Two years of living life and not really thinking much about the word "cancer" -- that describes Sam's world since the last update. Now in post-masked, post-COVID, post-colon cancer 2023, he has returned to what he enjoys most...projects.

In between assisting his new son-in-law with a remodeling construction project in Dallas and being hired in our neighborhood for various interior and exterior jobs, Sam has enjoyed fewer cancer center visits and has settled into a south Overland Park routine. He occasionally joins Dennis for breakfast at the nearby "Chick," sits on the front porch with his coffee, scrolling Marketplace for the best deals, makes multiple trips from home to Home Depot, and next week, he will join his nephew and great nephews riding motorcycles all around the Winter Park, Colorado, area. 

He is currently working on a basement remodel for a very nice couple. I don't know how he does it, but he always seems to envision a plan in his head, and it just seems to work out. This job is a big job, and there is no way Sam could do it on his own. But Sam does what Sam does, and as he was picking up supplies at the local Home Depot, he got into a conversation with a young part time employee who "gets it," and now Sam has someone young and strong to help him with his project. Earlier this extremely hot July week, Sam's good friend Cosmo stopped by and rather than work outside in the hot sun, he opted to stay and help Sam in the cool basement. It just seems to work out...    

Sam continues to have excellent CT scans, and his visits with Dr. Al-Rajabi include longer breaks between appointments, now every four months. We have come to expect great news with every visit - NED, no evidence of disease. Sam still takes all the supplements and the alternative FenBen on a daily basis. And I still sing this song in my head every time we enter through those doors:

Earlier in the spring, Sam met with Dr. Parikh, his urologist who is overseeing his prostate cancer. Sam has had a break from the Lupron injections and Xometa infusions, and it was time for new doses. His PSA has slowly begun to rise, and so the doctor ordered a PET scan so that he could have a better picture of what is happening. The PET scan showed cancer in the prostate, but the metastases to the bones were not lighting up as they had previously -- great news, once again!

Dr. Parikh, in his gentle, soft-spoken way, shared that because of these results, Sam now has some options to consider.

1. Radiation to the prostate, now that it looks like that is where the cancer is localized.
2. Surgical removal of the prostate. 
3. Continue with the hormone therapy and add Xtandi.
4. Take a full break with no treatment at all, and just see what happens while waiting it out.

Appointments were set up with a radiation oncologist and a urologic surgeon to explore these possibilities. We met with Dr. Xinglei Shen a few weeks ago to discuss radiation, and although we walked in thinking this was the least favorable option, Dr. Shen began to change our minds. He was another KU class act: kind, compassionate, took his time and did not make us feel rushed or pressured to make a decision. He already knew Sam's case and said the tumor board had discussed Sam at length over the course of his disease progression. When we left his office, we felt educated and assured once again that we were at the best place possible for treatment.

Yesterday was the appointment with Dr. Will Parker, the urologic surgeon. All along, I have not been afraid of surgery -- Sam has been there, done that, and it is what we know. Radiation is another ballgame and therefore, the "unknown." So, as his wife, I was fairly confident that this would be where Sam would eventually land. Just get it OUT. If the cancer is now localized, GET IT OUT. Dr. Parker walked in, very personable and confident, and after introductions and niceties were exchanged, he came right out and said, "I am probably going to tell you some things you were not expecting."

(Gulp.)

And then he went on to describe Sam's past 6 years and what he knew about Sam, sharing that he knows Sam's history very well. Sam is an anomaly at KU, and these cancer doctors don't see many miracles in their line of work, I guess. Dr. Parker matter-of-factly said, "I will not operate on you. If I did, I would hurt you more than I would help you."

Woah. What? 

He went on to explain that Sam has Stage 4 metastatic prostate cancer -- yes, we know -- and because those cancer cells have left the prostate, it does Sam no good for Dr. Parker to go in and remove the prostate, potentially causing more harm than good. Those cancer cells are in Sam's system, and to just remove the prostate does not remove the other cancer cells that are most likely still there. Because Sam's testosterone levels are so low right now and he has been on hormone therapy, those cancer cells are not "lighting up" on the PET scan, but as a surgeon and physician, he cannot definitively say they have been eradicated. In his experience, that is not the case. Dr. Parker said, "Don't get me wrong - I am a surgeon and I love to operate. But for YOU, Sam, radiation oncology is your best course of treatment at this stage. I will NOT take you into the operating room." 

Needless to say, we were very impressed, all over again. Sam's best interests are being considered, and although Dr. Parker will not be Sam's surgeon, we HIGHLY recommend him if anyone is ever in need of a urologic surgeon.

Next step: make plans to begin the radiation project.

Our devotion for yesterday was written just for Sam:

"...Help me walk through this perilous world in trusting dependence on You. I know that You go before me and open up the way, carefully preparing the path I will follow. I'm counting on You to remove many dangers and obstacles from the road ahead - and to provide all I need for coping with the difficulties that remain. Even when I walk through the darkest valley, I will not be afraid, for You are close beside me. Your nearness comforts and delights me. As I stay in communication with You, I trust You to guide me faithfully through this day - and all my days. For you are my God forever and ever; You will be my Guide even to the end." - July 13, Jesus Listens, by Sarah Young

This morning, I am overwhelmed by God's provision and hand on Sam's life. Once again, it all just seems to work out. Thank you, God.