I met with the urologist this afternoon to go over my most recent PSA test results and the plan going forward. In a nutshell, we agreed to remain in limbo for another three months and retest the PSA in January and consider a PSMA PET scan if warranted at that point. (She was a bit skeptical that the PSMA PET scan would be conclusive even at my current PSA of 0.69 ng/mL.)
The urologist thought it was a little premature to start talking about androgen deprivation therapy, but recognized that that’s the next likely step down this path. I mentioned that, when I met with the urologist and medical oncologist in February, one suggested ADT at metastases and the other suggested starting at a PSA of 2.0 ng/mL. She said she could understand both positions.
Bottom line is that I continue to be in this sort of “no man’s land” of prostate cancer. We know it’s there; we just don’t know where, and we don’t want to pull the trigger on ADT prematurely. So more waiting.
One other thing that we discussed was radiation proctitis.
Graphic Biology Ahead
I’ve been sitting on this little tidbit for a while now, but I’ve been noticing blood in my stools. It initially appeared as spots a little smaller than a dime coin (~ 1 cm) but, over time, it has subsided to a small streak or a hint of blood. You know me: I had to create a spreadsheet to track it, and it’s been occurring in about ten percent of my bowel movements. That makes me feel better that it isn’t happening each and every time—that might indicate a larger problem if it were happening every time.
Fortunately, I haven’t had the diarrhea or mucus discharge that can come with more severe cases of radiation proctitis.
I mentioned this to my primary care physician during my appointment on 4 November, too. Both he and the urologist recommended a colonoscopy to check out what’s really going on. That joyful experience is scheduled for Friday, 22 November. Yippee!
I did come across this continuing education paper that gives a good overview if you’re really interested in learning more:
So the journey continues. Stay tuned for the next installment.
Header image: San Diego skyline and Mission Bay from Kate Sessions Memorial Park
Dan's Journey through Prostate Cancer 
Hi Dan. Yep, that’s exactly where I’m parked. And I’m getting exactly the same messages over here. Not an easy place to be! I have my next psa in two weeks, my most recent was 0.60. My prostate team tell me my consultant isn’t interested in talking to me until my psa hits 2.0 “ go grow a proper tumour” is how it feels!
Take care, Adrian
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Hi Adrian,
Great to hear from you again! Not great that we’re in the same boat going through the same trials and tribulations. Sorry to hear that.
I guess it’s also good to see that the approaches to our status are the same. It provides reassurance that our doctors are aligned in the standard of care.
Wishing you all the best,
Dan
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Always informative Dan and well worth the read. Keep on doing your good work!
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Thanks, Charles.
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I just recently moved into BCR land this year (12 years post radiation). We did the PET scan and found nothing so I’m in the waiting game. My uro wants to check PSA every six months. I’ve had radiation proctitis and bleeding was one of my early symptoms. I had the colonoscopy and they found nothing worrying. They did do a little cauterizing of something. I still get bleeding from time to time, but it’s associated with anal fissures, an internal hemorrhoid and not the proctitis. Here’s hoping for a simple cause for it.
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Hi Andrew,
Sorry to hear that you’re in BCR land after so long after treatment. That sucks.
Your insights on your own radiation proctitis are helpful. Thanks! I figured that, because my incidents are so infrequent and relatively insignificant, it’s just another nuisance side effect that I’ll have to keep an eye on. Hopefully, the colonoscopy confirms that next week.
I have to admit that I’m a tad concerned that the actual puffing up my innards and shoving a camera up there may cause damage that wasn’t there before the colonoscopy, so I’m going to make those concerns well known to the team before they knock me out.
Thanks again for sharing and I wish you well on your BCR journey.
Dan
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Do make sure GI knows about your radiation treatment. When I had mine done I told the doc and they were able to take extra care. My GI also said he’d look carefully in that area that normally is affected by radiation.
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Is part of the dilemma on ADT the fact that going on it precludes the potential of finding (via PSMA scan) and zapping the cancer?
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Hi Rob,
Yes, as I understand things, that’s one of the concerns. If we drop the PSA using ADT, then finding the location using a PSMA PET scan becomes more challenging.
We also know that prostate cancer can become resistant to hormone therapy after extended use, so if we start ADT too early, that may lead to castration resistance earlier at a time when you need it most.
I hope with the next test in January, we can get a scan ordered and have a much better idea of what we’re dealing with. I wouldn’t rule out zapping again if it’s an option.
Thanks for following along and for the question.
Dan
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