fingers crossed, again

Had blood drawn for PSA yesterday.

Patrick Walsh

I checked out the 2007 edition of Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, co-written with Janet Farrar Worthington. This is an excellent, very accessible text and I highly recommend it. My only quibble is that while Walsh revised the section on salvage radiation to include a statement by Danny Song of Johns Hopkins:"Even men with Gleason 8-10 disease, if they had positive margins, a longer PSA doubling time, and received early salvage radiation, were able to attain four-year control rates of 81%," Walsh still ends the chapter with a large, bolded box that says if you have ANY of these things--Gleason 8 or higher, positive seminal vesicles/lymph nodes, PSA recurrence within a year--you're not likely to benefit from radiation! Not only does Walsh contradict Song's statement, but he ignores some landmark 2004 and later research by Andrew Stephenson that shows even if you have a high risk factor like a high Gleason OR fast PSA doubling time, it is very likely you will benefit from radiation as long as it is started before your PSA gets too high.

I'll get blood drawn in the next week or two for my 9 month post-salvage PSA test. I'll go see the doc in early January.

Radiation After Surgery Keeps High-risk Prostate Cancer At Bay

ScienceDaily (Nov. 2, 2007) — An analysis of data involving more than 2,000 patients from 17 U.S. institutions demonstrates that men with high-risk prostate cancer who receive radiation therapy after a prostatectomy were less likely to have a recurrence of disease.

What's more, men whose cancer persists after surgery were less likely to see the cancer spread if they receive radiation (salvage therapy)...

These are the conclusions of a study presented October 30, 2007 at the American Society for Therapeutic Radiology and Oncology's 49th Annual Meeting in Los Angeles.

Citation: Fox Chase Cancer Center (2007, November 2). Radiation After Surgery Keeps High-risk Prostate Cancer At Bay. ScienceDaily.
http://www.sciencedaily.com/releases/2007/10/071030170214.htm

I haven't found any more details on this study, but will post them as soon as I do.

Surgery hikes odds of surviving prostate cancer

(Reuters)
CHICAGO - Men have the best chance of surviving prostate cancer in the long run if the gland is removed, particularly if they are younger or the cancer is aggressive, a study said on Monday....
It found that in the short-term, up to five years, there was little difference in survival among men based on the kind of treatment they received.
But after 10 years, "patients treated with radiotherapy or watchful waiting had a significantly increased risk of death from prostate cancer compared with patients who underwent prostatectomy (removal of the gland)," the study said....
The survival rates after 10 years were 83 percent for removal, 75 percent for radiation, 72 percent for watchful waiting, 41 percent for hormone therapy and 71 percent for other treatment....
http://www.msnbc.msn.com/id/21196506/

LESS THAN 0.1 !

This is the best possible news. (Note: I had earlier blogged that it was 0.1, but the nurse had misspoken on the phone.)

Before surgery: 4.8 (but really, 9.6 because I was on a medication that artificially lowered it)
3 months after surgery: less than 0.1 (or "undetectable" on the standard assay)
6 months after surgery: 0.2
10 months post surgery: 0.6
Day before radiation started (about 11 months post-surgery): 0.7
IMRT for 8 weeks
3 months post-radiation: 0.1
4.5 months post-radiation: 0.1
and now, 6 months post radiation: < 0.1

I'm clearly in the "complete responders" group Andrew Stephenson has reported on. His study shows 49% of those who got a complete response within 9 months were free from disease progression 6 years later. That may not sound great to you (50-50 odds) but overall rates of success in salvage radiotherapy in the long run are not nearly that high. My odds in the short run are excellent.

fingers crossed

Had blood drawn just now. This is roughly 6 months post-radiation. I'm hoping for it to come back LESS THAN 0.1.

