Bye

Today I have to visit the hospital again, for the next big box of ammunition, sorry, I mean pills. Before that, I have to get a whole bunch of blood tests. Most of the results are within norms, with a few big exceptions. First, my testosterone level has been reduced to almost nothing - 1.23 with the norm being 9.9-27.8. This suggests that the medicine is working as intended. Second, my PSA (the tumor markers) has jumped from 4.43 to 9.12 (with the norm being 0.01-4.10). This suggests that my cancer doesn't care and is developing apace. Precisely as I feared. Time to annoy the doctor with my questions again. As an aside, despite my regular intake of Vitamin D, its levels in my blood are below normal (53.1 with the norm being 80-250). This suggests that the destruction of my bones by the anti-cancer medicine is proceeding apace, too.

As another sign that my cancer is advancing, the mere thought of climbing to the 8^th floor on foot again makes me opt for the elevator. Remember when I told you that there are 5 elevators? Did you believe that? Ha-ha, joke's on you. Two of them are out-of-order and one is reserved for "official use only", whatever that means. Of course, the crowds haven't become any smaller.

So, I patiently wait in line in front of the remaining 2 elevators. One of them arrives, but it's occupied by a single doctor (normal capacity is 17 persons) who says "occupied, take the next one", probably because he needs to fetch some non-walking patient on a rolling hospital bed. Which one, doc? One of the two non-working ones or the one for official use that you should have used? Whatever.

Eventually, my turn to use the elevators comes (after significantly more time than needed to reach the 8^th floor on foot) and I reach my destination. A spot of luck - the line in front of the registration desk is much smaller this time. So, after "only" 20 minutes of waiting (instead of 45, like the last time), I'm "registered", relieved of the equivalent of 30 euros, and have to sign a bunch of papers again.

Whoops, my doctor (the big-name specialist) is not available. Again. He has to attend to his students. By now I have the impression that he should not be allowed anywhere near live patients and should be limited to teaching, writing textbooks, and doing research... Oh, well. Maybe it's for the best. It means that the younger doctor will write the prescription for the pills - the one who's much more responsive to questioning. Let's see how it goes.

Remember the last time the big-name specialist reading me the riot act, sorry, I mean the lecture that he has the obligation to follow the "international guidelines" every time I dared ask a question about my treatment? Well, he let it slip that he's following the European guidelines (not surprising, since we're in the EU), called ESMO, which are slightly different than the American ones. So, this time I've come prepared.

I've found and downloaded the ESMO document and have read carefully all the 16 pages of it. It covers the treatment of all kinds of prostate cancer (and is full of medical jargon), so most of it is irrelevant to my case - but I've managed to locate my case in it. My cancer is de novo (i.e., newly diagnosed; not a recidive), metastatic, low-burden (a term that is not explained anywhere in the document but which I assume means the same as "low-volume", with the latter being defined as fewer than 4 metastases), hormone-naive (vulnerable to hormone therapy, at least we hope so).

The recommended treatment is ADT (androgen deprivation therapy - this is what the injection is for), combined with a choice between 4 possible options - docetaxel, abiraterone, enzalutamide, or apalutamde. Apalutamide is what I've been prescribed - those are the pills, which are a small nightmare. I'm grateful that the oncologist hasn't opted for docetaxel, which is chemotherapy and a big nightmare. I can't be assed to look up what the other two options are since I'm not getting any of them anyway. But there is a third component of the treatment - radiotherapy of the main tumor. Just like I hinted to the expert the first time and got a lecture about the international guidelines instead. So, why haven't I started that?

After the mandatory waiting, the young doctor appears. He seems to handle his patients in the hall instead of in his office - either because he doesn't have an office, or because such is his preference. Thankfully, there is a place to sit in the hall. Again, he's much friendlier and more helpful than the big-name specialist and answers all my questions in detail.

The next times I'm supposed to get the treatments (injection, pills) fall on Sundays - and these guys seem to work only on Tuesdays and Thursdays. He assures me that it is OK to spend a few days without taking the medicine and that I should come the Tuesday after the Sunday. He confirms that my self-diagnosis of the exact kind of prostate cancer I have and the proper treatment for it in the ESMO document is correct.

Why no radiotherapy, then? Apparently, they need to conduct 3 rounds of treatment first, then take a PET scan to see how to cancer is developing and only then they can decide what to do next. That's when they'll determine whether it happens to be resistant to hormonal therapy and whether and how much radiotherapy I'll need. He reassures me that these 3 rounds mean 3 months, with each round lasting a month - not three 4-month rounds, like the expert told me. This is reassuring - after all, according to the literature that I had read before, one of the options when there are doubts that the cancer is resistant to hormonal therapy is close monitoring of how the therapy is going, so clearly I'm getting that. Yay, I guess.

The low levels of Vitamin D are, apparently, not a cause for concern - we didn't know what the levels were before we started the treatment and it takes time for the vitamin to build up in the organism. Fine.

The next steps go smoothly - trot downstairs to the bunker, return the spent cartridges, sorry, I mean the empty packages, get a new big box of ammunition, sorry, I mean pills, sign off for them, and head home.

Well, till the next month, then.