Making a Treatment Decision

This might be the most difficult part. There a lots of decisions to make in life. Other than decisions concerning eternity and my commitment to Jesus Christ, this is perhaps one of the most import ones I will have to make.

There is no simple formula that you can just plug all the numbers into and out comes the best answer. It also depends on who you ask. I read everything the Doctor gave me. I read other peoples testimonies. I read opinion of other Doctors. I talked to several people who have been on this journey before me and listened to what they had experienced.

One of the books that my Urologist gave me went through all the different options and one of the things it suggested is that I talk to my Family Doctor and see what he had to say. Frankly that did not go very well. He made it clear that he would not second guess the specialist and that I should not have bothered him with my request for his opinion. I told him that the book the Urologist gave me suggested I do this whereupon he said that my specialist was very good at what he did and that he was highly qualified and recommended. I think it was a waste of time to talk to my Family Doctor.

So what did the Urologist suggest. Well he laid out the choices.

  • Watchful Waiting: This should not be considered because of the more advanced risk that I am facing. 
  • External Beam Radiation or Brachytherpy:  These have similar long term consequences as surgery but once performed then surgery is not usually an option as a follow up because of the damage that radiation does to the tissue. Radiation can be done after surgery if there is evidence that the cancer was not contained and further treatment is necessary to kill it all. 
  • Cryotherapy: This is freezing the tumor to kill it. This is still somewhat experimental and is usually done in connection with other treatments. It cost extra to do this and does not seem to have better outcomes than surgery.
  • Proton Beam: This is super expensive. Probably several hundred thousand dollars and does not have long term studies proving it is any better than other radiation treatments. 
  • Surgery: Radical Prostatectomy: This is what my Urologist recommends. It involves the complete removal of the prostate, seminal vesicles, and some lymph nodes. In my case because the cancer seems to be on one side the nerves near that cancer will also be removed. The nerves on the opposite side can be spared which may help in the long term consequences of incontinence and impotence.  
Putting all this together along with careful discussions with my wife we decided that surgery did seem to be the best option.

It is very hard for me to not second guess my decision, but I pray everyday for God to give me peace as I face whatever is ahead.

I do have confidence in my Doctors and other health professionals I have dealt with.  I do not have any fear concerning my relationship to God and eternity. I am nervous about the possible side effects I may face. I have to keep reminding myself that I may recover very well from this and I could be one who does not have to deal with some of those difficult side effects. But, if I do I will be alive and that is better than not.

So after the initial diagnosis I had one more appointment with the Urologist at which time we reviewed my options and decided on the treatment. My main question at that appointment was not so much about alternate treatments, but if I should consider Da Vinci Robotic or Open surgery. I decided on the open approach because that seem to be done more often and the Doctor can actually see and feel what he is dealing with. The robotic approach would be less invasive but that also means that maybe the Doctor does not see as well what he is doing. The two approaches seem to statistically have similar out comes. So I decided to have open surgery with my very experienced Doctor rather than robotic surgery that would be done in Vancouver and perhaps performed by less experienced Doctor supervised by a senior Physician. 

This surgery is scheduled for January 23, 2019.

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