Prostate Cancer Before 50

so long, farewell, auf wiedersehen, adieu..

2012-02-01T14:28:00.000-07:00

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

2012-01-18T08:29:00.000-07:00

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

2011-12-29T13:19:00.000-07:00

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

2011-12-12T13:47:00.000-07:00

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

2011-12-06T09:27:00.000-07:00

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

2011-11-25T13:52:00.000-07:00

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.

2011-11-11T08:19:00.000-07:00

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

2011-11-10T12:33:00.001-07:00

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

2011-09-20T11:51:00.000-07:00

Diamondbacks CEO announces he has prostate cancer

Sunrise on the Bike Trail

2011-08-31T15:56:00.001-07:00

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

2011-07-28T21:07:00.001-07:00

Donated blood today.

PSA update, 4 years, 4 months post-SRT

2011-07-25T11:08:00.003-07:00

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

blood draw yesterday

2011-06-09T15:10:00.000-07:00

...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.

Weight and Risk

2011-05-21T15:53:00.003-07:00

Overweight men who had prostatectomies, saw their PSA rise, and then were put on hormone therapy (aka ADT) were three times more likely to see their cancer spread. Obese men had five times the risk.

"Obesity May Raise Risk of Prostate Cancer Spread"

Several months ago I was overweight, and on my way to becoming obese, but I've shed 40 lbs. with Weight Watchers and now have a normal BMI. My blood pressure and cholesterol have improved as well. And if my cancer comes back, it sure looks like it would be better to have a healthy weight.

My weight since joining Weight Watchers.

My blood pressure and heart rate trend over time as a result of losing weight and exercising.

De-stress with chess

2011-05-21T09:03:00.003-07:00

I still find online chess a great way to get my mind off the worries of the day, including cancer.

Martin receiving radiotherapy for prostate cancer

2011-05-04T13:22:00.001-07:00

This is very similar to my experience. The video is sped-up, otherwise you'd be bored to tears. As you can see the treatments themselves are very easy on the patient. Over time, side effects may build up, but an IMRT treatment is about the easiest thing you can undergo medically.

Latest Salvage Radiation News

2011-04-29T15:58:00.001-07:00

Researchers in Munich, Germany, studied 96 men at a single institution, and found that--as did earlier research done by William Catalona and others--that although most men show a significant drop in PSA after SRT, in the long run, most will see their PSA start to rise. In this case, 35% remained free of PSA progression at 5 years post-SRT.

Outcome After Conformal Salvage Radiotherapy in Patients With Rising Prostate-Specific Antigen Levels After Radical Prostatectomy.

Klinikum rechts der Isar der Technischen Universität München

Clinical Trials

2011-04-29T15:25:00.003-07:00

This was in an issue of the New York Times this week. It's sort of an op-ed advertisement for Mt. Sinai hospital. The authors call for increased funding for clinical trials for breast cancer.

Clinical trials are a crucial part of all cancer research. I'm reading The Emperor of All Maladies: a Biography of Cancer by Siddhartha Mukherjee right now (highly recommended, by the way) and just happen to be on the part that describes how clinical trials for cancer came to be. He opens with a quote by H.J. Koning: "Randomised screening trials are bothersome. It takes ages to come to an answer, and these need to be large-scale projects to be able to answer the questions. [But...] there is no second-best option."

Indeed, many cancer trials never get off the ground because they lack participants.

Encouraging New Study on Salvage Radiation

2011-04-19T18:57:00.001-07:00


Varian linear accelerator.

The March 2011 issue of Cancer, a journal from the American Cancer Society, carried promising news for all of us SRT (salvage radiotherapy) guys: salvage radiation has been shown, for the first time, to confer a survival benefit across the patient population, and PSA doubling time did not matter significantly. Some well-known doctors (D'Amico and Moul, for example) from Harvard and Dana Farber co-authored the study which looked at 519 men who had prostatectomies at Duke University between 1988 and 2008. The median followup time was 11.3 years. The way I understand hazard ratios, the results mean that the risk of death from all causes was roughly half that of men who did not have salvage radiation.

http://www.ncbi.nlm.nih.gov/pubmed/21437885?s_cid=pubmed

Photo courtesy digital cat: http://www.flickr.com/photos/14646075@N03/3798458685/. Used under Creative Commons license with thanks.

How Old is Too Old?

2011-04-11T18:32:00.001-07:00

I know my father, a prostate cancer survivor nearly 80, has stopped PSA testing. He was treated nearly 20 years ago and his PSA has been undetectable. What's the point of testing? If his PSA starts creeping up at this point, he's in no danger.

Screening Prostates at Any Age

By GINA KOLATA

Published: April 11, 2011

Older men are getting screened for prostate cancer at a higher rate, though many experts discourage screening for men whose life expectancy is 10 years or less.

http://www.nytimes.com/2011/04/12/health/12prostate.html

Gina Kolata is one of the best medical writers out there, IMHO.

Kindle - a portable prostate cancer library?