US News & World Report Video

latest PSA

It's still 0.1, just like back in June. That's not unexpected. Hopefully it will be less than 0.1 next time (September) or at the latest, by mid-December.
Cholesterol's a little high, though. I guess I should pay a little attention to that, since it looks like prostate cancer's not going to knock me off anytime soon!

another jab

It was time for a cholesterol check from my primary care doc, and he threw in a PSA test just for fun. So I'll get a peek at my PSA at the 4.5 month post-radiation point (I had one in mid June at 3 months, and wasn't scheduled by the radiologist for another until mid September). I had blood drawn today.
Pins and needles time again...

Proctitis continues to diminish. No bleeding in two weeks, but bowel movements still aren't quite normal and I have a lot of bloating (gas) regardless of diet. At this rate of improvement I hope to be back to normal by winter.

Bullseye

First post-salvage radiation PSA test came back today. Zero point one. That's a great score in my situation. I'm probably, hopefully, still on a downward curve, so maybe the next PSA will be less than zero point one, or "undetectable" on the standard PSA test. I was dreading the digital rectal exam (DRE) because of the proctitis, but it didn't hurt at all and there was no sign of blood, which means to me that the proctitis is just about gone.

The doctor said he would have been happy even if the score was 0.3.

This is a great day.

damn

My friend who just recently got diagnosed with pancreatic cancer, died last week.

44 hours until I get my PSA back.

Predicting the Outcome of Salvage Radiation Therapy

I've been following the work of Dr. Andrew Stephenson, of the Cleveland Clinic, who for several years has been trying to predict the outcome of salvage radiation, like the treatments I had this spring.

He, along with experts in the field like Scardino, Kattan, Slawin, and others, have just published an important paper in the Journal of Clinical Oncology. You can read a summary of the work here.

I obtained the full text of the document (you can too--just go to your nearest public library and tell them you need interlibrary loan). The full title is " Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer after Radical Prostatectomy" from JCO, May 2007, pp. 2035-41.

Stephenson and his colleagues looked at 1,540 patients across 17 medical centers in North America. All of these patients underwent salvage radiation (an attempt to rescue the patient when surgery fails to eradicate prostate cancer). The researchers created a nomogram to predict the outcome of salvage radiation. The nomogram is in the public domain and will be available soon in an easy to use web version at http://www.nomograms.org soon.

In general, Stephenson found as he did in earlier work, that the earlier you can get started with salvage radiation, the better. He writes "The 6-year response to SRT among patients treated at PSA levels of 0.50 n/mL or less appears to be durable because only two progression events were observed after 6 years among 32 patients at risk at 6 years (median follow-up, 90 months)" (p. 2037). Besides the pre-radiation PSA, other important variables are Gleason score, PSA doubling time (PSADT), surgical margins, hormone therapy administered along with or before radiation, and lymph node metastasis. In earlier work, Stephenson had found that of patients at high risk (because of a Gleason >= 8, or rapid PSA doubling time) many could still benefit from radiation, especially if they had positive surgical margins like I did. This new study validated this idea.


In my case, the nomogram shows I have about a 55-57% chance of being progression free at 6 years out from radiation. Those are pretty good odds, I think. The flow chart in the article, which for me goes like this:

Pre-RT PSA <= 2.0, Gleason 4-7, Positive margins, doubling time <=10 months and that comes out to 57% probability of being progression free at 6 years. This study goes back to way before the days of IMRT, though, and the average man in the study got less radiation than I did. So I think my odds are probably better than 57%, since the targeting of radiation and dose escalation are much better these days than was the case for most of the study participants. Of course, if my cancer was already systemic, then the radiation probably didn't do much good. I should get some idea soon--I had blood drawn yesterday and I get the results in one week. So check back, dear reader, on or after June 15--will this blogger get on with his life and career? Or will he start putting affairs in order? ?

Just when you think you have it bad..

I found out yesterday that a friend has pancreatic cancer. She has a few weeks to live without chemo, maybe 3 months with it. Damn.
Makes prostate cancer seem like a hangnail.

