Monday, July 31, 2017

Wouldn't It Be Nice; A Whimsical Diversion

 An extremely frustrating aspect of a PCa diagnosis has been the lack of consensus among the recognized experts. Most all practitioners including urologists, radiologists (a diverse group unto themselves), medical oncologists and a variety of surgeons appear to regard us as an ideal candidate for their area of expertise. Too often we PCa warriors rely on the first specialist we encounter or equally worrisome we research our options to the best of our ability and base our decision on woefully incomplete data. Either way it's a crap shoot. For the life of me (said with tongue only partly in cheek), I can think of no other affliction where the treatment choice is so problematic. 
 A couple of months ago the TV program "Sixty Minutes" covered a potential solution to our dilemma. The show covered a cancer center located at the University of North Carolina where a team of experts develop treatment plans for cancer patients who have failed standard therapy using the computerized Watson System of Artificial Intelligence. AI capability enables the team to formulate more effective plans based on all the medical literature published world wide including up-to-date clinical trial data.
Wouldn't it be nice if one institute or another with Watson AI capability focused on prostate cancer? Us PCa warriors can only hope.

To view a transcript of the Sixty Minutes segment; see:   

Thursday, April 20, 2017

Back on Track with Hormone Lite/Xtandi

Over the past year my PSA has risen slowly but surely from .11 to .76. As any reader of this journal knows, I searched long and hard for a solution with a high likelihood of success with minimal side effects. Rightly or wrongly throughout my ordeal I have placed a premium on preserving quality of life. To my way of thinking a cure would be most welcome, but the risk involved has inevitably tended to over shadow the desired outcome. Its been a crapshoot from the outset and that has never changed.
At this juncture I am pleased to report that after being on xtandi for only three weeks my PSA has dropped back to .11.The predominant side effect of fatigue has materialized as expected. In my case this means after two hours of tennis doubles three days a week I tend to fall asleep in the evenings while attempting to catch up on my reading or watching a sporting event on TV. Short story abbreviated to the max, I am satisfied with my results thus far. A brief but pertinent Patient Portal exchange with Dr. Myers appears below:
Pt.
 Assuming xtandi proves effective as indicated by my monthly blood draws, how long do you expect this medication to control the progression of my PCa?
Dr. Myers
 IT MIGHT WORK FOR YEARS OR AS SHORT AS 6 MONTHS
 
Stay tuned

Sunday, March 12, 2017

Serendipitous Contacts Transform the Treatment Plan

The following exchange of emails is self explanatory:
To Dr.Myers:
"As per your request, I consulted with a specialist at Univ. of Mich. who performs all of the hospital's prostate cryosugeries. He advised me that his outcomes parallel the national norms as outlined below:
--A cure rate of 50% as indicated by a PSA less than 1.0
--100% erectile dysfunction (the procedure destroys the enabling nerve system)
--5% stress related incontinence
--1% fistula
In a subsequent exchange of emails, a patient of yours and a friend of mine, informed me that he has been on xtandi for nine months. He expressed complete satisfaction with his results to date. His only side effect  is fatigue which he counteracts with a daily nap.
At one point you were prepared to put me on xtandi, but decided otherwise based on the fatigue factor. Although xtandi may not offer the prospect of a cure as does cryosurgery my personal preference would be to initiate what you at one time labeled Hormone Lite (Xtandi). Can we reconsider this option?"
From Dr. Myers:
"Yes, I will send a script".
 
I implemented the new protocol on March 11.
Stay tuned.

Friday, January 27, 2017

Approaching the Slippery Slope

 
 I have devoted considerable time and effort attempting to identify a safe and effective means to control or eliminate my recurrent PCa. I outlined the history of this endeavor in my previous journal entry. I have tentatively decided on the following ADT protocol recommended by a medical oncologist I consulted at the University of Michigan : Intermittent three-month-duration Lupron injections to be administered each time my PSA rises to 7.0. My current PSA is .60. His educated guess is it will take two years before the first injection will be needed. In the meantime, as per his recommendation, I will continue on Casodex as prescribed by Dr. Myers.
Up to this point I have avoided Lupron like the veritable plague. I first learned of  ADT researching options  following  my diagnosis in 2008. The known side effects are "off-putting" to say the least. It's a bit difficult to fathom at this point, but Lupron appears to be my best choice. For more perspective in this regard I have included a rough draft of a journal entry that I chose not to use until now: see below:
"ADT is a form of medical castration. It is designed to do many of the same things as surgical castration (orchiectomy). It is associated with a range of side effects that many men find to be highly delibitating and emotionally devastating, including loss of libido, loss of sexual function, genital shrinkage, hot flashes, weight gain, loss of bone mass, "Lupron Brain"(difficulty in concentrating, clarity of thought, memory loss, etc.) enlargement of the breasts and other symptoms of gynecomastia, and a long list of less common problems. This is not a form of therapy I would wish on anyone if it could be avoided. ADT on its own is not curative and has never been established to extend the survival of men with advanced prostate cancer. It is a palliative form of care whose primary function is to minimize the risk of bone pain associated with advanced prostate cancer. Many clinicians believe that all too many men with progressive prostate cancer are treated much too early with ADT because it can be used to manage the patient's PSA level. However overly early use of ADT is also associated with risk for early onset of castration-resistant prostate cancer. ADT  has shown to have a survival benefit only when used in combination with external beam radiation therapy for men with locally advanced prostate cancer (and to have a curative impact in some of these patients)."
Stay tuned.