2011-04-06T09:28:00.002-07:00

I just got a Kindle--quite an amazing piece of technology. Far lighter than an actual book, it can hold thousands of titles. I started looking at what prostate cancer books are available in Kindle format, and there are quite a few. Not all, but a lot of the ones I like and refer to often. I will probably load up with a few, so I always have a reference library at hand.

If you haven't held a Kindle, you should give it a try. The display is not a computer screen. It's not LCD. There is no light shining from it. It uses real ink particles on a surface that looks like real paper. Battery life is impressive, since after arranging the text on the page, the device isn't using any energy to display it. Books on Amazon are cheaper than the paperback versions (Walsh's book, for example, is $11.55 in paperback, but $9.99 in Kindle format) and they download very quickly. I bought and downloaded a novel last night--Game of Thrones, about 600 pages--in a minute. You can literally think of a book and be reading it in a few moments. Want to read a major newspaper? You can buy today's copy--just today's, if you want--for the newsstand price and take it on the plane with you without messing with newsprint and all the rest.

I got the one that is $139. It doesn't connect via 3G, only Wi-Fi, which is fine with me, since I have wireless at home, work, and it seems to be in most coffee shops now as well. I also bought the leather cover.

Here are some prostate cancer books available in Kindle format.

Lifetime goal achieved

2011-03-31T14:16:00.003-07:00

Yesterday I finished 6 weeks on the maintenance phase of Weight Watchers, and am now a Lifetime Member. I won't have to pay any meeting dues again as long as I stay within 2 lbs. of my goal weight. I have lost 37 lbs. since October.

My blood pressure is the same as last month (considerably down from October) but my resting heart rate has gone down to a healthier level.

I'm up to doing 3 sets of 9 reps in my pull-up workout, and expect to complete the 100 push-up challenge any day now.

My next PSA check is still a long ways off (end of July).

My bike is ready from the local bike shop after its tune-up, the weather looks great (in the 70's and 80's for highs next week) and the road is calling!

Free books!

2011-03-30T09:11:00.001-07:00

Terry Herbert of Yananow has set up a great website for people to donate books. If you have a prostate cancer book to donate, you can list it there. If you see one you want, just click on the email link to contact the donor to arrange shipment.

Right now I see multiple copies of Walsh's excellent book, as well as books by Strum, Marks, Scardino, Blum, and more.

What a great idea! Kudos to Terry.

Pay It Forward Books

Another independent validation of the Stephenson nomogram

2011-03-24T10:06:00.005-07:00

The nomogram developed by Dr. Andrew Stephenson was independently validated again, last year, by doctors at Loyola University. The "Stephenson nomogram" predicts the outcome of salvage radiation and is the basis for the interactive tool on the Memorial Sloan Kettering Cancer Center (MSKCC) website.

The researchers followed men for a median of 71 months and found no significant difference between the outcomes for their patients and what the nomogram predicted. At a median time of 71 months, 46% were progression-free (that is, their PSA had not risen after salvage radiation.)

Biking Through Cancer, and Life

2011-03-23T15:06:00.003-07:00

About a year ago, with the help of my wife, I got a nice bike for my 48th birthday. It was my first decent bicycle, a Gary Fisher Tiburon. It’s a hybrid, meaning that it’s not quite a mountain bike, nor is it a road bike. It’s ridden in a comfortable upright position, with plenty of springs and shocks to cushion the middle-aged rider. It’s the bicycle version of a Toyota RAV4. A little bit SUV, a little bit sedan. It’s beautiful, and I love it unashamedly.

I chose this particular model because I envisioned myself using it to commute the two easy miles to work. I do--sometimes. But the real joy, like so many of life’s pleasures, has been unexpected. It turns out that I do ride to work sometimes, and I do take my son on little outings; but the real mileage comes in the form of longer rides--one or two hours--along the many miles of irrigation canals that run through this metro area.

The canals, some of them started in the 19th century, follow ancient Hohokam Indian canals. Paved bike paths run along each side, diving beneath intersections in tunnels. Wide open spaces within an urban environment await the biker, calming the psyche and invigorating the spirit. It’s easy to forget that you are in the middle of a three million-plus metropolis.

I come across parents taking their kids for first-time bike rides, horseback riders roaming through vast, grassy flood-control fields, disc golf players, runners, people fishing for white amur and catfish from lawn chairs, and inevitably, the homeless. In one particular tunnel, early in the morning, I often see Reading Guy, who sits with a book in his little camp before departing for the day. The tableau of characters and landscape recalls the childhood classics by Lucy Boston, the Green Knowe books.

Prostate cancer, as a challenge and worry, has faded over the years, with consecutive undetectable PSA tests and clean exams (if you’re reading this blog for the first time, I was diagnosed at age 43, treated first by surgery and then with salvage radiation when my PSA rose). There are other issues now within my family in regards to health and well-being, and those, along with work pressures, and everyday anxieties are the reasons I get on my bike and ride miles from home.

As the miles pass, the worries diminish behind me. I stop to eat lunch beneath massive eucalyptus trees planted a hundred years ago by long-departed farmers. In the Green Knowe book, the trees were sometimes more than trees, and I think about this briefly as I sit back against their cool trunks. Then I relax and just exist in the moment.

