CW

Post radiologist dialog
July 15, 2016

Tracy,

Here are some communications I've had with my urologist following my MRI, biopsy and bone scans.  The quick and dirty is -- it's interesting that  I'm now a cancer patient, but the disease is otherwise unremarkable, and non-threatening at this time. The odds are good that the cancer will grow slowly. If it becomes more active, the odds are very good that it can be eliminated through radiation before it spreads to other organs, with possible discomfort, but otherwise manageable  impact on surrounding tissue. The probabilities are vastly in my favor.

The communication follows:

----- Message -----From: SMITH,ROBERT D
Sent: 7/15/2016 2:07 PM PDT
To: *************************, MD
Subject: RE: Bone scan
Hi, Dr. G*****. It's not clear from your message whether you want a face-to-face, or just an e-mail conversation, so I will start with an e-mail.

Here's my recall from what I learned today:

1. Very little chance that anything more than some "seed cells" have migrated from the prostate, if that. 
2. High PSA could be due to the size of my prostate (no news there); in light of the biopsy, I probably have a low grade cancer -- while at the same time acknowledging that there might be something more aggressive lurking there. 
3. Men over 65 who developed prostate cancer and treated it with radiation had a very good recovery rate, with about a 2 percent chance of fatalities. (I know I'm not being very precise here.) 
4. Radioactive seeding of the prostate is about as effective as radiation from an external source, and both are fairly effective at controlling the disease. My understanding is that that the risk of causing another cancer is limited and the likelihood of terminating growth of the current cancer is very good. 
5. There is not a sense of urgency. Dr. G****** talked about annual biopsies and continuing to watch the cancer.

This obviously isn't all we covered in our consult, but these are the high points as I understand them. 
Based on what he said, my thinking is to rely on PSA, biopsy and MRI for now, with an eye to external radiation treatment if it seems warranted. One model might be 6-month intervals for PSA, a possible MRI if there's a sharp growth spurt in the PSA score, and annual biopsies. 
This is my layman's analysis and I accept it might be flawed, so I'm interested in your thinking, and I'm open to your suggestions. I'm up for a face-to-face if you believe that's appropriate. I'm available 21 July -17 August, except for July 25, if you feel that a meeting is warranted.

Sincerely , 
Robert Smith

==========================

To:
Robert D Smith 
From: ********************, MD Received:7/15/2016  4:31 PM PD 
Hi Robert,
Thanks for the message. You have a good summary of the situation. A phone visit would likely suffice for any follow-up questions.
I scheduled you for a phone visit for Thursday July 21 at 8:00 AM.
Please feel free to contact me with any further questions or concerns. 

Regards, 
**************,
MD Capitol Hill Urology

Results of phone consult: I will have PSA (prostate specific antigen) blood draws every four months to see whether the prostate calms down or continues to generate higher PSA scores. We will respond to what we observe.

Love,
Dad