Off we went to Medical Oncology today and the news is not great. Our specialist was delighted to find I am still feeling so well, have no pain, and am enjoying such an active life. The bone scan a few weeks ago showed, he reckoned, nothing very significant.
But an extra PSA test I organised for myself yesterday showed a 25% increase in only five weeks since scoring an unexpected 50. So after a year of stable PSA around 25 – 28, in just three months I have got to 60. The disease may not be showing itself in pain or disability but it is clearly becoming much more active.
We will continue with the quarterly Zoladex as the primary agent to reduce testosterone on which the cancer feeds. Now, Simon summed up our future options as:
1. Chemotherapy - to treat my whole system with cancer-reducing medications
2. Abiraterone - to restrict even more the production of testosterone,
3. Some targeted radiation therapy to tackle identifiable cancer growths.
We agreed there was also:
4. Do Nothing.
At the end of the day, any decision would be mine.
Bev and I left with four pages of information on Abiraterone — nothing new in there to anyone who’s done his research— and a plan to have a CT scan in a month and another discussion after that has come through.
So we have plenty to think about. Up to now I have been resolved that the substantial cost of Abiraterone – even if met by a generous public health system – does not justify an extra three months’ life-expectancy.
How do I quantify another year or two of reasonably active life and an extra three months at the end against what $100,000 could do for other younger people in the health system with other less expensive needs... For someone of my age and convictions, that is a moral and ethical problem. The system seems to say it can afford to make the offer to about 1000 men a year and invites me to be one of them.
Does that make it right?