Prostate Cancer Before 50

noreply@blogger.com (Replicant) — Thu, 14 Mar 2013 16:14:00 +0000

My History of Prostate Cancer.

A long time ago, in a pelvis far, far away:

Age 38
8 Dec 2000
bothered by frequent urination, went to primary care phys.
PSA 4.5
PCP said prostate was boggy
referred to Urologist
Biopsy Ordered

Jan 2001
Biopsy: negative for cancer, findings consistent with prostatitis

Age 39
16 Jul 2001
PSA 4.1

20 March 2002
PSA 6.1
START Cipro 500mg daily for 3 wks, Motrin 800 mg daily

Age 40
30 May 2002
PSA 5.7
Free PSA 11.9%
CONTINUE Motrin
Urologist believes probably prostatitis

30 Sep 2002
PSA 7.3
Free PSA 11.3%
START Avodart
STOP Motrin
ORDER Biopsy

November 2002
Biopsy: negative for cancer, but PIN III found

31 Jan 2003
PSA 2.2
Stop Avodart

Age 41
03 Sep 2003
PSA 4.9
Restart Avodart

23 Jan 2004
PSA 2.2
Continue Avodart

Age 42
24 July 2004
PSA 2.5
Continue Avodart

26 Jan 2005
PSA 3.3
Continue Avodart

29 Apr 2005
PSA 2.9
Continue Avodart

Age 43
11 Jan 2006
PSA 4.8 (on Avodart)
Abnormal DRE
Biopsy ordered

7 Feb 2006
Biopsy finds cancer
PIN also found
No perineural invasion
Gleason 3+4
20% on right
5% on left

Age 44
14 April 2006
SURGERY
Robotic prostatectomy
Positive margin at apex and left lobe
No perineural invasion identified
Extension into capsule, but not through
Gleason 3+4
70% of gland involved
stage t2c NX MX

16 May 2006
PSA less than 0.1

15 Aug 2006
PSA 0.2

14 Dec 2006
PSA 0.6

REFERRED FOR RADIATION

Day before radiation commenced, PSA = 0.7

Radiation Jan-Mar 2007. PSA quickly fell to less than 0.1 and remains there as of early 2013, now age 51.
No side effects from radiation at this point.

Latest Salvage Radiation News

noreply@blogger.com (Replicant) — Wed, 13 Feb 2013 21:40:00 +0000

A small, in-house study from the Graduate School of Medicine in Kyoto, Japan found multiple, independent risk factors for recurrence after salvage radiation (SRT). These were:

Gleason at or above 8
PSA nadir (low point) after SRT at or above 0.04 ng/ml
Negative surgical margins

They found that 77.8% of patients in their study with zero risk factors were free of PSA progression five years later. 50% of patients with one risk factor were progression-free, and only 6.7% of patients with two or three risk factors were progression-free at the 5 year mark.

In my own case, I was okay on the Gleason and surgical margins, but I don't know my PSA nadir to that level of specificity.

This was an interesting little study, but I trust Andrew Stephenson's much larger one a lot more.

Kyoto blossoms. Photo: jmurawski Creative Commons license.

Attention must be paid

noreply@blogger.com (Replicant) — Fri, 08 Feb 2013 17:12:00 +0000

In my office I have a few pet trilobites, in the same way people used to keep pet rocks.
Trilobites were highly successful, as species go, and their timeline will dwarf that of our own in the geologic record. They scuttled about the ocean floors for over 270 million years. Imagine the alien paleontologist of the future: "Humans--flashy but self-destructive. But these trilobites--wow!"
250 million years after the trilobites died out, I was promoted into my current position. Before that, the incumbent was here for over a decade. In a few years, that manager will largely be forgotten, aside from an occasional visitor to the company's archive. Almost no one remembers the two (or was it three?) people who came before her. "Look upon my works, ye mighty, and despair!", the forgotten Ozymandias admonishes across the sands of time. What my predecessor thought of as their potential legacy--a training program--was eliminated in a brief email discussion that probably took all of two minutes' thought. Not even a pen stroke, just a tap of the Enter button. "Look upon my--oops, okay, I'll just put my stuff in a box and go."
Last week, a friend of my father's, not even 70, dropped dead in a parking lot as she went to pick up her grandchild. Here one second, gone the next. As a genealogist, I know that the majority of people do not know the last names of their great-grandparents. Three generations, and poof!
Time, even on the scale of one minor planet in the Milky Way, is vast, and our lives are short. Ars longa, vita brevis. Art is long, life is short, Hippocrates tells us. But even art is short, and quickly forgotten, compared to geological time. That's what my frozen little friends on the shelf remind me. "Look upon our works, ye mighty," trilobites proclaim, "and despair."
I may be a poor player strutting and fretting my hour on the stage, but the hour is mine before I am heard no more. Cancer refocuses priorities for a lot of patients. I feel that refocusing.
As Geddy Lee put it, we must get on with "the real relation, the underlying theme."

