The Journey Continues
It has been a long time since I added to this blog.
Only read this if you really want to know my condition or are curious about prostate cancer and the possible treatments. I am doing this to help with my own organization of my thoughts and plans for myself more than to share with the world. But, if someone is interested, here it is.
I recovered from my prostate surgery pretty well and was pleased that after about 3 month I was completely dry! That is a real blessing because so many other men who have this surgery struggle with incontinence for month, years, and sometimes for the rest of their life.
The only real follow up is to have regular PSA test. After surgery one would hope that after a few months all the PSA is out of your system and you are done with cancer. The PSA should be so low that the lab calls it undetectable.
My surgery was in January 2019 and in March 2019 my PSA was .05, which is very low almost undetectable. I was pleased and hoped it would stay low. In September it was .11. This was enough to get my attentions but my doctor said not to worry it sometimes goes up and then down again. In December it was .22 which began to really concern me. I was afraid the doctor would want me to start further treatment right away and I would have to cancel our Maui trip in January. He did not seem overly concerned and told me to go have fun and have another PSA in April 2020. This time it had risen to .46. Now this got the Doctors attention and he referred me to a Radiation Oncologist.
I had that appointment on May 21 2020 and it was not very encouraging. My PSA number is doubling about every 3 month. My post prostatectomy pathology indicated that my cancer has a Gleason score of 8 which is considered to be an aggressive form of cancer. Although they found no cancer in lymph nodes or seminal vesicles, they did find that the cancer was right at the margins. That basically means there is a good chance that the surgery did not remove all the cancer. The rising PSA makes that a certainty.
The really difficult thing with this type of cancer is that there are many treatment options. The Radiation Oncologist made it clear that he is not "God" and does not know beyond doubt the best course to take. So he gives me options and I have to decide which way I want to go. I have to weigh the cost (side effects) and benefits (likelihood of cure) of each option and make my choices accordingly. It would be so much easier if there was only one viable treatment and you just choose to do that or not.
So for sure what I have to do first are scans to see if they can find any evidence of cancer with scans. If the scans find something then they have a target. If the scans do not find anything then that only says the cancer is too small to see, but does not say I am cancer free.
So my first scan is a Bone Scan on May 26 followed by the CT scan on June 1. A CT scan is an X-ray image made using a form of tomography in which a computer controls the motion of the X-ray source and detectors, processes the data, and produces the image.
Following that is a Bone Scan which is a nuclear imaging procedure. In nuclear imaging, tiny amounts of radioactive materials (tracers) are injected into a vein and taken up in varying amounts at different sites in the body. Areas of the body where cells and tissues are repairing themselves most actively take up the largest amounts of tracer. Nuclear images highlight these areas, suggesting the presence of abnormalities associated with disease or injury. A bone scan procedure includes both an injection and the actual scan.
This all MAY be followed up with a special kind of PET scan. (18F-DCFPyL (PSMA) PET/CT). This is experimental and I would be part of a special study. As I understand it simply this can help to detect cancer if it has spread. But this is also where I may need to make my first major treatment decision. The PET scan may be several months wait time and I cannot begin any other treatment before I have that scan.
My Doctor is saying that I may not want to wait for the PET scan because I should start treatment soon. I will have to wait and see what the CT and Bone Scan say and decide then if I want to start treatment asap or wait for the PET scan.
More decisions. The treatment is ADT first to slow the cancer down followed or along with radiation.
The following chart kind of shows the various options, it does not show side effects which also need to be figured in to one's decision process.
Androgen deprivation therapy (ADT) is a type of treatment for prostate cancer that blocks the effects of androgens (hormones) and can slow prostate cancer growth. The ADT treatment has some pretty nasty side effects, but one only is on that for a 12-18 months and with the radiation, that may kill the cancer. If you use only radiation and that does not kill the cancer then you have to use ADT therapy for the rest of your life, so that does not seem to be a very good option.
In a nutshell this chart kind of indicates that I will probably end up with the ADT and radiation.