The prostatitis continues to diminish. Hardly any discomfort or bleeding any longer, but two days ago I did have a worrying episode of diarrhea. Maybe it wasn't related.

I'll go get my blood drawn in about a week, then get my results on June 15.

Bad Omen

Not the first time I've seen this, but it's disturbing. A new report shows that a PSA that rises more than 2.0 in the year before treatment is the single most important indicator that a man has a very aggressive cancer. Mine was rising faster than that--it went up 2 points in only SIX MONTHS. That, according to the study, puts me at high risk of dying from prostate cancer.
I'm going to get a full-text copy of the report, because I have a lot of questions--such as, did any of the men have salvage radiation and how did that affect their odds of dying?

2 months since radiation..

..and things continue to improve slowly. I'm doing much better than I was a month ago. My current regimen is Proctofoam 2-3 times daily. I avoid insoluble fiber as much as possible but take Benefiber (2 grams twice a day). Benefiber is pure soluble fiber. After each bowel movement I take 1/2 dose of Immodium. That prevents any diarrhea. In a week or so I'll try stopping Immodium altogether.
Bowel movements are now simply uncomfortable, whereas before they were very painful. And I'm not in any discomfort afterwards now, where before I would be uncomfortable for most of the day.
About 1 month until PSA time.

A visit to the radiation oncologist

After I ran out of the Proctofoam, I went back to the radiation oncologist and told him what was going on. Thankfully, he did not examine me, understanding what that would be like. He did give me a generous Rx--lots of refills--for Proctofoam. Things are slowly improving, and the Rx will help with symptoms in the meantime.

some relief

Maybe it's the Proctofoam and maybe it's just the passage of time, or both, but the symptoms of acute radiation proctitis are easing. Bowel movements are no longer like giving birth, and there's less--some times zero--blood afterwards. I still haven't gone back to the radiation oncologist, I'm just using the prescription from my family doctor. When that runs out, if symptoms flare up, I'll go see the radiation guy to get some more Proctofoam, but hopefully I'm on the downhill side now as far as symptoms go. Bladder irritation has fallen off as well.
I'm still careful what I eat and drink. No caffeine, no alcohol, very little fiber. Soon I'll try adding soluble fiber to the diet and see what happens.
It's now been almost a month since my last IMRT session.

proctitis

Well, what I thought was hemorrhoids aggravated by mild proctitis now turns out to be a strong case of proctitis causing all the pain during bowel movements. I saw my primary care doctor instead of the radiation doc because I thought it was just hemorrhoids. But after an exam that tested my naval vocabulary, the doctor assured me the problem was radiation proctitis, and that we needed to get on it right away. So I'm taking prednisone orally for a few days, and if the inflammation doesn't go down dramatically, he gave me a prescription for Proctofoam, which seems to be a pretty standard treatment.

Still, I'm not too badly affected throughout the day. More frequent BMs, but not diarrhea right now. It's just that when I go, I have to bite down on a towel or something for a few seconds.
I'm glad I saw my doctor. Now I have to explain to the radiation oncologist why I didn't report this to HIM. Actually, I'd get on the phone Monday and tell him, but things have to cool down in the bowel before anyone else does and exam down there.

I don't want this to scare anyone away from IMRT as salvage after prostatectomy. If you need it, you need it.

DONE

Last IMRT treatment today. Left with a little gift from the staff and a followup appointment in 3 months. Feel good--energy level hasn't diminished since last week, no diarrhea since the other day, and the urinary side effects haven't increased. I've never been so happy to see March 13.
The next time I post will probably be to report my PSA. Stay tuned....

2 more

Diarrhea hit hard the other day, but Imodium hit back harder. Feeling good overall. They've got the TV working in the treatment room, so I now bring in DVDs.

fatigue

Fatigue has gotten worse. Bowel issues slightly worse, too, but it's the fatigue that's getting me. Someone suggested CoQ10. Not sure if I should take it now or wait until treatment ends next week. I'll ask the oncologist.
6 to go.

