Health update: second biopsy

This is a follow-up to my January and February posts. In January I reported that an increase in my PSA would necessitate a prostate biopsy and in February I reported that the biopsy was inconclusive and would require another biopsy in April. In March at the suggestion of our friend rabjeff, who has been living with prostate cancer for several years, I had a 3-D Doppler ultrasound of my prostate taken by the only radiologist in North America who does them. The radiologist told me I had a non-active prostate cancer of insignificant size and suggested I adopt a strategy of watchful waiting/active surveillance including eliminating dairy from my current pescetarian diet, taking nutritional supplements that are beneficial to the prostate and having the 3-D Doppler ultrasound again in six months. There are treatments for small prostate cancers, however, that can target the tumor in a way that does not impair the entire gland, have fewer side effects than treatments that might be required later if the tumor grows larger, and unlike those other treatments can be repeated should other tumors develop. But to have the option of such targeted treatments required I undergo the second biopsy scheduled for April. The radiologist advised against the biopsy warning that biopsies can actually spread cancer. My urologist said that the radiologist was mistaken and probably basing his opinion on outdated research (the urologist also expressed the opinion that the reason no other radiologist uses 3-D Doppler imaging of the prostate is that it is inaccurate). My own on-line research on biopsies indicates that if the cancer is as small and inactive as the radiologist said it is then it could not survive outside the host organ. Thus having the biopsy posed little risk and would give me more options. 

 

The January prostate biopsy took 12 samples; the April biopsy took 14 samples and was more painful than the first one both during the biopsy and in the weeks since. Only one of the 14 tissue samples had cancer, cancer was found in only 5% of that one sample, and the cancer cells in question are moderate (3 on a scale of 5) and not lethal. Three other tissue samples showed pre-cancerous growths. Prostate cancers are measured on the Gleason Scale (2-10): anything under 7 is considered favorable and non-lethal, and my Gleason score is 6. By and large my April biopsy confirmed the radiologist's scan the previous month, but it also gave me additional information. My Gleason 6 makes me a candidate for what is known as a male lumpectomy (targeting part of the prostate instead of the entire gland). The method that most accurately targets the tumor with the fewest side effects, High Intensity Focused Ultrasound (HIFU), is available abroad (for about $20K in Toronto) but is not yet FDA approved. If my prostate gland were a bit smaller (25 mm or less) than it is (32mm) my urologist could get me into a local HIFU clinical trial. Another form of male lumpectomy is Partial Cryosurgery (freezing half the prostate and leaving the other half intact), but that would destroy one of the two nerves responsible for sexual function. So I decided I will adopt a strategy of active surveillance which includes PSA tests every three months, biopsies every six months, following the no animal fat diet mentioned above, and continuing to take meds and nutritional supplements that may shrink my prostate sufficiently to qualify me for a HIFU clinical trial or in a best case scenario may shrink the tumor itself so that treatment other than continuing active surveillance becomes unnecessary. Active surveillance can continue for decades and has no side effects. I prefer giving up dairy cheese and ice cream and enduring the biopsies to over-treating an as yet non-lethal condition.

Posted via web from davidfcooper's posterous

Health update: second biopsy

This is a follow-up to my January and February posts. In January I reported that an increase in my PSA would necessitate a prostate biopsy and in February I reported that the biopsy was inconclusive and would require another biopsy in April. In March at the suggestion of our friend rabjeff, who has been living with prostate cancer for several years, I had a 3-D Doppler ultrasound of my prostate taken by the only radiologist in North America who does them. The radiologist told me I had a non-active prostate cancer of insignificant size and suggested I adopt a strategy of watchful waiting/active surveillance including eliminating dairy from my current pescetarian diet, taking nutritional supplements that are beneficial to the prostate and having the 3-D Doppler ultrasound again in six months. There are treatments for small prostate cancers, however, that can target the tumor in a way that does not impair the entire gland, have fewer side effects than treatments that might be required later if the tumor grows larger, and unlike those other treatments can be repeated should other tumors develop. But to have the option of such targeted treatments required I undergo the second biopsy scheduled for April. The radiologist advised against the biopsy warning that biopsies can actually spread cancer. My urologist said that the radiologist was mistaken and probably basing his opinion on outdated research (the urologist also expressed the opinion that the reason no other radiologist uses 3-D Doppler imaging of the prostate is that it is inaccurate). My own on-line research on biopsies indicates that if the cancer is as small and inactive as the radiologist said it is then it could not survive outside the host organ. Thus having the biopsy posed little risk and would give me more options. 

 

The January prostate biopsy took 12 samples; the April biopsy took 14 samples and was more painful than the first one both during the biopsy and in the weeks since. Only one of the 14 tissue samples had cancer, cancer was found in only 5% of that one sample, and the cancer cells in question are moderate (3 on a scale of 5) and not lethal. Three other tissue samples showed pre-cancerous growths. Prostate cancers are measured on the Gleason Scale (2-10): anything under 7 is considered favorable and non-lethal, and my Gleason score is 6. By and large my April biopsy confirmed the radiologist's scan the previous month, but it also gave me additional information. My Gleason 6 makes me a candidate for what is known as a male lumpectomy (targeting part of the prostate instead of the entire gland). The method that most accurately targets the tumor with the fewest side effects, High Intensity Focused Ultrasound (HIFU), is available abroad (for about $20K in Toronto) but is not yet FDA approved. If my prostate gland were a bit smaller (25 mm or less) than it is (32mm) my urologist could get me into a local HIFU clinical trial. Another form of male lumpectomy is Partial Cryosurgery (freezing half the prostate and leaving the other half intact), but that would destroy one of the two nerves responsible for sexual function. So I decided I will adopt a strategy of active surveillance which includes PSA tests every three months, biopsies every six months, following the no animal fat diet mentioned above, and continuing to take meds and nutritional supplements that may shrink my prostate sufficiently to qualify me for a HIFU clinical trial or in a best case scenario may shrink the tumor itself so that treatment other than continuing active surveillance becomes unnecessary. Active surveillance can continue for decades and has no side effects. I prefer giving up dairy cheese and ice cream and enduring the biopsies to over-treating an as yet non-lethal condition.

Posted via web from davidfcooper's posterous

In search of the perfect short-term contraceptive (maybe safe for work but probably TMI)

I'm wrote what follows, but Shoshana read it and approves its publication. A little over a year and a half ago Shoshana's gynecologist switched her oral contraceptive from Triphasil to Yaz as a lower dose intermediate step before menopause. A month ago her gynecologist told her to go off oral contraception entirely so she could tell when menopause actually occurs (at which time hormone replacement--at much lower doses than contraception--is available if needed). That required us to find an interim form of contraception. Though the chances of Shoshana conceiving at age 51 are slim they are not zero. Because Shoshana is close to menopause a long term contraceptive such as an IUD (which can last up to five years) is not called for. 

Shoshana's gynecologist suggested either barrier methods or spermicides. We don't mean to brag, but male condoms don't suite us, because with male condoms coitus ends with ejaculation, and since I can remain aroused and erect for several minutes after ejaculation, and Shoshana is multi-orgasmic, a form of contraception that requires us to stop before we want to would cramp our style. Even if that were not a factor, Shoshana is allergic to latex, and polyurethane condoms don't stretch, are available in only one size, and (again, I don't mean to brag) that size is narrower than the girth of my erect member. Spermicidal gels and foam containing paraben (which has been linked to breast cancer) are disqualified. That leaves contraceptive sponges, female condoms,  spermicidal ovular shaped capsules, and spermicidal film; we tried all four. 

The contraceptive foam is a polyurethane cervical cap smeared with spermicide and covered with a mesh fabric. On the plus side the spermicide is effective immediately; you put it in and you're good to go. But I found the mesh fabric irritates my penis, and Shoshana found that the spermicide caused discomfort urinating for three days after using it. One down, three to go.

