Ductal.

Ductal. That word is used twice on my pathology report. I read it again this morning.  I probably shouldn't have, but I did. It's what you do when you are done with salvage radiation and one month in to a six week wait before your next PSA test to see if the radiation and hormone therapy is doing its thing. This waiting is the hardest part yet. My mind wanders. Often to places and scenarios that it should not. But none the less, it does.  So I go back to my initial biopsy report.
H: Right Lateral Apex
PROSTATIC DUCTAL ADENOCARCINOMA, INVOLVING
7O% OF THE SURFACE AREA, IN 2 OF 2 FRAGMENTS .
PERINEURAL INVASION NOT SEEN.
NOTE: The behavior of this tumor is analogous to acinar
adenocarcinoma Gleason score 4+4 : 8.
I: Right Mid
PROSTATIC DUCTAL ADENOCARCINOMA, INVOLVING
<5 % OF THE SURFACE AREA.
PERINEURAL INVASION NOT SEEN.
NOTE: The behavior of this tumor is analogous to acinar
adenocarcinoma Gleason score 4+4 = 8.

Googling "ductal prostate cancer" reveals a few (but not many) very detailed documents that contain some pretty damming information.
"One histological variant of PCa is ductal adenocarcinoma, which has an incidence ranging from 0.5% to 6% of all diagnosed PCa [ 1,2 ] ." -source document
"Ductal adenocarcinomas are more likely to be high grade and present with distant disease, and they carry a significantly increased mortality risk in those with locoregional disease independent of pathologic variables and treatment." - Source document

So yet another seemingly innocuous word, "ductal"- a word that sounds like should be used to describe a suitable duck habitat, or at least something that involves gray tape - creeps into my diagnosis vocabulary. I saw it all along, but was completely oblivious to it's implications. Hell, I was (and still am) still trying to come to terms with the word "cancer".
 After reading all of the scholarly articles, just what conclusion am I supposed to come to? Just what the fuck does it all mean? Studying the  article, Metastatic ductal carcinoma of the prostate: a rare variant responding to a common treatment, I read the following  - "Four years following the completion of radiation, he developed hematuria and symptoms of urinary obstruction. Cystoscopy and bladder biopsies at that time confirmed recurrent ductal adenocarcinoma of the prostate and his serum PSA increased from less than 0.03 to 0.31 μg/L. He underwent urinary diversion with an ileo-conduit".
My father had a prostetectomy, and later a urinary diversion surgery due to cancer that had metastasized in his bladder. At the time, it was attributed to his life long tobacco habits, but I am not really sure that I buy that at this point. He passed away in 2008.
So, what the fuck does it all mean? Am I headed down the same path?  I know that I had a cyctoscopy prior to surgery, and the bladder was clean, so I have that going for me. I am in very good overall health - that is a plus.
  I have something else going for me. I am still here. That is huge. I am still capable of doing pretty much anything I want - although I tire a little easier than before. I am alive. I am alive.
I remember the day that I received my PSA results post Surgery. January 9th. I got the email on Saturday morning. I was literally on my way out the door to do a 20+ mile bike ride with my neighbor, Gardner. He was instrumental on getting me back on the bike last year after my surgery. Reading the results, I knew the fact that my PSA persisted at 0.95 bought me a ticket to radiation. I was scheduled to see my urologist the following week, but I had done my homework and knew the deal. It was what it was. I grabbed my water bottle and headed out to ride. We had a great ride. Talked about a lot of different things. Perfect weather. We finished up the ride and made plans to ride the following Saturday. He also rode on Tuesdays and Thursdays, being retired at 72 years young and still in perfect health.
I met with my urologist the following Wednesday to discuss my options, which consisted of radiation and possibly hormone therapy. He also referred me to my soon to be oncologist. The next day (Thursday Jan 14th), while at work, I read online that there had been an accident. A 72 year old man, while riding his bike, was hit by a truck. And just like that, Gardner was gone. Perfect health, and killed in an instant just less than 2 miles from being back home after cycling for over 30 miles. My neighbor - the man that helped motivate me to get back in the game after surgery - was taken out by the momentary distracted driving of a total stranger.
.http://www.legacy.com/obituaries/ocala/obituary.aspx?pid=177368759