GOALLLL!

2011-03-04T09:01:00.000-07:00

I'm at my goal weight for Weight Watchers. I actually hit it a couple of weeks ago, and I'm now on maintenance. It's nice to have a bunch more points to spend each day. So far, so good. 6 weeks on maintenance, staying within 2 lbs. of goal, and I'm a Lifetime Member (no more $ for meetings).

I'm now up to 3 sets of 6 reps each for pull-ups (more if I don't hang 100% down in between, but I guess that's cheating).

Can Exercise Keep You Young?

2011-03-04T08:57:00.000-07:00

From the New York Times:
Well: Can Exercise Keep You Young?

We know that prostate cancer is directly related to aging. So this should be of interest to all men.

pull-ups

2011-02-15T07:08:00.002-07:00

I can now do multiple sets of complete, full-hang pull-ups, 4 reps to a set--unassisted. It wasn't long ago that a single pull-up was a challenge. I'm already anticipating buying a dip belt so I can add weight to my pull-ups, once I'm doing 10 or more reps.

Prostate Cancer Genome Decoded

2011-02-14T06:57:00.000-07:00

"By mapping the full genetic blueprint of the tumor, researchers hope the information will eventually lead to the development of more targeted drugs and a better understanding of which prostate cancers are likely to spread, one of the biggest challenges for physicians and patients."

http://www.businessweek.com/lifestyle/content/healthday/649762.html

Exciting news; if not for us, then our sons and grandsons. Hopefully this is a first step towards truly discerning indolent from aggressive prostate cancer.

exercise

2011-02-12T17:53:00.000-07:00

I've been exercising a lot more in conjunction with my weight loss efforts. Today I did 16 miles on my hybrid bike (earning 7 WW points). I also just starting using an Omron heart rate monitorOmron HR-100C Heart Rate Monitor, which seems to work very well. Now I now when I'm at an optimum level of exercise.
Three days a week I do dumbbell workouts and two days a week I do pull-ups on a pull-up bar I installed in the doorway of our laundry room. When I started out I could do one, now I can do three pull-ups from a complete hang.

weight update, January 28

2011-01-28T15:03:00.002-07:00

I have now lost 30 lbs. on Weight Watchers since I started in October 2010, and am nearing my ultimate goal.

Blood pressure

2011-01-27T19:47:00.003-07:00

Since my weight loss, my blood pressure has fallen from an average of 122/73 in October to 114/73 now.

PSA update

2011-01-19T09:41:00.003-07:00

My PSA remains less than 0.1, now nearly 4 years after salvage radiation.

Weight loss update

2011-01-17T10:01:00.003-07:00

I've now lost 27 lbs. on Weight Watchers.

blood drawn

2011-01-14T13:55:00.000-07:00

Had blood drawn this morning for my 6 month PSA. It has now been exactly 59 months since I was diagnosed with prostate cancer, 57 months since prostatectomy, and 48 months since the commencement of salvage radiation (IMRT). So far, so good. PSA has been less than 0.1, which is undetectable on the standard assay. As I noted before, I'm a little concerned about my white blood cells, and will see what the radiation oncologist says about that.

I had a weigh-in at Weight Watchers today. I lost 1.6 lbs. this week, 1.8 lbs. the week before, and 26 lbs. since I joined. My body mass index has just fallen within the healthy range (now 24, was 28) and my appearance has changed dramatically, especially my face. I feel much better not dragging all that fat around, my blood pressure has come down a bit, and I've lost 4 inches in my waist. I now get questioned all the time about how I did it. It's not hard, and I don't feel like I'm depriving myself. I had a donut from Dunkin' Donuts this morning, for example. Last week I had a big slice of birthday cake at a party and I have a regular pub night (beer, nachos) with some co-workers. But I track it all as carefully as I can, and do my best to stay within the allowed number of points.

WBC

2010-12-19T09:34:00.000-07:00

For some time now my white cells have been too low in number. My WBC is 2.8 k/mm3 (2,800 per cubic millimeter of blood) and the count should be above 4.0 k/mm3.

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

2010-12-19T09:27:00.000-07:00

A single, 15 minute treatment for prostate cancer? Sounds appealing to me, knowing what surgery and two months of IMRT was like.
Beaumont Hospital Launches Study of Single-Dose Radiation Treatment for Prostate Cancer

age distribution of prostate cancer

2010-12-01T14:10:00.000-07:00

Here are some interesting age-related statistics about prostate cancer in the US, from the SEER database.

From 2003 to 2007:

DIAGNOSIS
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

DEATH

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.

MORTALITY
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

Weight Watchers

2010-11-24T11:31:00.000-07:00

Disgusted with some pictures from my reunion, I started Weight Watchers about 6 weeks ago and I've lost 15 lbs. so far. It's not so much a diet--because there are no forbidden foods--as it is a healthier way of eating and keeping track of things.

Adjuvant vs. Salvage Radiation

2010-11-01T18:43:00.002-07:00

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.

Can Aspirin Help Us Live Longer?