noreply@blogger.com (Replicant) — Fri, 01 Feb 2013 21:43:00 +0000

I'll have whatever he's having..

Post-hoc review of my genetic risks

noreply@blogger.com (Replicant) — Mon, 28 Jan 2013 21:22:00 +0000

My genetic risk factors. Over all my risk was/is 2.86x the average man of my ethnicity.

And my PSA result is...

noreply@blogger.com (Replicant) — Wed, 23 Jan 2013 23:08:00 +0000

...less than 0.1, as it has been for years. Yippee!

Blood draw today

noreply@blogger.com (Replicant) — Fri, 18 Jan 2013 18:54:00 +0000

Had blood drawn for PSA (and cholesterol) today, which coincidentally is the 6th anniversary of the start of my salvage radiation. Probably get the results by the end of the month. Not nearly as nervous as I have been in the past.

noreply@blogger.com (Replicant) — Sun, 18 Nov 2012 03:19:00 +0000

noreply@blogger.com (Replicant) — Tue, 25 Sep 2012 23:34:00 +0000

Just thought I'd stop in and say I'm still here, no news on the cancer front. My PSA is still undetectable (as of Spring 2012) and I'll probably have it the next time I have blood drawn for cholesterol screening. My overall health is excellent. I'm bicycling a lot, doing strength training (dumbbell workouts, pull-ups, push-ups), and keeping my weight at a healthy BMI. I'm not alone in being free of any signs of prostate cancer after salvage radiation. Visit a major cancer discussion forum and you'll find plenty of men just like me. It's now been over 5 years since my radiation.

noreply@blogger.com (Replicant) — Sat, 23 Jun 2012 05:01:00 +0000

Walsh has a new edition of his book! If you're newly diagnosed, or going through biopsy, or just want to understand your plumbing, check this out:

noreply@blogger.com (Replicant) — Thu, 03 May 2012 19:13:00 +0000

I recently signed up with 23andMe, a company that can tell you, based upon a saliva sample, a remarkable amount of information about your health risks, traits, drug responses, carrier status and ancestry. The second highest health risk for me is (was) prostate cancer, at 51.1%, or nearly triple the average risk. Out of 12 markers for prostate cancer risk, I had 10 indicating higher than normal risk. It's a fascinating service. They nailed my prostate cancer risk, which makes me pay attention to the others identified, like heart disease, thromboembolism, and arthritis.

as to the title...

noreply@blogger.com (Replicant) — Wed, 28 Mar 2012 23:31:00 +0000

I can't say I'm under 50 any longer.
In celebration of my half-century mark, I rode 65.3 miles in the American Diabetes Association Tour de Cure. It went well. I feel great! Still fine on the cancer front, still doing fine with weight control, blood pressure, and cholesterol.

I'm off to find an early bird dinner special!

so long, farewell, auf wiedersehen, adieu..

noreply@blogger.com (Replicant) — Wed, 01 Feb 2012 21:28:00 +0000

My radiation oncologist told me that since my PSA has been less than 0.1, and my DREs have been normal now for five years, he is releasing me from his care. So I'll just have my PSA checked along with my other lab work (cholesterol, CBC) every six months, by my primary care doctor.
He's a great guy, and I hope I never see him again (at least in the office!)

