After an hour delay Dr Cy Fer entered the examination room and cordially greeted my wife and me. His casual, besweatered attire suited his amiable, elderly persona; by way of internet I knew him to be 72.
At the outset we spent considerable time reviewing my medical history. Apparently Dr Fer did not have an opportunity to review the detailed background information I submitted as a prerequite to our appointment. Evidently the proposed agenda I prepared also escaped his attention. Even so the agenda proved helpful inasmuch as we referred to it from time to time to facilitate our discussion.
Following a review of my medical history Dr Fer focused on the unfortunate unavailability of any truly good treatment options for those of us with recurrent cancer. "If we fellows only possessed the temperament and organizational inclination of womenfolk, our prospects would be substantionately better." "Look at the progress attained in the treatment of breast cancer," Dr Fer implored. He looked to my wife for affirmation on this point. As a 12 year survivor of breast cancer, she readily and wholeheartedly agreed.
As one part of our dialog Dr Fer opined my recurrent cancer may not be limited to my prostate gland as determined by the choline scan and confirmed by the chemically enhanced, endorectal MRI. He wanted us to realize that " all such scans are subject to error both false negatives and false positives." He reminded us " this is particularly true of newly developed scans no matter how highly touted or aggressively marketed." I was generally aware of the imperfections of all such scans, but it was conclusively persuasive to hear this from a seasoned practitioner.
I knew Dr Fer currently provided followup care for a friend of mine whose treatment plan had been developed by a group in California described by one of my advisors as non-mainstream, called Cancer Patient Advocacy Clinic. This group uses hormone therapy to treat primary prostate cancer followed by a repeat of hormone therapy combined with antiangiogenic cocktail, followed by chemotherapy and so on until the cancer is cured or controlled. My friend underwent this pattern over a two and a half year period and has remained cancer free for eleven years as indicated by a low and stable PSA. I called my friend's experience to Dr Fer's attention and asked him if he thought the CPAC approach may be appropriate for my situation. "Unfortunately", he responded," CPAC does not publish their results, consequently I have no basis for recommending their methods. For your information I have three of CAPC's former patients including your friend whose case I regard as exceptional and two others whose outcomes I regard as unsuccessful."
Just as I began to think all of us had gotten off track irretrievably Dr Fer raised the prospect of a treatment plan. "Casodex", he announced unobtrusively, "a colleague of mine has met with a fair amount of success using this approach. A 50 mg tablet per day," he explained ," may control the progression of your disease for up to ten years with minimal side effects." "About the worst you could expect," he continued "would be hot flashes." "How would you rate my chances for such a favorable outcome?" I asked." "Better than even," he replied. "This regimen," he explained further, "also avoids the loss of muscle mass caused by traditional hormone therapy." "My patients on HT." he advised, "measure the reduction in their strength by the shortened distances of their drives off the tee." Although a non-golfer I do play tennis, consequently Dr Fer's message resonated with me. None of us would-be athletes want our game compromised.
While it is true I did not much care for Dr Fer's overall approach to our interview, I must admit the Casodex solution sounded extremely promising. The 50/50 chance of a favorable longterm outcome with no serious side effects possessed advantages far superior to anything my research had produced to date...or so it seemed. I thanked Dr Fer for his time, told him I would like to think about his proposal and get back to him. He signaled his approval and we parted company.