31 down

8 to go. I brought my son in the other day and the staff showed him the equipment and let him watch from the control area.
Bowel and urinary irritation continue, but they have not worsened. A few days ago I started noticing some tiredness. Could be radiation fatigue (the body tires from continually repairing tissue damaged by the radiation).
Some news out today on green tea and Celebrex slowing the spread of prostate cancer.

25 down

14 to go. Usual once-a-week images and meeting with nurse and doctor/PA. Side effects have not worsened in last week.

another side effect

No big surprise, this one.

I didn't write about it yesterday because I was hoping it wasn't real, but for 2 days now I've had some urinary urgency.

Entirely expected, no big deal at this point.

21 down.

Over halfway done

Today was treatment #20 out of 39.

Starting to plan for a celebration afterwards--just like the commercial says: "We're going to Disneyland!"

not a side effect

Diarrhea is completely gone; I'm now convinced it was not radiation-related. So I'm not having side effects of any kind at this point, nearly halfway done.

so far, so good

Just over a third of the way done. Met with the nurse, a physician's assistant, and the radiation oncologist today. Talked to them about the bowel stuff--which has actually gotten better. They still doubt it was caused by radiation, since it started earlier than the doctor would have expected to see it. And I'm doubting it, since it's getting better, not worse. Last dose of Imodium was a half dose, over two days ago.
They spent quite a bit of time with me, discussing all my concerns in detail, unusual in these days of managed care and 5 minute doctor visits.
Thank God "Lost" starts up again tonight! That will be a major distraction.

money

Got a loan from my bank to cover my part of the treatment costs (probably $2,000). Took some Imodium on Friday and had no problems until this morning, and had to take another dose. I'm not so worried about the symptoms themselves so much as what damage is occurring.

I don't sleep well without assistance. but like a log with 50mg Trazadone.

The end of treatment seems a long way off.

good news

The pre-treatment bone scan and CT came back clean. I knew they probably would, but it was good to get confirmation.

Still having bowel issues. Haven't had to take Immodium since the other day, but still things aren't the way they should be. I'm guessing it's partially the radiation, partially a little gut bug I picked up some where. No urinary side effects yet.

12 down, 27 to go.

10 down

29 to go.
Today I met with the nurse and a physician's assistant who both said that diarrhea should not be a side effect of my treatment. There might be bowel irritation, but diarrhea comes from higher up in the small intestine, which is not being touched by the radiation.
Also met with the social worker, who gave me information on various support activities. I'd like to go to the support group, but it meets when I work.
I also got the dosage. By the time I'm finished, the prostate bed should get 70.2 Gy (commonly called "grays"). I think 70.2 grays is a pretty standard dosage for prostate cancer.

side effect

A little diarrhea..not sure it's from the treatments, but it's kind of strange (I won't go into details) and I suspect it's bowel irritation. One of the therapists, looking at the chart, said "Yeah, that might be us. You're getting to the point where you might experience that." I just hope it doesn't get steadily worse for the remainder of treatments. 9 down, 30 to go.

More alignment images shot today.

An encouraging article

"The PSA disease-free survival after salvage radiation for all patients is approximately 25-40% at five-to-ten years after radiation.7,8 Favorable patients (PSA less than 2.0, Gleason score less than 8, positive surgical margins) may experience PSA diseasefree survivals of 60-70%.8"

Sailer, Scott L. "Radiation Therapy for Prostate Cancer: External Beam, Brachytherapy, and Salvage" North Carolina Medical Journal. March-April 2006, p. 152. http://www.ncmedicaljournal.com/mar-apr-06/Sailer.pdf

Since I'm in the "favorable patients" category (PSA 0.7, Gleason 7, positive margins) I'm in the 60-70% 5-10 year disease-free survival group. I'll take those odds. Before meeting with my oncologists, I had thought my margins were negative and my odds were much worse. (To clarify this--usually you would think negative margins are a good thing, because it means there was no cancer found at the cut edge of the removed tissue. However, when you are trying to figure out whether your recurrence is localized or not, it can turn things in your favor to have positive margins. Why? It provides a logical explanation for the increased PSA. It means there was an increased chance cancerous cells were left behind in the prostate bed, and if that's where your PSA is coming from, rather than distant sites, your PCa may still be curable.)

