The Cancer Diaries, Part 15

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“… my only object was that all the world should enjoy itself and live in peace and quiet, without quarrels or troubles; but my good intentions were unavailing to save me from going where I never expect to come back from, with this weight of years upon me and a urinary ailment that never gives me a moment’s ease…”
Miguel de Cervantes: Don Quixote of La Mancha, chap. 22

I was listening to an audiobook of Don Quixote while driving to the hospital recently, and heard that bit. It just seemed appropriate. And a bit funny.

Last week I got my first hormone injection — lupron: the brand name for leuprolide acetate. “Lupron belongs to a class of drugs called luteinizing hormone-releasing hormone (LHRH) agonists. These medications block the production of LHRH in the body, which results in the testicles producing less testosterone.”

At 70, I’m not terribly worried about my testosterone levels dropping. Sure, in the near future I may not buy a pickup truck, drink a case of beer, and wear a backward baseball cap while driving with my stereo playing annoying rap at ear-aching volume, but I’ll live with that. I’ll just have to content myself with reading, gardening, playing my ukulele, having a glass of wine with my wife, baking bread, a bit of online computer gaming, and walking the dog. And if it means my facial hair grows in less, well that just means I won’t need to shave as often.

Lupron is delivered via an intramuscular injection, which I got in my left buttock. Although the syringe looked like something a veterinarian might use to threaten a cow, it actually didn’t hurt at all to get it. Later the buttock muscles and got a bit stiff and sore, but it wore off after a couple of days during which we walked a lot. I have another injection scheduled for early February. I expect to get them every three months for some time.

Possible side effects of lupron can include:

  • loss of muscle mass
  • hot flashes
  • fatigue
  • skin irritation at the site of injection
  • erectile dysfunction or loss of sex drive
  • shrunken testicles and penis
  • changes in blood lipids
  • depression
  • osteoporosis
  • mood swings
  • breast tenderness
  • weight gain
  • the growth of breast tissue
  • anemia

Seems I might be able to share some of these effects with Susan, who still has menopausal hot flashes. She laughed at the thought of me throwing off the duvet in the middle of the night and sitting up to cool off, as she sometimes does. The weight gain I can do without: since the operation, I’ve been less active than in the past. But will I grow breasts?

As for a shrunken penis, well, the prostate operation last July pretty much set that stage. The nerve cabling that made Mr. Happy stand up and dance back when I was younger were shorn away during the surgery, leaving me to take comfort in memories and my imagination, while Mr. Happy slumbers.

Coincidentally, I recently read an amusing article about impotence in the past that noted that in medieval times,

… men weren’t afraid to discuss their impotence with their doctors and friends. This is in sharp contrast to the modern era, when the subject is verboten for so many men. Take contemporary advertisements for erectile dysfunction (ED) drugs, such as Bob Dole’s iconic 1999 Viagra commercial, in which he encouraged men to discuss their impotence with their doctors. Speaking seriously and wearing a navy suit with an American flag in the background, Dole said, “You know, it’s a little embarrassing to talk about ED, but it’s so important to millions of men and their partners that I decided to talk about it publicly.” Twenty years later, impotence is largely still a taboo topic, and advertisements for ED-focused startups like Roman and Hims emphasize that their products can be delivered discreetly.

Well, for me those modern products would be a waste, since there are no longer the nerves to send the signals to stand at attention, regardless of what the medication signals. I don’t feel embarrassed about it, just wistful: it’s not like something I did to myself. And it’s not like I’m 25; at 70 impotence doesn’t have quite the same sting. One of my favourite authors, Cicero, wrote about the loss of sexual passions in old age:

… granting that youth enjoys pleasures of that kind with a keener relish … although old age does not possess these pleasures in abundance, yet it is by no means wanting in them. Just as (a great actor) gives greater delight to the spectators in the front row at the theatre, and yet gives some delight even to those in the last row, so youth, looking on pleasures at closer range, perhaps enjoys them more, while old age, on the other hand, finds delight enough in a more distant view.

Sounds like he would have appreciated watching Pornhub had he lived today, although perhaps he was a bit too modestly straightlaced for modern pornography (although many Romans had a far more liberal attitude towards sex than we do). Even if the flesh is weak, he tells readers, the mind is still active and can imagine all sorts of physical things and recall the delights of the past. Imagination may be all I have left, but it’s still active enough.

I enjoy reading Cicero and many of the other classical philosophers and thinkers today because they wrote about and wrestled with the same issues and problems we deal with today. I wish I had read them more when I was younger, much younger, but I paid little heed to most philosophy until the last decade or so. I did read a lot of Buddhist philosophy that has helped me build my worldview, but in my youth, I should have paid more attention to the classical Western authors like Montaigne. I digress…

Some of the other effects can be mitigated (osteoporosis through calcium and vitamin D, for example). Mood swings? I’m already a cranky old bugger, so how do I tell? It’s hard to get depressed with Susan to give me strength, plus we have a delightful dog and three cats to boost my spirits. And I like to read, play the ukulele, and some computer games, which always lift my spirits.

As worrying as some of these side effects might be, they are certainly more attractive than some of the more radical alternative therapies to reduce testosterone, which include:

Orchiectomy. Also known as surgical castration, this is a surgical procedure to remove a person’s testicles. The testicles produce most of the body’s testosterone.

Yipes. I’ll risk the hormones, thank you. Not that I need my testicles for anything aside from ornaments these days, but still, I am reluctant to remove any organs except where absolutely required for survival, especially those external ones I’ve grown accustomed to seeing (and feeling). Besides, I’m not all that keen on surgery.

I’m also taking a daily tablet of ACH-Bicalutamide (50 mg) for a month (I’m in my second week) which, I read, is a class of nonsteroidal antiandrogens that “block the effect of the male hormone testosterone in the body.”

Bicalutamide is used in combination with another treatment that reduces the amount of testosterone in the body (either with medications called luteinizing hormone releasing hormone [LHRH] analogues or with surgery to remove the testicles) to treat late stage (metastatic) prostate cancer.

That last bit about “metastatic prostate cancer” is worrisome. I knew from my discussions with the urologist and oncologist that the cancer had spread outside my prostate, and the surgery was unable to collect it all. How much and how far, I don’t know yet. My recent radiation planning scan showed an enlarged lymph node, also troubling, but that might be caused by several things. I hope it hasn’t gone too far:

If and when prostate cancer cells gain access to the bloodstream, they can be deposited in various sites throughout the body, most commonly in bones, and more rarely to other organs such as the liver, lung, or brain. Bone metastases are seen in 85% to 90% of metastatic cases.

For which I have a second bone density scan coming up. But, like everything else going on with this cancer, there’s nothing I can do outside following through with the treatment, trust the doctors, and practice stoicism. I try not to dwell on the negative aspects. If the current treatments don’t work, I can still try chemotherapy.

More to come…

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