I had a PSA test in December 2019 that read 7.9. Knowing nothing about PSA or prostate cancer, I went blithely about my business. The Covid-19 pandemic then came upon us and I worried more about that for a while. Another PSA in July 2020 read 8.3 and a DRE found a lump. So, I was off to Biopsy Land!

The biopsy was scheduled for July 31. I had read just enough about biopsies (I hadn't yet discovered YANA) to scare myself. It was a twelve needle affair conducted by my urologist. I started counting down the perforations (21!!!! 20!!!! 19 Hey!!!!) when the doc laughed and distracted me, making me lose count. It wasn't nearly as bad as I had imagined, but still not something I'd relish doing again. I drove home with very little discomfort.

On August 3 I had the results. 9 of 12 cores with cancerous cells, most 70% involvement or more. 4 cores had a Gleason score of 3+4=7 and 5 cores were Gleason 4+3=7. 3 cores showed perineural involvement. Although I have yet to be told what my actual staging is, I have been advised that my cancer is of Intermediate Risk. My urologist said my treatment options were Radical Prostatectomy or Radiation Therapy accompanied by ADT and that I had six months to get going on one of them. He then proceeded to schedule me for an MRI in six more weeks! (Let's see, six months minus six weeks equals Less Damn Time! But what do I know? I majored in Art.) Meanwhile a bone scan on September 1 gave an All Clear. While I waited for the MRI, I started reading including this site, and reaching out for second, third and fourth opinions. I wasn't ready to call myself a cancer patient. But when you're asking for medical advice you kinda have to admit to that.

Let me explain something here that has a real bearing on my ultimate decision. My partner, Coby, has a rare appendicial cancer discovered when her appendix ruptured. After recovering from that, she endured de-bulking surgery, a prophylactic procedure in which two surgeons removed her right colon, her ovaries (instant menopause!) and scads of lymph nodes. "Great news! There were no signs of cancer in anything we removed!" Lovely. Then put it all back.

That was 3 1/2 years ago and fortunately she is now NED. However, blood tests have recently (like, at the same damn time as my biopsy) revealed that she may have multiple myeloma. Naturally, this requires more tests to detect something that's pretty nebulous.

So, my options are to stay home for a shorter course of SBRT or two months away from Coby for proton therapy while she tries to find treatment for whatever it is that she has. I'll meet with my radiologist on October 2nd and at least begin with the Lupron injection.

I received my first 3 month Lupron injection on October 8th. That hurts! But, as I was in the infusion room of the cancer clinic, surrounded by people receiving chemotherapy, I figured I could take it without whining.

I've decided that traveling out of town for proton therapy, paid for or not, is impractical. Being away from home for 2 months, the living expenses attendant to that, Coby's health (and missing her!) and the pandemic all weighed against it.

So today, October 9th, I visited another radiation oncologist who is affiliated with the same medical system as my PCP. (The previously mentioned docs operate from a large university cancer center.) I liked him very much. He explained my options, the pros and cons and even prescribed FloMax for me. Nobody else ever mentioned it. I just might choose him for my therapy.

He recommended EBRT (20 sessions) over SBRT (5 sessions). He believes it's more effective for patients such as myself.

Jim's e-mail address is: evlbstrdjim AT gmail.com (replace "AT" with "@")