Sunday, December 19, 2010
It was slipping way before I had radiation, but it has gotten worse since. And it's also gone back in a positive direction. In 2008 it was as low as 2.2.
My neutrophils count is also sometimes a little low, as it is now.
Scouring the web is not turning up much on this condition. It could be from radiation, I suppose, but the numbers and dates of treatment don't seem to correlate. Or there might be something wrong with my bone marrow, unrelated to prostate cancer. It's a mystery right now, because I have not seen a hematologist. My primary care doc wants to keep an eye on it right now. He says he would have referred me if I had been having trouble with infections (I haven't).
Beaumont Hospital Launches Study of Single-Dose Radiation Treatment for Prostate Cancer
Wednesday, December 1, 2010
From 2003 to 2007:
The median age at diagnosis was 67.
- 0.0% were diagnosed at age 34 or younger (that doesn't mean zero in absolute numbers, just percent)
- 0.6% were diagnosed between age 35 and 44 (that was my age bracket at diagnosis)
- 8.9% were diagnosed from age 45 to 54 (still a small fraction)
- 29.9% were diagnosed from 55 to 64 (now we're talking)
- 35.3% were diagnosed between 65 and 74
- 20.7% between 75 and 84
- 4.6% 85 and older
The median age at death was 80.
- 0.0% (again, this is percent, not saying zero men in absolute numbers) of the men who died from prostate cancer were 34 or younger.
- 0.1% of the deaths from prostate cancer occurred between 35 and 44.
- 1.4% of the deaths were between 45 and 54
- 7.5% between 55 and 64
- 19.9% between 65 and 74
- 40.3% between 75 and 84
- 30.8% were 85 and older.
24.7 out of every 100,000 male deaths per year are from prostate cancer. This number has been in decline since the early 1990's. This figure is dwarfed by that of cardiovascular disease.
Photo credits (used under Creative Commons license): alper and deVos
Wednesday, November 24, 2010
Monday, November 1, 2010
|Photo: cuppojoe (http://www.flickr.com/photos/cuppojoe_trip)|
If you're at high risk for recurrence, based on your post-prostatectomy pathology, should you have radiation right away (adjuvant) or wait to see if your PSA rises (salvage)? Prostate Cancer Infolink takes a look at the state of research into this question, doing an excellent job as always.
Monday, October 25, 2010
Wednesday, October 20, 2010
Read the rest of this story at the New Prostate Cancer Infolink.
Tuesday, September 28, 2010
Efficacy and tolerance of salvage radiotherapy after radical prostatectomy with emphasis on high-risk patients suited for adjuvant radiotherapy.
Monday, September 20, 2010
Saturday, September 18, 2010
I have updated my guide "How to Estimate Your Prostate Cancer Cure Odds". It now has a new home on the HealthMad website at http://healthmad.com/conditions-and-diseases/how-to-estimate-your-prostate-cancer-cure-odds/.
I noticed lots of men and partners show up on discussion forums, newly diagnosed, desperate to find out what their survival time might be, or the chances of a cure. So I incorporated and explained the tools available from reputable sites to do that.
It is certainly possible to find out the long term probabilities, but the patient should bear in mind that the probabilities really apply to large groups of men, and cannot predict with certainty the outcome for any one individual.
(Photo credit: Lisa Brewster: http://www.flickr.com/photos/sophistechate used under Creative Commons license with appreciation )
Friday, September 3, 2010
The full text of both articles is freely available.
To my U.S. readers--have a great Labor Day weekend!
Friday, August 27, 2010
- Never give in--never, never, never, never, in nothing great or small, large or petty, never give in except to convictions of honour and good sense. Never yield to force; never yield to the apparently overwhelming might of the enemy.
- Sir Winston Churchill, Speech, 1941, Harrow School British politician (1874 - 1965)
Friday, August 20, 2010
Here's to the loved ones in their care
Here's to the strangers on the streets tonight
Here's to the lonely everywhere
Here's to the wisdom from the mouths of babes
Here's to the lions in the cage
Here's to the struggles of the silent war
Here's to the closing of the age.
Here's to you my little loves with blessings from above
Now let the day begin
Here's to you my little loves with blessings from above
Let the day begin
- The Call, "Let the Day Begin"
(Photo credit: Jaqian. http://www.flickr.com/photos/jaqian/85569793. Used under Creative Commons license.)
Wednesday, June 30, 2010
I may have to subscribe!
Tuesday, June 29, 2010
Saturday, June 26, 2010
Blood draw yesterday (June 25). Results next week.
Friday, June 18, 2010
Saturday, May 29, 2010
Another question many of you have is in regards to the side effects of salvage radiation.
Many of you get here because you're under 50, or about 50, and are surprised to have been diagnosed with prostate cancer.
