Mark the Calendar

Entry 11

Written October 25
Pre-surgery Appointment

So far, so good. My prostatectomy is scheduled for about a month from now. We'll discover the exact time this week.

It does help to have someone with you when you visit the specialist because more questions and answers tend to be generated. I went solo to today's pre-surgery information appointment with Dr. Saranchuk, the urologist/surgeon and his resident.  My note-taker, Margaret has accompanied me to many of my previous appointments but she's in Vancouver with her elderly mother for a couple of weeks. 

By comparison to past appointments, this one was brief, less than half an hour. It hadn't been necessary to feed the parking machine for three hours.

During our meeting, the urologist explained the surgical process and the potential side effects once more. One new thing I learned is that there will be some blood loss during the surgery. In anticipation of that, my own blood will be drawn and stored just before the surgery. Other fluids are added to compensate for the drawn blood. He also told me that the average hospital stay is three days.

He reassured me that he would be doing the operation. We were wondering about that as this doctor is also an assistant professor working for a faculty of medicine in a teaching hospital.

Now, the wait......

Ancient Eygptian Surgical Tools

Decision Time

Entry 10

Written October 22th

Our good friend Graham who is a doctor in Selkirk has helped us to consolidate and process much of the information that has come to us. He also took our  last lingering questions to the specialists and then interpreted their responses so that for us the choice became more obvious.

I've elected to have a prostatectomy.  Now to tell our family and friends.

The following is from my e-mail to Hugh, my friend and June paddling partner:

"This is not a 'gimme' operation. I'll be on the table  for 4 hours and in the hospital for 3-5 days. The catheter stays in for 2 weeks.

My body is in a no holds barred battle with the cancer in my prostate; indeed it may have been the reason why I got Giardia and you didn't considering we drank mostly the same lake and creek water this spring. In retrospect it was probably fortuitous I contracted Giardia because it was while they were trying to figure that out that they twigged to the spiking PSA rate.


The docs all strongly recommended I get the flu shot including the Pneumococcal vaccine shot because of that immune deficiency. We have both had our flu shots as of today. Margaret & I have always got the flu shots to good effect over the years so there was no need to convince me.


In any event after long discussions with the Urologist, the Radiation-oncologist, and particularly my doctor all of whom have been amazingly patient, helpful, and objective about options other than their own field of expertise, Margaret and I decided to go the surgical route. I won't bore you with the details as to why mainly because it's complicated as hell.


What it boils down to is this - my bone scan was clean as was my CT scan, so to the best of their knowledge the cancer hasn't migrated outside of the prostate into the bones or organs. The key then is to get it before it does.  If it does get out the highway is via the lymph nodes in the pelvic area. Surgery is the only way to find out if it has metastasized because when they open you up they biopsy the lymph nodes while you are on the table and remove them just in case they don't get all the cancerous tissue during the surgery (microscopic cells invisible to the naked eye hiding in the walls and lining to the other organs). Radiology accepts the CT Scan as the truth and does not address the lymph nodes. I have trouble accepting that.

In any event I go in next Tuesday for another conference with the Urologist (Surgeon) and he will give me a date as to when the offending gland and the related bits and pieces are to be removed. I would expect it to be within a month."

Article on Surgery

Surgery is Cutting Things with Knives

Entry 9

October 13

Before Dr. Ong, the radiation oncologist met with me to discuss radiation as a treatment option for prostate cancer, his resident, Dr Peterson came in to interview me and explain the process.

It's very clear after speaking with Dr. Ong that each treatment method has advantages and disadvantages. And each treatment method has other treatments that follow should the first method fail to eradicate the disease. The choice of how to proceed now has been left to me.

Some treatment options have been quickly eliminated because of the state of my disease (Intermediate, Gleason 7, PSA 17, T2c [which means cancer is in both lobes]). Active surveillance, laproscopic surgery, and brachytherapy are out; prostatectomy and radiation are in.

It has been evident from the beginning that surgeons prefer surgery and radiation guys prefer their method of treatment. To quote Dr. Peterson, " Surgery is cutting things with knives."

We found a good chart  that shows the range of options for men with prostate cancer & typical side effects.

Link: Urologists are biased about the treatment of prostate cancer…but not like you’d think..

Annual Seminar : A Room Full

Entry 8

September 28

We attended an evening seminar on many aspects of prostate cancer. The panel featured four medical specialists including Dr. Jeff Saranchuk, Urologist and Dr. Aldrich Ong, Radiation Oncologist with whom I'm meeting in early October.


It was a very informative evening hosted by the Manitoba Prostate Cancer Support Group. The auditorium at the Health Science Centre was packed. After all speakers completed their 10 minute presentations, audience members could ask questions. Even those were interesting.  

Support Group Newsletter [Oct 2010]

A Better Experience

Entry 7
September  21

The Manitoba Cancer Care Centre is impressive. We headed up to the Prostate Care Centre on the 3rd floor.

Beforehand, we knew a bit about Dr. Saranchuk from Graham who said the guy is about fourteen. (He's closer to forty)

Dr. Saranchuk was amazingly professional from the first moment to the last of the appointment. He outlined the options for us based on the evidence at hand. He then conducted my third DRE of the summer.  I learned I was a good candidate for radical surgery or external beam radiation. A less aggressive or less advanced cancer might be "treated" with watchful waiting, laproscopic surgery, or bracytherapy.

