Cancer versus me

As many of you know I have been battling cancer for quite a few years now. It started with a 
basal cell on my nose that had to be surgically removed (the doctor, who evidently was a golfer,
got a kick out of telling me he was going to take a divot out of my nose).  So far I have not 
had any more problems, but I have to remain vigilant and be on the lookout for any spots that 
are new or changing color or size. You should use sun screen with a high protection factor to
filter out A and B rays. And you need to use it on your nose and ears every day - especially 
those of you who live in Arizona.  

More serious has been my battle with prostate cancer. Much has been written lately about over 
treatment of the disease. I think the study that has gotten the attention, which was the work 
of a University of Arizona Medical Center doctor, is having a most unfortunate - and i presume 
unintended - result by making men put off psa tests or prostate exams.  I cannot stress enough
the need for men to have annual psa tests starting for Caucasians at 50 at the latest, earlier 
for African Americans. Any psa count over 4 may mean trouble, and what should be done at that point 
must be worked out with the advice of an expert urologist and/or oncologist. 

I had a test back in 2002 that showed an elevated psa, but, given my healthy diet and life style,
I refused to believe I had a problem. Plus I had heard the psa test was not that reliable. My 
urologist recommended a biopsy, and I had that unpleasant procedure shortly thereafter. It came
back negative. (This was when a Yuma Hall student asked me how my autopsy had come out. I replied
I was at the beginning stage of cancer with a biopsy; the autopsy came at a somewhat later stage.)  

The urologist strongly recommended that I have a second biopsy with equipment that would take
more tissue samples. I put it off. When my next psa test came back at 36, I reluctantly agreed.
The second biopsy showed cancer throughout my prostate. I should not have waited as long as I did,
and that should be a lesson to you and to any males you care about - fathers, brothers, friends, 
partners, husbands (am i leaving anything out?).

In March of 2003, I had a radical prostatectomy, performed at the Tucson Medical Center by the gifted 
surgeon and urologist Bruce Dalkin (former head of urology at the University of Arizona medical center 
and now head of urology at the University of Washington). I had no complications and was back in the 
classroom in about two and a half weeks. (The  next week some of my delightful colleagues in the poli-
tical science department  tried to get my job eliminated. I survived that too.)

There was no lymph node involvement, but Dr. Dalkin advised me that there was a good probability the
cancer would recur, given the size of the tumor (although my Gleason score was 6, which is not too
bad).  Once you have your prostate removed you continue to have psa tests, since any recurrence of the
cancer (if some of it escaped the prostate) will show up in an elevated psa. Sure enough by 2005 my
psa was inching up again. When it got to the very low number of .43, Dr. Dalkin recommended radiation, 
and I had forty some treatments that spring under the supervision of Dr. Dalkin's able colleague, Dr.
Del Steinbronn.  By then I was swimming several miles a week, and I sailed through (swam through?) the 
treatments with no side effects at all. 

Several years later my psa began inching up again, and in 2010 the rate of increase itself increased. While the
count remained ralatively low, clearly the cancer was active, most likely either in lymph nodes or attaching
itself to a bone. To stop it from spreading, in Janurary of 2011 I embarked on a course of intermittent hormone 
therapy and had my first four-month injection January 18th. I am in the very capable hands of University of 
Virginia medical school doctors at the University hospital, and they are keeping a close eye on my progress or 
lack of progress and on any side effects from the therapy. I have been having fairly frequent hot flashes (one or 
two a day) but they are mild. I will suddenly wonder why the room is so warm, but almost immediately the sense of 
that goes away. I am glad to report that another possible side effect, breast enhancement, has not happened so I 
have not had to start wearng a two piece swim suit. I have however put on about five pounds of fat, sad to say.

At the end of the first four months of the therapy my psa count, which had been creeping steadily upward, had 
taken a sharp fall, from 3.47 when the therapy started to 0.07 on May 17th.  I had a second four month injection 
on that date to continue the therapy. September 26th I found that my psa count had declined slightly to 0.05. I
opted for a third four-month injection, and on February 1, 2012, my psa count was down to 0.02. I opted for a 
fourth four-month injection, and we will see where the count is in June at which time, if it is at 0, I may go 
off the therapy and say goodby to the hot flashes. We will then monitor my psa count, and, when it starts up 
again, as they tell me inevitably it will, I will renew the hormone therapy.  

Eventually the cancer will probably become immune to the hormone therapy, but there are new treatments 
being developed that I might be able to take advantage of at that time.  Clearly, in the long term, I am not 
going to win this battle, but there is no need for concern at this stage. Even the worst case scenario has me 
around for several more years. My oncologist says there is over a 50 percent chance that I will live for 
five more years, and given my good health and success with the injections, maybe several years beyond that. My 
ultimate goal remains to live long enough to see Clarence Thomas off the Supreme Court. :)