To treat… or not.

My dad was diagnosed with prostate cancer on his 82nd birthday. I expected it when his PSA test started increasing. He had a biopsy.  I couldn’t attend the appointment for the results but asked my mom to make sure she found out his Gleason score. When she called me on his birthday, I heard it in her voice before she said the words.
Cancer.
It’s considered an intermediate- risk tumor.  There is no metastasis. But given his advanced age and other co-morbidities, namely the Alzheimer’s, surgery is not recommended.
At his age, hormone therapy and radiation is recommended. Without treatment, he has perhaps 10 years.  But that means the tumor will get larger, he’ll have more lower urinary tract symptoms of obstruction and likely bone pain from metastasis.   Radiation is not easy.  It involves daily trips to the hospital for weeks;  20-39 radiation visits. That’s 20-39 days that my mother has to drive him to and from hospital and pay exhorbitant fees in parking. My mom went through  radiation treatment for her own breast cancer 15 years ago. She still remembers how hard that was on her. How difficult now will this be on my dad? He asks her several times a day what the next doctor’s appointment is for. Because he forgets. How difficult will this be for my mom to take him to the hospital day in and day out,  in his already semi-frail and de-conditioned state?  Is it cruel to put him through treatment? Is it cruel not to?
After meeting with his radiation oncologist and learning about a new treatment protocol involving only 5 weekly visits for radiation therapy, it looks like we will be embarking on treatment for my dad.  He seems to understand the side effects of treatment and that it means weekly visits to the hospital.  Of course, he’ll ask many times why he’s going but that is okay for now.  Five weekly visits is going to be much easier for my mom.  If and when it gets to be too much, we’ll make a decision to stop.  But for now, he/we are going to fight this.

Near the End.

She stepped over the threshold of their home, a visitor.  Through the doorway the hospital bed was visible and the hiss of the oxygen tank audible. She heard the patient’s voice speaking in his native tongue, French. His son whispered in her ear that he was talking to family abroad. She stepped into the room and put her bag and coat on a nearby chair.  He waved to her, finished his call and gestured for her to come closer.  She took his hand in both of hers and squeezed.  He thanked her for coming.

The hour passed quickly. She learned that his wife, having been always very demure and quiet in the office, was quite the spitfire at home.  His wife chastised him for wanting an ounce of red wine when he was barely eating any food. Though he was hungry at times, he could only eat a few mouthfuls before the nausea set in, this despite being on the appropriate medication to aid in controlling his nausea.  She explained that slowly his need for food would diminish and that would be okay.  So long as he could enjoy sipping on water, juice, or wine, that would likely be enough.  She learned that he enjoyed doing puzzles.

At one moment, he looked her in the eye and asked if she could help him go.  Tears welled up in his eyes.  Then in the next breath he said he wasn’t ready.  She reassured him that these emotions were normal.  There would come a time when he would become less aware of what was happening and so she reminded him to say the things that needed to be said now while he still had the chance.

She forgot about the tea that had been offered and accepted.  He told her to drink it before it got cold.  He asked for water, then said he was tired and wanted to rest.

She said goodbye and squeezed his hand again.  She said she’d like to visit again soon. He said he’d like that.