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.

The Story So Far..

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

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

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


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


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

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

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

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

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

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

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

I'll let you know how it goes.