(1) Any number under 1.5 is good.
(2) It is time for concern only when a patient experiences consecutive rises of at least two points.
October's result will undoubtedly be better. Right? Right.
Saturday, October 13, 2012
Another Bump in the Road?
.My most recent PSA registered a disappointing 1.27 an increase of .47. I wish it were lower, but it is too soon to panic. I have experienced minor blips before, and hopefully, this too will be nothing more than a minuscule bump in the road. I remain mindful of the following two UFPTI post-treatment standards:
Wednesday, October 10, 2012
Colonoscopy Surprise Research Completed
Dr. A.N. Swer's response took the edge off my worry and concern. His final words of advice "Don't worry" support the gist of my additional research, a summary of which appears below:
(1)Bob Marckini
"The condition you describe is very common. It is a phenomenon called radiation induced neovascularization. New blood vessels form in the small area of the anterior wall of the rectum... in general it's nothing to be concerened about. The good news is that they intentionally treated a margin around your prostrate. This serves to kill the cancer that is in the margins. This includes any prostate cancer that might have been in the margins. Having an invisible scar is a small price to pay."
(2) UFPTI
The physician who planned and supervised my care at UFPTI responded to a letter outlining my concerns as depicted below:
(A) We refer to the condition you describe as radiation scarring---not damage.
(B) This condition is unlikely to progress.
(C)Be certain not to let anyone biopsy the affected area.
This message was delivered over the phone by his nurse.
(3)An Interactive Proton Radiation Website
This site provided a wide range of reponses. Perhaps the following two were the most relevant and the most diverse:
(A) "Based upon the fact that you were competently counseled based upon prior entries to your blog, and based upon your review and knowledge of the precise relevant passage of Marckini's book, I cannot imagine why you feel justified in saying evidence of radiation damage is a surprise."
(B) "Thanks for your post and your compelling blog which gives a guy like me a glimpse of one patient's real world post-protion treatment ups and downs. "
Case closed. The bottom line is that had I been prepared for the striking difference in the pretreatment/posttreatment colonscopy photographs, there would have been far less handwringing, agony, worry and concern.Hopefully the readers of this journal will be spared these emotions.
Friday, August 24, 2012
Post Treatment Colonoscopy: An Update
.
As reported in my previous entry, proton radiation permanently damaged a small segment of my colon. This diagnosis triggered an immediate research effort on my part. I am particularly interested in its long term implications. My research is incomplete and ongoing. In view of the potential interest to others, however, I feel compelled to file this interim report based exclusively on the opinions of Dr. A. N. Swer.
Dr. Swer is a practising physician with a Phd. in microbiology from Harvard University. His specialty is nuclear medicene. His interest in prostate cancer and proton therapy has been augmented by personal experience with both. Based on a photograph posted on the internet Dr. Swer's colon looks a lot like mine. In response to several of my concerns, Dr. Swer opined, in part, as follows:
"I would consider angiodysplasia to be the word for the tissue changes that are associated with radiation proctitis. Since the procedure that cured my bleeding, I have not worried about my angiodysplasia (which is likely worse than yours). My bleeding didn't start until many months after the treatment though I imagine that a great many men who have had photon or proton radiation for Pca have angiodysplasia of one degree or another and one pattern or another, with or without problems from it. I haven't seen a publication documenting this, however, I think it would be quite interesting ... I can't guarantee that you will never bleed, but also my guess is that area will never heal..."
"Radiation for Pca likely creates a small increase in the risk of cancer in tissues that it doesn't kill, including but not limited to the adjacent bowel. The overall increase is probably lower with proton than with photon therapy. That consideration goes in the plus column for choosing protons...
In short, I think your gastroenterologist is right on target, including scheduling you for follow-up colonoscopy; and my final word of advice, for what it's worth is: Don't worry."
Dr. Swer's expert opinion may not qualify as the clean"Bill of Health" I may have hoped for , but
it is not the proverbial "Kiss of Death" it could have been. More specifically my worst fears have been substantially amelioriated.In retrospect at this juncture the worst part of my colonoscopy mini-adventure is the complete absence of any expectation of permanent colon damage. None of my research before, during or after treatment prepared me for this outcome.
As reported in my previous entry, proton radiation permanently damaged a small segment of my colon. This diagnosis triggered an immediate research effort on my part. I am particularly interested in its long term implications. My research is incomplete and ongoing. In view of the potential interest to others, however, I feel compelled to file this interim report based exclusively on the opinions of Dr. A. N. Swer.
Dr. Swer is a practising physician with a Phd. in microbiology from Harvard University. His specialty is nuclear medicene. His interest in prostate cancer and proton therapy has been augmented by personal experience with both. Based on a photograph posted on the internet Dr. Swer's colon looks a lot like mine. In response to several of my concerns, Dr. Swer opined, in part, as follows:
"I would consider angiodysplasia to be the word for the tissue changes that are associated with radiation proctitis. Since the procedure that cured my bleeding, I have not worried about my angiodysplasia (which is likely worse than yours). My bleeding didn't start until many months after the treatment though I imagine that a great many men who have had photon or proton radiation for Pca have angiodysplasia of one degree or another and one pattern or another, with or without problems from it. I haven't seen a publication documenting this, however, I think it would be quite interesting ... I can't guarantee that you will never bleed, but also my guess is that area will never heal..."
"Radiation for Pca likely creates a small increase in the risk of cancer in tissues that it doesn't kill, including but not limited to the adjacent bowel. The overall increase is probably lower with proton than with photon therapy. That consideration goes in the plus column for choosing protons...
