A Visit to the Oncologist

Samain and the Fallow Moon

Got in Ruby at noon and drove, once again, to Lone Tree. Through the everlasting construction project that is toll roads for 470 West. Wanted to drink water, get my bladder in shape for the next radiation treatment but no. That’s over with. August. Now it’s November and I’m on my way to a three month follow up with Anna Willis, Dr. Eigner’s physician’s assistant.

I have one question that matters to me. Is the cancer still there? The reason? I have two. First, that 0.03 result on my September PSA (test for prostate specific antigen). I thought, I’m on lupron which suppresses testosterone. I finished a course of 35 sacrifices under the Cyberknife. Shouldn’t this mean no cancer? Or, could it mean, that 0.03 is detectable psa, that the radiation didn’t work?

The second reason is Gertie. Gertie’s is our eleven year old German wirehair pointer. She’s deaf in at least one ear and her eyes have cataracts that cloud them. Her nose though works fine. During the time leading up both to the prostatectomy in 2015 and the recent recurrence Gertie sniffed my pee a lot.

I know, gross, right? Well, no. Not for dog owners. Dog’s get a lot of information from urine. That’s the whole fireplug thing. And, dogs can smell cancer. She seems fascinated again. Still. Could be my paraonia, I know. Still, it factored in to my hunch that the cancer was still there.

Yes, indeed, it is. That is in fact what the .03 means. There are still psa producing cells in my body which means prostate cells. They’re supposed to be eliminated by first, the surgery, second, the radiation, and third, suppressed by the lupron.

However. It’s ok. Dr. Eigner “stole” me from Anna Willis, his p.a. That is, he watched for my appearance on the schedule and arranged his day so he could see me in place of Anna. His schedule books far, far out so his schedulers won’t give me time with him. He checks and so far has seen me each time I’ve come in. That makes me feel good. He remembers me.

Good to see you! He’s in blue surgical scrubs, looking thinner than when I saw him last. He does seem glad to see me. I only have one question that matters to me. Is my cancer gone? Or, does the .03 mean that the radiation failed?

Well. Let me show you. He got a piece of blank paper and a ballpoint. At the top he wrote .2. Not so long ago .2 was undetectable. Then, .1. He inscribed .07, then a .05, then .02, and finally a .01. Each of these have in their turn described undetectable. So, 5 years ago we would have said your cancer was undetectable, but now our assays are more sensitive. That means your .03 is a really low number, but, yes, it also means there is still some cancer in your body.

Have you heard of secondary cell death? No, I haven’t. Radiation kills directly most of the cancer cells, but it continues working for a long time after treatment finishes. How? It damages the DNA of some cancer cells, but doesn’t kill them outright. Only when they go through mitosis, division, do they die.

Oh. Glimmer of hope.

He then drew a graph that showed the effect of lupron on my psa. PSA decreases rapidly, then flattens out near the bottom and remains there over time until it’s discontinued. At that point testosterone begins to rise again and psa goes up.

This line though is radiation. This line sloped down gradually, but where the lupron line began to go up, signifying its discontinuance and the resulting rise in psa, the radiation line continues to the bottom of the graph and stops.

Here is the critical time. He indicated the spot on the graph where the lupron line, going up, met the radiation line on its slope down toward zero. Your psa will rise here until the radiation effect takes over. This spot was well before the radiation line met the bottom of the graph.

Both you and I will be concerned until it flattens out, then begins to drop. That would mean a cure, right? Exactly. Sometimes, of course, it continues to rise, but even then we’ve knocked it back a long ways. Can you go back to the lupron then? Oh, yes. And there are other drugs, too. It’s the trend line over time that’s important.

OK. I see. How long do I need to be on the lupron? Ah, the great debate. One year, some say two years. What’s right? With you, a year. Your last lupron injection will be next March. Then, in June we’ll have a psa that will tell us where we are. Might still be going up some, then. Remember the graph? Then the psas following that will show us the trend.

I get it. Thanks.

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