Six Years and Counting

It’s been a while since I posted about my prostate cancer journey. A lot of cancer survivors (and an irritating number of contestants on The Bachelor) use the word “journey” to describe their experience because we never want to tempt the fates by saying we arrived safely—that we beat it. In any case, its been six years since they rolled me into the operating room at Memorial Sloan Kettering Hospital and removed my cancer-ridden prostate. I figured it was time for an update.

First, some medical context.

A couple weeks after my surgery, I received the post-operative pathology report confirming my stage-III adenocarcinoma diagnosis and upping my Gleason score to a “high 7,” or 4+3. For the blissfully uninitiated, prostate cancer cells are rated on a scale of 1 (largely normal) to 5 (scary as hell). A Gleason score is the sum of the most prevalent type of cell (in my case, 4), plus the second-most prevalent type (in my case, 3). According to my surgeon, MSK’s Karim Touijer, my Gleason score, clinical stage, and pre-op PSA (19.6) earned me the distinction of being a high-intermediate risk. Yippee.

Knowing all that, I had come to believe surgery would be the first step, not the only one, in my cancer treatment. Radiation and, potentially, ADT (androgen-deprivation therapy, which reduces your testosterone to nada), seemed like inevitable next steps after the prostatectomy. Fortunately, the post-op pathology report showed clear margins and no invasion of the seminal vesicles or nearby lymph nodes, which allowed me to avoid those steps. Whew, to say the least.

For the first five years after my surgery, I drove down to MSK’s Westchester facility every six months to have my blood drawn for a PSA test. Then I drove three hours back home and haunted the MSK portal until my results showed up. Each time I received the desired result of < 0.05 ng/mL (essentially undetectable), I felt like I’d been given a six-month hall pass for happiness. Then it was rinse and repeat six months later. At first the PSA test anxiety was intense, but, as the years passed, it subsided to routine apprehension.

When I reached the five-year mark, my doctor moved me to annual PSA tests, the most recent of which I completed at the end of January. A couple days afterward, Dr. Touijer met with me by videoconference to review the results. By that time, I’d already completed MSK’s standard questionnaire on my health and wellbeing, so he had that information in hand. He asked a few questions about how my junk is functioning, then moved on to complimenting me on my nearly-white beard and inquiring how my family is doing. I confirmed that the effects from my prostatectomy were, at worst, minor nuisances, and that I consider myself extraordinarily lucky—to have had an outstanding surgeon and to be enjoying remarkably good health.

As the conversation wound down, Dr. Touijer said, “Well your PSA came back as undetectable, which is obviously what we want to see.” Of course, it’s great to see the results on the portal, but having your doc confirm them is golden. So I thanked him for the zillionth time for having provided such excellent care and getting me this far—and I meant every word. MSK is an amazing institution, employing hundreds of amazing people. Which brings to mind advice I give everyone diagnosed with cancer: Be picky as hell about your caregivers. You deserve the very best care, and no one should have to settle.

I’m keenly aware that cancer can return at any point. A fellow whose blog I follow experienced a chemical recurrence at eight years, and his stage and Gleason score were tamer than mine. I think about him almost every day (he seems to be doing well, thank goodness). So I never take good health or smooth sailing as a given. But I’ve also gotten better at not letting cancer darken my outlook or modify my expectations of life. Doing so required putting some years between me and that unnerving diagnosis.

So now I’ve got my one-year hall pass and I’m back to the routines of a 62 year-old writer’s life. I just finished my second novel—which accounts for my absence from this blog—and I spend an embarrassing amount of time walking or hiking with my 140-pound Saint Bernard. With six years between me and that nasty diagnosis, I feel—how do I describe it?—less worried, but never worry-free. Any cancer survivor reading this blog will get that distinction. But then again, who among us is worry-free?

Well, maybe my Saint Bernard.