Planning Begins

I met with my oncologist today and got started with planning the treatment for my metastatic prostate cancer (PC). We went through the history of different treatments, the current status of my PC, and the rationale for the planned treatment. The first move is to get started on an androgen deprivation therapy (ADT) drug, which in my case will be Orgovyx, a daily pill, no injections or infusions. That will start in January. At this time there are no other drugs and no chemo in the plan. The small PC lesion on my right femur may be a candidate for obliteration by radiation. The radiation oncologist will have to determine the feasibility of this. If it's possible it would happen after two months on Orgovyx.  

Back in 2010 I was on ADT (Lupron) for 9 months and it wasn't pleasant. The drug itself is not problematic, and it did it's job well. The problem is that the mission of all ADT drugs is to shut down production of testosterone, and without testosterone things can get miserable. The best defense for me is to stay active, walk regularly, and do weight bearing exercises. I've been lazy for a few weeks but I'll get a new regimen going next week. This is a challenge given the other disabilities I've acquired over the years. Upper body exercise is bounded by natural "you're getting older" damage to my left shoulder and permanent damage to nerves and muscles on my right chest due to surgery in 2018. Exercises like pushups and lat pull downs would only make things worse. Long walks are a challenge due to hip tendonitis on both sides. I'll have to get creative with this because I'll be on Orgovyx for two years. I'm looking for a balance of things that work and are interesting enough to make me want to do them. 

Because you're reading this you've probably already seen my book. Unlike this blog, which is updated frequently, the book doesn't change and it's unlikely that you visit that site or think much about the book. Please go back and have a look at that web site. Renew your understanding of it's purpose and send a link to your friends and colleagues. You are the promoters. I have to leave it up to you because I'm tapped out on this and frankly do not have enough time and energy to work on it. I'm in fact the guy with eight cancers and I'm pretty damn busy just trying to survive. If you have any thoughts about this feel free to contact me directly. 

Tomorrow is Christmas, a big holiday in the US and important to Christians all around the world. This year it is also the first day of Hanukkah, which is important Jews in the US and all around the world. Best wishes to everyone! I think we can all use a day of peace and community.  

 

The Wait Is Over

Yesterday I secured an appointment with my medical oncologist for the morning of December 24. According to him the bone lesion on the femur is almost certainly prostate cancer. The most appropriate treatment for the PC at this time will be androgen deprivation therapy (ADT). The actual drug or combination of drugs remains to be seen, but I'll know next week.

A different doc who is an expert in mesothelioma ordered a bone biopsy for a lesion on the iliac crest, a specific part of the pelvic bone. All four doctors want to know what it is. They say it's unlikely to be mesothelioma, but you never know. That's not scheduled yet but it will probably happen within a few weeks.

Nobody wants to touch the lesion on the spleen. It's hard to biopsy and may bleed. At present the idea is to monitor it. It's all a little frightening, but it's good to have a plan.

Still Waiting...

I had the PSMA PET/CT on December 5, as planned. Three days later I was able to see the results. The prostate cancer (PC) has spread but not extensively. It has reappeared in the prostate gland. The small lesion on the femur is PC. The lesion on the pelvic bone is not PC and so remains a mystery. The spleen is also a mystery. There is no guidance yet as to how to proceed.

Why no guidance? So far no doctor has contacted me about the scan. Yesterday I made a call to see what's happening. I had a chat with an admin and then received a call from the radiation oncologist. It sounded like he hadn't seen the results until just before he called me and went through it. 

The back story is that there are four doctors in the communications loop, each of them a specialist in different but overlapping fields. They are looking at two different cancers and two unknown lesions. They have been in touch with each other but I think someone may have dropped the ball on following up with me, the patient. I politely triggered one doc to step into this yesterday. He's now requesting that the cancer oncologist meet with me ASAP. Everyone else will be copied on that message. 

Oddly, I'm not upset about this. I kind of wish the whole thing would just go away, so this period of inaction is welcome. But I know that things are going to get busy in 2025.

Hurry Up And Wait

Last week, the day before Thanksgiving, I met with my radiation oncologist. The rise in PSA since the last treatment did not cause undue alarm. However, it’s likely that the disease has spread to other locations. Tomorrow I’ll have a PSMA PET/CT to look for those other locations. Small lesions on the femur and pelvis are suspects. The lesion on the spleen is probably something else. Future PC treatments will have to be hormones or drugs. Now that the cat is out of the bag the pinpoint radiation treatment will no longer be effective to contain the disease.

The doctor who treated my peritoneal mesothelioma in 2014 recently retired, so I met with his replacement yesterday to talk about the lesion on the spleen and what it’s cause might be. He said that there are many possibilities (some of them benign) and the return of mesothelioma is not a favored diagnosis, nor is PC. Tomorrow’s imaging study should show definitively whether the lesion is caused by PC. If not, his approach will be a very specific imaging test to better define the spleen problem. Unless something specific is discovered, the plan will be regular images to monitor the size of the lesion and the spleen. If it continues to grow then a biopsy is likely. Biopsy results would determine future actions. Interestingly, the doc described the spleen as a loose sack of hamburger. It’s highly vascular and a biopsy may cause bleeding that would require a surgical repair. If the lesion continues to expand, the risk is that it may rupture unexpectedly, which would require immediate attention due to the risk of bleeding out and dying.  

Summary: This is a step-by-step situation. I’m pleased that these doctors are in touch with each other and that all of them see all of the test results and images. I’ll post again when the PSMA PET/CT results are in.