Why there have been no posts since April

There have been no posts since last April. There is a reason—cancer.

At the end of 2014, my prostate specific antigen (PSA) level was above the recommended level. In April, 2015, a retest confirmed this, and my urologist recommended a prostate biopsy. The biopsy was done at the beginning of May, and the pathology confirmed it was an aggressive stage T2b cancer. Many different tests immediately followed.

On May 14 I had a CT scan that showed no evidence of cancer spreading to the lymph nodes. On May 18 I had a bone scan that showed some areas that were likely degenerative (in other words, just old age) but couldn’t exclude the possibility of metastasis. So, on May 21 I had X-rays that, thankfully, showed no evidence of metastatic disease.

At the end of May I met with my urologist who described all my options (surgery or radiation treatment). Having already given this question a lot of thought (I had also studied up on expensive, out of my insurance coverage, proton beam therapy at Loma Linda), I chose surgery at the Kaiser hospital in Walnut Creek. The type of surgery performed there is robotic assisted laparoscopic prostatectomy (RALP). The hospital performs a lot of robotic assisted surgeries, so my surgery date was not scheduled until July 14. I didn’t like this delay. It was a long time to struggle with anxiety.

At the beginning of July, I did some pre-op questionnaires and had an EKG. This didn’t go well. Atrial flutter was diagnosed, so I wore a Holter monitor for a day and had an echocardiogram. The cardiologist prescribed a blood thinner (coumadin) after surgery.

On July 14, the day of surgery, I arrived at the hospital at 2 pm and after a very short wait I was taken in to get prepped, which was mostly getting stuck with various IV needles. After this I was wheeled down to the OR where I got a short look around at the multi-armed robot and my doctor working at the control console. The anesthesiologist introduced herself and a short time later I was under.

I woke up in recovery with Karen, Dan, and Annmarie, but I was pretty groggy. I’m not sure what time it was, but I don’t think the surgery took more than 2 hours. After a while Karen went home and I drifted in and out of sleep. I was never moved to a hospital room because I was going to be discharged in the morning. Some time in the middle of the night the nurse got me up to walk, so I shuffled back and forth a few times in the recovery room.

Karen came back in the morning. After a while the doctor came by to talk and remove the drain tube. He then released me, and we were back home by noon (so the whole procedure, door to door, was less than 24 hours).

A few days later the doctor gave me the pathology report. The lymph nodes that he sampled were cancer free. The margins were clear except for a problematic 1 mm spot that may, or may not, become an issue. I’ll have periodic PSA tests to monitor this. Sixteen grams (30%) of the prostate was cancerous.

Recovery has been OK. I dedicated myself to lots of walking. Discomfort from the six punctures in my abdomen was tolerable—actually, only the largest one was really sensitive. The biggest drawback, and discouragement (I’m impatient), was regaining bladder control. That took many weeks.

On August 24 I had a PSA test (a more sensitive test than the normal one) and it gave a value of 0.02 which is right at the lower detectability limit of the instrument. The doctor would have preferred a level <0.02 (in other words, not detectable by the instrument). On October 14 I had another PSA test and this one returned a result of <0.02, which was a relief to me. Like all cancer patients, I have to live with the thought that the cancer may not be completely gone, and it may become detectable in the future. I will be on a surveillance program with periodic PSA tests.