Hey Dr. Medical oncologist (MO): Now that I've got 1478 characters I can express myself a bit better. 

I've certainly noticed my decline in function over the last six months to a year. And as we both know now it was the cancer starting to run its course. I've known since the 2014 that for someone my age and who couldn't have an RP, it was not a matter of if but when. I assure you I've thought long and hard about hormone deprivation.

Spent hours at UCSF Library. Read countless blogs, spoken to dozens (hundreds?) of men in my shoes. You may recall that I tried it for the better part of year one time. I was borderline suicidal as a result not to mention the depression, the hot flashes, the weakness, the malaise, the loss of muscle mass and the increase in body fat and last really, truly last what is the loss of sexual function. Not number one concern.

And it might buy a year....a miserable year. No Doc, I want to focus on and maintain as long I can, fairly good quality of life. Castration does not provide that. 

PSMA, once approved is promising but the medical community still insists on castration to even be CONSIDERED, which I will never understand. I hope that HDT in its various forms of poisonous treatment is banished. But I'm not a "standard protocol" guy, which you know. It's worked rather well going on 8 years. 

Dr. MO, thank you for your knowledge, your compassion, your friendship, your often sage advice. I have truly appreciated you as a physician and simply a nice guy. 

Best, Scott

Hospice - It's time

When I started this journey going on almost eight years ago, I assumed that at some point I would probably have to write a post regarding end-of-life care and possibly hospice. I actually expected to have to write it sometime back but I beat the odds for a long time. Regardless of whether that's due to the initial western treatments I had, the heavy use a full extract cannabis oil or just plain old good luck I just kept me kicking around. Today I met with a very nice registered nurse from Hospice of the East Bay who we will call Cindy. She was here to do an intake. I had noticed over the last year, in the last six months in particular, that my energy, my memory, my pain levels, my appetite had all degraded and continued to do so. The PSA score of 330, triple what it was two months before (i.e. it was then finally the state of the art PSMA Pet scan on my birthday that gave firm evidence that the PCa had metastasized extensively to both lungs, liver, what's left of the prostate and multiple lymph nodes both in my neck and groin. Having lived through the AIDS crisis of the 80s and 90s, having buried both parents to cancer in one sense or another, I've had a lot of interaction with hospice and these are very special people that do this kind of work. So now the doctors will be coming to me. Well at least they RNs will. My disease associated medications are now 100% covered and will be delivered to me. I'm getting a couple of assistive devices is such is a walker and a shower stool not because I can't stand and shower or because I can't walk but sometimes it's difficult. I want each of you to know that I am at peace with this decision. As a matter fact, I have a great sense of relief. I've been fighting this pretty much on my own for five years and dealing with it for going on eight and I just I have to recognize reality. Hospice can do the most good for you if they get involved early. So that is by way of saying that I'm not going anywhere this week. I kidded the nurse today that it seems that I'm a tough motherfucker to kill. lol....... Fortunately she had a good sense of humor ;) Please know that emotionally I am really good. I'm not throwing in the towel and I will continue to seek out possible treatments that makes sense. But I won't take hormone deprivation unless it becomes a palliatively necessity. I've had a good run considering what my diagnosis was. Eight years instead of five.. But truth of matter, I'm exhausted from treatments, the limitations, the lifestyle, the never ending pain. Please support my decision. It's not one I've made lightly; it's one I thought about for many, many years. All I ask of my friends and family is that you just keep loving and joking with me! Laughter is good and I'm good with it. I dearly love my friends and family and it goes without saying, I've been extraordinarily blessed in my life. To the men around the world that I've been able answer questions and give you some info or reassurance......well I'm proud I was able help in some small way. 

 But I'm at peace folks.