I felt fine, always did. I wasn’t running to the bathroom two or three times a night. My doctor never felt anything. I have no family history of prostate cancer. [...]]]> Here’s the deal: All along, this whole “prostate cancer” thing seemed to me like a gigantic fraud. Well not fraud, but maybe “surreal.” That all changed yesterday.

I felt fine, always did. I wasn’t running to the bathroom two or three times a night. My doctor never felt anything. I have no family history of prostate cancer. It was just a blood test, an imprecise secondary indicator, that suggested a biopsy.

Okay, I believed the biopsy, but still it all seemed abstract.

So I had the surgery. Sure, take it out. I don’t really need it. But I want to know.

This is why I picked surgery over radiation. The radiation therapy is known to be effective, but it’s still all abstract, not real.

Yesterday I went in to have my staples and catheter removed. (Yay!) (Anyone who is facing this procedure and wants to know more about it, I’m happy to share in a private exchange.) Meanwhile my nurse practitioner delivered the pathology report, and I asked her for a printed copy.

I’ll post all of the relevant parts below, followed by a few word interpretations.

Here is the pathology report:

Collected: 1/19/2010
Received: 1/20/2010
Signed Out: 1/21/2010

————————————————————————–

FINAL PATHOLOGIC DIAGNOSIS

PROSTATE, ROBOT-ASSISTED LAPAROSCOPIOC[sic] PROSTATECTOMY:

1. PROSTATIC ADENOCARCINOMA, GLEASON SCORE 6 (3+3).
2. MAXIMUM TUMOR DIMENSION IS ESTIMATED AT 1 CM.
3. THE TUMOR INVOLVES THE GLAND IN A BILATERAL FASHION AND EXTENDS FROM THE APEX TO THE PROXIMAL PORTION OF THE GLAND.
4. VASCULAR INVASION IS NOT IDENTIFIED.
5. PERINEURAL INVASION IS NOT IDENTIFIED.
6. THE TUMOR IS CONFINED TO THE PROSTATE.
7. THE SEMINAL VESICALS ARE NOT INVOLVED BY TUMOR.
8. SURGICAL MARGINS OF RESECTION ARE FREE OF TUMOR.
9. HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA IS PRESENT.
10. THE NON-NEOPLASTIC PROSTATE SHOWS HYPERTROPHIC CHANGES.
11. TNM STAGE: II (PT2C NX MX).

Report Electronically Signed by
STEVEN R. MCLAREN D.O.
Date Signed out: 01/21/10

————————————————————————–

MICROSCOPIC DESCRIPTION
A microscopic examination is performed.

CLINICAL HISTORY

CLINICAL HISTORY (REQUIRED): Prostate Cancer

GROSS DESCRIPTION
The specimen consists of a radial prostatectomy specimen weighing 42 grams. The prostate itself measures 3 x 4.5 x 4 cm. Attached to the specimen is the left seminal fesicle, which measures 3 x 1.5 x 1.2 cm with the contiguous vas deferens measuring 0.7 cm in length and 0.3 cm in diameter. The right seminal vesicle measures 4 x 1.5 x 1 cm with the contiguous right vas deferens measuring 0.6 cm in length and 0.3 in cm in diameter.[sic] The outer surface of the specimen is inked and the gland is serially sectioned. Sectioning of the gland reveals nodular tan-gray cut surfaces.

CASSETTE SUMMARY:.
[Inventory of slices omitted]
[End of meaningful report]

Item 9 is interesting, “High Grade Prostatic Intraepithelial Neoplasia” is also referred to in the industry by its shorthand HGPIN.

I believe this is shorthand for a common cell formation detected under microscope. Neoplasia is literally “new growth.” And intraepithelial means “within the layer of cells that forms the surface or lining of an organ.” It’s an abnormal mass of cells that are known to sometimes morph into cancer.

Finding HGPIN, aside from the tumor, is significant in that it adds to the diagnosis, and provides another data point in the statistical link between HGPIN and a cancerous tumor. Nice for me is that it’s fully contained within the gland, “intraepithelial.”

Following on with item 10, non-neoplastic would then refer to everything that isn’t “new growth,” all the non-tumor parts of the prostate. Hypertrophy is the increase in the volume of an organ or tissue due to the enlargement of its component cells. It’s just evidence that my prostate was getting bigger. That’s what they do.

Item 11 is meaningful too, and puts the cancer into a statistical class. TNM is short for “Tumor, Node, Metastasis.” Stage II says the tumor has not spread outside the prostate. The overall stage is then followed by T, N, and M numbers. T2C means the tumor is found in both lobes. (I suspect the qualifier PT2C means this is a prostate cancer specific designation.) NX and MX mean the lymph node and metastasis stages could not be determined. That makes sense, since the lab is handling a disconnected prostate gland in vitro.