Second Birthday

noreply@blogger.com (Replicant) — Wed, 18 Jan 2012 15:29:00 +0000

Five years ago today I was recalled to life, when I started the first of 38 radiation treatments, in an effort to rescue me after a prostatectomy failed to eradicate my cancer.
It worked!
In spite of a rapidly doubling PSA and short time between surgery and biochemical recurrence, it worked. I sit here now, half a decade later, with a PSA of less than 0.1.

Tomorrow (I was a little slow) you can download the Kindle version of my story for free.

Free for Kindle

noreply@blogger.com (Replicant) — Thu, 29 Dec 2011 20:19:00 +0000

I've put down my salvage radiation story and what I think are the most important facts in a Kindle single.

On New Years's Eve and New Year's Day this 6 page article will be available completely for free. Don't have a Kindle? You can get free Kindle software for your PC or phone.

Recalled to Life: Salvage Radiation for Recurrent Prostate Cancer

and it's always free to Amazon Prime members.

less than 0.1

noreply@blogger.com (Replicant) — Mon, 12 Dec 2011 20:47:00 +0000

For those of you keeping score at home, my PSA remains < 0.1, nearly 5 years after finishing salvage radiation.

an early look at my PSA

noreply@blogger.com (Replicant) — Tue, 06 Dec 2011 16:27:00 +0000

I'm not scheduled to see my radiation oncologist for a PSA check and DRE until late next month. It is, however, time for my 6 month CBC & lipid panel with my primary care doc. This is mainly to check my cholesterol in order to get a refill of Pravachol. I noticed he had also scribbled "PSA" on the lab request, probably out of an abundance of caution in looking at my file. So I figured why not get a sneak peek? After all, if PSA tests were free, I'd get one every month!
I'll report back next week on the results.

To recap my situation, I was diagnosed in 2006 at the age of 43 with prostate cancer. I had surgery early that year and the pathology showed Gleason 3+4, penetration into but not through the capsule, and I had a positive surgical margin. My PSA, after adjusting for medication, was about 10.0 at the time of surgery.
At first my PSA was fine after surgery--less than 0.1, but that didn't last. By 9 months, it was detectable and rising fast. I consulted a medical oncologist and radiation oncologist, and started salvage radiation in the form of IMRT at my local hospital. The day before radiation, my PSA was 0.7. Within 6 months of the end of radiation, it fell to less than 0.1, and it has remained there since. It's now been close to 5 years since my radiation treatments.
I continue to get 6 month PSA checks and exams from my radiation oncologist.

Guest Post by David Haas

noreply@blogger.com (Replicant) — Fri, 25 Nov 2011 20:52:00 +0000

Cancer Survivor Networks: Connecting with Others

When you have been diagnosed with cancer, it is easy to feel alone and isolated. You don't need to feel alone; there is hope. Other cancer survivors are ready and willing to help you. All you must do is seek out a support network either online or through a local group with regular onsite meetings.

Cancer survivor networks allow you the opportunity to share your innermost feelings about cancer and treatment with others who understand what you are going through. An article by the Mayo Clinic titled "Support groups: Make connections, get help," states that cancer support networks often have other benefits that you might not expected, such as providing a source of information about cancer and available treatments and an opportunity to learn tips and information from other cancer survivors who are further along in their treatment.

Online meetings have several advantages. For example, if you are undergoing treatment and you aren't feeling well enough to go out, you can attend meetings or participate in forums online. Many of the online meetings are conducted via a chat room and you do not need sophisticated technology to participate. The forums allow you to post questions and read the answers posted by other cancer patients. Online support groups have the additional benefit of allowing you to find a group of cancer survivors who suffer from the same illness that you have, for example, mesothelioma or colon cancer. In addition, many of these forums even have a doctor or nurse available to answer basic questions about treatment or recovery.

If you aren't technologically savvy or if you prefer to connect with people on a more personal level, you can participate in face-to-face meetings. During these meetings you can share experiences with real cancer survivors in your community. Many survivors find that the emotional support and feeling of belonging that they experience in a face-to-face support group makes recovery more tolerable.

If you are interested in finding a cancer survivor network, ask your doctor or nurse for a list of groups near you. Your local telephone book or newspaper might provide additional information as well. If you prefer an online group, search for a group or visit the website of the national foundation for cancer or for your particular type of cancer. You have nothing to lose by reaching out to others, but you have everything to gain.