2010-10-25T19:37:00.000-07:00

Maybe so. Check out the story on MSNBC, or Oncology Times here. (Photo credit: Duncan. http://www.flickr.com/photos/duncan/ . Used under Creative Commons license with appreciation)

New: Partin Nomogram

2010-10-20T07:21:00.000-07:00

A multi-center research team has used data from > 7,300 radical prostatectomy patients treated between 2000 and 2005 at two major medical centers to construct a new "2010 Partin nomogram" to improve prediction of pathologic outcomes after radical surgery...
Read the rest of this story at the New Prostate Cancer Infolink.

Efficacy and tolerance of salvage radiotherapy after radical prostatectomy with emphasis on high-risk patients suited for adjuvant radiotherapy.

2010-09-28T20:14:00.000-07:00

Another look at salvage vs. adjuvant. Contains some probabilities of being free from progression at 5 years post SRT. For patients with no extracapsular penetration, pre-RT PSA less than 1.0, and positive margins, the 5 year biochemical free survival was 89%. The same probability for high risk patients was 78%, about the same success rate as reported for adjuvant RT.
http://www.ncbi.nlm.nih.gov/pubmed/20817287?s_cid=pubmed

A better way to detect prostate cancer?

2010-09-28T15:25:00.002-07:00

Visit msnbc.com for breaking news, world news, and news about the economy

Prostate Cancer - HealingWell.com Forum

2010-09-20T08:43:00.000-07:00

Prostate Cancer - HealingWell.com Forum
This is the best prostate cancer discussion board. By far the busiest and best-moderated I have ever seen.

Adjuvant vs. Salvage Therapy: Gerald Chodak MD (video)

2010-09-18T12:12:00.000-07:00

Dr. Chodak provides his views on recent studies about adjuvant (immediate) radiation vs. salvage (radiation given after PSA rises) in this video.

Updated Guide: How to Estimate Your Prostate Cancer Cure Odds

2010-09-18T11:31:00.001-07:00

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 )

Stand Up To Cancer - It's Up To You

2010-09-10T12:05:00.000-07:00

update to my guide to salvage radiation

2010-09-03T10:16:00.000-07:00

I have updated my one-page guide to salvage radiation, which encapsulates everything I have learned about the subject as a patient. I just now added links to two very useful articles about SRT--the recent PCRI Insights newsletter article ("Nine Decisions") which is written in a style and vocabulary that just about anybody should be able to read; and "Salvage Radiotherapy for Patients with PSA Relapse Following Radical Prostatectomy: Issues and Challenges" by Richard Choo of Mayo. Dr. Choo's article is a regular medical journal article meant for practitioners, but patients who have been researching the ins and outs of SRT should also find this article invaluable.
The full text of both articles is freely available.

To my U.S. readers--have a great Labor Day weekend!

Stand Up to Cancer

2010-08-30T08:45:00.000-07:00

Thought for the Day

2010-08-27T09:27:00.000-07:00

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 SchoolBritish politician (1874 - 1965)

Thought for the Day

2010-08-20T14:03:00.004-07:00

Here's to the doctors and their healing work
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.)

Nine Decisions

2010-06-30T09:28:00.000-07:00

The "Nine Decisions Before Electing Radiation Therapy" in the May 2010 PCRI Insights newsletter could not have been more well-written. Nathan Roundy is the new editor, and "Nine Decisions" is his first article for Insights. He covers all the bases, and touches on all the recent, relevant research into salvage and adjuvant radiation. I also liked the article on Provenge.
I may have to subscribe!

PSA less than 0.1

2010-06-29T08:53:00.001-07:00

Again!

Photo credit: bingbing. Used under Creative Commons license. http://www.flickr.com/photos/bingramos/126661740/

blood draw

2010-06-26T09:23:00.000-07:00

It's that time again. This PSA test will be at about 39 months post-salvage RT.

"Tell your fortune, sir? Step right up, put your arm out right here, make a fist and Bob's your uncle. Now, if the little number comes back "less than one" then your lordship is all right, see? But if it goes the other way...well, let's just say you're in for a change, right guv? Am I right, am I right sir? Nudge nudge wink wink!"

Blood draw yesterday (June 25). Results next week.

Review of the state of salvage radiation

2010-06-18T12:20:00.000-07:00

If you're interested in salvage radiation, this review article by Dr. Choo of Mayo Clinic pretty much sums up everything I've been reading and talking about here (and more!). The full text is free.

The Lost Prostate Riders

2010-06-18T12:05:00.000-07:00

JB71, a guy who posts regularly on HealingWell.com, is undergoing salvage radiation. He's got an interesting Facebook page.

Resources

2010-05-29T15:06:00.001-07:00

I know a lot of you come here because you or someone you know has prostate cancer that has recurred (or is very likely to recur) after surgery, and you want to know the odds of success of radiation (called "salvage" if it is done after your PSA starts to rise). Many of you are asking specifically for the Stephenson nomogram, the major tool that predicts success.

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:
http://www.mskcc.org/applications/nomograms/prostate/SalvageRadiationTherapy.aspx
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..