I’m sure that an industry professional might correct some of my interpretation to be more specific, but I think I have the gist of the report.

And I like what I see.

The short version is that I was diagnosed with a small but clinically significant prostate cancer in September, and will have [...]]]> With Jane’s encouragement, I thought I would write this blog entry. I want to keep my friends and family up to date, and for the most part they are the only ones reading this blog anyway.

The short version is that I was diagnosed with a small but clinically significant prostate cancer in September, and will have RP surgery (Radical Prostatectomy) using robotics on January 19. I’ll be at Kaiser’s West L.A. Medical Center for one night, then recovering at home for about three weeks. Within a few months, the expectation is that I’ll be pretty much back to normal for the duration.

For those of you who really want all the details, how this came about, and what decisions were involved, I’ll go into it all below. For lots of people this comes under the category of “too much information,” and you are certainly excused without prejudice.

It all started with a routine physical back in June. A blood test then revealed an elevated PSA (Prostate Specific Antigen) level. 3.5 is considered significant, and mine was 3.6. My previous test 18 months earlier was around 1.something.

One positive test is not a result, so my doctor ordered a retest, which had a count of 4.1. That called for a referral to the urologist.

The urologist meeting came in September. Prostate cancer is so slow-growing that one has the luxury of dealing with it deliberately. After reviewing my chart, he scheduled a biopsy, which we did the following week or so.

(In discussing the process with other men who’ve been through it, the biopsy seems to be the most unpleasant part. I called Jane after mine and said, “I need a drink.” We met at Traxx Union Station shortly after.)

The biopsy took fourteen “cores” (yes think of core samples) which were examined visually under a microscope. One sample was 30% cancer cells, and one was 10%.

Interestingly there are absolutely no symptoms at this stage of the cancer. I feel great, have no urinary troubles, and no other symptoms of any kind.

In this instance, I must recommend my experience with Kaiser Permanente. They take advantage of having a vast and closely-tied medical staff, combined with the best Electronic Medical Record system in the business. The efficiency and accuracy is very confidence inspiring.

The question after diagnosis becomes the choice of treatment. Interestingly, because prostate cancer grows so slowly, new treatment studies can’t know their effectiveness for 15-20 years. The accepted treatment these days is either RP (surgical removal of the prostate) or radiation treatment.

My urologist scheduled me for a type of seminar session in which Jane and I would meet with specialists from each of the different treatment options to discuss the matter. In one morning we discussed the options with surgeons and radiation oncologists.

(For men closer to 70 than 50, another possibility is “no treatment.” Prostate cancer is really slow growing. Indeed most men will have prostate cancer when they die, but it will be something else that killed them.)

Which treatment to pursue was really a no-brainer. Surgery and radiation treatment are about equally effective. The big advantage of the surgery is that they get to actually examine and analyze the cancer in vivo. They get to take it out and send it to a lab for analysis or  research. The surgeon can see without any doubt if it has spread beyond the prostate and if any follow-up treatment is required. All of those advantages disappear with the somewhat blind radiation treatment.

The modern robotic surgery technique is fascinating. The doctor sits in a corner watching high-def video and manipulating the tiny robotic instruments. I’ll spend one night in the hospital and head home the next day.

I get to spend ten days at home with a catheter, and another couple of weeks recuperating. They taught me an exercise regimen to restore tone to the pelvic floor muscle, so I’ll be doing those.

I decided to do one other bit of preparation before going in. I had already joined Weight Watchers, and have been sticking with it to drop another five pounds of weight or so. I also hired a personal trainer to try and be in decent physical shape. I managed to make progress in both areas over the past three months. These are not part of the official protocol for surgery prep, but to me they just made a lot of sense.

This Friday, Jane and I are going to celebrate our 10th wedding anniversary in Las Vegas at the Venetian. We’re going to have a splendid vacation weekend. I’ll turn 53 on my birthday on Monday, January 18, but won’t get to eat any solid food that day. It’s okay, we’ll celebrate plenty the day before.

A lot of men are going through this now, or will be in the future. Prostate cancer is the most common cancer, but not the most common killer. Don’t put off the routine physicals; this thing has no symptoms until it starts to become a serious problem.

At my stage of the game, I can treat it as an inconvenience. Throughout everything leading up to this, I’ve lost no sleep, had no serious worries. Bridge players learn to do the best they can with the cards they hold, and it doesn’t hurt to have a top-notch partner across the table from you.

Update: This lolcat went by today on ICanHasCheezburger: