PC: Transitions

[mdlbear]

Thanks for being here.

So... yesterday I transitioned from being a person diagnosed with prostate cancer, to a person under treatment for prostate cancer. (Confusingly, the before, during, and after treatment states are all lumped under "cancer survivor". Awkward.) But I suppose that during treatment I can call myself a cancer patient, though apparently people who identify themselves as cancer survivors report better health outcomes. An intermediate state, that of "person with an official diagnosis of Stage III, high risk prostate cancer", only lasted a few hours.

My oncology appointments yesterday didn't go the way I expected. At all. But that's okay.

I got my "official" diagnosis (as distinct from what I was able to gather from a combination of scan results, visit notes, and the Web) pretty early in my first appointment, with Dr. Nyame, the urologic oncologist. (His specialty is minimally invasive, "robotic" surgery -- does nobody call remote manipulators "waldoes" anymore? Maybe "waldoe surgeon" sounds silly?) Who then went on to briefly discuss the options, and explain why a radcal prostatectomy at my age, weight, and cancer stage would be extremely risky. At best I'd end up with erectile disfunction, and most likely urinary incontinence as well. (Which I already had/have and have no interest in keeping.)

Since there was time -- half an hour -- before my next appointment, they had a nurse, Jane, come in to remove my Foley catheter and teach me how to use a re-usable coudè catheter to drain my bladder. I was nervous, as one might expect, but it actually went pretty well and hurt less than I expected. Wish I hadn't rejected the idea back in September, but after spending the day in pain, midnight in the ER isn't a good time or place for clear thinking.

Next up was Dr. Liao, the radiation oncologist. Radiation -- would probably be photons for my case, rather than protons (which they also use). Problem with radiation is that it's not guaranteed to kill everything, so it would have to be followed by two years of chemo, which in the case of prostate cancer means Androgen Deprivation Therapy (ADT). Sometimes also called "hormone therapy", except that it's really an anti-hormone therapy. Prostate cancer cells die without testosterone.

But radiation wouldn't do much to fix the urinary blockage -- it wouldn't do much to shrink the cancer -- and my cancer is too spread out for it to be a good target. So the plan is to start me on ADT and look again in three months to see whether the cancer has shrunk enough to make radiation a good follow-up, or whether it's even necessary.

If the cancer doesn't shrink enough to clear up the urinary blockage they can do a comparatively minor surgical procedure called TURP (Transurethral Resection of the Prostate) to scrape it away. Which brings us to my last appointment.

The last appointment, with Dr Sunkara, was in a different building, Fred Hutch Building 2. (It's the Fred Hutchinson Cancer Center, but everyone calls it Fred Huch, and if I feel lazy enough I'll probably just call it Fred. Not to be confused with Fred Meyer, which everyone here calls Freddy's. Their website describes it as an independent organization that also serves as the cancer program for UW Medicine.)

I'll actually be getting two different kinds of hormone therapy. One is an LHRH antagonist (I'm getting one called Degarelix), which is a monthly injection that reduces testosterone levels very quickly (it's also considered a form of chemical castration), but only blocks androgen production in the testicles. So I'm only getting that one once. The adrenal glands also make some, and in fact some cancer cells can evolve to make their own. Yikes! So the next step is to block all androgen formation, in my case using a drug called abiraterone, which blocks one of the enzymes involved in the process.

Actually I kind of lied when I said I'll be getting Degarelix -- the last thing they did before I left was give me a shot of it. And although it's a monthly injection, I'm only getting it the one time, while they were getting the Abiraterone pre-approved by my insurance. Which came through this afternoon.

It's getting close to bed-time, so I'll probably move the details into another post.

TL;DR, now I'm taking testosterone blockers. That's the other transition. If I were transitioning all the way to a trans woman I'd also have to be taking estrogen, but I'm not. So I guess I'm transitioning to a trans enby. I find this amusing.

Comments

[ravan]

Welcome to the land of enbyness?

Seriously, I hope that all goes well, and that you kick cancer in the ass.

[mdlbear]

Thanks! Everyone else in the household is either enby or otherwise genderqueer, so I fit right in.

[acelightning73]

After I had my uterus removed because of endometrial cancer, they noticed I'd never had a mammogram. They found a very slow-growing kind of breast cancer. I was getting radiation therapy (photons, or high-energy electrons from a Linear Accelerator) to my abdomen, and after I had the breast cancer removed, I had the same kind of radiation therapy on my breasts. They wanted to give me tamoxifen for chemo after the breast surgery, but tamoxifen has been known to cause cervical cancer later on. Now, I no longer HAD a cervix then, but they told me they couldn't give me chemo anyway. So I got the Iridium Dildo as my final radiation treatment. So I'm a a cancer survivor twice over.

And I've also survived cataract surgery on both eyes, congestive heart failure, at least one kidney stone, a small stroke, and removal of my gall bladder. So hang in there until 2047, you promised me a dance.

[mdlbear]

I only have to beat my mom's lifespan by a couple of months...

[acelightning73]

It sounds as if you're on the right track to do so. I've already outlived my mother, and I'm close to outliving my father's age also - despite two kinds of cancer, diabetes, high blood pressure, kidney disease, and removal of my gall bladder. I need to get up and go shopping, but the bed is so nice and warm, and so HORIZONTAL. I need a nice strong cuppa tea.

[freyjaw]

I took care of plenty of post-TURP patients when I floated to med-surg. I hope you don't need one. Cancer sucks. Kick its arse.

[solarbird]

fuuuuuuuuuuuuuuuuck cancer!

and good luck, may you be a long-term survivor!

[siliconshaman]

Well, fuck cancer for a start! And here's hoping it dies easy so they don't have to get too drastic with it.

[andrewducker]

I'm glad you're getting very thorough treatment. I really hope it helps.

[patoadam]

It seems to me that if prostate cancer cells die without testosterone and you are getting testosterone blockers, then your cancer cells will die and, whether or not you will be completely cured, your lifespan will not be diminished, but what do I know? I hope I am reading between the lines correctly.

Know that I am thinking of you.

[mdlbear]

Pretty much -- standard of care is to stay on chemo for two years; not sure where it goes after that.

changing the subject

[patoadam]

FYI:https://www.worldpoliticsreview.com/netherlands-elections-politics-wilders/

[redsixwing]

Fuck cancer, and I hope yours fades without a fight.

Welcome to enbyness ;) I hope you enjoy it.

[mdlbear]

Thanks!

[azurelunatic]

Good luck!

It seems like all of the food establishments in buildings 1 & 2 are cashless.

I very much like the automatic garage in building 2.

[mdlbear]

Yeah -- that's quite a contraption.

[teddywolf]

That is a lot of health scare to deal with at once. My condolences, and my best wishes for better health.

[mdlbear]

Thanks!

[cellio]

Fuck cancer. I hope yours gets chased away quickly.

[mdlbear]

Thanks!

[texxgadget]

Will it simplify shaving?

[mdlbear]

:) Probably not. The only part of my face I really need to shave is the bit between my nose and my mustache, for my CPAP mask. I'm hoping my beard won't thin too much.

[figmo]

Another friend of mine is dealing with the same thing—prostate cancer with androgen therapy. He and I were half-joking about how I'd happily give him my excess testosterone.

Seriously, he didn't come out enby. He's still 100% male; he's just not responding to the usual sexual triggers.

[mdlbear]

I have no idea where I'm going to end up on the cis/enby/trans spectrum; enby is both more interesting and more amusing to contemplate.