Tuesday, January 3, 2017

Disease Progression and Treatment Synopsis

2005 to 2008  PSA  rose from 1.39 ( Apr. 8) to 3.97 ( Sept. 4 )
2008 Diagnosed with PCa. Two cores positive, Gleason 4+3
2009 Completed PBRT at UFPTI on March 11  PSA  dropped to .8. UFPTI reviewed my biopsy slide and agreed with Gleason 4+3 determination
2012  PSA  rose from .8 to 2.59 from May to Oct.; Dr. Kwon of Mayo Clinic  identified a small cancerous lesion in  prostate by Choline Scan. Mayo Clinic reviewed  my biopsy slide and determined my Gleason to be 4+4 
2013  Began Hormone Lite as prescribed by Dr. Charles Myers; see below:
  I. Prescription Drugs
    A. Metformin 500 MG 2 daily. Anti-cancer
    B. Avodart .5 MG 3 a week. Anti-cancer
    C. Casodex 50 MG 1 daily. Anti-cancer
    D. Zocor 10 MG 1 daily. Anti-cancer
    E. Losartan 50 MG 1 daily. Blood pressure.
 II. Supplements
    A. Pomegranate 1 daily 10 MG. Anti-cancer
    B. Vitamin  B12 1000mcg
    C. Vitamin D3 5000 IU 2 daily. Restore deficiency
    D. Super Bio-Curcumin 400 MG 1 daily. Anti-inflammatory
    E. Optmized Resveratol 250 MG 1 daily. Anti-inflammatory
  III.  Mediterranean Diet
2015
  I.PSAs rose from .077 in Jan. to .18 in Aug. Dr. Myers increased my Casodex  from three times weekly to a daily dosage. PSAs returned to their former lower levels.
  II. Endorectal MRI at VCU; 3x5 mm tumor identified
2016  PSAs ascend from .11 in Apr to .49 in Dec. Follow-up endorectal MRI at VCU; tumor more than doubled in size to 10x7 mm .
I have considered several options the past few weeks including Pencil beam PBRT, cyberknife, prostatectomy, brachytherapy, focal beam ablation, cryotherapy , Hi Fu, modified hormone lite, full blown hormone therapy and chemotherapy. The first seven options have been pretty much eliminated each for a different reason. More recently an advisor recommended estrogen therapy which looks promising at least for a temporary period (a year or so?)
Major changes under consideration; too early and too fluid to document.
Stay tuned.

Monday, October 31, 2016

Hormone Lite Loses Its Mo Jo: Quality of Life In the Crosshairs

Over the past few months my PSA has risen incrementally as shown below:
April   .11
May   .18
June  .24
July   .29
Aug.  .38
Sept. .38
Oct.   .39
In response to these numbers Dr. Myers and I discussed several options via the Patient Portal including radiation, surgery, full blown hormonal therapy (I. e., complete suppression of testosterone along with its concomitant adverse side effects) and modification of Hormone Lite by substituting xtandi for casodex. We agreed on the latter, but decided to postpone action to monitor my PSAs awhile longer.
I pondered this discussion over the next few days and returned to the Patient Portal  to raise a few related concerns. I advised Dr. Myers it would give me peace of mind if I knew whether he had guidelines in mind as to when action may be indicated. More specifically I posed the following questions: (1) Will we wait until my PSA reaches a certain level? (2) If so what might that number be? (3) Is the speed of ascension a determinate? As was his prerogative Dr. Myers chose not to respond. Rather than press him for answers via the internet, I elected to revisit these concerns at our upcoming annual appointment which occurred a few weeks later on October 26.
The planned informational exchange did not occur. Au contraire! I got blindsided and bushwhacked. The meeting began as usual. Initially a medical technician conducted a few routine tests, e. g., blood pressure, weight, temperature etc.  Dr. Myers' physician's assistant continued with a few routine preliminaries. Out of the blue she dropped the following bombshell: "It would appear the casodex has ceased to control the progression of your PCa. It is also conceivable that the casodex has begun to nourish the cancer. She continued  with the following barrage: "You might wish to consider Cyberknife  intervention. There is a physician in California who has demonstrated considerable success with this technique." Her frontal attacks were subsequently supported by Dr. Myers who added the option of  PBRT. While xtandi and full blown hormone therapy should remain in the mix, Dr. Myers wanted me to understand, both of these options harbored the risk of castration resistance resulting in a painfully slow, agonizing death. In any event before deciding on a course of action Dr. Myers and his PA agreed a follow up endorectal MRI was an essential prerequisite.  Dr. Myers urged me to have this procedure performed by VCU in Richmond Virginia since it was this clinic who provided the "benchmark" examination two years ago. 
So there you have it. The tumultuous journey is back on track with a vengeance. The endorectal MRI is scheduled for November 12th at VCU. Stay tuned.

Monday, September 12, 2016

Update on Radiation Treatment for Gynecomestia

The following e-mail exchange is self-explanatory:

Patient
It's been seven weeks since the completion of my radiation treatment. My breast size and pain have subsided substantially. I am pleased with my progress to date and I appreciate the effort of the radiation oncology team.
My questions are as follows:
--How much longer can we reasonably expect further improvement?
--I expect to remain on Hormone Therapy, which precipitated my gynecomestia, for evermore. After my improvement has reached its maximum  will my breast size and pain begin to reoccur?
--What can I expect in the long term, let's say, in the next three to five years.
 
Treatment Team Representative
  You can continue to have improvement for several more months.  The symptoms should not recur with continued hormone therapy – the radiation kills the cells in the area that are sensitive to the unblocked estrogen.  Normal cells should be oblivious to the estrogen.  Hopefully, no new issues.  With this low dose, problems with delayed fibrosis are rare – in fact, I’ve not seen any.

Stay tuned.