bestest buds

Peter has been faithful; despite my outbursts and even wishing him harm, he as stuck by me without question or recrimination. Peter is giving; he retains nothing for himself but passes on all that he has every minute of every day.

These hot, fast friendships have their challenges. We found that Peter was a bit demanding and a bit clingy. And while his friendship tapped an inner well I rarely thought about, having him around each minute of each day is wearisome. Peter is an “up front” sort of friend, but admittedly very private. So, getting ready to leave the house with Peter is stressful and frankly exhausting.

My friendship with Peter is as close a relationship as I have ever experienced. It is also an ill-fated relationship, for today Peter and I must be parted. The reality is that I must move on in my recovery, and I have to go, alone. Peter cannot go for me. The absence of his indwelling presence will be a void in my life.

Farewell, my friend, Peter.

[During a radical prostatectomy, a foley catheter is inserted into the urethra. The catheter assists the surgeon during the transection and resection of the urethra and then supports the urethra as it heals. The patient keeps the foley catheter in place from 7 days to 3 weeks depending on the procedure and the surgeon involved. I named my catheter "Peter."]

Other  posts in the Prostate Cancer Journal can be found under Categories in the sidebar of this blog.

While my prognosis is just about the best that one could hope for, I am at somewhat of a loss before a buffet of good treatment options. Advancements in medicine offer those with prostate cancer a plethora of choices of excellent treatments:  da Vince, brachytherapy, IMRT, IGRT, clinical trials, active surveillance, proton beams, HIFU, laparoscopic robotic radical prostatectomy, cryotherapy. While the biopsy was certainly uncomfortable and nerve-wracking, and the news that I had cancer invoked rage and fear, having to pick my own treatment may yet be the most agonizing part of this journey through prostate cancer so far.

Dr. de la Paz told us that either surgery or radiation therapy will offer cure rates of about 90% or better, that is that after 10 years there is less than 10% chance of recurrence of prostate cancer. Hardly before I truly had the opportunity to rejoice in the prognosis, my mind was spinning at the idea that I will have to make such a momentous choice. It’s hard to confess this. Shouldn’t I be celebrating?  I sure wouldn’t have wanted him to say the only thing to do was go home and pray! While today’s prognosis means that virtually any treatment is available to me, today’s prognosis means that I will eventually have to choose my treatment from all the treatments available to me.

Pulling out the cross-section model of the male torso, the doctor carefully started at the beginning and showed us the position of the prostate in the body and its relationship to other important organs and structures. In his view, I have five reasonable choices: active surveillance, surgery done one of two ways, or one of two radiation treatments. Using his pen he points to what else besides the prostate is effected by each of these choices. By my own research I have already decided that active surveillance, sometime called watchful waiting, has no place in our consideration: once the “C” word is on the table, we beyond the point of waiting. De la Paz agrees that at age 50 with a history of PC in the family, we would only be exchanging handling the cancer now or handling it later.

The surgery, called a radical prostatectomy, completely removes the offensive gland, and the urethra is then reattached to the bladder. Done the tried and true way, Dr. de la Paz would make about an 8″ incision for down from the belly button to my pubic bone. Alternatively, one of his colleagues could use the daVinci robot to assist him in completing the surgery laproscopically through five small holes. The daVinci surgery promises a better chance at preserving the precious nerves around prostate and shorter recovery time. Either way, surgery means I will be peeing through a catheter for two weeks after surgery.

While a surgeon himself, de la Paz acknowledges that radiation therapies have about the same effectiveness in curing prostate cancer as a radical prostatectomy. The choices for radiation are either image guided radiotherapy or brachytherapy, which involves driving tiny radioactive “seeds” directly into the prostate.

But what of the morbidity, the side effects, the dreaded “I” words: incontinence and impotence? My own research along with conversations with prostate cancer survivors I have come to know have convinced me that the risk of prolonged or bad incontinence from either surgery or radiation is not great–in the range of 90 percent are free of any serious incontinence issues a year after surgery. Impotence is a whole other story. Impotence was an accepted cost of all prostate surgery until relatively recently. But in the ’80s, surgeons found the nerves that control erections and perfected “nerve-sparing surgery” to save them. Research seems to support that three-quarters of patients my age or younger who have surgery regain satisfactory erections within a couple years. The reversal of the two “I”s isn’t an easy road, and satisfactory rarely means a man regains all of what he had before the cancer. Impotency is an immediate reality after surgery. With radiation it can take two to three years after radiation treatment with nearly half of all radiation patients eventually becoming impotent.