In short, I think your gastroenterologist is right on target, including scheduling you for follow-up colonoscopy; and my final word of advice, for what it's worth is: Don't worry."
Dr. Swer's expert opinion may not qualify as the clean"Bill of Health" I may have hoped for , but
it is not the proverbial "Kiss of Death" it could have been. More specifically my worst fears have been substantially amelioriated.In retrospect at this juncture the worst part of my colonoscopy mini-adventure is the complete absence of any expectation of permanent colon damage. None of my research before, during or after treatment prepared me for this outcome.
Saturday, August 11, 2012
Post Treatment Colonoscopy A Good Outcome With A Few "Inconvenient" Surprises
My colonoscopy uncovered a precancerous polyp which my
physician removed as a matter of routine. This outcome was not unexpected,
since I had similar results with my two previous colonoscopies five years and
ten years hence. This was welcome news nonetheless because of the uncertainty
introduced by the intervening proton radiation.
Thanks to my wife and her conscientous record keeping, I was able to compare the photographs of my current colonoscopy with those taken in 2006. What I saw caused concern. Comparatively the current photographs showed substantially larger and considerably redder blood vessels. In two of the five photographs, it appeared as if bleeding had occured. Accordingly I contacted by physician; the phone discussion developed as follows:
Comment: Please explain the differences between the current photographs and those taken in 2006.
Response: What you see is the result of radiation. Such damage to the colon is concommitant to all forms of radiation.
Question: Is there a difference between the effects of proton radiation and photon radiation?
Response: In my 30 years of practise you are my first patient to have undergone proton radiation. I would say that comparatively speaking you have a considerably milder version of what I typically see.
Comment: Two of the photographs were particularly red; please elaborate.
Response: Those particular areas appeared atypical and required a degree of probing and compression; consequential bleeding occured. No doubt these areas have completely healed by now and should not be a concern to either of us at this point.
Question: How much of my colon has been damaged?
Response: A very small segment in the area of the prostate.
Question: What kind of problems can I expect in the future?
Response: Inasmuch as you have experienced no problems in the past, e.g., spontaneous bleeding, it is unlikely you will experience any problems in the future.
Question: Is the damage to my colon temporary or permanent?Thanks to my wife and her conscientous record keeping, I was able to compare the photographs of my current colonoscopy with those taken in 2006. What I saw caused concern. Comparatively the current photographs showed substantially larger and considerably redder blood vessels. In two of the five photographs, it appeared as if bleeding had occured. Accordingly I contacted by physician; the phone discussion developed as follows:
Comment: Please explain the differences between the current photographs and those taken in 2006.
Response: What you see is the result of radiation. Such damage to the colon is concommitant to all forms of radiation.
Question: Is there a difference between the effects of proton radiation and photon radiation?
Response: In my 30 years of practise you are my first patient to have undergone proton radiation. I would say that comparatively speaking you have a considerably milder version of what I typically see.
Comment: Two of the photographs were particularly red; please elaborate.
Response: Those particular areas appeared atypical and required a degree of probing and compression; consequential bleeding occured. No doubt these areas have completely healed by now and should not be a concern to either of us at this point.
Question: How much of my colon has been damaged?
Response: A very small segment in the area of the prostate.
Question: What kind of problems can I expect in the future?
Response: Inasmuch as you have experienced no problems in the past, e.g., spontaneous bleeding, it is unlikely you will experience any problems in the future.
Response: I would be very surprised if it looked much different when we reexamine five years from now. I do not expect further deterioration nor do I expect much improvement.
In conclusion I would say (1) There has been permanent damage to a small portion of my colon that I did not expect based on my (limited) research to date and (2) It may be something or it may be nothing. Perhaps this entry will generate enlightened comment.
Wednesday, July 25, 2012
Tumultuous Journey Smooths Out
.My post treatment two year anniversary PSA came in at .8. UFPTI considers any post treatment PSA under 1.5 as a positive sign. In retrospect over the past year and a half all six of my PSAs have been under this guideline. Hooray and hallelujah for a reassuring post treatment trend.
Sunday, July 15, 2012
Promising Turn of Events
Rather than continuing its upward trend, my PSA registered a
reassuring .8 this trimester. A second positive step occurred in my
recovery,i.e.,the total absence of colonic bleeding. The reader may recall 30%
of us who undergo proton radiation experience such bleeding. Needless to say I
am extremely pleased with these developments.
Other than routine PSA monitoring the next most notable milestone in my post treatment history will be a colonscopy which is overddue, but should take place next spring. In the meantime HAPPY HOLIDAYS!
.
Other than routine PSA monitoring the next most notable milestone in my post treatment history will be a colonscopy which is overddue, but should take place next spring. In the meantime HAPPY HOLIDAYS!
Thursday, June 14, 2012
Cause for Concern
My last five PSA results were as follows: Oct.2009, .55;
Dec. 2009, .9; March 2010, .8; June 2010, .83; Sept. 2010, 1,03. There appears
to be a modest trend in the WRONG DIRECTION! Accordingly I contacted UFPTI.
"Not-to-worry," as goes my interpretation of their response,
"we do not believe cause for concern exists until a patient experiences consecutive rises in their PSA of at least 2 points. This would mean a rise of 4 points over a 6 month period. My modest, inconsistent elevation over the past 12 months seems inconsequential when compared to this standard. Even so, I would prefer that my PSAs trended downward, not upward.
."we do not believe cause for concern exists until a patient experiences consecutive rises in their PSA of at least 2 points. This would mean a rise of 4 points over a 6 month period. My modest, inconsistent elevation over the past 12 months seems inconsequential when compared to this standard. Even so, I would prefer that my PSAs trended downward, not upward.
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