countdown

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

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

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

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

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

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

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

Stand By Me from Mike Yates on Vimeo.

How to Estimate Your Prostate Cancer Cure Odds

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

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)

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

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

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

The Question

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 Radiation: Nomogram updates

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

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

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!

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.