 Meanwhile, I am still here. Cancer be damned, I am still here. Radiation be damned, I am still here. Persistent PSA be damned, I am still here. Ductal be damned, I am still here. Hormone therapy be damned, I am still here. In a puddle of sweat from hot flashes, but still here, none the less.
I guess that is what it all means. It means that I get to spend more days with my wife. I get to watch our recently graduated daughter prepare for grad school in London. I get to see a few more sunrises and sunsets. I get another chance to try and make a difference in the world. I get to travel to Quetico in just over two months.
So I wait. I wait on an upcoming blood test. June 6. It will take 4-5 days after that to get the results. Results that will indicate whether we have this thing turned around, or we have to try something else. Meanwhile, I am here and alive. And that is huge. Regardless of the results of this test or the many that will  come after it, I have to continue to appreciate every day that I have, and, as the song says, "Take it to the Limit, one more time".

Random thoughts

4/27/16
Back in February when I first started radiation, I got three green dot tattoos to serve as alignment markers. One on each thigh and one in the pubic area. In an attempt to help the therapists, with one swath of a razor, I shaved the area immediately surrounding the dot in front. No more than necessary, but I figured that they didn't want to root around down there any longer than necessary trying to find it (the dot). So there it is, my initial foray into "man-scaping". It is now the end of April, and there is not so much as stubble in that spot. Zero. Nada. From a guy that has hair on nearly every square inch of his body.  I guess that the Lupron is actually starting to take hold. Out of everything I have been through so far on this journey, I don't know why that singular insignificant thing bothers me so much, but it does. Maybe because it is the first outwardly visible indication of what is actually going on inside. I don't know.  On the good side, What the prostectomy took away, perhaps the lack of hair will give the perception of adding back. Just some crazy shit from left field.

4/28/16
Last night was a great night. Surgery, radiation, and hormone therapy be damned, it was a great night. I was able to experience something with my wife that I thought I was never going to be able to experience again. It felt good. damn good.
About a week or so ago, I was watching TV. Michelle had already gone to bed. It was Nurse Jackie on Netflix. There was a gratuitous sex scene. Suddenly, things started "waking up". I was actually feeling the beginnings of an erection. That hadn't happened in several  months. Things had just started coming back after surgery, when I was put on hormone therapy in January. That pretty much killed everything. I was even denied the well documented "Lupron bump"by being placed on firmagon first. That combination pretty much made my big toe far more entertaining than my penis.  Imagine my surprise when this started occurring three months later. Well, I did what every red blooded guy would do in this situation, I decided to try and help things along. and it worked. Hot Damn!! The next night I decided to try it again - this time with the help of a small pill. It took a little effort, but it worked. After the third night , I told my wife of the improvement - that things were not quite ready to "go live", but definitely on the upswing. And I emailed my urologist. As much as the guy in me was going "Hell Yea!!", the engineer in me was going "oh shit - if the lupron isn't doing what it is touted to do in this way - what else is it not doing!!??" My urologist reassured me if my ED was improving even while on lupron, it was definitely a good thing. Only one thing left to try.
Last night was a great night. I will leave it at that. I also slept better than longer than I can remember. Straight through the night (afterwards).
I am not sure how long this will last. Common sense says that the longer I am on hormone therapy, the more it will take control. I am going to damn sure seize the moment while it lasts. You can bet on that.

04/29/16
I decided to get up early and drive to Gainesville to see Charlie. He has been on my mind for a few days. He was at my bell ringing, but I didn't get to catch up with him afterwards. I just felt that I should check and see that he is managing ok. He seemed genuinely happy so see me. I didn't go in - just chatted in the parking lot. Told him that I had an appointment down the street.He said that he was managing it well, but his eyes told a different story . They were sort of sunk in. He did ask if the energy came back. I assured him that it will return quickly and that digestive issues would improve rapidly as well.  I gave him my contact info and told him to look me up if he ever wants to feel better about his golf game..and to call when he rang out!!
Glad that I made the trip to Gainesville. it was worth it. Now time to get ready and go to St Augustine for Ashley's graduation!!!

