who said the best recommendation would be the image-guided radiation therapy using fiducial markers. I also opted to have a hydrogel “SpaceOAR” injection, which helps keep the prostate separated from other organs at risk from the radiation, to help cut down side effects. The gel then breaks down and is absorbed in six months or so.

Because of the “unfavorable” subtype, the doctors agreed that I should have a short-term (six-month_ course of androgen deprivation therapy (ADT), which is an injection that blocks the production of testosterone by the body. Since prostate cancer is “fed” by testosterone (much like some breast cancers are fed by estrogen), this treatment is also effective in slowing or stopping the growth of the cancer. I got a shot of a medication called Camcevi in December. It’s felt that this short-term ADT helps make the radiation more effective in eliminating all the cancer.

In the past, ADT was mostly used for prostate cancer that has metastasized, since it can inhibit the growth of he cancer wherever it may be located. One problem is that prostate cancer tends to develop resistance to ADT with time, but there are newer ADT medications that seem to get around this “castration resistance.” (Hey, we’re lucky. Surgical castration used to be the only treatment). My urologist did some genetic testing which found that my prostate cancer was not inherited, but that I had a genetic variation that might make ADT less effective.

The hot flashes hit around New Years Day, so I guess I don’t have to worry about that possible genetic variation too much.

I had the markers and hydrogel implanted in January (with some technicians from the company that makes the hydrogel looking on), and a “simulation/mapping” session done two weeks later.

The actual radiation treatments started yesterday, and I had the second one today. Quite an impressive machine, that circles around you and is very quiet. So far no ill effects. This thing is so precise that they can tell when I didn’t drink enough water for breakfast and can compensate.

I’m getting treatment through the AdventHealth system and UroPartners. My radiation treatment and radiation oncology team are at the AdventHealth Cancer Institute in Hinsdale. It’s in the building right next door to my Hinsdale office, which is quite a coincidence. (Well, this was one of my choices). all the people there, as well as at Hinsdale and LaGrange Hospitals, have been great. The AdventHealth system has now partnered with University of Chicago, which is great as far as access to the latest treatments and clinical trials if I should need them.

I also have to give a shout-out to Wellness House in Hinsdale. I signed up with them as soon as I got my diagnosis, for exercise, stress management, and support services. I’m in a prostate cancer exercise class, an “Exercise during Cancer Treatment” class, and a prostate cancer support/networking group. It’s an enthusiastic and positive group of people, both the facilitators and the participants. If you’re looking fora nonprofit doing great work that you want to support, I strongly recommend Wellness House. I even went to a Tai Chi class there. I plan to attend more classes as my treatment progresses.

You may have gotten the impression that I’m a prostate cancer expert. One thing I’ve learned from this is that anyone who is diagnosed with cancer needs to become an expert on their cancer, and on treatment options and advances. The guys in my support group have been an excellent source of news and information, and the news is largely positive and more optimistic with each passing year.

I’ve also shifted my perspective on cancer, after having lost a number of family members and friends to the disease. The diagnosis of cancer used to feel like a death sentence, but I prefer to think of it as the beginning of a “change of course” in life – a journey through health challenges and a quest to find meaning in life differently than before. I have a new cause – once I have complete this treatment, I plan to focus on practicing with people diagnosed with cancer and other life-challenging conditions.  I’ve had many clients who were cancer survivors, but “living with cancer” is a different way to look at it. Yes, we can talk about a “cure,” the definition of which varies with the type of cancer and even the form of treatment (“cure” for prostate cancer has been defined as 10 years cancer free after surgery, but only 5 years cancer-free after radiation therapy). I watched an interview with a man who has been living for 16 years with metastatic prostate cancer!

The other thing that’s happened this week is that – after I shared my diagnosis with some dear friends – two of my dearest friends have just been diagnosed with different forms of cancer within the past two days. So my feelings about it have intensified. We can talk about “beating” cancer, but I’m thinking that “overcoming” cancer is a better way to think of it.

CC BY-ND 4.0 Health challenges by Fitzgerald Counseling is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.