Robert A. Buckman, M.D., Ph.D.
Adjunct professor, Behavioral Science
The University of Texas M. D. Anderson Cancer Center
Dr. Buckman:
Good, so no major problems after the biopsy then?
Mr. Hawkins:
No, not really, Doctor, no.
Dr. Buckman:
Okie Doke. Now, before I go into the results and such, why don't you tell me what you understand about the situation and what your family doctor told you and what Dr. Wilson said to you before the biopsy?
Mr. Hawkins:
Well, he said that the blood work was abnormal. I think that's the word he used.
Dr. Buckman:
Correct, that's correct, I see.
Mr. Hawkins:
But then he carried on. He said that he wasn't sure about the prostate...
Dr. Buckman:
Right.
Mr. Hawkins:
At this point. He could not tell at this point.
Dr. Buckman:
He couldn't tell?
Mr. Hawkins:
No.
Dr. Buckman:
In your own mind were you thinking it might be something serious going on in the prostate, or something not so serious?
Mr. Hawkins:
No, no. I thought it wasn't all that serious. I mean...
Dr. Buckman:
It didn't strike you as something serious?
Mr. Hawkins:
No, I thought maybe the blood work, he, someone had missed it or that...
Dr. Buckman:
Okay.
Mr. Hawkins:
Yeah.
Dr. Buckman:
Now, if it turns out to be something serious...
Mr. Hawkins:
Yeah.
Dr. Buckman:
Would you like me to tell you exactly what's going on in the prostate and how we plan to treat it?
Mr. Hawkins:
Oh, yes certainly, doctor, by all means, yes.
Dr. Buckman:
I will do that. Okay, that blood test, you are absolutely right. The blood test was abnormal. It's this blood test called the PSA, the Prostate Specific Antigen. It's just something that indicates a problem in the prostate, okay.
Mr. Hawkins:
I know they took blood for that then.
Dr. Buckman:
That's correct.
Dr. Buckman:
And that's why Dr. Wilson took those pieces of the prostate, the little biopsy...
Mr. Hawkins:
Yes.
Dr. Buckman:
Specimens, to see what was going on...
Mr. Hawkins:
Yes
Dr. Buckman:
Because sometimes that blood test is high and it's nothing serious. Sometimes it's something more serious.
Mr. Hawkins:
Oh, I see.
Dr. Buckman:
Okay. You with me so far?
Mr. Hawkins:
Yes, I am.
Dr. Buckman:
Okay. In your case, Mr. Hawkins, it turned out that indeed it was, unfortunately, something more serious.
Mr. Hawkins:
Oh.
Dr. Buckman:
In fact, in over half of the pieces that were taken out of the prostate, the cores of the biopsy pieces, there was cancer in the prostate. That's obviously a shock.
Mr. Hawkins:
Yes.
Dr. Buckman:
Okay.
Mr. Hawkins:
Yes, it is.
Dr. Buckman:
And, and, I'm very sorry it's a shock. It usually comes as a surprise. In your particular situation under the microscope, it looked to be moderately, sort of average kind of aggressive.
Mr. Hawkins:
Okay.
Dr. Buckman:
But the CT scan, the x-ray that we took, showed that it was quite advanced locally. That means it had spread outside the actual prostate gland itself.
Mr. Hawkins:
You sound like it is rather serious, doctor.
Dr. Buckman:
Potentially, that's correct, Mr. Hawkins. We do, we do have to take this seriously.
Mr. Hawkins:
Okay.
Dr. Buckman:
And in your case, Mr. Hawkins, what we need to do is, we need to start treatment with radiation, radiotherapy, in other words, to try to kill as many as we can of the cancer cells inside the prostate.
Mr. Hawkins:
Well, does this normally work?
Dr. Buckman:
Very important question. At this moment, at this moment right now, I can't promise you that the cancer will never come back, or will never get out of control. I can tell you that with the radiation therapy often that is the case...
Mr. Hawkins:
Great.
Dr. Buckman:
But not always. What I'm going to do is, I'm going to ask you, I'm going to refer you to the radiation oncologist, the person who does the radiotherapy.
Mr. Hawkins:
Yes.
Dr. Buckman:
And in fact, I'll actually make the appointment for you before you leave today. It'll probably be sometime within the next few days.
Mr. Hawkins:
All right.
Dr. Buckman:
Okay. And then we'll discuss all of the details of the treatment. And then I will keep an eye on you thereafter. And if anything comes back or if the cancer recurs, we'll sit down and talk about it then. If it doesn't, of course, we don't need to.
Dr. Buckman:
But the first step is the radiation treatment.
Mr. Hawkins:
All right.
Dr. Buckman:
I've told you a whole load of stuff about what's going on in the prostate, and what we need to do.
Mr. Hawkins:
It's spinning around right now.
Dr. Buckman:
Is it spinning around in your mind? Are there any questions that come to the top of your mind straight away?
Mr. Hawkins:
Well, on an average, my chances are what on a scale of one to ten?
Dr. Buckman:
Well, at this moment in time, I would have said that the chance of this cancer coming back may be as high as 50%. It's really, it's not something we can take as trivial, you know.
Mr. Hawkins:
No, no, I know.
Dr. Buckman:
There is a considerable chance of it coming back, and the only way, as it were, that we'll know is for me to see you each time you do those blood tests and maybe more scans if we need them in the future.
Mr. Hawkins:
Okay.
Dr. Buckman:
So what I'm basically saying now is I can't tell whether it's going to come back or not. But, we do need to keep an eye on you with blood tests and maybe these scans as well, visit to visit, to visit and keep an eye on the situation.
Mr. Hawkins:
Okay, doctor.
Dr. Buckman:
That's a lot to take, isn't it?
Mr. Hawkins:
Yes, it is. Yes, it is.
Dr. Buckman:
If, by the way, and this is important, if you want to bring your wife or any other family member to any of the visits with me, no problem at all.
Mr. Hawkins:
Okay, I'd like to bring the wife, actually.
Dr. Buckman:
Would you?
Mr. Hawkins:
Yes.
Dr. Buckman:
Sure, one last thing. Probably by the time you get to the car park, you'll have about 30 questions going through your mind, it's always the way.
Mr. Hawkins:
I've got that nearly now.
Dr. Buckman:
You do, okay.
Mr. Hawkins:
Yeah.
Dr. Buckman:
Don't hesitate...
Mr. Hawkins:
Okay.
Dr. Buckman:
To write those questions down on a piece of paper...
Mr. Hawkins:
I will.
Dr. Buckman:
And bring them along next time.
Mr. Hawkins:
All right.
Dr. Buckman:
I don't mind that at all and it makes it easier for you to remember what you wanted to ask me, and we can tick them off one by one and then you'll know the situation.
Mr. Hawkins:
Okay, okay, doctor.
Dr. Buckman:
All right, Mr. Hawkins.
Mr. Hawkins:
Thank you.
Dr. Buckman:
You can take a seat in the waiting room, I'll make an appointment for the radiation oncologist, and then I'll see you back at the next appointment.
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