The second opinion

We (my sister Ellin, Ginny, and I) went to see the radiation oncologist on September 9th.  And after a very thorough discussion and examination we all went into his office to talk.  And he was much more specific about where I was right then, clinically, and he provided a boatload of information and data.

But his first question to me was this: "What is your biggest frustration right now?"  Amazing question, right?  At least I thought so.  My response...
"There's too much general information on the web and not enough specific to my case. I can't correlate all of the pieces clearly enough to make a decision."  And he understood.  And he began to provide real data.  But first, he listed what he called my pathology.  Here it is:

• PSA = 13.7 from one lab (lower from another, but still in double digits)
• Clinical stage = T2B - meaning, he could feel that half of the prostate was involved
• Biopsy results = 58% of the samples (7 of 12) had significant cancer
• Gleason score = 7 (2 of the biopsy samples were scored 4+3, the rest were scored 3+4)
• Negative bone scan
• Negative CT scan
• No data on PSA rate (how fast it increased) because I didn't have enough data points
  

Then he showed me print-outs of the Partin tables on the Johns Hopkins web site. The Partin tables are complicated but they do what I was after, and they're based on an incredible amount of data.  So, I could correlate my PSA score, my clinical stage, and my Gleason score. Based on this data, he considered me to be in high risk that the cancer had already moved outside the prostate... but was undetectable by the scans.

Then he referred to some recently published research papers, both of which fit my pathology very closely... and both of them supporting his opinion that surgery would not prove to be effective.  And based on that, he encouraged me to do a combined approach of hormone treatment, radioactive seed implants, and external beam radiation therapy (EBRT, later referred to as IMRT - intensity modulated radiation therapy).

How did I take this?  Oh man... I felt dizzy.  I had been steeling myself to go in for surgery.  Now, I was presented with data that seemed very close to my situation.  And data like that was not something I could easily ignore.

I needed to do more research, and more reading (of the research papers he gave me).

He supported the urologist's thought that I needed to move fairly quickly.  So, I asked if I needed to decide before I went on a week's vacation (which had been planned for awhile).  He said that it could wait until I got back... but not long after that.

So, off we went.  And off on vacation I went... with research papers and laptop (to do web searches if need be).  I was now no longer leaning to surgery, but I was still undecided.  And more than a little worried.