The Mountain Summer Moon
Shabbat gratefuls: Ginny and Janice. Trees. Those old Ponderosas off Hwy. 73. The things they have seen. Tara. Kristie. Lab Corps. Jessica Roux. The Beaver and Aspen print. Woodland guardians. Herme’s journey. Life. Aging. Mussar. Kabbalah. Neuroscience. Sensory data. Intelligent receipt of that data. The inner world of mind. Charging the heart.
Sparks of Joy and Awe: The Lev
One brief shining: Oh, yes, coffee please, I said, as I sank into the booth, lower than I expected with the table further away than seemed convenient, while I waited on Ginny and Janice, the two look alike sisters brought a thick porcelain cup of coffee, utensils wrapped in a napkin, and laminated menus, restoration and reconstruction as always with close friends. About to happen.
Saw Kristie yesterday afternoon. She feels I’m in castration sensitive territory, not castration resistant. “I don’t diagnose that until you’ve been on both Orgovyx and Erleada and your PSA starts to rise.”
Back on Erleada now as of this morning. This is the gold standard androgen deprivation therapy. Yet another blood draw later in August. That might tell the difference between castration sensitive and castration resistant. Castration sensitive means a less dramatic prognosis than Dr. Leonard’s assessment of castration resistant.
Even so. She and Dr. Leonard present my case to the tumor board* on August 9th. This is not the first time my treatment options have gone before a tumor board. My numbers and imaging don’t fit in neat categories. Things could get complicated after this.
Let me explain. Kristie is a urological oncologist. Dr. Leonard is a radiation oncologist. I’ve seen Kristie for three years. Though I’ve seen Dr. Leonard only once, I have seen other radiation oncologists before him. Depending on the outcome of the tumor board, Kristie may refer to me yet a third oncologist, a medical oncologist. Kristie, Dr. Leonard, and the medical oncologist I would see are all on the tumor board.
A medical oncologist has a much larger toolbox/armamentarium than Kristie does. 4 times as large she told me. They are, I imagine, what we usually think of when we say oncologist. I’ve gone a different route due to the prevalence of prostate cancer and its resulting first treatments by urologists. Seeing a medical oncologist opens up other drugs, especially chemotherapy, to my care.
I know. Who knew? Tumor boards? Different kinds of oncologists? Salvage therapy? Which means any treatment after the best and generally successful treatments like a prostatectomy and radiation don’t affect a cure. Castration sensitive and castration resistant forms of cancer? A throwback to the days before androgen deprivation therapy drugs when an orchiectomy was the only way to lower testosterone; castration achieved levels of low testosterone are the metric against which ADT success is measured.
In summary. I may be in a less dire category but we don’t/won’t know right now. Maybe in a month. Maybe later. I’m back on the drugs I was on before my drug holiday, but may need supplemental treatment by a medical oncologist and a radiation oncologist.
The roller coaster of the last three weeks has drained me. I’m tired out. Partly thanks to being on the drugs again. Partly due to uncertainty, partly due to the need to level myself emotionally. Friends and family have helped a lot in that regard. You know who you are. Thanks.
*”A tumor board is a group of physicians and scientists who meet to discuss treatment options for individual cancer patients. Typically, those involved come from different backgrounds, specialties, and expertise, and may include surgeons, radiation oncologists, pathologists, and medical oncologists, so that fresh and differing perspectives can be discussed and knowledge can be shared.” cancercommons
