Chemo day 28 - round 2.2

I'm back at the cancer center for another round of chemo. My port was blocked by a clot, so it took a while to flush it out and get a good blood draw. Eventually it worked. My results are at the low end of the normal range, but generally ok (WBC 4.1, hemoglobin 13.0, hematocrit 37.2, platelets 298, neutrophils/ANC 2.5).

While waiting for the results, I met with my oncologist. She was pleased that the constipation was under control last week, and noted that this week was Gemzar only, so I should not be feeling as much nausea. I hope so. We discussed how I held felt more lethargic last week, and she will be paying close attention to my red blood cell counts to make sure that I am not anemic. Otherwise, she said that it could simply be the cumulative effects of the chemo. She said that it takes 3 or 4 weeks to recover from each chemo session, so I should not be surprised as it all adds up.

We also discussed what to expect after chemo ends in late April. She said that, after 4 weeks or so, I would have another round of PET and CT scans to see if there is any evidence of distant metastasis. If so, I would not proceed with surgery, but instead the team would reconvene and see what the next treatment should be. There is about a 25% chance of that happening. If the scans show no evidence of distant metasteses, then I'd be scheduled for surgery, likely in early to mid June. A cautionary note is that the scans are not conclusive - they only show metasteses that are big enough, so microscopic spreading likely would be missed. So it's possible that I could have the surgery and still later have the cancer pop up somewhere else. They closely watch for 5 years, figuring that if nothing pops up by then, it probably won't.

Meanwhile, assuming the surgery goes forward, I need to wrap my mind around life without a bladder or prostate. (Last week my urologist told me by email that they remove the prostate because in 45% of cases with my type of cancer, they find that the cancer has spread to the prostate. So if they leave it in, then they leave a diseased organ behind in nearly half the cases. And bladder cancer in the prostate is a lot worse than most prostate cancers, which typically is a much slower-growing disease with lower risk to the rest of the body.) I'm still reading up on the multiple types of neobladder options, but I've been more concerned about the side effects of the surgery - 10% chance of blocked ureters, 20% chance of incontinence, and 50% chance of impotence. That sucks. I think that I'm going to check in with other doctors regarding different neobladder procedures, as well as robotic-assisted nerve-sparing surgery.

But first things first. Get through today's chemo. Get a booster shot tomorrow. Slog through the week. Be regular. Don't bleed. Keep my counts up. Avoid sick people. Repeat again, and again.