The Meeting

Carolyn and I finally met the doctor Wednesday evening around 4:30. We waited for around half an hour in the lobby of the McMinnville urology clinic. Waiting seems to be a big part of having cancer. You get someplace and you wait to be told what happens next. When that happens, there's more waiting for results. When all else fails, you're waiting around in lobbies waiting to be told what you're going to be waiting for next.

The McMinnville clinic uses doctors from Portland and, despite the modern building it's housed in, has a decidedly seedy feel. The receptionist's station is covered in unfiled papers, postits, bad art, broken printers, you name it. The doctor's office consisted of some mystery photo of a vintage car, a used steelcase desk with broken formica, a dusty monitor, a couple of chairs, no windows. He clearly didn't live here.

The good news was the bone scan was clear. He gave us a copy of the biopsy report, which was a monument to clear information delivery. Three pages. A photo of the malignant tissue. A map of where the cancer was located. The Gleason scores of the samples and the Partin table reflecting the probabilities that my cancer was at certain stages. The Gleason score classifies the cellular differentiation of the cancerous tissue in the samples. It looks at two predominant patterns of differentiation in cancerous tissue and adds them together to create a score. The goal is to minimize subjective opinions about the severety of the cancer in samples. The Partin Table is a matrix based on samplings of PSA, stage, grade and surgical findings of over 4,000 men to predict the probability that the prostate cancer has spread to the lymph nodes, seminal vesicles, penetrated the capsule or remains confined to the prostate. My cancer stage was T1c-Def which means the cancer is still microscopic. The right mid section sample of my prostate had a score of 3+3=6 in 10% of the sample. That's pretty low. The right apex sample was 3+4=7 in 60% of the sample. Not so good. The Partin table says there's a 42% chance the cancer is organ confined, a 40% chance it's extended beyond the prostate, 12% it's invaded my seminal vesicles and 6% it's invaded my lymph nodes.

The doctor explained the various treatment options available and offered his opinion on the best option. He encouraged me to pursue second opinions. Watchful waiting was out. If I was in my mid 70's that might have been an option. But prostate cancer tends to be more aggressive in younger patients and my PSA score of 19 indicates that mine really has its mojo working. Radiation and Cryo are options but they leave a question mark about how much or if the cancer has spread. And if the cancer comes back, it's much harder to treat after either of those processes. High Intensity Focused Ultrasound (HIFU) is showing promise but is still in clinical trials in America and still leaves the questions about the cancer spread. Besides, it has a stupid acronym. Hormone therapy isn't curative and I'll grow breasts. Okay, that second part isn't true but I watched my father go through hormone treatment and I have a reflexive dislike of it as a consequence of what he went through. The only option that offers the possibility of a cure is a radical prostatectomy - removing the whole bally lot of the thing along with local lymph nodes and seminal vesicles. They can then dye the prostate to see if the cancer is outside of it and test the other tissues too. If cancer is found, I have more treatment options available. This was the doctor's preferred option.

He then launched into outcomes and possible side effects of the surgery. This is when the meeting started to get weird.


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