Sailer also says:

If a patient’s PSA does not initially decline to zero, he likely had occult metastatic disease at diagnosis and would not benefit from localized radiation, unless the source of the residual PSA is a positive margin and the Gleason score less than 8.

Well, my PSA was below 0.1 initially, but who knows what it would have been on an ultrasensitive test? .06? .07? I would say that it's likely my PSA did NOT decline to zero initially, and I would have likely had metastatic disease (or maybe more properly "systemic"), BUT I have positive margins--which gives a possible explanation for the PSA--and my Gleason was less than 8. Sailer is restating my earlier pessimism--when I thought I had negative margins, I figured the cancer was out of the barn. With negative margins, where would my PSA be coming from? Distant sites? Very possible. As I wrote above, normally positive margins=bad and negative=good..except when you're evaluating a rising PSA after surgery and trying to figure out whether or not salvage will work. With positive margins, it increases the probability that my problem is still local. Again, no guarantees. But I'm much happier to be in the 60-70% likely to have durable benefit or cure rather than in the 10-20% probability of durable benefit.

And remember, if you're having a recurrence after surgery--you're a unique human being, not a statistic. These are probabilities only. An acquaintance of mine had similar circumstances--PSA rising rapidly after prostatectomy--but he had negative margins. Nevertheless, he seems to have received a benefit from radiation--his PSA dropped from 0.5 before radiation to 0.01 afterwards. That's very encouraging--and against the known probabilities. Hopefully he's cured. He didn't have IMRT, like me, but proton beam therapy at Loma Linda University Medical Center.

number of treatments

I forgot to ask the doctor how many sessions exactly, so I asked the therapists today. To get the prescribed dose of radiation, it came out to 39--one day short of 8 weeks.
Seven down, 32 to go.

pretty pictures..

Yesterday I had my first weekly meeting with the radiation oncologist. He showed me some images from system that he used to plan my treatments. IMRT is amazing in how it can target specific areas and spare others. Here are some sample images to show you what I mean.
One week into treatment and everything's going fine. And I continue to recover from surgery (now 9 months ago.) Everything is rapidly returning to full capability, I'm happy to report. The radiation will likely cause some setbacks in those areas, but I'm optimistic that any problems will be mild and temporary. After seeing my insides modeled in 3D, and seeing how the radiation goes into all the nooks and crannies where the cancer might be hiding, I'm confident these treatments will knock it out, as long as it's still localized.
I now take along an MP3 player (too poor for an iPod!) to listen to music or podcasts during the treatment. Makes it go by faster. One segment of Science Friday fills the time nicely.

cat and bone scans

Today I got the CT and bone scans recommended by the medical oncologist. Even he is "almost completely positive" they will be clean. Plus, I hope I never need his services, these will serve as a baseline. I had to drink that contrast stuff and get an IV during the CT--it always does a number on my stomach later and today was no exception.
If you've never had a bone scan, there's nothing being beamed into you. YOU are lighting up the picture by virtue of some mildly radioactive element that you get injected with earlier. You just lie on this big scanner while your temporarily radioactive bones create their own art. The result looks like this (not my picture, of course):

baseline PSA

Got the results back on the PSA I had done the day before radiation started. 0.7. Not too bad. Based on my previous two scores, I had thought I might be at 0.8 or 0.9. Plenty of research shows you're more likely to benefit from salvage radiation the lower your pre-radiation PSA is. I would have liked to have started before I got to 0.5, but my cancer cells were too rambunctious for that. (If you're reading this for the first time and thinking "geez, what's this guy talking about? Zero point seven? That's nothing! My PSA was 4.2!" the deal is I've had a prostatectomy, so I should not have any measurable PSA by conventional tests--so I've still got cancer, and now I'm undergoing radiation.)