I know these things because I can see the keywords in Google that bring people here.
So I thought I'd write a post that directly addresses the possible reason you're here.
First, if you are looking for the Stephenson nomogram, it is the basis of the the Salvage Radiation Therapy nomogram on the Memorial Sloan Kettering website here:
Put in your Gleason, PSA, and other items from your medical history and get an idea of the odds of successful salvage.
Next, if you want to know the side effects, I will tell you that in the case of IMRT, the type of radiation technology used on me, the side effects when used for salvage are usually mild and temporary. If you are continent before salvage radiation, you'll probably still be just as continent afterwards. If you have erectile dysfunction from your surgery, IMRT might worsen it, and the worsening could happen over a couple of years following the end of radiation. You might have bowel irritation. Most of the time, this is treatable and temporary, but sometimes it is chronic and hard to cure. Most of the time, men don't have serious, quality-of-life side effects from salvage radiation. For more on that, see: Peterson JL, Buskirk SJ, Heckman MG, Crook JE, Ko SJ, Wehle MJ, Igel TC, Prussak KA, Pisansky TM. Late toxicity after postprostatectomy salvage radiation therapy. Radiother Oncol. 2009 Nov;93(2):203-6. Epub 2009 Sep 18. PubMed PMID: 19766337.
If you're here because you're 50 or under, well, there are actually quite a few of us these days! Statistically we're an anomaly, but if you hang out on prostate discussion forums, you'll run into other youngsters. Which leads me to my last resource..
By far the most active prostate cancer discussion forum I know of is the one on HealingWell.com:
The next most-active prostate cancer discussion is on CancerForums.net:
and there is also a group I read on WebMD, although it is very quiet now after some major changes to the discussion forums (now called "exchanges") that hamper communication, IMHO:
I am aware that there are other discussions, like the Usenet group, and the one on the US Too website, but none are as busy and populous as the one on HealingWell.
Friday, May 28, 2010
Substitute "cancer" for "concentration camp" and "patient" for "prisoner" and - in my opinion - his insights apply to our (collective) situation and they can offer inspiration.
Wednesday, May 26, 2010
Wednesday, May 5, 2010
Plan to get back to playing online chess soon on Gameknot.
Tuesday, April 13, 2010
So next month, I'll get that patched up. Turns out to be an "incisional" hernia, meaning I wouldn't have had it without the surgery. It's at the bottom of the main incision where the prostate was removed.
In other news, I'm trying to lose weight (which should help with the hernia, too) and get healthy. I just bought a Gary Fisher Tiburon bike. When I'm totally healed from surgery I plan to start the P90X program with my son. I also plan to follow David's lead and learn how to play disc golf, because I live right on a course.
I'm also now on Pravastatin for high cholesterol. Cholesterol, blood pressure, prostate cancer, hernia, presbyopia ...yep, it's officially middle age.
But life overall is good. Has anyone noticed that television has gotten a lot better over the past decade? When I was a kid, "The Beverly Hillbillies" was prime-time fare. Then it was an endless, boring parade of car-chase detective shows in the 70's, and lame comedy in the early 80's. Now we've got 30 Rock, The Office, Modern Family, and Big Bang Theory for comedies; and great dramas like House. But the best thing to ever be put on TV (for me) is definitely ABC's Lost. All of this TV cuts into my reading time, but I am managing to squeeze in some Bernard Cornwell.
My next PSA test is in July. Until then, I'm going to have my belly button turned back into an "innie", heal up, get healthier, and enjoy life.
Thursday, March 11, 2010
I was not screened - which is what the main uproar is about - but rather tested after coming to my primary care doc with a complaint. There is a difference.
The complaint was increased night time urination. It was almost certainly a result of my tendency to hypochondria along with a little BPH.
So PSA testing resulted in me going to see a urologist years before I would have otherwise. He immediately did a biopsy, and did not try antibiotics, or watch my PSA velocity (this is a main complaint of the PSA pioneers Ablin and Stamey as I understand it - going straight to biopsy after one PSA).
Eventually, after several years, lots of PSA tests, and three biopsies, cancer was found. It was found by the trend, though--a sudden jump after a period where it was low--along with a positive DRE. It appears, based on Gleason and doubling time, that it was not indolent. It would have, and may still, kill me before other causes like my high cholesterol or blood pressure.
Did mass PSA screening play a role in saving me? No. It most definitely did not, because I did not get screened and I was years away from that. Testing may have played a role - and if you read PSA discoverer Ablin's comments (New York Times, March 10, 2010)carefully, he does not dispute that there is a role for testing, especially in high risk cases, nor does he dispute the value of PSA in post-treatment monitoring.