Discussion groups

By far the most active prostate cancer discussion forum I know of is the one on HealingWell.com:
http://www.healingwell.com/community/default.aspx?f=35

I moderate a discussion on CancerForums.net:
http://cancerforums.net/forum-5.html

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:
http://exchanges.webmd.com/prostate-cancer-exchange

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.

I hope that this post points you in some useful directions. If you want more information about salvage radiation, I encourage you to read this:

http://knol.google.com/k/salvage-radiation-for-prostate-cancer

Best wishes.

Cancer and "Man's Search for Meaning"

2010-05-28T18:17:00.000-07:00

I guess I'm not the first to draw a connection between Frankl's work and the lives of cancer patients. Robert Young, creator of the Phoenix5 prostate cancer site, in 2001:

Viktor Frankl survived four Nazi concentration camps and was witness to men who had no reason to live, who felt they would be better off dead and yet he counseled them to live in the worst conditions and situations that any people have possibly ever endured.

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.

http://www.phoenix5.org/books/Frankl/FranklRelevance.html

The Value of Believing in Others

2010-05-26T19:49:00.001-07:00

This is a little off-topic, but perhaps you can see how it fits into the life of a cancer patient.

Holocaust survivor and author of "Man's Search for Meaning", Viktor Frankl:

Hernia fixed

2010-05-05T08:34:00.001-07:00

Had it done the "open" way (non-lap) in the outpatient clinic yesterday morning, under general anesthesia. Some pain and discomfort. Couldn't get comfortable last night without pain med (roxicet) but I'm trying to keep those to a minimum because of the nausea when they wear off. I rented "The Hangover" on Blu-Ray, but I'm afraid to watch it until I heal up some more! Get to remove the big Band-Aid tomorrow and see the handiwork. Appetite is coming back today.
Plan to get back to playing online chess soon on Gameknot.

navel gazing

2010-04-13T14:18:00.000-07:00

I've noticed, since my surgery, that my navel didn't quite look normal. Over time, it's gotten much bigger. I showed my primary care doc, who said casually, "Oh, that hernia? Here's a card for a surgeon."

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.

Namaste.

PSA and Me

2010-03-11T09:52:00.001-07:00

I would like to speak about my individual case for a moment, rather than statistics.

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.

Has salvage radiation worked for you?

2010-03-07T17:00:00.002-07:00

Did you have salvage radiation for a rising PSA, post-prostatectomy, years ago and are still free from progression?

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.

Problem resolved

2010-03-07T13:30:00.003-07:00

Sorry about the hijacked blog. A widget I had installed, a chess challenge, was apparently the culprit. I've deleted it and it seems to have fixed the problem.

NYT: Results Unproven, Robotic Surgery Wins Converts

2010-02-14T10:10:00.001-07:00

Results Unproven, Robotic Surgery Wins Converts

By GINA KOLATA

Published: February 14, 2010

Robot-assisted prostate cancer surgery makes sense in some ways, but it is not clear if its outcomes are better.

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.

blood donation

2010-01-28T09:30:00.002-07:00

I gave blood yesterday for the first time in years.

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.

If you can help Tim Johnson...

2010-01-25T19:16:00.006-07:00

I have been in contact with the family. If you would like to give by PayPal or by mail, I have that information. Email me at galileo1962@cox.net .

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.

Whatever you're doing right now...

2010-01-25T10:07:00.003-07:00

I urge you to stop what you're doing now, go to this news story, and ask yourself what you can do to help this guy with advanced prostate cancer. We can't do everything, but we can all do a little. We're all brothers in this fight, right? Let's all do a little to help, and combined, that will mean a lot.
Tim's Story

Salvage RT and ADT Compared: Study

2010-01-12T14:36:00.006-07:00

Researchers in South Korea have found that when PSA rises after prostatectomy, treating men first with salvage radiation and then hormone therapy later, if needed, controls PSA in most cases and slows clinical progression, compared to hormone therapy alone.

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.

Song C, Kim YS, Hong JH, Kim CS, Ahn H.

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.

another excellent PSA

2010-01-06T10:27:00.002-07:00

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/

Outcome of salvage radiotherapy for biochemical failure

2010-01-05T09:28:00.002-07:00

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.

Cheung R, Kamat AM, de Crevoisier R, Allen PK, Lee AK, Tucker SL, Pisters L, Babaian RJ, Kuban D.

Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. mrcheung@mdanderson.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]

Characteristics of prostate cancer in men less than 50-year-old

2010-01-02T11:14:00.001-07:00

A literature review by French doctors:

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
Paris, France.

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]

Schrödinger's cat

2010-01-02T10:40:00.003-07:00

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/

countdown

2009-12-16T09:05:00.006-07:00

My next followup with the radiation oncologist is in one month. I'll have blood drawn 7-10 days before that. This will be 3 years since the start of salvage radiation. So far, so good, but it's been six months since my last check.

Looking at the curves in Stephenson's research, at this point about 10% of the patients fall off the curve each year in my group (those who started salvage when their PSA was between 0.51 and 1.0). At two years, 68% were free from progression; at three years 59%, at four years 55%, and at six years, 40%. The good news is, after six years the curve starts to flatten out, although there are still failures happening all the way out to at least ten years.

