Prostate cancer and work vs. retirement

I was already retired but if I was still working, the only challenge would have been scheduling for a month plus of radiation treatments. I was never a surgical candidate so someone else will have to chime in on that. Sounds like the biggest thing you need to pay attention to is medical insurance. Keep in mind that any Cobra available through your employer is at full premium that your employer pays. It's pricey and cancer treatment costs are nuts. Without insurance my prescription cost alone is over $250K/year. Best wishes.

@mjp0512 thanks for the reply. That’s crazy about your meds! Yes, COBRA is high and also temporary (18 mos?). When my company offers early retirement packages, they sometimes include the cost of COBRA for a period of time, which would be great.

@stidadof4
Sorry to invite you to club.
Your 3+4=7 is a good number if you have to have PC. That is what mine was.

Right now to early for you to try to decide on what to do. Wait until you get the results of the Decipher and PSMA test you mentioned you are going to get. Those test are really going to help determine the risk and stage of your PC.

I was not young when I had proton radiation. I was 76. However was very active with swimming, walking, and water aerobics. I had been doing Sprint Triathons but had to stop bike riding so those races stopped also. I had minor fatique about half way in through my 30 doses of proton radiation. I did not have hormone treatments and that is where your Decipher test will really help like mine did.

There are many different radiation treatments out there to consider. The newer ones can offer a 5 day course versus 20-30 doses over months versus 1.5 weeks. The time it takes to do a radiation treatment is minimal total time there probably less than 30 minutes with only about 10 minutes on table. Just giving you what is norm at UFHPTI and what I had.

Wait for those Decipher and PSMA test as will determine if need hormone treatments which make a huge difference in how you will feel. With radiation there is no symptoms having the treatments just over time you can have side affects that most likely would not prevent you from working.

@jc76 thanks for the advice, and kudos to you for being so physically active at 76! That’s actually part of my thinking. I’m reasonably active, but hope to devote more time to health and fitness once I stop working. I love long walks, hikes, and cycling, but they take a good bit of time. Plus, business travel (eating out) and sitting at a desk all day are not great for your health.

I was still working when I was first diagnosed, and then had a RARP in 2015 (age 62). My employer had a generous medical leave policy and I didn’t return to work for about four weeks, although I did some emailing and paperwork from home when I was up for it. My primary focus was recovery though. Even the first week back to the office was just a few hours per day, and I built up to 8-hour days over a of couple of weeks. My stamina came back gradually and steadily. The biggest challenge was urinary continence. For a few months, I was going through several pads a day. I even kept a spare pair of pants at work for accidents (and they happened a couple of times). It was definitely a process, and that process was made easier by the medical leave policy of my employer (I never went on disability). I was laid off a little more than a year later and continued working as a consultant until the pandemic hit. It was intermittent work, but also required some travel, including international travel. The urinary continence issue was annoying at times. I was down to one or two pads per day, but stress would make it worse. I finally retired fully in 2020. In 2023, I finally had a urethral sling surgery (outpatient) that my urologist put on the table years earlier. That procedure returned me to 100% continence immediately. It was a real game changer for QoL.

If you can successfully navigate the health insurance landscape until you reach Medicare age, and you are in good shape, treating the cancer when you are in good health and late 50s is something to consider. I am 73 now and am in pretty good physical shape and remain physically active, but the ravages of aging just keep presenting new challenges—joint replacement, hernia surgery, hearing loss, etc, etc. Same with my wife.

I just finished eight weeks of radiation therapy for a local recurrence on November 18. So far the only notable side effect has been fatigue, which I almost over now. But I can tell that the whole process was more taxing than it would have been ten years ago, even though I am retired.

Btw, I was also diagnosed in early 2015 with Gleason 3+4, and 3 of 12 cores positive. I was a candidate for treatment, but my urologist didn’t convey a sense of urgency. So the surgery was scheduled for a couple months later when it fit with my work schedule. But, the post-surgery pathology also showed that I had a positive margin, and the Prolaris test gave me a 53% chance of a biochemical recurrence in ten years. My urologist’s response to that data was, “We didn’t act any too soon, and we need to keep a close eye now”. He offered adjuvant radiation at the time, but we agreed to just watch my PSA. It remained undetectable for ten years and DREs came out fine, so no further therapy. And then lo, this past June, my PSA rose to 0.1, and I had a palpable lump in my prostate bed that lit up like crazy on a PSMA PET scan. Salvage radiation (IMRT) was the next step.

But yes, it sounds like you have some breathing room for making a decision as how and when to proceed. Best wishes.

Mel

@melvinw thank you so much for sharing your story, especially about struggles with incontinence after RARP. My urologist is recommending RALP. I don’t know if that makes a difference. I’m reluctant to move forward with surgery or anything too quickly, but your story is a good warning to not drag my feet either. This is very helpful and I really appreciate the guidance.

I was diagnosed at 62 and had surgery. I was running a computer consulting business with around 80 different clients. I was working all day every day. I had surgery and four days later I went to three different offices and worked on their computers. Three days later, I went back to work full-time, even though I had a catheter in. None of my clients had any idea I had surgery.

At 65 it came back and I had to have radiation for 8+ weeks. I went every morning for radiation and went to work immediately after. Never had any problem or need to slow down. I did retire at 67, Too many ransomware possibilities As well as possible server breakdowns, things I no longer wanted to be responsible for. Turned my clients over to another company that I had found that had some really great expertise.

You’re going to have to figure out what kind of treatment you’re going to have and how much it will affect your every day life.

@stldadof4
Whatever decision you make, do not let your insurance lapse between the time you retire and Medicare eligibility. It will be hell to get coverage, and very expensive, if you do. (Unless, of course, you qualify for gov't benefits)

Ì didn't work during my six-month ADT and treatment period. Way too weak, too much brain fog and no drive or initiative.

My testosterone has recovered in recent months and I will return to the workforce at age 64 next month.

Gotta admit I'm scared to restart work. Don't know if I will be able to perform properly. Definitely not the man I was 9 months ago.

I was in my mid/late 50s when cancer knocked me off my feet. I was unable to work for several months, but as soon as I could sit up in a wheelchair, I started back in at 8 hours/week (my job was already work from home). I eventually took that up to 15 hours/week, which cut my private disability insurance benefits in half, but it was important to be to be engaged with the world after so many months of staring at the ceiling from a hospital bed, so I didn't mind.

Unfortunately, my position ended just after I turned 60. I'm looking for small contracts in my field, international humanitarian aid, not so much for the money (and health insurance is a non-issue in Canada) as for the personal connections and teamwork. No luck yet — they all require things incompatible with my cancer treatment, like living in Africa for a year — but I haven't given up.