Prostate Cancer Update

A friend told me yesterday that he had looked, in vain, here on my website for an update on my prostate cancer. Here is an update.

I am recovering well from my prostate cancer surgery on July 2. I am walking, running a bit, and could I think do some cycling, although Dr. B tells me to wait on that. I am also doing physical therapy, once a week, and PT exercises daily. I am doing Kegel exercises, in all different variations: lying down, lying down with legs raised, sitting on the side of the bathtub, doing mini-push-ups. I am sometimes wearing underwear rather than adult diapers; my urinary control is getting better, although it is not good when I am walking the dog. She pulls this way and that, and I tend to leak.

A week ago I went to the City of Hope, a cancer hospital in Duarte, California. I met there with a national expert on prostate cancer, Dr. S, to discuss whether I need to have adjuvant radiation, in other words, radiation now. He advised against it: he said that there was nothing to suggest that the surgeon did not remove all of the cancer. To “strengthen the argument,” he ordered up a more accurate PSA test. I had had, a week earlier, a standard PSA test, and it showed no PSA. But that test is not that sensitive; Dr. S called it “almost useless” in this situation. He ordered up an ultra-sensitive PSA test, and by the end of the day was able to call me and report that even on that ultra-sensitive test, I have no detectable PSA. If I heard him rightly, the test measures down to .008 ng/ml; so I have less than that level of PSA in my blood. The cancer may well be gone, or if there are some cancer cells, there are a handful. If you want to read research, I recommend Kang et al, Ultra-Sensitive PSA Following Prostatectomy Reliably Identifies Patients Requiring Post-Op Radiotherapy, 2015.

What about the Decipher test? According to Dr. S, even if the Decipher test was right, that I had an aggressive cancer in my prostate, that does not tell us anything about the spread of the cancer, about where we are right now. So Dr. S was not that worried by the Decipher result, although he understands why it made me nervous. I am still awaiting the results of the “post-surgery” version of the Decipher test, but even if that is equally negative, I am not going to have radiation right away; I am going to wait and see whether the PSA rises.

Perhaps the more important part of my visit with Dr. S was personal. Dr. S. loves to read, loves to read history and biography and memoir, and I gave him a copy of my Stanton book, which he said he looked forward to reading. He is also an author and promised me a copy of his book, a historical fiction set in first century Rome. He said that I should focus my attention on my next book, Chase, rather than on the cancer. “Let me worry about that,” he said, “you worry about Salmon Portland Chase.”

So that is what I have been doing these past few days. I have a stack of books here beside me, checked out from the UCI Library, that I intend to read over the next few days: Senator Wilson and the Civil War, The Nebraska-Kansas Act of 1854, Freedom National: The Destruction of Slavery in the United States, 1861-1865. (The last title echoes a speech by Chase in March 1850, in which he declared that “Freedom is national, slavery is sectional,” a phrase which would itself become the mantra of the Republican Party.) I have been reading Chase letters on the Library of Congress website, and struggling over his handwriting. (He often chided his daughters on their handwriting but his own handwriting was sloppy.) In short I am working on Chase.

I have an appointment to see Dr. S again on November 14. Early that morning I will have a blood test, so by the time we meet, we should have the results of that test. Hopefully, it will once again be essentially zero; if not, we will talk about what comes next. But between now and then I hope to make lots of progress on gathering, reading, organizing information about Chase.