So I'm by no means safe. I will celebrate another "less than 0.1" reading, certainly, but I won't really start to feel like I'm out of the woods for another 7 or 8 years. With some cancers, there's a huge milestone at the five year mark, but not so with prostate cancer, since it generally moves a lot slower.

Good news on IMRT side effects

2009-11-27T08:10:00.003-07:00

No impairment of quality of life 18 months after high-dose intensity-modulated radiotherapy for localized prostate cancer

A German study showing only temporary quality-of-life issues after IMRT (intensity modulated radiation therapy) as a primary treatment. For more information on IMRT, do a keyword search in the custom Google search box (look to the lower right part of this page).

Sunday mornings

2009-11-08T09:11:00.005-07:00

Gotta love Sunday mornings. Sleep in, read the newspaper, coffee, relax. Not much to report right now. My next PSA will be in January. The anxiety isn't too bad yet.

This morning I'm reading "The Tao of Chess" and practicing some moves on Gameknot where you can find me playing as Replicannt (note the extra "n"). There are always lots of people to play, the atmosphere (I find) is much more civil than on Yahoo games, and the interface is terrific. If you use the link above and get a premium subscription, I will get a free month, but you can certainly have a lot of fun without paying a dime.

Also trying out some Clic Magnetic reading glasses. They're great, but since you are most likely a man reading this, I would encourage you to get the large size. I bought the regular size and they're almost too small. Otherwise they're a very cool invention. You can see them worn on CSI.

FHLW

2009-10-28T15:12:00.004-07:00

Check out the new Faith-Love-Hope-Win website, http://www.flhw.org . FLHW is a non-profit organization that raises money to fight advanced prostate cancer. They deserve the support of the prostate cancer community (hint: order some blue bracelets from them!)

Few Side Effects Found From Radiation Treatment Given After Prostate Cancer Surgery

2009-09-29T09:30:00.000-07:00

ScienceDaily (2009-09-29) -- The largest single-institution study of its kind has found few complications in prostate cancer patients treated with radiotherapy after surgery to remove the prostate. Men in this study received radiotherapy after a prostate-specific antigen test following surgery indicated their cancer had recurred.

http://www.sciencedaily.com/releases/2009/09/090928131212.htm#

Larry King

2009-08-22T17:15:00.001-07:00

If you missed last night's Larry King Live, here is a transcript:
http://transcripts.cnn.com/TRANSCRIPTS/0908/21/lkl.01.html
The whole show was about prostate cancer.

Proton Cancer Therapy Accelerates

2009-08-21T15:56:00.001-07:00

Interesting news story on CBS.com

"...new research being developed at Lawrence Livermore National Laboratory, which could reduce the size of proton accelerator machines from that of a football field to that of a traditional X-ray machine, could soon make proton therapy more easily accessible to all."

off topic: cool music video

2009-08-21T12:31:00.001-07:00

Stand By Me from Mike Yates on Vimeo.

How to Estimate Your Prostate Cancer Cure Odds

2009-08-08T12:15:00.003-07:00

I've just written an article on eHow that summarizes the tools (nomograms, tables, etc) that help you predict how far prostate cancer has spread, and the likelihood of successful primary treatment. "How to Estimate Your Prostate Cancer Cure Odds"

Lack of volunteers impedes cancer research

2009-08-07T09:33:00.003-07:00

An important article from the New York Times, a paper that should be commended for its excellent coverage of cancer over the past few years.

Forty Years' War - Lack of Study Volunteers Hobbles Cancer Fight

Excerpt:

There are more than 6,500 cancer clinical trials seeking adult patients, according to clinicaltrials.gov, a trials registry. But many will be abandoned along the way. More than one trial in five sponsored by the National Cancer Institute failed to enroll a single subject, and only half reached the minimum needed for a meaningful result, Dr. Ramsey and his colleague John Scoggins reported in an editorial in the September 2008 issue of The Oncologist.

How to Choose a Cancer Center (ehow)

2009-08-04T11:16:00.001-07:00

I have just published a quick guide on finding a top cancer center near you (for those of you in the U.S.)
http://www.ehow.com/how_5264421_choose-cancer-center.html

Stephenson nomogram revalidated

2009-07-20T11:55:00.002-07:00

The Stephenson nomogram, which predicts the outcome of salvage radiation, has been revalidated: http://www.ncbi.nlm.nih.gov/pubmed/19466946 .

The electronic version, a calculator, can be found here:
http://www.mskcc.org/applications/nomograms/prostate/SalvageRadiationTherapy.aspx

The updated paper version of the nomogram is here, but I find the digital version much easier.

The upshot of the validation is that the nomogram is a good rough guide to probability of success. It's better at the two ends of the risk spectrum (high and low) than it is for men in the middle, however.

Less than 0.1

2009-06-04T13:33:00.001-07:00

I couldn't wait any longer, so I called for my PSA results. Once again, less than 0.1!

