Possible Strategies For Dealing With My Personal Prostate Cancer Challenge

I saw my radiation oncologist as planned and we discussed the likely scenarios as to how the PC spread. It's worth noting that the radiation treatment (5 sessions of SBRT) in late 2022 appears to have been very effective. There is no sign of PC in the area treated. This suggests that some PC cells left the gland prior to that treatment and lodged themselves elsewhere. They didn't show up on the scans from 2022 because there were likely very few cells that had migrated and thus they were below the detection limit of the scanner. Over time that small number can grow and the PC becomes evident.

Today the PC cells are visible in one para aortic lymph node, but that doesn't mean there are no other locations. They could be anywhere, but again, at too low of a number to detect.

We moved on to possible treatments. One option is androgen deprivation therapy (ADT). This blocks the production of testosterone, a hormone thought to support the PC growth. The benefit of this approach is that it is systemic and it would starve PC cells anywhere in the body. Unfortunately this treatment has extensive side effects including loss of bone density, loss of muscle mass, fatigue, and a complete lack of libido. I experienced this once for about 6 months and it was awful. Often this treatment stops working after a few years. So it can create a period of time when you are not growing any PC but your quality of life is diminished during that time. If/when the PC returns then you're off to some other therapy, maybe, or you succumb to the PC. 

Another option is more radiation therapy, and it breaks down to two approaches. The first is to blast the single lymph node known to be cancerous. This requires 5 sessions in the treatment machine. The second is to blast a whole group of nodes in the same area, the thought being that one or more of them may contain PC cells (too few to detect) so you blast them all with the hope of nipping it in the bud. This requires 28 sessions in the treatment machine. Side effects would be more pronounced than the single lymph node approach. With either approach, it's possible that there are PC cells elsewhere in the body so the radiation therapy may simply fail. It may be possible to switch to ADT at that time but it's not clear if that would be effective. 

My next step is to meet with the medical oncologist who would be handling the ADT therapy and get his views on this. And finally, I need to check with two different surgeons who have treated me for mesothelioma (chest and abdomen) and see if there are any conflicts with the proposed PC treatments. I have to watch my back on this. Given the long history of cancer and treatments and the damage some of them has done, I can't assume that everything is compatible when in fact there may be a conflict that is counterproductive. 

This is the information I have to inform making a decision. There are a lot of unknowns. 

 

Prostate Cancer Problem

PC is yet another problem that won't go away. Since I last posted about this I've spoken with my radiation oncology nurse and received some clarification of what the imaging test shows. I previously mentioned that there was a troubling spot outside of the gland itself, but also that it has not changed in two years. That was an incorrect self interpretation. There is a new spot outside of the gland in what appears to be a para aortic lymph node. This almost certainly means that the PC has escaped from the prostate gland. This changes everything and reduces the number of potential treatments. I have an idea about where this is going and I'm not happy about it. I'll see the doctor on Wednesday to get the full story and the suggested course of action. 

Lease Renewed!

I just came home from a follow up visit with one of my doctors. The CT scan done early this morning shows no signs of change or disease progression of any kind in the chest or abdomen. This covers mesothelioma, kidney cancer, lung cancer (all of which have been treated) and any other organ that might look suspicious. Whew. 

Results from the PSMA PET-CT performed two days ago are more difficult for me to interpret. This test was done to identify the source of rising PSA after treatment for prostate cancer. It appears as though the radiation therapy performed in 2022 was effective. However, there is one spot just outside of the gland that is suspicious. It hasn't changed in 2 years but the focus will likely shift to that area because there is no other "suspect" for the rising PSA and that area was not within the treatment zone. I expect to hear from my radiation oncologist next week. I am not out of the woods yet.

Prostate Cancer Recurrence Knocking At The Door

I mentioned back in February that there is a disturbing trend in my PSA levels. This is after two radiation treatments (2010, 2022) and one six month Lupron treatment (2010). A recent test confirms rising PSA (I saw it online right away) and I immediately received a call from my radiation oncology nurse. I'm scheduled next week for a PET-CT to try to determine where the problem is. I won't have any insight until I discuss the results with my radiation oncologist. 

Two days after the PET-CT I have another CT follow up from pelvis to neck. This happens every six months to monitor any invaders in my chest and abdomen. Previous invaders include kidney cancer, lung cancer, and mesothelioma. I call it my six-month-lease-renewal. So there's a lot on the line next week. I can't predict the results so I'll hang tight and use the time to think through some of the challenges I may be facing.