Treatment Options:

Active Surveillance  |  Experimental and Alternative Therapies  |  Surgery  |  Laproscopic Surgery  | 


External Beam Radiation  |  Brachytherapy  |  Hormone Therapy  |  Chemotherapy  | 


Complementary Therapies  |  Palliative Therapies

Dr. Saranchuk then introduced us to Dr. Anne Katz, his colleague and fireball who buzzed about how "it's your body" and "do what's right for you".  She made obvious her preference for the skills of Dr. Saranchuk over those of Dr #1 Urologist without being overtly critical.  Before we left the office, thanks to Anne Katz, we had a future appointment with the Radiation Oncologist for the beginning of October.

Thank you Dr #1 Urologist

Entry 6

September 17th

During our follow-up appointment with Dr #1 Urologist, he informed us that as the result of the bone & CAT scans there was no sign of further spread of the prostate cancer.

 

He gave us answers to every question we could think of.  We were pleased with his patience and feeling a little guilty that we had scheduled an appointment with Dr. #2 Urologist aka Dr. Jeff Saranchuk.

We were informed that the cancer rated 7 on the Gleason Scale which ranks it as intermediate, the most common grade of prostate cancer.


The only odd thing about the tests was that the bone scan showed some right ankle damage. That was all. Are you sure that's my bone scan analysis??? I broke my knee in a heli-skiing accident but I've never injured an ankle.

We have a slight remaining, niggling concern that these scans were taken with what our friend Graham calls, "blunt instruments." 


We found the Nomogram prediction tool online. Maybe that will help with my decision making, maybe not.

I'm Glowing

Entry 5

September 10


It seems I needed tests and more tests. One of the major concerns at this point was the extent to which the disease may have spread.
 
I had to offer a blood sample before I had this, my second CAT scan in two months (the other had been in June for a sore back).

CAT Scan

On September 10th, I also had a fully body bone scan to check for spread of the disease. In preparation for this test a nurse injected radioactive material into a vein in my arm.

 

Call Me, I Have Bad News 4U

Entry 4
Aug 19 - Aug 25

Dr #1 Urologist returned from his month of holiday and had his office person phone us. "Could you be available to take a call from the doctor tomorrow afternoon?" 

Of course.

He didn't call on Wednesday as expected. Harry called his office the next morning. 

"Could you be available this afternoon for his call?" asked the receptionist.

Again, no call on Thursday as expected. Again, Harry called the doctor's office the next morning. 

"He's on a four day holiday. Could you come in on the 25th?" inquired the receptionist.

Surely the diagnosis can't be bad when your urologist displays such a lackadaisical attitude prior to the followup meeting ...---... Wrong. The appointment on the 25th started with Dr #1 Urologist walking into the examination room with a Manitoba Prostate Cancer Support folder in his hands. "Let's get right to it. All twelve cores in your biopsy tested positive for cancer."

Prostate Cancer Research Institute 

 

Luckily, we started our habit of taking notes at these appointments. This was the beginning of our information overload.  It was also the first occasion that it occurred to us that we needed a second opinion.

1st Visit to a Urologist

Entry 3
July 21, 2010

After considering my PSA count and having palpated my prostate, Dr #1 Urologist decided during my initial visit to him that a needle biopsy was in order. He took tissue samples from 12 spots in my prostate. We would wait one month for the results.


Some doctors schedule a screening for resistant ecoli infection before conducting a biopsy. In my case, minutes passed between between the DRE and the biopsy...no warning.

That hurt. Apparently, he had not used a local anesthetic.


Disoriented after that procedure, I couldn't find our new Subaru Outback that I had driven into the hospital parkade. Thinking it had been towed, I called the towing company who denied having our car. Only then did I remember I had used Margaret's Jetta that day. There it was where I left it.


Life goes on. I went on a second summer canoe trip, this time with Jim Buckingham, Pam Little, Doug and Donna McKown in the Sturgeon-Weir area. [Pictures]


A Urologist's Biopsy Experience

Doctors Don't Like Giving DREs

Entry 2

DRE stands for Digital Rectal Examination.

We read somewhere that doctors don't especially like giving DREs. That would not seem to be our experience. They seem to delight in giving them.

The first DRE in mid June revealed a hardening on the right side of my prostate.

That was the first of five DREs I was to experience.

Thank Goodness for Giardia

Entry 1
June 21, 2010

Hugh Burton and I completed a canoe trip to the Bloodvein River system in the first few weeks of June.  [Photos] A week or so after our return, I felt fatigued and had diarrhea, cramps and no appetite. That matched descriptions of giardiasis. Not good. Hugh didn't seem to have a problem.

Fortunately, in the process of having my doctor and good friend Graham Fuchs check me over and treat me for giardiasis, we learned that my PSA was elevated (17.5 nanograms/milliliter) from what it had been 16 months earlier (5.5 ng/mL).

A man's PSA (Prostate Specific Antigen) count is measured by a routine blood test. Interestingly enough, the medical community cautions us to not become anxious when the PSA rises slowly, however, as in my case, if it rises suddenly it can signal a problem.

If it weren't for having giardia, I might have missed the first sign that I had prostate cancer.

The Importance of a PSA Test (mp3 audio file)