Appointment with oncologist

Dr. Labban informs me that it is very unusual that the lymph-node biopsy came back positive, after that the preliminary one was negative. In 90% of the cases those two results match. The cancer is upstaged to stage 3 because of these lymph nodes being positive. They can still treat me, they can still manage it. Only difference from last week is that now they recommend chemo and radiation up front. It is important that the cancer area is tattooed, so that the surgeon can remove the affected area. Surgery is still needed, even if the affected area has no cancer after the chemoradiation. My situation is not simple, it is complicated, since I also had a high PSA (4.8). We will for now assume that a prostate biopsy comes back negative. (prostate biopsy will be done on 4/17, and results will be ready 4 days later). The doctor tells me to see the radiation doctor as soon as possible to discuss how the radiation is done, and also to get the radiation doctor to determine how long. The oncologist needs this info in order to adjust the chemo dose, and length to match. The chemo will come as tablets, called Xeloda. It is a pill, however it is a strong pill. These pills should only be handled by me, not by friends or family. These will be given along with the radiation twice a day. It will be two or three pills in the morning, and the same amount in the evening. Usually for 6 weeks. The radiation doctor will determine if this is going to be 5 weeks or 6 weeks, and that is based on the size of the tumor. When done with radiation, I stop the pill. The benefit of the Chemo pill is that it makes the radiation work more efficaciously on the cancer, it make the radiation more potent. It helps it kill more cancer cells. Once done, with radiation, I am done with this portion of the treatment. Then I go back to the rectal surgeon, and he will do the surgery. After the surgery, based on the result of the surgery, I might need extra chemotherapy. Part of it might be Intravenous, part of it might be just the pill. It depends on the surgery. But with me being young, he is leaning towards giving me a combination of the same pill in addition to an infusion, another chemo that is given intravenously for a total of 6 months. Treatment needs to start within 2 to 3 weeks. It should not be later than that.

 

The lesions in the lung and the liver can be ignored for now. Once we are done with the chemoradiation, we will take another PET scan to make sure that these have not grown.

They will evaluate me routinely with the scans, so they will keep an eye on those.

 

It should be no problem for me to drive myself back and forth to the radiation.

 

There will also be a prescription for some nausea pills, in case I will have nausea. The will be no hair loss with the Xeloda pill.

 

Risks / Complications

Just the prostate, if that turns out to be cancer. If that is the case, the doctor will probably take my case to the board to discuss what to do.

 

Site effects of chemoradiation

Fatigue. In the rectal area: Diarrhoea, and bleeding.

 

Ability to work

In a desk job, I would be able to work part time. The radiation time is 10 to 15 minutes, so that is simple. In a more physically demanding job, he would recommend to not work at all

 

Exercise

It is important to do exercise while being in treatment.

 

Chemo tablets and payment

At this doctor, they have an agreement with a Specialty Pharmacy, that will provide the pills. Insurance-wise this will be comparable to IV Chemo treatment at the doctors facility. In some cases the insurance company will get it for me directly. They sometimes have a direct distribution agreement with the producer of the drug.

 

Financial counselor

The doctor has a financial counselor on staff that can help me figure out the cost.