Again, PSA as a diagnostic tool *may* have helped me. Maybe I've been cured of a disease that would have slipped by, otherwise, and killed me early, a la Fogelberg or Zappa. But here's the thing - I don't know. It's possible that I have gone through surgery and radiation and in spite of my good results so far, my PSA will come zooming back and in the end, the result will be the same, maybe even the same timeline.
Only a lot of time will tell. I read, over and over again, on multiple forums, from men who have just been treated, that PSA screening has saved them. In some cases, they weren't really screened, but tested after presenting with a complaint. And in a lot of cases, they are saying that PSA testing saved them when it's too early to know that with any certainty. When Stamey spoke at the meeting I went to, there was a lot of anger from the men in the room, because what he was saying was essentially that although everyone hoped they had been saved by PSA, given enough time, a significant portion would find that wasn't the case, or that some of them had been "saved" from a disease that would have never threatened them.
Again, I'm not saying that I agree or disagree with the PSA pioneers, and I hope that PSA played a role in saving my life. The bottom line is, however, that I don't know.
Sunday, March 7, 2010
I have for the past couple of years, scoured the Internet in hopes of coming across individuals who, after having salvage radiation after prostatectomy, have had no signs of cancer (i.e. they are progression-free) for several years.
I have found people who had salvage radiation a couple of years ago, and on a Google prostate cancer group, I think I read the story of someone who was 4 years out from SRT, with PSA still undetectable.
I am following the cases of several guys on HealingWell.com who are having SRT now, or who recently finished (within the last 24 months).
I know from stats that there must be some folks out there who had their PSA rise after surgery, then had radiation, and who are still free from PSA progression 5 or more years later. Are you one of those people, or do you know one?
If so, add a comment here. I'd like to hear your story, and so would visitors to the blog.
I do moderate the comments, so you won't see your message until I have a chance to review it. Keeping the spammers at bay, you know.
Sunday, February 14, 2010
At age 42, Dr. Jeffrey A. Cadeddu felt like a dinosaur in urologic surgery. He was trained to take out cancerous prostates the traditional laparoscopic way: making small incisions in the abdomen and inserting tools with his own hands to slice out the organ.
But now, patient after patient was walking away. They did not want that kind of surgery. They wanted surgery by a robot, controlled by a physician not necessarily even in the operating room, face buried in a console, working the robot’s arms with remote controls...
Full text after the jump here.
Thursday, January 28, 2010
The American Red Cross now allows prostate cancer patients to donate if it has been at least a year since treatment, and there is no sign of recurrence. The same holds true for most other cancers.
This is a change from past rules, which said it had to be five years.
Monday, January 25, 2010
If we all give a little, we can help a lot. In the last month, 465 of you visited my little blog here. You came from 46 states and 55 countries. Can you imagine the impact, if just half of you threw $10 Tim's way?
In case you're wondering, I don't know Tim or anyone in his family (or town, for that matter). I read his story this morning, following a link on prostatecancerinfolink.net.
Let's see what the power of the blogosphere can do.
Tuesday, January 12, 2010
49% of the patients failed salvage radiation during the study, after an average of 30.7 months. Those patients were then put on ADT. 14% of those patients successfully controlled their PSA with ADT for 20.7 months, leaving 86% who controlled their PSA for over 3 years.
Fast doubling times (less than 3 months) were predictive of RT failure.
Treatment failure and clinical progression after salvage therapy in men with biochemical recurrence after radical prostatectomy: radiotherapy vs androgen deprivation.
Departments of Urology and Radiation Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.This is personally troubling to me on a couple of points--first, my doubling time was very fast--well under 90 days. Secondly, this study reinforces my belief that I'm far from out of the woods. I'm a little under three years out from the end of salvage radiation, just about the point, on average, where men who fail RT see their PSA rise again. Obviously, I need to keep monitoring my PSA. If it begins to rise and the doubling time is as fast as it was before treatment, I should probably not delay hormone therapy.
Wednesday, January 6, 2010
Just got the results from the nurse. Less than 0.1 once again. It's been about 3 years since I started salvage radiation, or about 34 months since the end of treatment.
I always think it's going to be bad news, and so far it's been just the opposite every time. Years to go before I can start to say "cured," of course.
Photo credit: Bithead (Creative Commons license) http://www.flickr.com/photos/bithead/340102475/
Tuesday, January 5, 2010
Outcome of salvage radiotherapy for biochemical failure after radical prostatectomy with or without hormonal therapy.
Not sure how I missed this one--probably because I usually search "radiation" and not "radiotherapy"--but a study from MD Anderson in 2005 reaffirmed the idea that the earlier you start, the better, with salvage. Like Stephenson et al at Cleveland Clinic, they found that the best results were obtained when the man's pre-radiation PSA was 0.5 or less.
