Apr 16, 2014 - 10:09 pm
Hi, I'm 58 and in good overall health. In December I went to my primary care physican for my routine yearly physical. No new complaints. Every lab value was normal except for my PSA which was 4.69. My DRE is unremarkable. My doctor referred me to a urologist, however made the comment that it is probably prostitis. The urologist ran several variations of the PSA, and each one validated the original number. He suggested a 12 needle biopsy. At first, I refused. My dad had PSA's in the 8 to 10 range from my age until his death from a stroke at age 80. He underwent a number of biopsies and was never diagnosed with cancer. I figured that this was more of the same wild goose chases. My urologist finally talked me into the biopsy. During the procdure, the untrasound shown nothing abnormal. My prostate is slightly enlarged which could explain the elevated PSA, and the doctor stated that he will be suprised if there is any cancer. A week later he called with the news. Postive for adenocarcinoma on the right side 3 out of 12 samples. The Gleason score is 4 + 3 = 7. I have an extensive medical history, but function very well. I have undergone four spinal fusion surgeries from a back injury, and have a lot of nerve damage. The nerve damage is severe enough that my left foot became weak, a tendon popped, and I underwent a tendon transplant surgery. I survived a very large acoustic neuroma brain tumor in 1999. The tumor was located on my brain stem, and when diagnosed it was in iminate danger of shearing off my brain stem. I underwent FSR, Fractionated Stereotactic Radiosurgery in a pilot program at Johns Hopkins Hospital in Baltimore and have been in remission since that time. The tumor cost me the hearing on the left side, and my balance function. I learned to balance by eyesight.
Even with all of these problems, I managed to earn a four year degree in nursing, a second four year degree in psychology, and a Master of Social Work. I work full time as a RN at one hospital and part time at another. I work an average of 70 hours a week and am what people call an adrenilin junky. I am right the middle of any emergency, anytime, all of the time. I am also good at it! I love this stuff! Since I did not earn my education until my mid 40's I am still in the process of working hard, paying off a home, paying off student loans, and getting ready for retirement. If we get derailed at this point, finanicaly we cannot recover and ensure ourselves an independent retirement in a few more years.
Now is the part where I have to decide which treatment suits my situation. Since I have had three hernias repaired and am full of surgical mesh, my doctors say that I am not a canidate for robotic surgery. I am also against surgery period. I have undergone so many surgeries in my lifetime that I think the doctors should have installed zippers. The doctors and I are leaning towards either IMRT or the Proton Beam procedure. A good IMRT service is offered in our town, however they use the ultrasound approach rather than the leaf method. The doctors believe it is better. The Proton Beam procedure is offered 100 miles away, so it is a commutable distance. Since I am 58, still working my butt off, and have had zero physical symptoms, I would like to minimize the amount of disability caused by treatment. The wife and I enjoy a very active sex life, four to five times a week without fail. We joke that with all of the health problems I have endured, we have been lucky that one thing works without fail. I am also concerned that the amount of nerve damage I have from the back injury may predispose me to be particularly suceptable to problems from the prostate treatment.
Now is the time to select an appropriate treatment. All of the doctors want to augment my treatment with Lupron, a hormone therapy which they say will enhance the cancer kill rate and increase my 20 year survival rate by 5%. I am willing to endure anything short term, so this seems worth the inconvinence. The folks at the Proton Therapy center say that with thier treatment I have a 95% chance of no perminant disability. The radiation oncologist who provides the IMRT says that my chances of avoiding permnant disability is between 70 to 80 %. Since the Proton Therapy center is a chain of 14 centers around the country and they are paying for a 200 milion dollar piece of equipment, the thought has crossed my mind that the data may be slanted to make the Proton Therapy appear better then it actually is. Overall research to date does not show one treatment as significantly better than the other one is. Th million dollar question is if the Proton Therapy is better than the IMRT? Does anyone have some insights to this question? Thanks in advance. Charles S.