Decisions... Decisions....

Brandon had his first appointment with his oncologist today.  It went really well.  We both really liked the doctor, and felt extremely comfortable with him.  Neither of us really knew what to expect from this appointment, but we both had loads of questions for the doc.  The doctor had reviewed Brandon's medical charts and also had the results of the full body bone scan that Brandon had done on Wednesday.  Here is another opportunity to praise the lord - the bone scan was completely clean.  It had NOT spread to the bone!!  This is exactly what his urologist predicted, but it was great to hear nonetheless.

After talking to Brandon about his medical history, the doctor explained that although at least 98% of Brandon's cancer was the lesser aggressive seminoma cells, the remaining 2% came back as non-seminoma (a more aggressive form of testicular cancer).  There are many different forms of non-seminoma cancers that can be found in the testicle.  The type that Brandon has is called embryonal carcinoma.  This is a relatively uncommon, but very aggressive form of cancer.  The doctor explained that often times, when this type of cancer is found, it has already invaded the lymph nodes.  For this reason, Brandon's diagnosis is Stage 1B testicular cancer.  So where does that leave us??

Brandon's first option is what they call "surveillance".  This would mean no immediate treatment, but Brandon would go once every three months for labs, CT scans and tumor markers.  If anything changes from his current stage - chemotherapy.  This would go on for 5 years before he was considered cured.  That's a lot of scans people.  The doctor explained that Brandon has a 20% chance of the cancer returning based on the type of cancer found.  He also explained that this choice was only a good one if Brandon could commit himself to this strict follow-up regimen for the next few years.

Option 2 (which Brandon and I both feel isn't a very good one) - a surgery to remove and dissect the lymph nodes on Brandon's lower abdomen to determine if there is any remaining cancer cells in the lymph nodes that are too small to show on the CT.  (Apparently even though Brandon's CT shows no lymphatic invasion, there is still a chance that the cancer has spread there, but is too microscopic to show on the scan).  If there is cancer found - chemotherapy.  If there is no cancer found - surveillance.  That is why Brandon and I feel like this option isn't for us.  Either way, he would be going back to one of the other two options.  AND the surgery would be another rough set back for Brandon.  The recovery would be more lengthy than his recent surgery, and more painful.

Option 3 - one to two rounds of BEP chemotherapy.  Obviously, chemotherapy has a lot of side effects.  And no one wants to have to endure this if unneccessary.  But the good thing about this option is that Brandon can move on with his life afterwards.  The cancer will be gone and he won't be waiting on it to show up again in his scans.

Brandon's oncologist is also discussing Brandon's case with a doctor out of Indiana (the same doctor who treated Lance Armstrong) to get his recommendation.  Normally, with the embryonal carcinoma cancer, chemotherapy is a must.  But Brandon only had 2% show up in his pathology, so that seems to be the hang up.  Does he need to risk it not spreading or risk the side effects of the chemo??

Brandon has a lot to think about, and I'm praying that he will come to a decision peacefully himself.  I don't want him to feel persuaded one way or another by his crazy wife :)  In my heart of hearts, I feel like Brandon will go with whatever the doctor from Indiana recommends (who wouldn't?)  We should have his recommendation by the middle of next week and we will go from there.  Continue to pray for Brandon - he has a big decision to make this week.