Summation

It's getting difficult to follow all of these posts, isn't it? If you're a regular reader you've been taking a walk in my shoes. It's getting crazy because there are too many things happening at the same time. Here's a summation of where I'm at right now.

1. The basal cell carcinoma was removed from scalp, leaving a large wound that required a skin graft. The donor site was my right clavicle. The graft seems to be working and the donor site is healing nicely. That should be the end of this specific issue.
2. I've been taking Orgovyx for about 10 days. The idea of using estrogen to counteract some of the dangerous side effects of Orgovyx is not supported by my oncologist. He said there is not enough data to recommend its use and he wants to stick with Orgovyx for a while to see how well it works before adding anything else. Makes sense. 
3. The bone lesion on my femur has been identified as prostate cancer and radiation therapy has been scheduled to treat it. The treatment consists of 1 setup appointment (scheduled for mid-February) and 5 sessions in the radiation machine (scheduled for the first half of March). This treatment will not be curative, so I guess you would call it palliative care; treatment of a symptom, not the disease that caused the symptom. This could be a little more complicated with PC, because these treatments may extend my life as well eliminate some symptoms. Time will tell. 
4. In late December four doctors decided that the mysterious bone lesion on my pelvis should be biopsied. This hasn't happened and I haven't been able to get an answer as to why it's not happening.  Today I was told that the group that does these biopsies, Interventional Radiology (IR) is so heavily booked that they have been unable to schedule this procedure. My surgeon's PA has promised to follow up on this and see if she can get me into the IR schedule. This is my fourth attempt to get answers. It's not that I'm eager to have a surgical procedure; I do what the doctors recommend. I just want answers to pin down loose ends. 

There are other active issues, but the PC and mesothelioma and unknown lesions on my pelvis and my spleen are my biggest concerns.

Last minute update on #4: An hour after I posted this I received a call from my surgeon's PA. Based on their experience, the IR team does not agree that this lesion should be biopsied. It is not indicative of cancer and the correct approach is to monitor it. They spoke with the surgeon who ordered the procedure and he agreed. One less thing for me to do! But where did that story of "so heavily booked" come from?

 

First Dose of Orgovyx - Prostate Cancer Treatment Has Begun

I took my first dose of Orgovyx, an androgen deprivation therapy (ADT) drug, on Friday, January 10th. It is known to kick in fast, and indeed, it has kicked in fast. The current plan is for me to take Orgovyx for two years and just deal with the side effects. I'll have my first follow up with my oncologist in mid-February to see how this is working out.

There are some newer ways to counteract a lot of the dangerous side effects of ADT. Do you know that men produce estrogen, a hormone that is generally associated with women? The concentration of estrogen in men is much lower than in women, but it's still essential for men. The purpose of ADT is to reduce testosterone, but it also reduces estrogen production. Lack of estrogen is the culprit behind many of the ADT side effects. There is now solid evidence that estrogen replacement during ADT mitigates those side effects and results in improved overall health and quality of life. This does not have any impact on the efficacy of ADT. This has been confirmed in clinical trials. There is no FDA approval for this use of estrogen, though it can be used "off label" and it's inexpensive if health insurance won't pay for it. I'm checking with my oncologist to see if he will green-light this estrogen replacement strategy or explain to me why it's a bad idea.

The most common side effect for men using estrogen is gynecomastia, the growth of boobs (sometimes known as "man boobs," which is fairly common in older men; just go to the beach and look around). If I can get onto this therapy and I grow some boobs, I think I can handle it. But no staring! ; )

Basal Cell Carcinoma Removed From Head

Yesterday I had a basal cell carcinoma BCC) removed from the top of my head. The procedure was done using a process called Mohs surgery. The surgeon takes as little skin as possible. The part that is excised goes to a lab immediately and they look to see if the margins are clear of the BCC. It only took two excisions, but the whole process took four hours because it takes time to prepare the excised skin for analysis. When the margins are clear, a decision is made about how to close the wound. In this case it could be natural healing, but the wound is about the size of a half dollar. It would take 3 to 6 months before the wound fully heals. We decided to do a graft instead, with donor skin taken from the clavicle area. Sadly, this will not happen until next Wednesday, but the upside is that the graft should be healed in a month. Right now I have a very bulky pressure bandage on my head. It looks weird, but I can cover it with a hat when I go out. 

It's worth mentioning that the entire procedure was pain free, with the exception that I felt the needle used to inject the local anesthetic. Minor pain for a few seconds. Later, at night, I felt the wound throbbing. Tylenol took care of that. No problems this morning.