Diagnosis, advanced prostate cancer, with possible metastasis in the bones

By Michel, 62 years old

April 19, 2004: Although my urologist routinely required a blood test in order to complete my medical chart, this time the results were very unsettling. The 48 PSA level was high according to the doctor who immediately ordered a biopsy. The procedure was done quickly - three days later. While I began to feel apprehensive, I kept a business engagement outside of Montreal. Two weeks later I returned to the hospital to get the results of my biopsy. I was concerned when I entered the urologist's office, yet I felt confident, in spite of everything.

The diagnosis was advanced prostate cancer, with possible metastasis in the bones. Perplexed, I could not understand what I heard, asking the doctor to repeat it three times so that I could somehow understand. I felt stunned, practically senseless, incapable of speaking or mentally registering the diagnosis. It was for me unthinkable, incredible and, above all, completely unexpected. I had always thought of cancer as a disease that affected others for whom I could express profound sympathy, but it was not supposed to happen to me - I was terrorized merely hearing the word cancer. In my mind, a diagnosis of cancer amounted to a sentence of imminent or immediate death.

Immediately after I received the diagnosis, I met with a medical team consisting of the urologist, a radio-oncologist and a nurse who discussed my case and carefully planned my course of treatment. Firstly, I was obliged to undergo several different types of scans over the course of the next few weeks in order to check for the presence or absence of metastases in the bone and to determine the appropriate treatment. The deliberations of this competent multidisciplinary team and the exchanges between these health care professionals impressed me, even though the medical terminology was totally foreign to me and I felt completely helpless.

Why cancer? What provoked it? Was it the result of hereditary factors (which was not the case in my family)? Was it my diet? I had been watching my diet for years. Was it caused by emotional or cumulative stress? Why then? A year later I still have no precise answer to these questions and this frustrates me. I would really like to have an answer one day or, at least, some clarification.

Back home after the meeting with my health care team, I stayed home for days feeling nauseous, unable to eat or to speak about my condition, except to some loved ones who were alarmed by my news. This was the beginning of a real nightmare. "Courage" and "confidence" became merely empty words. I wished I could have been confident and courageous, but I felt total emptiness.

I had the painful impression that an insurmountable wall blocked my path. All my plans, appointments and activities were put in doubt...I felt truly disabled, anguished, unsure about everything and isolated from everything and everyone.

It was as if I no longer had a real taste for or interest in life. I felt myself becoming more and more depressed. I admit this was the most difficult period of my life.

August 19, 2004: I was relieved to learn that the scans did not reveal bone metastases. This was good news, in spite of everything! I now had to choose between radical surgery to remove the prostate or radiotherapy.

I was given a great deal of excellent documentation about prostate cancer and the different treatment options. I also received invitations to periodic information meetings led by competent professionals. While the sessions I attended were instructive and informative, at home, my level of anxiety increased as I agonized over which treatment to choose. I read, made phone calls, contacted men who had survived the experience, consulted PROCURE's complete and well-documented web site and asked competent people for advice. Finally, after much reflection, at the end of September, I opted for radiotherapy.

Another blood test was required and at the beginning of October, I learned that my PSA level had risen again (59) - another moment of deep uncertainty and anguish. The radiotherapy was delayed and I had to be hospitalized at the beginning of December. I underwent abdominal surgery to remove the ganglions and to check for the presence of cancerous cells. Again, the waiting was very difficult for me. I was afraid of hospitalization and of contracting one of the bacterial infections that had invaded hospitals at the time, which made me even more apprehensive about the outcome. Finally on December 14, 2004, I was informed that the ganglions were intact, but that the cancerous tumor was aggressive. My care plan was then finalized. I was confronted with three years of hormone therapy (an injection every three months) and two months of radiotherapy. The latter began on February 16, 2005, preceded by different scans and two sessions of marking, during which the precise location where radiation would be targeted was marked.

I had to familiarize myself with this entirely new world of radio-oncology, radiation rooms, imposing equipment and technicians. Every day in the waiting room I met men and women waiting for cancer treatment. Because we all were living through this experience, our sense of solidarity grew every day. Fortunately, the staff were extraordinary. Their competence and kindness made me feel confident. The volunteers in the waiting room and those responsible for transporting patients to and from the hospital for their appointments were remarkable.

Living through these experiences for a year was very difficult, and the hardest part was the waiting. Within the context of a busy hospital, waiting, in a way, is inevitable. You wait for scan results. You wait every day for radiotherapy and for the results of procedures. Waiting is certainly inevitable and very trying at the hospital or at home and has been particularly tough to cope with when a previous appointment has been delayed. These delays lead to disappointment, and more interminable waiting...No one knows why...no one understands what is happening.

Often, you take a number and stand in line for another blood test, waiting. You wait your turn for your appointment with the specialist, because he has too many patients also waiting for him, in his waiting room. And the staff are always overloaded. It is amazing to see how generously they give of themselves each day in responding to the demands placed on them and the constant phone calls from worried patients and their families.

You wait again for an encouraging look, a gesture, a smile that gives confidence. You wait for your name to be called, finally entering the specialist's office hoping to hear good news, which is almost impossible to give because the test results are not complete. And then you are forced to wait again. All this is part of the experience.

April 14, 2005: Two months of radiotherapy have ended. What a surprise to receive a yellow rose from the hospital volunteers - an emotional moment. The rose, which symbolizes courage and determination, means a lot to the patient.

May 12 : I undergo another blood test. The results given to me by the radio-oncologist on June 12 are encouraging. The tumor has diminished and my PSA level has gone down substantially. According to the specialist, the combination of hormone therapy and radiotherapy was effective. After a year, an enormous weight is finally lifted!

Periodical follow-ups, blood tests and exams will be carried out in the following months, and I hope that the results will also be as encouraging. I would like to express special thanks to all the caregivers in the radio-oncology and urology departments for providing me with information, treatment and the necessary support. They have been exceptional.

I am still dealing with the secondary effects of my radiotherapy and hormone therapy. My body's resistance is lower: fatigue, need for sleep, intestinal problems, sweating, hot flushes are side effects that now seem "normal," and, according to what I was told, should disappear gradually.

I no longer recognize the body I live in, which means that not only is my body affected, but also my mind. Cancer injures the soul. But that is another story - the subject of another reflection. For now, patience and tolerance are necessary and, above all, the obligation to gradually adjust to a new way of living peacefully by reducing the stress, the waiting and the daily demands. I will need to make "readjustments" in order to live a healthy life during the coming years - God willing!

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