5/5/2016
One of the most frequent themes I hear when telling someone that I finished radiation is "Good. Now all that is all behind you". That is the way we live our lives these days - from one concern to the next - never focusing on any one thing for any length of time. Most people do not dwell on things for long. Just like the 24 hour news cycle, we need to move on to the next thing. Perhaps it is not that, but they are trying to be positive and encouraging. The thing is, what becomes more clear every day that I am on this journey is that there is no "putting it behind you". It is a thing that will be there from now on out. It will at least partially frame every other aspect of my life. I am currently waiting until June to take my next PSA test. Then three months after that..and on and on. I just read a post on line from a man that was good for two years after his treatment, and it just started returning. back on hormone therapy he goes. So I wait. I wait for a test in June that really won't tell me much - hopefully. I am still on HT, so things should be completely suppressed. Just a baseline. Anything other than undetectable means that my cancer is resistant to both radiation and lupron. That is a possible outcome, but very unlikely. It will most likely return undetectable, as will the next two while I am still on the lupron. then once I start coming off lupron, the real story will be revealed - sometime around the end of the year or next. Then monitoring. waiting . wondering. All out in front of me.

Graduation, Mother's Day, And the Ocean

                                                             

Saturday, April 30th, 2016. Ashley graduated from Flagler College with a bachelor of Arts in History. What a proud moment. I do not think that I have ever seen her that happy. A no-holds-barred fully animated sort of happy.
Michelle and I spent the weekend at Anastasia State Park campground. It seemed only fitting. We stayed there in August 2012,  the weekend that we dropped Ashley off as an incoming freshman. I remember that day. The day we packed up the camper and drove home without her. I don't think a single word was spoken the entire way home. I don't think either of us were capable of speaking without breaking down into tears. I guess that you can only hold on to something for just a little while.
Fast forward almost four years, and here we are again. A few more tears..this time somewhat happier than before. All in all a good commencement ceremony. Lots of happy faces. She spent the night with us at the campsite making smores over a campfire and talking. Just like we did so many times when she was growing up. Of course, this weekend also came with more news. She was offered an opportunity to do her graduate work at Hull University in England. What an opportunity. It means that she will be out of the country for at least a year. maybe two. Without a doubt she has to seize this opportunity. Of course, that means that I have to muster up the courage to buy her a one way ticket to England, all the while maintaining a smile. I guess that you can only hold on to something for just a little while.
Michelle and I took a nice walk on the beach this morning before we left. You could see families setting up for a day of fun. A couple of toddlers playing in a tidal pool. It really doesn't seem like that long ago we were doing the same thing - watching Ashley chasing birds up and down the beach. Back then we would occasionally see older people walking and looking wistful as they watched all of the commotion. Probably reminiscing about when they had a young family.  I get that now. I know what they felt, because I am now where they were twenty years ago. And those older people we saw way back then - they are more than likely not even around anymore. I guess that you can only hold on to something for just a little while.
Mother's day is next weekend.  Mom died the day before Mother's day in 2014. I was thinking about that while walking in the surf this morning. I was thinking about the fact that to this day, I have never shed a single tear over her passing. Not one. I have no idea why I haven't. I loved her very much and miss her every day. I miss the woman she was before Alzheimer's took her away. But I guess that you can only hold on to something for just a little while.
I went by her grave a couple of weeks ago. That is where you are supposed to be able to get closest to those that have died. Nothing. I felt absolutely nothing. And no tears. And no real sadness. What does it all mean? I do know that, over the past several months, I have seen her look at me through other people's eyes. Total strangers. I catch it out of the corner of my eye when I least expect it. That look - her look - her eyes resting calmly above her high cheeks. Her distinct smile. Then it is gone. But it was there for a moment. I know it for certain. To be quite honest, it scares the hell out of me. I'm not one to buy in to supernatural or religious stuff, and am definitely not one to "look for a sign" - but it has happened on several occasions now. Maybe mom has my back on all this cancer stuff. Maybe I need to get things in order in the case that it doesn't go in my favor. Maybe it is just the lupron and everything fucking with my mind.
                                                              

You ever notice that while walking in the surf  - oh about ankle deep - and something catches your eye? You reach down to get it, but before you can, another wave comes by and takes it away. The ocean, she is funny that way. She holds on to most all of her secrets most of the while.  This morning was no different. As I walked along, reflecting on graduations, family, mom, and cancer, my eyes were scanning the surf. Lots of cool looking stuff, but before I could really see what it was, it was gone. Is that a sand dollar? Got it..no..just a cracked piece of shell. Twenty years of visiting this beach, never really found anything that cool in the surf. But wait. That right there! That really is a complete sand dollar. Of course as I reach for it,, another wave comes in. As the water momentarily recedes, it reveals..the sand dollar is still there. I pick it up. The ocean missed her opportunity, and I got it. I Guess I will get to hold on to it for a little while after all.