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".