The PET Scan Results: What Am I Really Facing?
My Prostate Cancer Diagnosis: Episode Five
A Delayed Appointment and Sleepless Night
I was scheduled to get my PET scan results on a Thursday afternoon. My urologist’s office was 50 miles south of Denver, and afternoon traffic heading past the city is notoriously bad. That day, congestion was worse than usual, and I arrived 20 minutes late.
When I finally checked in, I received another blow: I was at the wrong office. My appointment had been scheduled at their other location, across town. To make things worse, the staff was at a retirement party, and my urologist had already left. Frustrated and anxious, I had to reschedule for the next morning—another sleepless night waiting for the results.
The Diagnosis: Good News and Bad News
Friday morning, I arrived on time. My urologist entered the room and, rather ominously, sat across from me.
“Well, I’ll start with the good news,” he said.
I braced myself.
“The PET scan came back negative. There’s no spread.”
Relief washed over me. If the cancer was still localized, my prognosis improved dramatically. But then came the bad news.
“The bad news is, it’s still a Gleason 9. That’s considered high-risk.”
I already knew that, but hearing it again reinforced the gravity of my diagnosis. When facing something as frightening as high-risk cancer, you don’t grasp everything in one visit. The reality unfolds over weeks as new tests reveal more about what you’re facing.
Understanding My Treatment Options
High-risk prostate cancer requires treatment—there’s no option for watchful waiting. Without intervention, it would spread. My urologist laid out the primary treatment options:
- Surgery – Prostatectomy
- Radiation – CyberKnife or External Beam Radiation (EBRT/IMRT)
Focal treatments exist, but for aggressive cancer, they’re risky. If even a few cancer cells remain, they could multiply and spread.
Why I Ruled Out Surgery
“The problem with surgery,” my doctor explained, “is that the prostate is surrounded by nerves. Removing it can lead to permanent erectile dysfunction and incontinence.”
The thought of wearing a diaper for life—or losing sexual function permanently—was something I wasn’t willing to consider unless absolutely necessary. Surgery would be my last resort.
Why I Leaned Toward CyberKnife Radiation
Radiation therapy comes with its own risks. My doctor referred me to a CyberKnife clinic, a highly precise form of radiation therapy. I liked the idea of targeting the tumor with precision rather than blanketing my prostate and pelvic area with radiation.
I started calling CyberKnife a precision-guided missile and other radiation forms carpet bombing—an oversimplification, but it helped me weigh my options.
The Challenge of Hormone Therapy: Lupron vs. Orgovyx
Prostate cancer thrives on testosterone, so treatment involves androgen deprivation therapy (ADT) to eliminate it. This comes with significant side effects:
- Hot flashes
- Loss of muscle mass
- Weight gain
- Fatigue
- Mood swings
- Decreased libido
My choices:
- Lupron (leuprolide acetate) – A long-lasting injection, making it irreversible for months.
- Orgovyx (relugolix) – A daily oral tablet, allowing me to stop if the side effects became intolerable.
The ability to control the dosage made Orgovyx the obvious choice. My urologist had samples on hand, and I took my first dose immediately.
Next Steps: Radiation Consultation and Genetic Testing
I didn’t have to decide on radiation immediately. Hormone therapy would stop the cancer’s growth, buying me time. My doctor also recommended genetic testing to determine if my cancer had a hereditary component—information that could be valuable for my family.
Resources for Those Facing a Prostate Cancer Diagnosis
If you or a loved one is navigating a similar journey, here are some resources:
🔹 What is a PSMA PET Scan? Learn how this advanced imaging tool detects prostate cancer spread.
🔹 How High Can PSA Go? Some extreme PSA cases have exceeded 10,000.
🔹 What PSA Level Suggests Metastasis? PSA levels above 20 raise concerns.
🔹 Understanding ADT & Hormone Therapy Learn about Lupron, Orgovyx, and their effects.
🔹 Radiation Therapy Options CyberKnife vs. EBRT/IMRT and what to expect.
🔹 Genetic Testing for Prostate Cancer Who should consider it and what it can reveal.
Final Thoughts
Hearing Gleason 9 is sobering. The PET scan brought good news—no spread—but my battle with high-risk prostate cancer was just beginning. Next, I needed to decide on radiation treatment and explore other options.
Next Episode: Weighing My Radiation Treatment and Other Focal Options.
