My First Cancer

I’m on my own now.

On Oct 17, I had my final three-month injection of hormone suppressant. So any day now, the side effects (hot flashes, chemo-brain and fatigue) should start ebbing, and testosterone should start flooding. The problem is, testosterone fuels the growth of prostate cancer, so now also begins the big wait-and-see, the medical equivalent of Neighborhood Watch, an anxious lookout for something to go wrong: recurrence.

A diagnosis of cancer is an ambush. Recurrence is predation in the night, a stalking, circling menace, unseen but sensed and feared — yet not fully realized until the pounce.

I’ve yet to meet a cancer survivor who doesn’t have at least a farthing of fear of recurrence. We all sense this menace, and it changes us and how we approach the very notion of time. We condition our present with a parenthetical (for now), and we hedge our future with a conditional “if all goes well.” We don’t talk of being “cured,” just that there’s “no evidence of disease.” Some survivors even animate recurrence: “the bear in the back room,” my friend Sandi calls it, waiting to break out.

These are the altars of language we kneel before to pay homage to Truth: With one routine test, our cancer circumstance can abruptly change — and with it our lives.

For prostate cancer survivors like me, it’s the PSA test that brings a slowly ratcheting anxiety, but all strains of cancer have follow-up tests or scans of their own, and all cancerians know the accompanying tension: the dread that the results will — this time — bring that feared change in circumstance. I finished my first round of hormone therapy in Oct 2009 and for nine fleeting months tested negative: no evidence of disease. But on July 12, 2010, with just five words, my cancer circumstance was abruptly changed. “Your PSA is not undetectable,” they said. PSA, a blood-marker of prostate cancer, had returned.

The predator had pounced.

Recurrence shook me. All the important things I’d been diligent about, all my strategies for pushing back, now seemed trivial, almost wasted, and I was reminded, one more time, that cancer is a disease and a metaphor for loss of control. It hadn’t mattered what I’d done. The cancer that had metastasized to my lymph nodes prior to surgery — even before diagnosis? — had endured.

A small voice within whispered, “You’re in trouble.” This was proving to be a more difficult contest with cancer than I’d foreseen, hoped or assumed. I doubled down on diet, exercise and nutrition, and I began seeing a naturopathic oncologist. I also began paying closer attention to new drugs in testing and coming to market: Which one, I muse, could someday become a vital part of my life?

Eventually, recurrence led to my recent round of salvage radiation, a one-off attempt to see if, finally, we could root out — even just suppress for a few years — the cancer that’s eluded all prior attempts. On Jan 23, I’ll have my first quarterly PSA check since radiation and, after that, quarterly tests for as far as the eye can wait-and-see: April…July…October…January. Lather, rinse, repeat.

But today, no pills, no injections, no radiation — I’m off treatment and on my own (for now).