It’s been a couple of days since I received the findings of my pathology report. Overall, the news is positive, but it is not quite what I wanted to hear. Most of the cancer was removed with the prostate surgery but positive margins were found.
I’d read the pathology report many days earlier because it is available to view in the patient portal before you see your doctor. I know better than to read a medical report without it first being explained to me by the Doctor but curiosity got the better of me. Nothing in the report alarmed me as I nervously read through it, but then I am not a doctor and I have no business drawing my own conclusions, so the news was a bit of a surprise. Lesson learned.
What do the findings mean for me? During the surgery samples surrounding the prostate, known as margins, are tested for cancerous cells. A positive margin means the cancer is present. It’s known as locally advanced prostate cancer, which means that the cancer has broken through the capsule wall. For me, it’s in the bladder neck margin and right posterior margin, with a Gleason score of 4+5. It’s not the same as metastatic cancer, which means cancer that has spread to a different area of the body, which is worse again.
The next step will be to have a PSA test two months from now. If that is elevated, the course of treatment will involve hormone therapy and radiation. Prostate cancer usually depends on testosterone to grow. Hormone therapy blocks or lowers the amount of testosterone in the body. Radiotherapy uses high-energy waves similar to X-rays to destroy prostate cancer cells.
It’s natural for me to have an out-of-body experience like observing someone else’s story. I normally detach from emotion and immediately move into action planning, which I did, but I also began to experience great sadness and grief. If you’d have asked me twelve months ago how I felt about the prospect of surgery, hormone therapy, and radiation treatment, I’d have said that type of treatment is reserved for advanced cases and considered a last resort, but here I am, and it’s overwhelming. I feel sad about the whole situation, one step forward, two steps back. I’ve had a few cries to myself, which is a healthy part of processing emotions. I’m grieving the loss of my planned future – I’d set out a timeline over the next 6 months around my health and fitness journey and when I plan my next career move as I’ve taken some time out to work on myself. Im the kind of person who needs to wrap up a box with ribbons before I can move on to the next. How do I move forward with these loose ends and ambiguity? I don’t have these answers yet but finding a middle ground seems logical but for now, I just need to be present with my emotions and tell myself it’s ok to feel sadness and grief.
It’s not been 4 weeks since my surgery, and im still recovering, but the new findings have made me realize how very lucky I was to have this surgery, but at the same time I feel sick from the enormity of decision-making involved in the process.
High-intensity focal ultrasound treatment, which was my original treatment plan, would not have uncovered that it was already advancing outside of the prostate. Although there are fewer risks associated with urinary and erection problems with focal therapy, the same risks significantly increase if you later need surgery, because of the high-intensity heat effects on the prostate and its margins.
I consulted 4 different Urologic Doctors before deciding on surgery, and speaking to them gave me the peace of mind I needed in my decision to give myself the best possible future.
In dealing with this next phase of treatment, I am naturally worried about the effects of hormone treatment and radiation on my body. Testosterone maketh the man, or so we are led to believe. We associate testosterone with the building blocks of masculinity, and the more of it, the more of a man you are. We strive to increase our testosterone to build better bodies, if you’re gym obsessed. We associate testosterone with male vanity. I feel like im about to be stripped of all of my male masculinity. As a gay man, it might not feel like there was much there in the first place, but Im as vain as the next person! I simply feel like I’m going to get old, fast and my quality of life will be impacted. The practical side of me has of course read up on all the possible side effects and looked into each of them.
Although I wouldn’t necessarily choose this course of treatment, its benefits outweigh the risks, so I’ll find a way to accept the short-term costs.