The above picture was taken last year almost to the day in Orange Beach, Alabama. I remember the day vividly. My wife and I went to the beach and for almost every minute of the day construction vehicles were working and making noise just outside our condominium. It was comical how loud and persistent the noise and activity was. BP was paying money for the clean up and Orange Beach was using every penny of it looking for tar balls. We would see workers shift sand all day and from what we could tell from our balcony and on our walks very little was being found. It looked very “governmental to me.”
Anyway, just before I had left Gainesville a patient who had been diagnosed with prostate cancer with a high Gleason score had had a bone scan. I was concerned about it. The patient and his wife became “office friends” of mine and in fact the wife was so kind to drop off several excellent cakes to my office as a thank-you for our help in his case. The cakes were so good that my wife, who loves to cook, said ” I’ll never cook another cake again. I’ll just get these.”
While at the beach I call on several occasions to get the report of the bone scan. My nurse read me the report as I watched the heavy equipment move sand in front of the beach.
“Wide-spread metastatic bone disease consistent with known history of prostate cancer.”
“Damn it!” I was sick with the news. I called the wife and gave the news and arranged for the couple to come to the office to discuss the findings, the significance and our plan going forward. I arranged for the patient to go by the office and get a LHRH shot and called in Casodex.
That was one year ago. He passed away this week. I loved him and you would have too. Man the man loved to work. He went to work with crutches toward the end. His wife came by almost weekly for a prescription for Oxycontin, the only thing that allowed him to go on. I never heard him complain. His wife was absolutely beautiful through the whole thing. I am sorry Bess (my daughter says I mention Frank Zappa too often) but it was Frank Zappa, Dan Folgelber, Ablin’s father all over again.
How is it in today’s world, the internet, prostate cancer month, Movember that someone presents too late to cure of prostate cancer?
If this patient had had a PSA several years ago would that have made a difference? Or stated differently…at what point would a PSA and knowing that this patient had prostate cancer would it have made a difference? What do the epidemiologists of the world have to say about this class of patient?
A frequent commenter to this blog I bet has some thoughts on this and we should listen to him.
Keith…are you there?