Only read this if you really want to know my condition or are curious about prostate cancer and the possible treatments. I am doing this to help with my own organization of my thoughts and plans for myself more than to share with the world. But, if someone is interested, here it is.
I recovered from my prostate surgery pretty well and was pleased that after about 3 month I was completely dry! That is a real blessing because so many other men who have this surgery struggle with incontinence for month, years, and sometimes for the rest of their life.
The only real follow up is to have regular PSA test. After surgery one would hope that after a few months all the PSA is out of your system and you are done with cancer. The PSA should be so low that the lab calls it undetectable.
My surgery was in January 2019 and in March 2019 my PSA was .05, which is very low almost undetectable. I was pleased and hoped it would stay low. In September it was .11. This was enough to get my attentions but my doctor said not to worry it sometimes goes up and then down again. In December it was .22 which began to really concern me. I was afraid the doctor would want me to start further treatment right away and I would have to cancel our Maui trip in January. He did not seem overly concerned and told me to go have fun and have another PSA in April 2020. This time it had risen to .46. Now this got the Doctors attention and he referred me to a Radiation Oncologist.
I had that appointment on May 21 2020 and it was not very encouraging. My PSA number is doubling about every 3 month. My post prostatectomy pathology indicated that my cancer has a Gleason score of 8 which is considered to be an aggressive form of cancer. Although they found no cancer in lymph nodes or seminal vesicles, they did find that the cancer was right at the margins. That basically means there is a good chance that the surgery did not remove all the cancer. The rising PSA makes that a certainty.
The really difficult thing with this type of cancer is that there are many treatment options. The Radiation Oncologist made it clear that he is not "God" and does not know beyond doubt the best course to take. So he gives me options and I have to decide which way I want to go. I have to weigh the cost (side effects) and benefits (likelihood of cure) of each option and make my choices accordingly. It would be so much easier if there was only one viable treatment and you just choose to do that or not.
So for sure what I have to do first are scans to see if they can find any evidence of cancer with scans. If the scans find something then they have a target. If the scans do not find anything then that only says the cancer is too small to see, but does not say I am cancer free.
So my first scan is a Bone Scan on May 26 followed by the CT scan on June 1. A CT scan is an X-ray image made using a form of tomography in which a computer controls the motion of the X-ray source and detectors, processes the data, and produces the image.
Following that is a Bone Scan which is a nuclear imaging procedure. In nuclear imaging, tiny amounts of radioactive materials (tracers) are injected into a vein and taken up in varying amounts at different sites in the body. Areas of the body where cells and tissues are repairing themselves most actively take up the largest amounts of tracer. Nuclear images highlight these areas, suggesting the presence of abnormalities associated with disease or injury. A bone scan procedure includes both an injection and the actual scan.
This all MAY be followed up with a special kind of PET scan. (18F-DCFPyL (PSMA) PET/CT). This is experimental and I would be part of a special study. As I understand it simply this can help to detect cancer if it has spread. But this is also where I may need to make my first major treatment decision. The PET scan may be several months wait time and I cannot begin any other treatment before I have that scan.
My Doctor is saying that I may not want to wait for the PET scan because I should start treatment soon. I will have to wait and see what the CT and Bone Scan say and decide then if I want to start treatment asap or wait for the PET scan.
More decisions. The treatment is ADT first to slow the cancer down followed or along with radiation.
The following chart kind of shows the various options, it does not show side effects which also need to be figured in to one's decision process.
Androgen deprivation therapy (ADT) is a type of treatment for prostate cancer that blocks the effects of androgens (hormones) and can slow prostate cancer growth. The ADT treatment has some pretty nasty side effects, but one only is on that for a 12-18 months and with the radiation, that may kill the cancer. If you use only radiation and that does not kill the cancer then you have to use ADT therapy for the rest of your life, so that does not seem to be a very good option.
In a nutshell this chart kind of indicates that I will probably end up with the ADT and radiation.
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