Bye

A former classmate of mine, who is a doctor (retired, but still practicing), when she learned about my medical condition, insisted that I talk to one of her colleagues, who is some kind of big-name specialist in urology and oncology. I told her that this would be a waste of time (both mine and his), because I know perfectly well what my situation and prognosis are and there is nothing that anyone could do to change it. But she insisted, so I agreed to meet him.

He introduced himself not just as a "doctor" but as an "associate professor". "Well," I thought to myself, "if we're going to flaunt our titles..." and introduced myself as "Dr. Bontchev". I also started by apologizing that I'll most likely be wasting his time, because I'm perfectly aware of my situation and that I'm meeting him only because my classmate insisted. I also emphasized that I do not expect any magical cure or false hopes from him.

Then I asked him whether to he would like me to tell the whole story from the beginning, or whether to move directly to the diagnosis and the treatment I'm currently undergoing. "Just tell me what ails you," he said, clearly in a hurry and obviously expecting to hear something like "I have prostate cancer and am taking some pills", like what any normal person in my situation would say. But I am not a normal person...

"Well," I said, "I suffer from oligometastatic prostate adenocarcinoma. The Gleason score is 8. I have secondary lesions of an iliac lymph node and the fifth left rib. I'm taking 240 mg Apalutamide daily and an injection of Leuprorelin every 6 months." I intentionally used the chemical contents of the medicines instead of their trade names (Erleada and Eligard, respectively). "I've had two radiotherapies, one of the rib, because the lesion there was still active, and a second one covering both the prostate and the lymph node simultaneously. I expect to have a PET scan some time in August, in order to see the results of these radiotherapies."

I'm sure that you wouldn't be surpised, if I told you that in highschool, my nickname was "The Professor"...

He looked at me a bit stunned and asked "Are you... a medical doctor?". "No," I decided to reveal my cards, "I'm a cybersecurity expert. I heal computers, not people. But I do read a lot." "Ah," he nodded understandingly and started poring over the documents I provided him. About a minute was sufficient for him to realize that I have told him exactly the relevant facts and that there was nothing missing or incorrect.

"Well," he said at the end, "you're getting the best treatment that is presently known to science for your condition." "I'm aware of that," I replied. "I've read the whole ESMO document and even found one minor error in it." (The ESMO is a 16-page document chock-full of medical jargon, which describes the European guidelines for treating every possible kind of prostate cancer. About two pages of it are relevant to my particular condition - but I've read the whole thing, of course. The minor error is that the document does not define the term "low-burden" - or say that it is synonymous with "low-volume", a term which it does define as there being fewer than 4 metastases.)

"Well," he said, "with this treatment you could live for 10 years or more." - the usual bullshit that doctors feel obligated to tell terminally ill patients. "This is extremely unlikely," I replied. "The statistics show that patients in my condition have only a 30% chance of still being alive 5 years after the diagnosis." "These statistics have been compiled over a long period of time," he countered, "and some of the treatments you're getting were not available back then." "The newest treatment that I am getting is the Apalutamide," I replied, "and it was approved for use in 2018. The statistics have been updated since. Besides, my oncologist confirmed that the hormonal therapy will stop working in 1-3 years."

"After it stops working, you'll switch to Docetaxel," he said. "Ah, yes, the chemotherapy," I nodded understandingly. "But, unlike the horomonal therapy, it doesn't stop the replication of the cancer cells - it only slows it down. Anyway, my only hope is that I do not die before my 93-year old mother does, because she can't take care of herself without me." "It will be as God wills it," was all he could say. And that was that. As expected, it was a waste of both of our times.

I'll be going to the hospital the next week for the next monthly dose of pills. I won't bother writing a blog entry about it, unless something unusual happens.

I'll update this page if there are any important changes and I am still able to do so.