When Cancer Comes Calling – Book Two: Awakening
Final Tumblers Before Treatment
David R. Weiss – August 28, 2025

This is a last (and much shorter) post to conclude my “Awakening” around prostate cancer (PCa). As indicated in the Introduction to my last post, when my formal treatment begins this fall, I intend to post a series of “Soundings,” short reflections on my lived experience in cancer treatment itself.

My “awakening” began in mid-June with the prospect of hormone therapy as part of the next phase of cancer treatment. I describe this in greater detail in my previous post. In short, although I had prepared myself (at least in the abstract) for the possibility of needing radiation after surgery, I had not really even considered the possibility of hormone therapy.

Thankfully(!) there was a week delay between the recommendation and my scheduled injection of a first six-month dose of testosterone suppression medication. I shudder to think where I might be today if my urologist had prepped the injection in advance and suggested I simply take the shot that day. I probably would’ve accepted it—likely to my immense regret.

During the intervening week I read up on hormone therapy, more specifically, ADT (Androgen Deprivation Therapy). ADT, which can be done using a variety of drugs, basically suppresses testosterone. Bluntly, it chemically castrates a person.Because prostate cancer cells depend on testosterone to drive their growth, ADT very effectively slows the spread of PCa, often weakening the cancer cells and making it easier for radiation to kill them. But testosterone suppression comes with a host of potential side effects damn near as unnerving as the cancer itself. After a frantic deep dive into ADT, I had learned enough to be legitimately alarmed about it—and legitimately reluctant to agree to it.

I cancelled the injection and ultimately changed urologists. While likely within the range of “standard practice” for cancer care, the way this treatment had been presented to me felt like a betrayal of my interests and a breach of trust. Since then, I’ve spent the rest of my summer learning about PCa, asking questions of my doctors (occasionally pushing back on their answers), and assembling a medical care team that fits my twin desires: to understand treatment as deeply as possible and to feel centered as a person during that treatment. I want to ensure that DAVID—and not just the cancer—is being treated.

And yet, here I am now, in the waning days of summer, preparing to start ADT in the next couple of weeks. Well, what’s shifted to bring me to a place of grim, resolute calm about this perilous chemistry project about to play out in my own body? (Equally in my mind. And just as truly in my marriage.)

I titled this post “Final Tumblers” (thinking about the tumblers inside a lock) because one way to consider my reluctant resolve toward ADT is to identify the various tumblers that have all aligned to allow me to move forward. I’m not “excited” about this phase of treatment. Even if it drives my cancer into remission for years (that’s the goal) it will come at a cost I cannot gauge in advance, and a cost I cannot be assured will be worth it at the end. Even if it adds years to my life. This is risky business, with existential stakes. So, let me tell you about the tumblers that have aligned to make it a bearable risk.

1. The first tumbler was the recognition that my cancer is the killing kind. 85% of prostate cancers are low or intermediate risk. Even those are nothing to smirk at, but (caught early) they can almost always be successfully managed or treated. The other 15% is the killing kind. Aggressive, mean-spirited, and bent on building a nest in my bones. In fact, my particular PCa is in the upper range of that 15%. I wish I had understood that sooner. But as I’ve come to terms with it, I’ve come to realize that, in the face of such extreme risk, I may need to embrace equal risk in my treatment. Not happily, but with resolve. I think, humbly, of Warsan Shire’s poem about refugees, in which she writes with heart-rending poignancy, “No one puts their children in a boat unless the water is safer than the land.” ADT may be my boat.

2. The second tumbler is having a medical team I trust. I should emphasize: nobody gave me poor care. But as a person driven by intellectual understanding, I needed every single person on my team to be forthcoming and transparent with me about my diagnosis and treatment options. Moreover, as someone deeply grounded in personal values and a sense of vocation, I needed a team able to recognize and honor those facets of me in the midst of shared decision-making—especially if we ever need to face even more harrowing choices. (Which, with high risk PCa is a distinct possibility.) It took some effort to make that happen; such a team doesn’t assemble itself by chance. But now, from my primary care physician to my urologist, radiation oncologist, and integrative oncologist, that team is in place.

3. The third tumbler is claiming agency in my day-to-day health. Guided by my own reading, I’ve adopted a whole set of dietary choices and plant-based supplements aimed to position my body to fight cancer alongside medical treatments. Ensuring that I am no mere bystander in my own care is critical to being able to “lean into” the storm. I’m confident the choices I’ve made thus far can support my health, but I’m especially glad to have the guidance of a trained integrative oncologist to help me further refine them. And I’ll be adding a variety of practices, ranging from active exercise to gentle movement and mindfulness in order to ensure I’m as active a participant as possible in my own care. 