The Question

2009-06-03T14:50:00.003-07:00

The Question comes up periodically, whenever it's time. The Question haunts my dreams, occupies my waking hours, and adds a tinge of uncertainty to everything.

What's my PSA?

If it remains less than 0.1, all will be well,and the Question will quickly recede in my mind, at least until the next test date approaches.

If my PSA is anything else, life will change radically, assuming it's not a lab error. It would mean my cancer was systemic, and incurable with today's medicine. There might be a second PSA test to confirm, with an interim waiting period of a few weeks to 3 months, or I might head straight to the medical oncologist--a prostate specialist. With a rising PSA after surgery and salvage radiation, there would be only one realistic option. Castration.

How's that for drama?

Now, I almost certainly would not choose surgical castration, but rather medical castration. Most people are squeamish about the word "castration" and so we say hormone therapy, or androgen deprivation--but the effect is the same. I would become a eunuch, lose all interest in sex, and hopefully the cancer would be stalled for years. And while it was stalled, I would probably stay on the therapy. If all went well, perhaps it would stave off metastasis for a decade or more. More likely, it would last a few years. There is intermittent therapy, where you get to take holidays from androgen deprivation, but it doesn't sound all that great to me either way.

In the next few days, I'll find out the answer to the Question.

Salvage Radiaton: Nomogram updates

2009-05-14T12:42:00.005-07:00

It looks like the Memorial Sloan-Kettering Salvage Radiation Therapy nomogram on Nomograms.org (direct URL: http://www.mskcc.org/applications/nomograms/prostate/SalvageRadiationTherapy.aspx ) has been updated. It's now easier to use and the response makes sense. It used to give your result as post-surgery rather than post-radiation.
I had been thinking that the nomogram was too pessimistic, compared to the paper version. But what I didn't realize was that four months after the paper version was released in the Journal of Clinical Oncology, an erratum was published that corrected a mistake in regards to pre-radiation androgen deprivation (hormonal therapy). The corrected PAPER version of this important tool is here: http://jco.ascopubs.org/content/vol25/issue26/images/large/zlj0150759390003.jpeg ; however, I see no reason to use it because the digital nomogram is much easier, quicker to use, and less prone to human error.

Now both paper and online versions tell me that I've got a 39% chance of being progression free at 6 years. That jibes pretty well with Catalona's research that showed that long term success with prostate salvage radiation is uncommon--only about 25% of patients overall are progression free at 10 years. Of those who had a complete response to radiation, as I did, Catalona found that 35% were free from PSA progression.

The full text of the original article (remember, the nomogram in this original article is not correct) is here: http://jco.ascopubs.org/cgi/content/full/25/15/2035.

If you have a rising PSA after prostatectomy, and you're considering salvage radiation, I encourage you to read the original article and use the online nomogram at Memorial Sloan-Kettering.

FLHW

2009-05-04T11:16:00.003-07:00

I just ordered some bracelets from FLHW.org (Faith Love Hope Win), a charity run by David E. David is a guy about my age with advanced prostate cancer. His blog is one of the most compelling pieces of autobiography on the web.

I urge you to visit http://www.FLHW.org, buy a few bracelets, and read David's blog.

I think you'll agree that David is a true hero.

Undetectable PSA and odds of progression after salvage radiation

2009-03-26T13:29:00.002-07:00

http://www.oncologystat.com/journals/journal_scans/Achieving_an_Undetectable_PSA_After_Radiotherapy_for_Biochemical_Progression_After_Radical_Prostatectomy_Is_an_Independent_Predictor_of_Biochemical_Outcome_Results_of_a_Retrospective_Study.html

If you achieve an undetectable PSA after salvage radiation, this study shows your odds of being progression free 3.5 years later are 75%. But if your PSA doesn't fall that low, your odds are only 18%.

ha!

2009-02-16T17:01:00.002-07:00

From the March 2008 Atlantic Monthly "What's Your Problem?" Q&A column by Jeffrey Goldberg:

Is life after college really as monotonous and depressing as it looks?
--Ben, Manhattan, Kan.

Dear Ben,
No. It's worse! Just kidding. It's actually a joy. Except for the prostate exams.

Good news on PSA once again

2008-11-07T09:15:00.002-07:00

Less than 0.1.

A deep sigh of relief. A new lease on life.

With that, as promised, I'm putting this blog to bed. Unless there is really big news in the area of salvage radiation, I don't plan on posting or updating. There is a news feed at the bottom of the page that's automatically populated by news from Google, but I won't be manually adding anything.

And if I hit the mark again on my next PSA, I will probably delete the blog, so that I'm not promulgating obsolete information.

In case you're wondering, YES, we will be celebrating. Magic Kingdom, here we come!

the background picture

2008-11-06T21:15:00.001-07:00

The background picture behind the blog title is a shot of the Milky Way I took out in the desert. One of my hobbies is amateur astronomy. I put my old 35mm film camera on a tracking tripod for 3 or 4 minutes.

biography of a prostate

2008-11-06T14:06:00.007-07:00

Here's my history, mainly focusing on the time up until salvage radiation began. I was only 38 when we found I had a PSA that was out of range. My uro tried an antibiotic (Cipro) and high dose Motrin with some success. We then tried Avodart in an effort to prevent cancer (chemoprevention) without luck. I had 3 biopsies over the years, and a few urine analyses here and there (urinalysis never found anything).

