Posted 2/14/2021 6:00 AM (GMT -6)
My six year RALP anniversary is Wednesday this week. My next checkup is at the end of March, with a note on my bloodwork form that reads "Do not draw before 3/1/21".
So, six years since RALP. That's more than a time marker. It's a long time. I have no reason to suspect I won't get another "<" on my PSA report. However, the word "cure" still feels weird to use. I've looked back at my story linked in my signature, and it feels like it happened to someone else, in a weird way. Here are some things that I recall, from today's viewpoint:
I was incredibly fortunate in my PCP and my first Urologist. Back when I turned 40, at my dad's encouragement (he was dealing with his own PCa at the time), I asked my PCP to start doing an annual DRE and PSA. This would have been in 1998, so it was not within any screening guidelines at the time. He didn't have any problem with it, so he added PSA to my basic blood panel and did the DRE during my annual physical. I still recall, with a chuckle, what he always said during the DRE: as I'm leaning over the table and he rolls up on his stool and puts the glove on with a snap, "I hope you enjoy this more than I do." Which kept it light. When my PSA started rising in 2012 (first reading above zero on the low sensitivity test), he mentioned it, and said that it wasn't surprising--I was 54 at the time--and that we'd keep an eye on it. When it doubled every year for 3 years, he said it was time for me to see the Urologist. Living in a small town, there was one Urologist in town. He did the biopsy (12 core TRUS), no MRI, and when the results came back he set up both a bone scan and CT scan, and then set up a consultation appointment. His policy was to have that appointment at the end of the day, he'd send all his staff home and met with my wife and I and gave us all the time we needed. He explained what he could do there (open RP), what local RT options there were (basic EBRT), and told us that he had no problem providing a referral to Barnes-Jewish hospital/Washington U/Siteman center in St. Louis--the nearest NCCN center of excellence..and he would be glad to provide post-treatment care thereafter. How lucky was I?
I found "my team" there at Barnes. Most people outside the area have never heard of Barnes, and I think they like it that way. They take being in flyover country as a point of pride. I chose RALP, in many ways because of convenience (I'll admit it). When it's a 2 hour drive each way, in midwest wintertime, to have a treatment, making as few trips as possible is a real consideration. I was immediately comfortable with Dr. Figenshau, he has a fantastic reputation within the PCa community--I found that when I moved out here to suburban Philadelphia, my urologist here raised his eyebrows when he read my history from Barnes--he commented that while he had never met him, he certainly knew his reputation as one of the best. Also a great stroke of good fortune.
I had what was really an uneventful recovery from the RALP, everything clocked right along on schedule. I was wearing thin shields during the day by week 4, I was on the thin shields at night by week 6. I was having useable erections also by week 6. My PSA went undetectable at 3 months, and has stayed there.
Life goes on. I'm able, physically, to do pretty much whatever I want. I'm not in as good a shape as I'd like. I've had persistent high cholesterol for years--statins are a daily thing. I have persistent GERD--my early CT scan showed a classic hiatal hernia. Once Covid passes--and I'm vaccinated--I'm going to join the Y and start swimming to get back in better shape. I have some low level aches and pains, which makes me right in line with my age.
I'm looking forward to being a PITA to my wife and kids for a lot of years into the future.