4. The fourth tumbler is having extra medical support ready and waiting in the background. Although I’ve not yet tapped into them, I recently found out that my health care system (M Health Fairview) has a whole suite of Oncology Supportive Care Services. Through them I can access guidance for nutrition, exercise, and mental wellbeing, all specific to a cancer patient’s journey. I can access counseling, expertise for sexual health during cancer, and, if necessary, palliative care and a social worker. I may not need all of these services at the moment, but just knowing they’re available provides a level of added security. It’s like discovering my care team has a “deep bench” that I can draw on as the needs arise.

5. The fifth tumbler is having medical insurance that, while imperfect, is pretty expansive and pretty generous. While it stung earlier this year to pay out my entire deductible and out-of-pocket max for co-insurance over just the first 65 days of the year, since then my medical expenses have been 100% covered—and have far outstripped what we had to pay early on. Every procedure and medication recommended by my doctors has been approved for coverage (except for one medication, which wasn’t a big deal). That’s not true for everyone. Cancer is expensive, and financial anxiety—or worse, medical bankruptcy—can be a devastating side effect. Thankfully, I’ll be able to focus on the side effects going on in my body and psyche without worrying (too much) about what going on in my wallet.

6. The sixth tumbler is my (still) growing awareness of the multitude of support groups and other resources that offer insight, guidance, and solidarity on this path. Through online forums, social media, and in-person encounters, I’ve engaged with other men dealing with situations similar to mine. One of PCa’s most insidious “symptoms” is its capacity to isolate you. There is so much untapped energy and empowerment in sensing the solidarity of others alongside you. Solidarity may not be curative of the cancer, but it is healing of the isolation. I expect I’ll be deepening my connections with support groups, because having good roots here will help anchor me—and because it’s a good feeling to know that I can help anchor others.

One specific resource I’ve just acquired is Androgen Deprivation Therapy: An essential guide for prostate cancer patients and their loved ones (Wassersug, Walker, and Robinson, Demos Health-Springer Publishing, 2023, Third Edition). There are countless online discussion threads about ADT and plenty of stand-alone articles and videos about managing the side effects, but this book is the only comprehensive guide written collaboratively by PCa survivors and medical professionals and focused exclusively on the side effects of ADT. It addresses how to anticipate, understand, and (as best possible) manage the side effects, personally, socially, and in one’s intimate relationships. Arranged as a workbook (ideally read and discussed with a partner or close friend), it just arrived two days ago, and it already feels like I’ve received a compass designed to help me navigate this unknown land—with Margaret at my side.

7. Last, but far from least, the seventh and final tumbler to slide into place has been the understanding of family and friends. Over the past two months, I’ve been able to bring family and friends up to speed on what this fraught path means for me. While I politely accept the well-wishes that say, “I’m sure everything will work out. I know you’ve got this,” the truth is I’m not at all sure ‘everything will work out,’ and I’ve read far more about my PCa than anyone who tells me that. I’m not at all sure that ‘I’ve got this.’ And words of encouragement that strike me as naïve don’t actually deliver encouragement at all. What actually does feel good is the much humbler pledge of simple solidarity: “Wherever this leads, David, we’ll be there with you and for you. And with and for Margaret, too.” That’s gold.

If my writing has been stark over these past two posts, it’s been so to make sure that the support I have, meets me where I am. I need the support of family and friends—Margaret does, too. But I can’t afford for that support to be rooted elsewhere than in the stark reality that I/we are facing. I’m glad to say my family and friends have taken the time to read my words carefully and do their best to hear me. I am not giving up, but neither am I interested in pretending that the odds are on my side. They’re not. Which is why it matters all the more to know that the people who love me are on my side—and that they’re not pretending about the odds either.

With those seven tumblers in place—a dire diagnosis, a medical team I trust, agency in my own health, supportive services from my care provider, solid insurance, resources from the PCa community, and the love and solidarity of family and friends—I am at last ready to move forward with ADT and radiation. With something akin to grim, resolute calm.