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
Start hytrin for blood pressure control; drug also provides some BPH relief

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
Urologist thinks PSA is elevated from BPH

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

24 Feb 2006
Pre surgical CT scan of pelvis and abdomen, and whole body bone scan. No mets evident. However, it looks like my shoulders are starting to wear out! (Degenerative changes in both AC joints showed up in bone scan). Plus a bulging disk in my spine at L5-S1.

17 March 2006
Pre-surgical chest x-ray is normal.

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
Prostate was 22.5 grams
Bundles on both sides were preserved.
stage t2c NX MX

24 April 2006
Catheter out

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 late 2008. Note from radiation oncologist to urologist: looks like assumption of local-only recurrence was valid, judging by PSA response.

blood draw

2008-11-05T15:49:00.003-07:00

Had blood drawn yesterday. Figured a lot of people would be at the polls--seems to have paid off. There was only one person ahead of me.

Now the dilemma that many of us face--to call the office or wait and get it in person? I usually can't stand the wait, and call. One time a nurse gave me an incorrect figure over the phone, leaving out the "less than", even when I questioned her..so I was needlessly anxious. That's the risk of getting it over the phone.

Reading "The Prize" by Daniel Yergin now. Recommended by a college professor I know. It's an enormous book, but so far very readable. It's about oil, in case you're wondering.

I'll post my PSA--which will be 20 months post-salvage radiation--as soon as I find out.

Wish I could skip the DRE...

Miscellaneous

2008-10-28T09:42:00.003-07:00

I ran in a local 10K (6.2 miles) event the other day. It's the first time I've run that far in years. I did pretty well, relative to my own past performance. I was still in the back of the pack, but I ran 12-minute miles, much better than the 14 minute miles I had been running up until then. I really got out of shape from just before surgery up until last month.

I usually don't eat before a long run. I use an energy gel (Carb Boom) about 15 minutes before, and if I'm going to be running for an hour or more I take another one with me. They taste pretty good--like pie filling. They're made from fruit and are fairly low in sugar compared to other gels. Just enough of a boost to do the run without getting shaky, and no stomach upset as long as I drink some water with the gel.

After running, I make a recovery smoothie in the blender that has ingredients like this--varying depending on what's in the fridge:

half cup frozen blueberries
half cup frozen strawberries
Half a banana
Cup of pomegranate juice
Cup of plain yogurt or cup of low fat vanilla frozen yogurt
Whey protein powder
a few ice cubes

OR--once in a while I have an Egg McMuffin.

Current reading list:

Nothing to Be Frightened Of (Julian Barnes)
2nd Chance (James Patterson) (tip of the hat to David E)
Moby Dick
Six Easy Pieces (Richard Feynman)

nail biting time

2008-10-17T10:53:00.002-07:00

So I'm one month away from my next appointment with the radiation oncologist. Which means I'm less than three weeks away from the blood draw for the PSA.
I find myself Googling for anything about the effectiveness of salvage radiation that I haven't seen before. So far, nothing new.
When you look at the graphs, most men respond initially to salvage with a drop to 0.1 or below. However, for the next several years, people "fall off" the curve, moving out of the "percent progression-free" category.
Thus the return of PSA anxiety.

With luck, I'll have another "< 0.1" report and go back to living my life fairly normally for the next 6-12 months, depending on when the RO wants to see me again. And, as I've posted before, if that is the case, I plan on starting a shut down of this blog, to be complete upon the NEXT good PSA report.

I have developed a backup plan, however. If my PSA rises, I have identified a medical oncologist who specializes in prostate cancer at a leading NCI cancer center that happens to be in a nearby city. I've decided not to see the medical oncologist I consulted before. Nothing wrong with him, but he does not specialize in prostate cancer.

I feel great, and continue to train for a marathon in January.

Us Too University

2008-09-23T09:51:00.001-07:00

This looks interesting!
Us Too! University

"Us TOO International is proud to bring you a vitally important event featuring leading experts in the area of prostate cancer issues and treatments, sharing the most current information you and your loved ones NEED TO KNOW. Topics range from emerging treatments, comprehensive treatment and care, post-treatment issues and solutions, and clinical trials currently underway.

Us TOO University Tempe will take place Friday, November 7, 2008 from 4:30-10:00pm at The Buttes Resort by Marriot. There will be free parking avaiable, free refreshments, excellent door prizes and overflowing goody bags. The night will include exhibitors with products & services and will end with time to discuss and answer your questions...."

cholesterol

2008-08-07T13:27:00.002-07:00

One month on South Beach reduced my overall cholesterol 26% to 189. My other numbers, out of whack a few months ago, have fallen into place as well--triglycerides, HDL, LDL, glucose.

However, my white blood cell count remains low at 2.2 (normal range 4-11). My primary care doctor is not concerned. Not sure if I should be. Nothing else looks strange, although absolute neutrophils are slightly low.