The female condom is like a XXXL size polyurethane male condom with a polyurethane cervical ring and optional lube (which has paraben so we used our paraben free silicone lube instead). Shoshana really dislikes the female condom. Neither of us succeeded in positioning the cervical ring over her cervix, maybe because the cervical ring comes in one size that does not fit all cervixes (a polyurethane motif). Without the cervical ring it's like a super large male condom (one that actually fits), but we don't care for male condoms (see above). Two down, two to go.

That leaves the spermicidal capsules and spermicidal film, each of which requires a waiting period before it's effective. The capsules become effective ten minutes after insertion. Ten minutes of foreplay is not a problem, but upon commencing intercourse the spermicide began to burn both of us. Ouch!  Three down, one more to try.

That leaves the contraceptive film, a thin tissue that is folded, inserted, and becomes effective 15 minutes after insertion. Perhaps because intercourse works so well for us, 15 minutes is longer than our usual foreplay, but stimulating each other with our fingers and mouths for 15 minutes is not a bad thing either. During intercourse the spermicide is warm but not unpleasant. We think we have a winner! The only possible drawback to contraceptive film is that if we want to have intercourse a second time we have to insert another contraceptive film and wait another 15 minutes. 

Posted via web from davidfcooper's posterous

In search of the perfect short-term contraceptive (maybe safe for work but probably TMI)

I'm wrote what follows, but Shoshana read it and approves its publication. A little over a year and a half ago Shoshana's gynecologist switched her oral contraceptive from Triphasil to Yaz as a lower dose intermediate step before menopause. A month ago her gynecologist told her to go off oral contraception entirely so she could tell when menopause actually occurs (at which time hormone replacement--at much lower doses than contraception--is available if needed). That required us to find an interim form of contraception. Though the chances of Shoshana conceiving at age 51 are slim they are not zero. Because Shoshana is close to menopause a long term contraceptive such as an IUD (which can last up to five years) is not called for. 

Shoshana's gynecologist suggested either barrier methods or spermicides. We don't mean to brag, but male condoms don't suite us, because with male condoms coitus ends with ejaculation, and since I can remain aroused and erect for several minutes after ejaculation, and Shoshana is multi-orgasmic, a form of contraception that requires us to stop before we want to would cramp our style. Even if that were not a factor, Shoshana is allergic to latex, and polyurethane condoms don't stretch, are available in only one size, and (again, I don't mean to brag) that size is narrower than the girth of my erect member. Spermicidal gels and foam containing paraben (which has been linked to breast cancer) are disqualified. That leaves contraceptive sponges, female condoms,  spermicidal ovular shaped capsules, and spermicidal film; we tried all four. 

The contraceptive foam is a polyurethane cervical cap smeared with spermicide and covered with a mesh fabric. On the plus side the spermicide is effective immediately; you put it in and you're good to go. But I found the mesh fabric irritates my penis, and Shoshana found that the spermicide caused discomfort urinating for three days after using it. One down, three to go.

The female condom is like a XXXL size polyurethane male condom with a polyurethane cervical ring and optional lube (which has paraben so we used our paraben free silicone lube instead). Shoshana really dislikes the female condom. Neither of us succeeded in positioning the cervical ring over her cervix, maybe because the cervical ring comes in one size that does not fit all cervixes (a polyurethane motif). Without the cervical ring it's like a super large male condom (one that actually fits), but we don't care for male condoms (see above). Two down, two to go.

That leaves the spermicidal capsules and spermicidal film, each of which requires a waiting period before it's effective. The capsules become effective ten minutes after insertion. Ten minutes of foreplay is not a problem, but upon commencing intercourse the spermicide began to burn both of us. Ouch!  Three down, one more to try.

That leaves the contraceptive film, a thin tissue that is folded, inserted, and becomes effective 15 minutes after insertion. Perhaps because intercourse works so well for us, 15 minutes is longer than our usual foreplay, but stimulating each other with our fingers and mouths for 15 minutes is not a bad thing either. During intercourse the spermicide is warm but not unpleasant. We think we have a winner! The only possible drawback to contraceptive film is that if we want to have intercourse a second time we have to insert another contraceptive film and wait another 15 minutes. 

Posted via web from davidfcooper's posterous