How I got to this point

A little backstory:

Several years ago I realized I was getting up more and more at night to go to the bathroom. I eventually asked my primary care doc about it. He performed a DRE (digital rectal examination) and said it felt a little "boggy." He ordered a PSA test. It came back just over 4, as I remember. That's high for someone my age--late 30's at the time. So off I went to the urologist.

The urologist examined me but didn't find anything unusual (nothing palpable). He tried antibiotics and anti-inflammatories, but nothing really seemed to do the trick with my PSA. And it rose a bit. So--biopsy time. Now at that time, local anesthesia was not widely used in prostate biopsies. Prostate biopsies are the kind of thing doctors classify as "uncomfortable" while the rest of us compare the experience to being poked with knitting needles. (These days, don't worry--your uro can give you a shot of lidocaine right in the area of the prostate and the biopsy will be tolerable, although still not a lot of fun).

The biopsy came back negative for cancer. Everything looked normal.

So we tried some more monitoring and as I recall, more drugs to try to see if it was something entirely benign. But eventually the PSA rose up again (I don't recall that score) and we went for another biopsy. This time, high grade PIN cells were found. In a large percentage of men with high grade PIN, cancer is found on subsequent biopsies. But--I was still negative for cancer. So we tried Avodart, a drug that would shrink the prostate and just maybe, have some chemoprevention properties. My PSA dropped more than 50%, to just over 2.0, and stayed there for a couple of exams.

And then it doubled in 6 months.

My uro checked me out with another DRE and found a palpable nodule. Now I went to the hospital, under general anesthesia, for a saturation biopsy. Lots of samples. And 20% were cancerous.

At this point my official PSA was 4.8, but since Avodart was cutting my PSA in half, my "real" PSA was more like 9.6.

I had a Da Vinci prostatectomy in late Spring 2006. Recovery wasn't bad, except that I wasn't psychologically prepared for the catheter--it took some getting used to (2 weeks after surgery it was out--and it wasn't bad coming out, either. Glad to be rid of it.)

The surgical results: positive margins, negative seminal invasion, Gleason 3+4. Both lobes involved, cancer found throughout the gland.

I continued to recover just fine from surgery. Incontinence was only a problem for a few weeks. ED has been a problem but it's getting better all the time.

My first PSA after surgery was less than 0.1. 3 months later, it was 0.2--worrisome but probably no reason to act yet. 4 months later, it had tripled to 0.6. My urologist referred me to a radiation oncologist and a medical oncologist.

I was very anxious and depressed--but I didn't have the right information. I thought I had NEGATIVE margins, in which case I would have been more likely to have distant rather than local disease. At 44, I was looking at hormones, chemo, and a very premature departure from the planet.

But the oncologists--both of them--saw that the pathology report actually said that the margins were positive. Both of them agreed--no hormones, just try IMRT. There's a good chance it will kill the remaining cancer cells, provided they haven't left the area where the prostate used to be. So that's what I'm doing.

treatment begins

Just like in the simulation and dry run, a therapist positioned me on the table, then fled the room. This time, though, the gantry did its thing. It started directly below the now-elevated table, made a high pitched humming noise for a few minutes, and then moved 15 or 20 degrees and did it again. When it had made a complete circle around me, the session was over. Less than 15 minutes. I can leave work, get the treatment, and be back at my desk all within 40 minutes.
I don't think I drank enough water this morning, though. I'll have to make sure I do that. Not that it makes any difference in what is experienced during the session, but over the course of treatments it should help reduce urinary irritation.

