Go Back, Jack, Do It Again

One maddening thing that people that have worked closely with me over the years know is that I analogize almost everything that happens to one of three things:

  1. A line from a movie.

  2. A scene from a “Seinfeld” episode.

  3. A song lyric.

While driving back from Morgantown, WV yesterday, I was fiddling nonstop with the Sirius XM stations (as I always do), looking for the perfect song. Somehow, I ended up on the “Classic Rewind” station where I hung out for a few songs. Steely Dan’s “Do It Again” came on and even though I was never much of a Steely Dan fan, I left it on because – let’s face it - it’s still a pretty cool song.


Once the chorus began to approach, I started to laugh because I had just been thinking about the events of the last week. You see, I had a biopsy of three lymph nodes in my neck where cancer had been found lurking. This location (i.e., the neck) is not really consistent with prostate cancer, but it’s also not out of the realm of reason.


Part of the tissue from that biopsy was sent off to Caris Biosciences. This is a really important step. Why, you ask? Thanks to advances in genetic profiling and molecular medicine, you can now create a genetic profile of a person’s individual cancer. That information, combined with years of research data, can lead to very specific treatment protocols that can help to improve the outcomes of cancer patients. This information can lead to two very specific improvements in treatment: (1) it can help to avoid treatments that won’t work and (2) steer the patient’s oncology team to treatments that might work better.


After 16 days, I finally got my report from Caris Lifesciences. I quickly scanned the multi-page report and nearly everywhere I looked, I saw “QNS.” Even with my limited layman’s understanding, I knew this didn’t sound right. In looking at the legend for the report, I learned that QNS means “quantity not sufficient.” There was not enough tissue sent to Caris for them to determine whether I was BRCA 1 or BRCA 2 positive, which is a cornerstone piece of information for formulating my treatment plan. UGH. Thankfully, the hospital’s surgical pathology lab had more tissue in their “tissue bank,” which they sent to Caris but in the meantime, we are starting all over again.


If I am BRCA 1 or BRCA 2 positive (about a 15% to 20% chance), I will likely go on the least invasive form of treatment called a “PARP inhibitor.” If not, we will consider a range of clinical trials that would likely combine a proven drug with immunotherapy (i.e. Keytruda - a “checkpoint inhibitor”) and another investigational drug not yet FDA approved. Chemotherapy is still an option, but it is the least preferred option at this point.


Indeed, sometimes the waiting is the hardest part.


Until next time,

Steve