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Diagnosis and Starting Treatment

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Arun had just celebrated his sixty-second birthday. He was content and happy with how life had panned out for him. His first grandchild was due in early July, something he had Juvays looked forward to, since he loved little children. These were exciting times.

On the night of 11 May, 2010, he said, 'The rheumatism from my childhood has returned; only this time it is not in the knees but in my left hip.' I gave him a pain-killer that night, and he slept. Prior to this, he had had no symptomsneither pain, nor urinary retention.

The next day we had an appointment with the orthopaedic surgeon at four in the afternoon. The doctor examined him and ordered blood tests and x-rays of the left hip and pelvis. The blood tests revealed elevated Prostate-Specific Antigens (PSA). The remaining blood profile was normal. The x-ray failed to show any significant abnormality. His last PSA, done in May 2007, had been within the normal range. He had slipped up on getting his routine check-up as our son was getting married towards the end of 2008.

At the time he had said, 'I have too much on my plate. All my previous tests were normal. I feel fine. I have no symptoms, let me be.'

An elevated PSA in itself is not enough for a diagnosis fostate cancer. Further investigations and a visit to blogist were necessary. A digital rectal examination, of the lower abdomen to assess the size of the prostate, and bone scans and bone scans were required. The confirmatory test would be a prostate biopsy.

We went to the urologist in a new facility in Gurugram.



He advised a prostate biopsy. Four days later, we had a report of prostate cancer, Gleason score 7. Thoug cores were taken, representative tissue was present in three. Meanwhile, the ultrasound and bone scan com 'Cancer prostate with multiple bone metastasis and advanced disease involving the seminal vesicles'. An test was now obligatory to rule out compression spinal nerves by the growing cancer. Fortunately, the the pain was not due to pressure on the nerves.

For Arun, the disease had already spread beyond the prostate, so surgery was not an option. There was compression of the spinal nerves, therefore no radiother was required. Arun needed a medical oncologist to sto treatment, preferably one who inspired confidence. Some he was willing to trust because of his knowledge, his humility and his compassion. We went to Dr AA, a senior oncologist with good communication skills. Interestingly, we only met an oncologist-there was no team involved, not even a dietician.

Arun had a forty-five minute discussion with the oncologist regarding his treatment and the likely outcome, He used all his journalistic skills to question the doctor and get the answers he was looking for. 'I can treat your disease, but I cannot cure you,' the doctor said at the outset.

Arun asked, 'How many years do you give me and what will be the quality of my life?

"If all goes well, you have about seven to ten years, but it depends on your response to the treatment. I will start with androgen deprivation therapy (ADT). Prostate cancer thrives on androgens-blocking the hormone will resun shrinkage of the tumour, the immediate effect of whic be the disappearance of pain. The growth and sp the disease will be suppressed. However, the tum not melt away. I will only switch to chemotherapy disease becomes resistant to ADT. The quality o as before.

Yth and spread of the tumour will herapy once the quality of life will be 

This discussion with the Arun felt comfortab to go ahead with androgens (Caso given to strengthe fractures due to the A JOURNEY WITH CANCER 129 aussion with the oncologist was reassuring and omfortable about his prospects. He was willing d with the treatment. He was started on two antite (Casodex and Zoladex). Zoledronic acid was strengthen the bone and prevent bone breakdown or as due to the metastasis. Zoledronic acid and Zoladex a be administered throughout his years of treatment, ective of whether he received ADT or chemotherapy. irrespective

Ten days after his presenting symptom of pain began, ADT was started. A week later, he was completely pain-free. The disappearance of pain, as expected, greatly increased Arun's faith in the doctor, lowered his stress levels, and restored his belief in himself. He felt he had the wherewithal to fight the cancer.

During the period between the onset of pain and the start of treatment, Arun had not stopped working, even though the pain put paid to his morning walks. As soon as he was pain-free, he felt confident enough to restart his walks. Life had a purpose again. He was back to meeting friends and enjoying his food. A month later, he was ready to travel again. Arun had no side-effects from this treatment and began to eat a diet specially modified for him, with the addition of green tea, wheatgrass juice and a salad before every meal.