An extra word about the final tumbler in my medical team

Last week Margaret and I met with and confirmed the last member of my team, a radiation oncologist. During that consultation (and then reflecting on that appointment with each other over supper afterwards) I could feel the final tumbler falling into place. What made me so sure she was the right person to complete my team? In a word, “kindness.”

Actually, it was a lot more than just that. She’s an excellent teacher; she thoroughly explained her plans for my cancer treatment, pulling up the two PET scans (January and June) that showed my one lymph node glowing brightly with its “cancer signature.” It was very evident that she’d carefully reviewed my medical records, including the notes from other physicians. She entered the room ready to discuss my ADT reservations with care. She’d even reached out in advance to a medical oncologist colleague of hers about getting me a hurry-up appointment for a final consultation regarding one other medication I might want to consider adding to my treatment.

She was honest and forthright; this is a big deal in my book! I asked if she considered my cancer “curable,” and she minced no words. “Most doctors agree, once the cancer has reached the lymph nodes—and if we can see cancer in one of your lymph nodes, the odds are that it’s microscopically present in others—a full cure is no longer possible. What I can tell you, is that I’ll be treating you with curative intent, meaning the goal of my treatment is to push the cancer far enough back that you have at least five years before it shows itself again.”

As we discussed my apprehension about ADT, she reviewed the possible side effects and identified some basic ways to mitigate them. She also made two commitments that earned my trust. First, she was quick to support my desire to use relugolix (brand name, Orgovyx) as my preferred ADT drug. It’s a newer drug that seems to have fewer side effects. Plus, it’s a daily oral pill while every other ADT drug comes as a time-release injection lasting one to six months. Thus, Orgovyx offers the quickest “emergency off-ramp” should the side effects ever become intolerable—and the quickest return to normal (fingers crossed) afterwards.

However, because Orgovyx is still relatively new, there’s no generic version on the market yet. So, it’s not covered by most insurance plans (including mine) without prior authorization based on a doctor’s clear recommendation. I needed her explicit support for it to be affordable. Based on my concerns, she submitted a prescription request that won approval from my insurance. Orgovyx is a $3500 per month medication (most cancer drugs are pricey), but it’s now fully covered by my insurance. Honoring my peace of mind in using my “drug of choice” and getting it cleared for insurance—that’s trust-worthy right there.

Second, and just as importantly, knowing that Standard of Care (Western medicine “best practices”) guidelines recommend 24 months of ADT for high-risk cancer, she nevertheless pledged to support me if I chose to stop at any point before that. She heard my concerns regarding the toll that ADT can take on a man—physically, psychologically, emotionally, relationally, and (in my case) vocationally by potentially disrupting or even diminishing my ability to write. She recognized that, for me, beating cancer could not be the singular goal. And she promised to work with me to honor my other “quality of life” goals, even if that meant easing up on my cancer treatment.

Further, when I shared my interest in using integrative medicine to support my body’s own capacity to fight against cancer, she explained that, in fact, (and in ways not yet fully understood) the combination of ADT and radiation seems also to fight cancer in part by creating openings for the immune system to act with its own lethal force against cancer cells alongside these other treatments. And she affirmed her willingness to respect the guidance of my integrative oncologist on how to adjust my plant-supplement regime to work well with the rest of my treatment. Because the effects of radiation on my cancer will continue unfold for several months after my active treatment ends, acknowledging this partnership between ADT, radiation, and my own strengthened immune response can make a big difference.

This value of trust in this doctor-patient relationship is amplified by one of the quirks of using ADT in combination with radiation. The surest way to track my cancer’s progress—and to know the success (or failure) of our treatment efforts—is by monitoring my PSA score. The rising or (hopefully!) receding presence of PSA (prostate specific antigen) in my blood will tell us whether we’ve beaten the cancer back. Except—ADT by its very nature as a testosterone suppressor—renders a PSA score meaningless for as long as I’m on hormone therapy. Actually for a few months longer, since we’ll only get an accurate PSA when my testosterone bounces back several months after ADT ends.

In other words, for at least the next year, as we hit this cancer as much force as I can bear, we will have no way of knowing whether we’re doing any good or not. I’ll need to trust her care, care that may take a toll on me in multiple ways, because the entire time I’m in treatment, we’ll be flying through dense fog, with no way to get our bearings until we come out on the far side—a year or more later. That’s some trust. And she earned it.