the name of this blog

So what's the big deal with PCa before the age of 50? Well, it's not common. Visit the waiting room of your nearest urologist, or go to a support group meeting. You'll see what I mean. I was diagnosed at 43.
A recent study showed the median age at diagnosis was 68. ZERO percent were diagnosed under the age of 35. Only one half of one percent of the diagnoses in that time were in my age group--35 to 44. Over 91% of the time, diagnosis happened at 55 or older.
See what I mean?
Now that doesn't mean prostate cancer isn't lurking. Autopsy studies of men who died from other causes have found prostate cancer is lurking in a surprising number of relatively young men. But obviously, since prostate cancer only accounts for about 3% of male deaths, and the median age at death from PCa is 80 most of those men probably had a form of the disease that was latent. Most men die with prostate cancer, not from it. My PSA was rising quickly, however. (and still is, at least up until I start radiation). I would most likely NOT be one of those guys who dies in their 80's with the disease--I'd be one of those guys who dies in his 50's FROM it, if not for treatment.

dry run

I had the dry run this morning. One of the therapists showed me the area from where they would monitor me and operate the accelerator. Then they took me into the room where I saw the machine for the first time...it looked a lot like this, but more of a beige color.and then they used it to take a few x-rays. After they were done the therapist showed me the x-rays from today, compared to CT scan taken when they put the alignment marks and tattoos on me. To me, and to the therapist, they looked EXACTLY the same. The cross hairs matched perfectly from one picture to another.

By now my doctor has met with the medical physicist and mapped out my treatment--how much radiation will go to which parts of me. Tomorrow the real treatments begin. The doctor advised me to make sure I have a full bladder, but not to the point of discomfort. That is supposed to help lessen urinary side effects of radiation.

Interestingly, the male therapist who helped me (let's call him Rick) looks younger than me and yet he too is a prostate cancer patient. Diagnosed last year, underwent the same robotic prostatectomy as me, at the same hospital. He hasn't gotten his first PSA back yet.

On my way back to work I stopped by a lab and had blood drawn, for PSA and CBC.

The Story So Far..

I'm young, as far as this disease goes. Diagnosed shortly before my 44th birthday (whoopee!). Robotic surgery (more on that later) shortly after my birthday. At first, all seemed fine...PSA dropped to less than 0.1. But a few months later it was 0.2, and then 0.6 just before Christmas. Merry Christmas, your cancer is still there...

I grew increasingly anxious. But the problem was, I didn't have all the facts. Here's what I thought my situation was:

Gleason 3+4
PSA 9.6
Seminal vesicle invasion--unknown
Negative margins


Now, with those indicators, and a rise in PSA within 1 year--it looked like my recurrence was distant. No longer curable. Time for hormones--at 44, I was looking at a drastic change in my personal life.


But I had two crucial facts wrong. My oncologists (radiation and medical) confirmed that I had POSITIVE margins--cancer extended to the edge of the tissue that was removed and it would be a safe bet that it went further than that. So that provided a logical, and much more optimistic explanation for the rise in PSA--there was cancerous tissue left behind. If that's the case, a cure might still be possible, by radiating the prostate bed.

And, the seminal vesicles were known to be free of cancer. Again, good news, and another slight nudge to the "local" end of the local vs. distant disease question.

Of course, there are no guarantees. I could have localized AND distant disease. But my outlook is much different.

I'll start IMRT this week. It's the latest thing in radiation oncology. The radiation can be focused very precisely, and the amount of radiation can be varied and exquisitely controlled by the oncologist.

I got tattooed last week. One right above my crotch, and one on the side of each hip. Lasers will be centered on those tattoos each time to insure the radiation goes where it should.

Next will be a dry run, where X-rays will be taken with me in position as if I'm going to receive treatment. The X-Rays will be compared to a CT scan done last week, to insure everything lines up.

And then the treatments will begin--15 minutes each morning, 5 days a week.

I'll let you know how it goes.