The MD Anderson study put men into two groups: favorable and unfavorable. Those in the favorable group had pre-RT PSAs of 0.5 or less, and positive margins. Unfavorable included everyone else. 81.7% of those in the favorable group had no PSA progression 5 years later, compared to 61.7% in the unfavorable.
I'm in the unfavorable group. The 61.7% chance of being progression free at 5 years (which would be spring of 2012 for me) matches up well with other research I've read.
Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):134-40.
Outcome of salvage radiotherapy for biochemical failure after radical prostatectomy with or without hormonal therapy.
Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. firstname.lastname@example.org
BACKGROUND: This study analyzed the outcome of salvage radiotherapy for biochemical failure after radical prostatectomy (RP). By comparing the outcomes for patients who received RT alone and for those who received combined RT and hormonal therapy, we assessed the potential benefits of hormonal therapy. PATIENTS AND METHODS: This cohort was comprised of 101 patients who received salvage RT between 1990 and 2001 for biochemical failure after RP. Fifty-nine of these patients also received hormone. Margin status (positive vs. negative), extracapsular extension (yes vs. no), seminal vesicle involvement (yes vs. no), pathologic stage, Gleason score, pre-RP PSA, post-RP PSA, pre-RT PSA, hormonal use, radiotherapy dose and technique, RP at M. D. Anderson Cancer Center, and time from RP to salvage RT were analyzed. Statistically significant variables were used to construct prognostic groups. RESULTS: Independent prognostic factors for the RT-alone group were margin status and pre-RT PSA. RP at M. D. Anderson Cancer Center was marginally significant (p = 0.06) in multivariate analysis. Pre-RT PSA was the only significant prognostic factor for the combined-therapy group. We used a combination of margin status and pre-RT PSA to construct a prognostic model for response to the salvage treatment based on the RT group. We identified the favorable group as those patients with positive margin and pre-RT PSA < or =" 0.5" p =" 0.03).">
PMID: 16111581 [PubMed - indexed for MEDLINE]
Saturday, January 2, 2010
Prog Urol. 2009 Dec;19(11):803-9. Epub 2009 Jun 4.
[Characteristics of prostate cancer in men less than 50-year-old.]
[Article in French]
Peyromaure M, Valéri A, Rebillard X, Beuzeboc P, Richaud P, Soulié M, Salomon L;
les membres du CCAFU.
Service d'urologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014
OBJECTIVE: To report the characteristics of prostate cancer (PCa) in men less
than 50-year-old and the results of different treatments of PCa in this
population. METHOD: A bibliographic research was performed using Pubmed database.
The keywords that we used were: prostate cancer, age, young, radical
prostatectomy, brachytherapy, radiotherapy, active surveillance. The studies
which included a significant number of patients were selected. A total of 38
articles were used as bibliographic references. RESULTS: PCa in young men does
not seem to have different characteristics than in older men. Nevertheless, young
men seem to have a lower risk of severe urinary and sexual sequelae, particularly
following radical prostatectomy. CONCLUSIONS: There is no recommendation
regarding management of PCa in men less than 50-year-old. In case of localized
cancer, two options may be considered. First option consists in decreasing the
urinary and sexual complications of radical prostatectomy. A minimally-invasive
treatment, such as brachytherapy or even active surveillance, may reach this
objective. Second option consists in being more aggressive. To propose a radical
prostatectomy offers to the patient the possibility of salvage radiation therapy
in case of locally-advanced tumor or local recurrence.
PMID: 19945663 [PubMed - in process]
I don' t see the doctor for a couple of weeks, but I wasn't doing anything this morning, so I figured why not have a stranger stick a needle in the soft inside part of my elbow and let blood run out into a tube. So that's what I did.
I wonder if the phlebotomist thinks, even for a moment, about the role she is playing in the drama of life and death. Does she understand the portent? Perhaps it's better if she doesn't; or else her hands would be shaking so hard she couldn't do the job.
Up until the blood draw, I feel like I don't have prostate cancer anymore. But as soon as it is drawn, and before I get the results, it's like I'm in some kind of no man's land. Either the radiation wiped it out or it didn't. But at this point, I feel like Schrödinger's cat, both alive and dead at the same moment. Or rather, saved and doomed. It's not until I get the results that the probability wave collapses on itself and I become one or the other.
I know, I know. Quantum effects don't hold up in the macro world of people, tumors, and tubes of blood. But that's how it feels.
Sometime late next week, I'll call the nurse and get the result. At that instant, I will either push prostate cancer to the back of my mind and go about life pretty much as I have the past year; or I will start down a path that will quickly lead to the end of my sex life and eventually, the end of life itself.
It's like every 6 months my life path has two forks--two possible doors.
Photo credit: Annie Mole. Used Creative Commons (cc) license. http://www.flickr.com/photos/anniemole/2599914432/