In all these ways, my radiation oncologist proved herself the right person to complete my team. But let me come back to that word, “kindness.” There were several radiation oncologists I could’ve met with. Each with impeccable credentials. But this radiation oncologist highlighted the value of kindness in her brief online statement about her understanding of medical care. That’s a rare word to appear in any doctor’s description of their approach to medicine. Everything about her ended up impressing me. But it was the mention of kindness that first got me through the door. I’m so glad it did. And I told her so.

My cancer calendar

With all the tumblers in place, it’s time for this phase of treatment to begin. Here’s how.

Just this morning I had blood drawn for some labs. This will let my integrative oncologist adjust my supplements as she thinks best to support me during treatment.

On September 5 I have a consultation with a medical oncologist about whether to add abiraterone to my ADT regime. Recent evidence suggests that in high risk PCa, combining abiraterone with traditional ADT offers a dramatic increase in effectiveness. Still, while ADT is sometimes called chemical castration, using abiraterone is sometimes called androgen annihilation. It doubles down on the absolute erasure of androgens in the body, but it also doubles down on potential side effects. (And requires the addition of another medication, prednisone, just to offset its side effects.)

I’ll say more about this after the consultation. For now, my radiation oncologist believes the research makes it worth my thoughtful consideration, but she is emphatic that only I can make this decision. Trust. We’ll see what the medical oncologist can tell me.

Sometime soon after the September 5 consultation I’ll start taking relugolix/Orgovyx, with or without abiraterone. The “loading dose” is three pills; after that it’s one pill per day. In less than a week my testosterone will be gone. Part of the purpose of beginning ADT now is to wear down the cancer cells for a month before radiation begins.

On September 9 I’ll meet with my integrative oncologist to review labs results, go over any adjustments to my supplements, and discuss any other integrative supports she can offer now that the rest of my treatment is scheduled.

On September 12, I’ll have surgery to repair my incisional hernia. This was an unfortunate souvenir from my prostate surgery, an unexpected complication that appeared over the summer. I think it was present even sooner, but I initially misinterpreted it as a “slab” of scar tissue that would eventually soften and disappear. Nope. It grew and bulged. Oops. In any case, the repair, like the prostatectomy, will be done robotically—though this time as an outpatient procedure. My overflowing innards will be tucked back in place and stitched up, now with a piece of tissue-friendly mesh for reinforcement. As I heal, my body tissue will wed itself to the mesh, hopefully creating a much stronger incision site than the last one.

That repair might seem like a minor footnote in my treatment, but it’s actually critical because one of the best ways—one of the only ways—to stave off the loss of muscle (and the gain belly fat) when testosterone is shut down, is through persistent weight training. Not to become a body builder; just to hold onto as much of my “masculine” body structure as possible without testosterone. Some of this is psychological self-care; some of it is also preventative medical care because absent testosterone, the male body is prone to bone weakness and heart problems. I’ll want to commence weight training with caution post-hernia repair, but also in earnest.

On September 24 I’ll have my radiation “mapping” procedure. I’ll climb up on the table and the radiation oncologist records all manner of bodily reference points to make sure that each time the machine is fired up, its beams are aimed exactly where we want them to be—and nowhere that we don’t want them to go. At each actual treatment, they’ll use this set of reference points to ensure that the machine and I are in sync.

On or around October 6 (it takes about ten days to do the computer modeling so all the beams are coordinated), I’ll begin 33 sessions of radiation. Five days on; then the weekend off to rest and heal. Then again, and again, for seven-and-a-half weeks. Around November 19 those treatments will conclude, although the “echo” of the damage done to the cancer should reverberate into March 2026. ADT will continue in the background at least that long as well. If I can tolerate it, it may run through next summer. And, of course, my own immune system will be busy the whole time, too.

So many tumblers. All lining up. Just now. Just so. Hopefully to make this treatment both successful and endurable. Each of you reading is one of those tumblers, too. Falling graciously into place to help unlock the path forward. As I’ve come to realize how precarious this journey will be—both the diagnosis and the treatment—I’ve become equally aware of how precious every companion on this path is. Including you.

Thanks for reading—for keeping me company along the way. 

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David Weiss is a theologian, writer, poet and hymnist, “writing into the whirlwind” of contemporary challenges, joys, and sorrows around climate crisis, sexuality, justice, peace, and family. Reach him at drw59mn@gmail.com. Read more at www.davidrweiss.com where he blogs under the theme, “Full Frontal Faith: Erring on the Edge of Honest.” Support him in Writing into the Whirlwind atwww.patreon.com/fullfrontalfaith.