“Your prostate cancer is back.” As any man can imagine, those were words that I didn’t want to hear. Thought I was over this phase of my life…apparently not. But I have two choices, dwell on how I feel or find a solution.
As the journey continues it appears that for recurring prostate cancer there are few tests (well only one that I’ve found) that can shed light on where the cancer might be in my body. That test is the Chloine C-11 PET scan done at the Mayo Clinic in Rochester, MN.
Here are comments from the Mayo Clinic website:
- Helps detect recurrent prostate cancer sooner. Choline C-11 PET scan can help doctors detect recurrent prostate cancer before it may be detected by more conventional imaging tests. In men with rising prostate-specific antigen (PSA) levels, this test may help detect sites of possible recurrent prostate cancer at PSA levels as low as 2 nanograms per milliliter (ng/mL). Conventional tests may not detect a recurrence until PSA levels are between 20 and 30 ng/mL.
- FDA-approved Choline C-11 PET scan site. Mayo Clinic in Rochester, Minn., is the first, and currently the only, medical center in North America to receive approval by the Food and Drug Administration (FDA) to prepare and administer the Choline C-11 PET scan imaging agent (Choline C-11 Injection). Mayo Clinic in Rochester, Minn., is currently the only site in the United States using the FDA-approved imaging agent.
- Helps identify areas of recurrent prostate cancer after all forms of treatment. Previous treatment may leave scar tissue that can be confused with active cancer when viewed using conventional imaging. Choline C-11 PET scan can help doctors distinguish between scar tissue, inactive cancer cells and active, recurrent prostate cancer.
Not being a person to delay action, I went to the Mayo Clinic site and requested the test. Of course, it was not quite as easy as that. I was informed that I would be approved for a consult and an appointment was scheduled.
Wow…that was easy.
Then it hit me, wonder if my insurance would pay for my treatment choice. My wife, the person in my life that thinks more analytically than I, suggested that I call my insurance provider to see if preapproval was necessary. Now I have to be honest, I really have a hard time with insurance. When did big insurance companies become the dictators of one’s health? Arrrg.
Not sure what I expected, but the Mayo Clinic was far nicer that my wildest imagination. Johns Hopkins provided great service, but the place was kind of a dump – especially compared to the Mayo facilities. But pretty wasn’t what I was there for.
I met with Dr. Eugene Kwon and quickly found a kindred spirit. He was articulate and focused on, what I would call, the right kind of patient care. He made the comment that all too often Doctors, with recurrent prostate cancer, were concerned with palliative care for the patient vs. cancer elimination. In fact, he seemed to believe that we need to do better with initial treatment options. Either way, after our interview Dr. Kwon laid out a specific course of action that would lead me to gaining what I desired – a Choline C-11 PET scan. But there were some pre-conditions.
1. I would need to have a CAT scan.
2. I would need to have a bone scan.
Now, to me, that made no sense. But, as Dr. Kwon explained, in order for the insurance company to approve the Choline C-11 PET scan, I would have to fail both a CAT and bone scan. While I’m not sure the costs, it appears that these are prerequisites to insurance approval for the scan that would make a difference. Such a game and one that makes no practical sense. Doesn’t it just make more sense for reason to rule when making decisions like this? Seems that the insurance companies set the rules and doctors have to play by them. What a waste of time, energy and money.
As I left the Mayo Clinic I have to admit I was impressed with the efficiency of their operation. On the spot a PSA test was ordered and within 1 hour it was completed. I was told that I could sign in to the Mayo Clinic website and create my own account so that we could use that as a portal for results and communication. OK…that’s different. And by the time I flew home and logged in (the next day) I had my PSA results. Amazing!
NOW THE TESTS
I have to admit it’s a bit funny…both the CAT scan and bone scan are painless so why the anxiety. It’s the freaking needle! Yes, I am such a baby when it comes to being stuck. So here I am at the imaging center and what I fear is a simple injection so that the scans can be done. Oh well…it appears that I may as well prepare for the fact that being stuck is going to be an active part of life moving forward whether I like it or not.
So…I tell the nurse that I request a “baby” needle. She looks at me kinda funny and says, “Really?”
“Yes, really! Or perhaps you want me flopping around on the floor.” I’ve come to understand that if I want baby treatment I will exaggerate my fear of needles so that they take me seriously. Why not? Seems that any babying I can get is better than just being treated as a piece of meat. And then as they prepare my arm I hear, “Good veins!” My I hate to hear those words as I know being stuck is the next thing that follows.
“Now drink this.” Before the CAT scan I had to drink what seemed to be a quart (but more likely a pint) of some nasty liquid flavored with vanilla. Now that’s a way to turn someone off of vanilla. But drink it I did and within an hour or so, I was in for the CAT scan. The scan – well that was easy – just lay down and the machine does the rest.
“The scan is done, Mr. Gallagher. You’re free to leave. Come back at one for your bone scan.” And with those words I gladly left the imagining center for some nourishment.
The tests weren’t what was bothering me. Rather, it was the thought that here I am at 56 and facing again those dread two words, prostate cancer. Somehow I felt, having defeated prostate cancer once (or at least I thought I had), that I would have a long life ahead. Now there were doubts. Not that dying is a great fear (well I guess for us all it is at one level), but more than that it is not finishing what I came into this life to accomplish. For the current moment, it seems that I dwell more of the value of the moment rather than taking them for granted. Actually I wonder at times if I have done OK. God knows that I’ve made mistakes, but I’d like to think that when I am gone – the world will be a better place. Then I think about my life to date and wonder if it truly is.
Mostly I think of my two sons and hope that I’ve been a good enough father. Being reared without a father, I have had little to go on as an example. I love my sons. Perhaps it’s time to show that more than I do. Either way, it is becoming painfully clear that life doesn’t last forever and we all have a mortality…so what ever I can do I need to do it now.
FINAL TEST FOR TODAY
“Mr. Gallagher, step back here for your scan.”
Soft music was playing and in no time I found that I was awakening myself with a resilient snore. Seems I had drifted off during the bone scan.
“We done here. Hope you had a nice rest.” And with those words this part of the journey was complete.