My wife and I left Dr. de la Paz’ office nowhere near ready to make a choice. We live out lives shaped by the choices we make. I am afraid of making a wrong decision. More reading. more conversation. more prayer.

Other  posts in the Prostate Cancer Journal can be found under Categories in the sidebar of this blog.

Update:

At least one person has contacted me and was wondering what are my “numbers.” Well here they are for those keeping score: age 50, PSA 4.8, Gleason score (3+3)+6, Stage T1c.

“Mr. Kinnaman, your results came back positive…” That really is the only thing I heard in our brief conversation. As Dr. de la Paz continued to speak I looked at the pictures on my desk, pictures of my wife and I on a cruise, pictures of our four grandchildren. I ask a few questions, write a couple of notes that mostly make sense later, but while hearing, I really am not listening. I have cancer.

The Roller coaster of Rage and Fear

Rage is what fuels all the reading, it is the cranking up of the roller coaster, “clack, clack, clack,” as I am taken higher, the rage that this should happen to me “clack, clack, clack,” higher and higher; rage, being pushed on by the idea that if I read enough I can find a solution, rage that compels me to exhaustion to find the next website, the next procedure, the next presentation on YouTube. And then just as I reach the pinnacle and seemingly have nowhere else to go, I overtop and begin the free fall into fear: fear of loosing my health, fear of the surgery, fear of radiation therapy, fear of incontinence, fear of impotence, fear that I’ve let you down, fear that dying will hurt, fear of leaving my wife alone. While on the way up it felt like rage would leave me with no place to go, fear seems like it could go on forever. And along the way fear throws me into switchbacks of loathing and pity and ultimately into the 360° of doubt: did I do enough, should I’ve been more vigilant, can I make a treatment decision that will make a difference?

Peace

A hymn derailed this mad train of my own making.

Picked weeks before by Pastor Mayes, the opening hymn stopped me cold. I’ve loved this hymn for many years; I love to sing it with gusto. But the words have never meant as much to me as the now did in the opening minutes of the Divine Service.

Christ is the world’s Redeemer,
The lover of the pure,
The font of heav’nly wisdom,
Our trust and hope secure,
The armor of His soldiers,
The Lord of earth and sky,
Our health while we are living,
Our life when we shall die.

Christ has our host surrounded
With clouds of martyrs bright,
Who wave their palms in triumph
And fire us for the fight.
Then Christ the cross ascended
To save a world undone
And, suff’ring for the sinful,
Our full redemption won.

Down through the realm of darkness
He strode in victory,
And at the hour appointed
He rose triumphantly.
And now, to heav’n ascended,
He sits upon the throne
Whence He had ne’er departed,
His Father’s and His own.

That line in the first stanza: “Our health while we are living / Our life when we shall die.” I’ll never sing it again quite the same way. These words stopped my voice in my throat. But in an instant they also stopped my fear, my panic, my rage. Just a few words hiding in a well loved hymn, and I was pulled back into the loving arms of Mother Church. I could only listen to the next couple of stanzas, or I would have lost it. “Our health while we are living / Our life when we shall die.” For me a new cradlesong. These words rested me firmly in the arms of Christ’s Bride, who then took me back to the font, and to the cross, and then to the Supper. I was soothed with the words and the texts of the Divine Service. Yes, the same words that I have proclaimed to others during the years of ministry, but I was hearing them with new ears, ears tuned by my own angst, my own fear, ears tuned by God to now hear how I was going to really be able to make it through it all. And it all turned around on a hymn.  I’ll have it memorized soon.

Glory to God the Father,
The unbegotten One,
All honor be to Jesus,
His sole-begotten Son,
And to the Holy Spirit-
The perfect Trinity.
Let all the worlds give answer:
Amen! So let it be.

Other  posts in the Prostate Cancer Journal can be found under Categories in the sidebar of this blog.