THE TREATMENT

Radiation, ADT and the Road Ahead

I once believed surgery might be the chapter where cancer treatment ended.

My pathology told us otherwise.

After the prostatectomy, the conversation changed. The pathology showed aggressive disease, including cancer outside the prostate, seminal vesicle involvement, positive surgical margins, and lymph-node involvement.

Suddenly, Sue and I were no longer talking only about recovering from surgery. We were talking about what came next.

Radiation.

Hormone therapy.

Systemic treatment.

Words like ADT, Eligard, abiraterone, and prednisone became part of our vocabulary.

Once again, the road had changed.

Surgery Wasn’t the Finish Line

There is something emotionally difficult about finishing one major treatment only to discover that another treatment is waiting.

You go into surgery hoping it will be the thing that puts cancer behind you.

You want to wake up afterward, recover, and eventually hear someone say:

“We got it.”

I wanted that too.

But cancer does not always follow the version of the story we would prefer. My final pathology gave my doctors more information than we had before surgery, and that information changed the conversation.

The question was no longer simply whether the prostate had been removed.

The question became what else needed to be done to address the risk that prostate cancer cells could still remain.

That was a difficult shift mentally.

Surgery had been a major milestone. It just wasn’t the last one.

One Treatment Became Several

Before cancer entered my life, I think I imagined cancer treatment as one major event.

You have surgery.

Or you have radiation.

Or you take medication.

What I began learning is that aggressive prostate cancer can require multiple approaches working together.

For me, the discussion after surgery involved three major pieces:

• Radiation therapy
• Androgen deprivation therapy, or ADT
• Additional systemic treatment

Each one came with its own purpose, its own questions, and its own set of things Sue and I needed to understand.

That was another lesson in this journey:

A treatment plan is not just a list of treatments.

I needed to understand why each piece was being recommended, how the pieces worked together, what the potential tradeoffs were, and what life might look like while I was going through them.

Radiation: Another New World to Learn

Radiation brought another set of unfamiliar terms, appointments, planning, and decisions.

After spending so much energy preparing for surgery and then recovering from it, it was strange to find myself preparing for another major phase of treatment.

But I was beginning to understand something important:

Treatment decisions cannot always be viewed in isolation.

Surgery was one piece of the picture. The pathology was another. Radiation would become another.

The more information we received, the clearer it became that I needed to understand how all of those pieces fit together rather than making assumptions based on any single one of them.

ADT Changed More Than a Lab Number

Hormone therapy introduced a different kind of reality.

A surgery happens on a particular day. Radiation happens during scheduled treatments.

ADT felt different because it represented something that would become part of everyday life.

When my doctors began talking about drugs such as Eligard, the conversation was not only about treating prostate cancer.

It was also about what treatment could mean for:

• Energy
• Strength
• Mood
• Hormones
• Sexual health
• Bone health
• Relationships
• Identity

Those things matter.

They are not side notes to the cancer story. They are part of the cancer story.

Then Came Systemic Treatment

Abiraterone and prednisone were more new names to learn and more questions to ask.

By this point, I was beginning to realize how quickly a treatment plan can grow in complexity.

There are medications. Monitoring. Appointments. Blood work. Side effects. Questions.

And behind all of it is the question every patient eventually asks in one form or another:

Is this working?

That question carries a weight that is difficult to explain until you have lived with it.

Being Treated and Living With Treatment Are Not the Same Thing

One of the biggest things I have learned is that being treated for cancer and living with cancer treatment are related, but they are not exactly the same thing.

One happens in the clinic.

The other happens at home.

It happens when you wake up.

When you look in the mirror.

When you decide whether you have enough energy to do something that used to require no thought at all.

It happens when you make plans.

When you try to explain how you are feeling to someone who loves you.

When your spouse is experiencing the journey beside you but cannot experience it exactly the way you do.

When you wonder what your body will feel like six months from now.

Or a year from now.

Or two years from now.

The treatment room is only one part of treatment.

The rest of it comes home with you.

Sue Is on This Road Too

Cancer may be happening in my body, but Sue is living this journey too.

Every new result changes her plans too. Every new treatment becomes part of her calendar too. Every uncertainty belongs to both of us in different ways.

That is something I never want to lose sight of.

The patient may be sitting in the treatment chair, but the people who love us are often carrying a tremendous amount of the journey from the passenger seat.

They are listening. Remembering. Driving. Waiting. Watching. Worrying. Encouraging.

Sometimes all at the same time.

The Questions Became More Important

As the treatment plan became more complicated, I found myself asking more questions — not because I distrusted my doctors, but because I wanted to understand the decisions being made about my own body.

Some of the questions I learned to keep asking included:

• What exactly are we trying to accomplish with this treatment?
• Why are you recommending this treatment for my specific situation?
• How does this treatment fit with the other treatments I am receiving?
• What side effects should Sue and I be watching for?
• How will we know whether the treatment is doing what we want it to do?
• If something changes, what happens next?

I have become convinced that understanding the reason behind a treatment matters almost as much as knowing the name of the treatment.

I am not trying to become my own oncologist.

I am trying to become an informed participant in my own care.

Where Things Stand at This Mile Marker

As I write this, there are still uncertainties ahead.

There are treatments still to navigate. There are side effects we cannot completely predict. There are future test results we do not have yet.

Earlier in this journey, I think I felt pressure to somehow solve the entire future in my head.

I wanted to know what every treatment would feel like.

I wanted to know whether it would work.

I wanted to know what life would look like years from now.

Cancer does not always give you those answers when you want them.

I am learning to live with that.

The Next Right Thing

I have stopped believing I need to solve the entire future today.

Sometimes the next right thing is simply:

The next appointment.

The next treatment.

The next conversation.

The next question.

The next Mile Marker.

We do not know exactly where this road leads.

But we are still on it.

And we are still moving forward.

What I Hope You Take From This

If you are somewhere on your own treatment journey, I hope you remember that a change in the plan does not automatically mean the plan has failed.

Sometimes new information changes what comes next.

Mine did.

Surgery, pathology, radiation, hormone therapy, medication, scans, blood tests — each can provide another piece of a much larger picture.

I cannot control every turn in this road.

But I can continue asking questions.

I can understand why a treatment is being recommended.

I can stay involved in the decisions being made about my care.

And I can keep moving toward the next Mile Marker.

And So…The Adventure Continues.