Bye

Time for my next set of radiotherapy sessions. But first, I have to have a consulation with the radiologist and a scan to see what's where in my body.

As before, the radiologist asks me how we should proceed. As before, I tell him that he's the expert, so he's the one who should decice. He informs me that there are two possibilites - I could either have a radiotherapy now, or I could not have it. (Thank goodness, because a third option would be too much for me to handle.) Each approach has its pros and cons. The cons are that this time, the radiotherapy will have unpleasant side effects. The pros are that it will severely reduce the risk of the main tumor re-activating.

I inform him that, as far as my personal preferences are concerned, I would prefer no side effects - but I'd also prefer much more not to die of cancer soon. I would also prefer that we irradiate the secondary tumor in the lymph node now, because the process of irradiating the main tumor in the prostate is accompanied by other unpleasant stuff, like me not being allowed to eat various things (he gives me a list and, honestly, it would have been a shorter list if he just gave me a list of what I can eat), even more unpleasant side effects, and so on. But, in the end, I'll defer to his expert opinion and he should feel free to ignore my personal preferences.

He tells me that irradiating the lymph node now would be a pointless waste of time. The tumor there is inactive due to the hormonal therapy and is also quite small to begin with. In addition, he says that, depending on what the scan shows, they might be able to aim the radiation beam so that it passes through both tumors. So, we settle on irradiating the main tumor (despite that it, too, is currently inactive due to the hormonal therapy), just to be on the safe side.

Since this is a consultation, I get to ask questions. My first question is about the possibility of this treatment causing bladder cancer - which I've definitely read about somewhere. He again insists that this is "impossible". I again don't believe him but since the prostate cancer is the more pressing issue right now, I leave it be.

My second question is how is the scanning that I'm going to undergo today going to help, given that the hormonal therapy has made the tumors not show on the scans. He explains that while the tumors themselves are not visible, the prostate and the lymph node are - and they know perfectly well where the prostate is anyway. The scan is mostly done to ensure that the beam won't damage other parts of my body.

I've left the question that worries me the most for last. Do I understand correctly that, at the current stage of development of the disease, it is not possible to cure it and all these treatments - horomonal therapy, radiotherapy, and eventually chemotherapy - are only trying to prolong my life as much as they can. He admits that this is, indeed, the case. Once the cancer has gone metastatic, the game is lost and a cure is impossible. There are microscopic cancer cells floating around in my body, invisible on any scans, and even if we get rid of the current three tumors, sooner or later one or more of them will latch onto something (probably a bone) and will start replicating again. It also explains why the first oncologist said that surgery is "pointless". Sure, it could remove the tumors - but can't get rid of these microscopic cells, so it's better to use more gentle treatments that will have pretty much the same (limited) effect.

So, basically, I'm a zombie. You know, somebody who's still walking but, for all practical purposes, is already dead. Braaainzz...

As another doctor before, this one tries to sweeten the pill by spinning the usual fairy tale that he's had patients in my condition (metastatic prostate cancer spread to the bones) that have lived for 10 years. As before, I ask him how many of them had a Gleason score of 8, like me. He's forced to admit that the number is zero and the highest Gleason score among his long-term survivors was 7.

The bill to pay now is just 20 euros, instead of 70 like the last time - no idea why. We proceed with the scan and a new set of dots are tattooed on lower part of my body. I'm told to come for the first radiotherapy session on May 7 and am sent on my way. I take the bus home, eat some lunch, and go to sleep. I'm so tired these days...