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Waiting for God: Devastating news


For The Courier-Times

EDITOR’S NOTE: This is first in a six-part series developed from a diary written by former New Castle Mayor Jim Small upon learning of his incurable stage 4 metastatic prostate cancer in November 2013. The cancer is believed to be caused by exposure to Agent Orange herbicide while he was a Navy officer at Da Nang Air Base during the Vietnam War. The columns describe deeply personal feelings of a man knowing his life will be cut short by cancer. The articles express the author’s views only and do not reflect Courier-Times opinions. The columns will conclude Sunday, April 22.

Wednesday, April 17, 2013. Today began as any other day. I awoke around 6 a.m. to let our yellow lab, Chessie, out and retrieve the morning paper. I retired upstairs after breakfast to check e-mail messages and read the newspapers.

I was expecting to get a phone call from the office of my family doctor to advise me of the latest blood work results from my recent semi-annual physical exam. The test indicated that my Prostate-Specific Antigen (PSA) level had risen from 2.23 to 3.42 within the past six months and she recommended that I arrange an appointment with my urologist. An increase in the PSA level often indicates the possibility of prostate cancer. While below the 4.0 threshold for concern, it still indicated that something bad could be happening in my prostate gland. But since prostate cancer is normally slow-growing at my age, the chances were, according to medical protocol, that I would die from something else.

I was not experiencing any symptoms that might have otherwise indicated a problem. My answers were no to the typical questions asked by a family doctor or urologist. Urine tests showed nothing, nor did the urologist’s internal visual scan of the prostate and bladder (you can imagine how that was conducted) or the digital exam (imagine again). The scans did not indicate anything more than a slight prostate enlargement common to men of my age referred to as Benign Prostate Hyperplasia (BPH). Ultrascan testing also showed that my bladder would completely empty after going, so no alarm was raised. A blood test was ordered for six months later as a follow-on PSA test to see if the level had crossed the threshold, indicating the possibility of cancer.

Having only been concerned up until now, the results that I received from that blood test were upsetting. The PSA level had risen to 6.49, indicating that something was indeed happening. A biopsy would soon be performed to see if there were signs of cancer in the prostate.

The biopsy was conducted in the urologist’s office. The test was not painful as I had been led by others to believe it would be. It could best be described as “12 uncomfortable pinches” into the prostate through the rectum wall.

The biopsy results that my urologist would pass on to me were devastating. Of the 12 samples taken, 10 showed cancer in various stages, with two of them having a Gleason Score of nine and two others with a score of eight. Ten is the highest possible Gleason score, so I was diagnosed as having an “aggressive” prostate cancer. My hope now was that the cancer had not spread, or “metastasized” to other parts of my body.

I then began receiving the first of a number of hormone shots that would hopefully reduce my testosterone level to practically zero. The testosterone in a man’s body feeds the cancer, so by this “chemical castration,” the ability of the existing cancer or the cancer cells circulating in my blood to spread and lodge would be temporarily slowed. The effectiveness of this treatment is not permanent, as the hormone treatment will eventually lose its effectiveness and the cancer and cells in the blood will start growing again at a faster rate. How long this treatment will be effective varies in individuals from months to several years.

I was given two injections of Firmagon just under the skin on either side of my belly and one of Prolia in my arm, the latter to help overcome the bone-weakening effect from the shots. Thus began the first of my medical treatments, with a number of tests and treatments to be performed in the next several weeks.

This was followed by a bone scan and a CT scan performed at Henry Community Health. Radioactive liquid was injected into my blood via an IV and I was released to come back several hours later for a CT scan that would pick up any radioactive material that might have lodged on cancerous bone.

I was then sent to the Ball Memorial Hospital Cancer Center downstairs in the Forest Ridge Medical Pavilion in New Castle for another CT scan that would accurately define my bone structure for future positioning on the radiation table in the event the scans show that my cancer had spread to my skeleton. Subsequently, I had an MRI of my pelvic area to back up the results of the CT bone scan.

After reviewing the results, the radiation oncologist confirmed that the cancer had spread to my bones and explained that I would be having a series of 10 daily high-energy radiation treatments (X-ray, not radioactive) in an attempt to kill the cancer cells in one of the sites within my left hip, that particular area being the area of greatest concern and which was possibly the cause of the pain in my hip and leg. Other cancerous sites were suspected – on a rib, my spine, pelvis and right hip – but they will not be addressed until my PSA and/or testosterone levels begin to increase, thus indicating that they are again starting to grow, or if I begin to experience cancer-related symptoms in those locations, at which time I will first have another bone scan, MRI, etc., of the suspected area(s) and the whole process will start over.

Coming Tuesday: Part two, Treatments begin.