Friday, 9 March 2018

Cancer Diagnosis

Yesterday I found out I have prostate cancer. This is my reflections on the diagnosis, my reactions, and my experience getting to this point.

(Hotel Dieu Hospital in Kingston, where I got the bad news)

The first thing to note is that it's a highly survivable form of cancer; the 5-year prospects are nearly 100%, and 15-year is 96%. I've also been told "if a man lives long enough, he either dies from it or with it" and that 14% of men, about 1 in 7, are diagnosed in their 60s (I'll be 64 in June).

The second thing to note is that going from suspicion to certainty is a slow process. If you're asymptomatic like me, the first sign is an annual blood test for Prostate Specific Antigen, PSA. (Note to my male friends: you do get an annual checkup, right?) It's a lousy test with a lot of false positives; the only reason the medical system uses it is that it's the only test they currently have. In this case I found out in September that my PSA was elevated and I needed to see a specialist. I'd been hovering around 2.5 for decades; the specialist told me it was now 7.5. Since the test is unreliable, they repeat after about 3 months, so in early January I had another test. I found out on January 18 that it was even higher, somewhere over 8. This meant that according to their mathematical models I had a 32% chance of cancer, and needed a biopsy. I had that on February 8. Pathology takes a long time, so I had to wait until March 8 for my results. So that brings us to yesterday, roughly 5 months after the first suspicions.

The results were towards the low end of the scale they use to judge aggressiveness of the cancer, but still indicate that it needs treatment instead of waiting and monitoring its progress. At my age it is apparently 50/50 whether radiation or surgery is the better option. My take on this is "pick which side effects you prefer to risk." I've spoken to the surgeon, who thinks surgery is best, and will eventually see an oncologist, whom the surgeon predicted would think radiation is best.

HDH, like KGH, is a teaching hospital, so the first person I saw yesterday was a medical student. He started off asking if I understood the scale they used, then spent several minutes explaining it, and told me my numerical results. I finally asked him if that meant I was at higher risk for cancer, and he said no, I had cancer. I didn't say it but thought, you could have lead with that.

There are other tests coming up. Next Friday I have a bone scan, and will eventually have a CT scan of lymph nodes, both looking for metastasis. It's not likely but they have to check. I didn't ask, but I'm pretty sure metastasis means chemotherapy, where they try to poison the cancer cells faster than they poison the rest of you.

I've been through cancer treatment before: testicular cancer, in 1990; ironically, that may have delayed the onset of the prostate cancer, since testosterone is fuel for it. That time diagnosis to surgery was about 3 days so there was little time to freak out. This time I think I was reasonably calm through the whole waiting period, but I'm not particularly in touch with my emotions, so I could be wrong. The main reaction I became aware of back in January was that I have had a lot of trouble concentrating. My job requires a very high degree of abstract and analytical thinking. I'm on sabbatical and have been trying to read a lot of advanced papers in my field (software architecture). For the two weeks before January 18, I read about 20 papers and made survey notes about them. In the seven weeks since, I read maybe one, total. I couldn't make any progress on my main hobbies, reading and writing speculative fiction. I wonder if the uncertainty might have been worse than the bad news; we'll see over the next few weeks if I can concentrate any better.

There have been blessings to be thankful for, including support from several men at church who've been through this themselves. Also, my distraction hasn't hurt anyone else at work since on sabbatical I haven't been expected to do any teaching or administrative work that other people depend on. It may be that treatment will be over by the end of June when I'm supposed to go back to being undergraduate chair. For now, I'm going to try to focus on the present, and let the future take care of itself.