Thank you.

noreply@blogger.com (Replicant) — Fri, 11 Nov 2011 15:19:00 +0000

And I heard the voice of the Lord, saying, Whom shall I send, and who will go for us? Then I said, Here am I; send me.
Isaiah 6:8

To all those who served, thank you.

A Journal Entry From 2006

noreply@blogger.com (Replicant) — Thu, 10 Nov 2011 19:33:00 +0000

Two days after Christmas, in 2006, I started keeping a journal. Here is an excerpt from that day:

Story so far--PSA rising after surgery. Diagnosed February 2006, surgery in April. First PSA undetectable, second 0.2. December PSA 0.6. I think I'm in big trouble. Meeting with a radiation oncologist and a medical oncologist January 9. I will try radiation, I think, even though the cancer is probably distant rather than local, since PSA rose so quickly. I imagine hormones and chemo are in the works before long. Worried about how long I will live, but more importantly, what that life will be like, with all the effects hormone therapy causes. Lots of thoughts passing through my mind, so figured it's a good time to start journaling. Waking up at 4 am with anxiety, but doing okay during the day. Read a part of Walsh's book yesterday--a study where a subset of men had PSA rise within one year. Only 1 of 16 got any benefit (from radiation) and his PSA started to rise three years later. Worried about _____ growing up without me. Everything is different now. Should I bother putting anything into my career? Should _______and I plan a romantic trip now, in case HT is going to destroy that part of life? Should I start getting into pictures and videotapes more now so that in the future, ____________ can see me as I was, not sick? Should we bank some family experiences now? I think I have a 74% chance of surviving three years but only a 15% chance of ten years. That's a pessimistic view (looking at "Risk of Prostate Cancer-Specific Mortality etc." from JAMA 2005; 294: 433-439.

It was actually an overly pessimistic view. I had thought, based on what my surgeon told me and the yellow Post-It attached to the record he sent the radiation oncologist, that my surgical margins were negative. But when the oncologist read the file, he found that actually, my margins were positive. Positive surgical margins mean that cancer was present right up to the very cut edge of the removed tissue, meaning that it's likely some bits of cancer were left behind in the region of the prostate. And those cancerous leftovers were a likely culprit for my rising PSA. Since their location could be approximated (the prostate "bed", or fossa), radiation was more likely to effect a cure, than if the margins had been negative.

I had salvage radiation in early 2007. Within a few months, my PSA fell back below 0.1, where it has remained. Am I cured? It's too soon to tell. It may always be too soon to tell. But I'll take what I can get.

Diamondbacks CEO announces he has prostate cancer

noreply@blogger.com (Replicant) — Tue, 20 Sep 2011 18:51:00 +0000

Diamondbacks CEO announces he has prostate cancer

Sunrise on the Bike Trail

noreply@blogger.com (Replicant) — Wed, 31 Aug 2011 22:56:00 +0000

As I've blogged about before, I enjoy riding my bike along the local canal system. It's a stress-buster and helps me manage the weight.

I hit the trail just after sunrise this morning, and was rewarded with this view.

Healthwise, everything is just peachy. Weight is level, right in the middle of my healthy range; blood pressure and cholesterol are showing the best numbers in decades. Next PSA (and DRE) in January 2012.

blood donation

noreply@blogger.com (Replicant) — Fri, 29 Jul 2011 04:07:00 +0000

Donated blood today.

PSA update, 4 years, 4 months post-SRT

noreply@blogger.com (Replicant) — Mon, 25 Jul 2011 18:08:00 +0000

My latest PSA, now 4 1/3 years after completing salvage radiation, is still <0.1 .

blood draw yesterday

noreply@blogger.com (Replicant) — Thu, 09 Jun 2011 22:10:00 +0000

...but not for PSA. That will be next month. Yesterday the blood draw was a comprehensive metabolic panel, cholesterol, etc. I expect my cholesterol numbers to be excellent again, given the Pravastatin and weight loss, and I'm curious about what my white blood cell count will be. It was low last time, and my doctor was concerned. Specifically, my neutrophil count was low. But since I wasn't having trouble fighting off infections, he didn't refer me to a hematologist. I still am very healthy in that regard--no problem with infections of any kind.