Wherein We Join the Show, Already in Progress...

Friday March 13, 2009 started the second chapter of my life with cancer. That's the day my PSA test showed its third increase in 9 months.

Let’s review: When I was diagnosed back in February of ’08 I was under the impression that the cancer had been found, would be removed, and I would move on. I would heal, slowly. At least that was the picture that was painted by conventional wisdom, statistics, doctors, nurses, friends, and the internets. But as the months wore on, and the regular PSA tests were done, a pattern emerged: the numbers were going up instead of going down or staying steady.

I had crossed over to the hall of mirrors where so many with cancer reside. It is a world of counter-intuitive information, contradictory facts, rules that are iron-clad until they aren’t, and polished marble floors that turn to quicksand just as you get a foot hold. In the past year I claimed I was living part-time in cancer-world. It seems my commutation ticket has been punched and while I still live part time in cancer-world now I own a condo with a fully stocked fridge so I can stay here longer.

Here’s the bio lesson: When you have a prostate it emits Prostate Specific Antigen (PSA) all the time. The measurable amount is low if nothing is wrong or high if something is amiss. Though that is not always true. But mostly it is. Except when it’s not. An infection, an injury, or cancer cells living there can make it rise. It is notoriously unreliable for detecting cancer but it is the only test out there. Basically: low number good, high number bad…except when it’s not. Now if you remove a prostate the PSA test becomes extremely accurate because the ONLY way the number can rise is from the presence of prostate cancer cells. But if you removed a prostate, and there are prostate cancer cells detected…uhhh…where are they?

Now follow this one: When they took out my prostate they found that the cancer was completely contained within the prostate, encapsulated they said, showed no signs of spreading. Good news, right? Not so fast. If the PSA had NOT gone up, yes good news. But it HAD gone up…so where exactly are the cells if everything was contained?

But if the cancer HAD NOT been contained and showed signs of spreading (Bad news right?), and the PSA went up, well they know where to look for the remaining cells…in the area where the prostate used to be, essentially these cells are left-overs. This is logical. Easy to treat.

So to recap: A clean pathology in May of ’08 is a good thing until it isn’t in March of ’09 and bad news is sometimes good.

So what do you do? You scan the bones for metastases; you scan the pelvic region to look for lesions. And if you find something ( that’s bad news, right?) you aim radiation at it, maybe a few other things, and you’ve got a good chance of a cure.

BUT…if the doc comes back with your reports with the “good news” that your bone scans are clean and show nothing (maybe a tad of arthritis here and there), and your MRI’s are clean and show nothing, this news that should normally be greeted with a sigh, a sheepish smile and a mumbled, “thankyougod,thankyougod,” is particularly alarming. Because what you’re being told is that yes, you have cancer, we know it, see the numbers prove it, we aint wrong…we just don’t know where it is…but it’s there...yup.

Objects in the mirror may be closer than you think…what you see is not necessarily the truth…or maybe it is.
So where am I now? Tuesday the 31st I see a radiation oncologist to decide a course of action. Probably radiation targeted at the area where the prostate was. How do we know that’s where the cells are? Well we don’t…we’re guessing. And that’s the best we can do. Maybe add in some hormone treatments, just not sure at this point.

I anticipate a major disruption to my life for treatments and side effects. Will it work? It might…but then again it might not. After that? We’ll see.