Month 122 – Doctor Consult

Last week, I completed my 63rd trip around the sun and had my appointment with my doctor. I tried arranging a tele-appointment, but that didn’t happen, so I had to go into the office for the visit.

I was brought back to the exam room by a staff member, and was told that they were running a bit behind schedule after a post-holiday surge. “No problem,” I said and pulled out my phone to do some mindless Internet surfing as I waited for the doctor to come in. About ten minutes later, the doctor rounded the corner and came through the door, and I’m thankful I was wearing a mask to help hide some of my reaction. (I’m sure my eyes and eyebrows betrayed me to a degree.)

It was Doogie Howser. (Photo from the hospital’s website.)

“Damn, I’m old,” I thought. Well, that, and he was really young. Both can be true. But, as the old adage says, you can’t judge a book by its cover.

Once we began talking, it was clear he was knowledgeable and had a great bedside manner. As predicted, we agreed that the wisest course of action right now, given my PSA level and my PSA doubling time is to continue to monitor. We’ll do this again with a PSA test in June and a follow-up appointment in early July. He was pretty emphatically against radiation. “If you were my brother or uncle, I’d tell you not to do it.” I chuckled at the concept of being his brother.

We also chatted about the PSMA imaging available at UCLA, and he was in the loop on that. He agreed that my PSA is too low for us to get a reliable result right now and also cautioned about false positive results. Right now, that imaging isn’t approved by the VA, so I would have to pay for it on my own if I had it (about $3,000 USD).

I have to admit that’s one thing that I like about having a younger doctor—they seem to be more current on the advances in the field than some of their older counterparts. I asked an older doctor about the PSMA imaging a year or two ago, and he barely had any idea of what I was talking about.

The appointment went just about as expected, so we’ll wait another 6 months and do it all over again.

Here’s hoping for a better 2021 for all of us!

P.S. Along those lines of a better 2021, because my office is in a hospital, I was able to get the first dose of the Pfizer COVID-19 vaccine last week. There were minimal side effects: a mildly sore injection site for about 36 hours and a bit of a headache later in the evening. Nothing bad at all. I go back to get the second dose at the end of January.

Month 121 – PSA Results

Well, I jumped the gun by a couple of weeks and had my latest PSA test done this past Tuesday. I was originally going to wait until the week before Christmas, but with all that’s going on, I decided to go a little early.

Let’s just say I received an early Christmas gift—my PSA dropped from 0.14 ng/ml to 0.13 ng/ml. I can’t explain it, but I’ll take it. It also bumps my PSA doubling time out to 67.7 months. I’ll take that, too.

My appointment with the doctor is on 5 January 2021, and I suspect that, just like the last one, it will be a telephone call rather than an in-person visit given all that’s going on with the pandemic. That’s fine by me. I suspect the conversation will go something like, “There’s no need for action. Let’s retest in another 6 months.”

I’ll have to admit that I psychologically prepared myself for a higher number—perhaps as high as 0.2 ng/ml—and I was a bit taken aback when I saw the results. In a good way, of course. It took a few seconds to reconcile the change in thinking.

All the best to everyone through the holidays and into the New Year! Steer clear of the ‘rona and stay well!

The epidemiology of prostate cancer (2003-2017) — THE “NEW” PROSTATE CANCER INFOLINK

A recent report in the CDC’s Morbidity and Mortality Weekly Report (MMWR) may offer one of the best analyses of an increasing risk for diagnosis with and death from advanced forms of prostate cancer over the period from 2003 to 2017 (the last year for which we have accurate data from the SEER database). There […]

The epidemiology of prostate cancer (2003-2017) — THE “NEW” PROSTATE CANCER INFOLINK

A Decade Living with Prostate Cancer

One decade. 522 weeks. 3,654 days. 87,696 hours.

That’s how long I’ve been living with prostate cancer since being diagnosed on 11 November 2010. Of course, the operative phrase is “living with.”

The diagnosis was terrifying. The treatment decision was excruciating and exhausting. The surgery recovery was longer than expected with some complications along the way. The long-term side effects have been what were advertised at the beginning.

On the positive side, there were 54 months of undetectable PSA results to indicate the surgery had done the trick. Or so we thought.

When my first detectable PSA test came in five years ago, I was even more terrified and panicked than when I was initially diagnosed. It meant that my first line of defense had failed. Now I had fewer options to control or rid me of the cancer available to me.

My doctors convinced me that there was no need for immediate panic and that we could and should monitor my PSA before considering any action. My PSA fluctuated up and down, but had a slow but steady upward trend.

As my PSA continued to climb—passing several markers that are normally used to consider starting salvage radiation therapy—I continued to do nothing. I’ve been pretty steadfast in my reluctance to start zapping without knowing where the cancer is, and even some of the best new imaging techniques won’t pick up the cancer at my PSA levels.

With a PSA doubling time of four years, I’m comfortable with that decision. Heck. I’m still here five years after that initial detectable PSA reading, and ten years after my initial diagnosis.

We may find out a little more about my future direction next month when I go for my next PSA test just before Christmas. As I’ve learned (albeit slowly) over the last decade, don’t get too worked up about the results until you have them in hand. It just doesn’t do any good to speculate about the unknown. January will tell me whether I can continue the status quo or it’s finally time to take action.


If you asked me ten years ago when I started this blog (to keep family and friends informed in my pre-Facebook days) that I would still be doing this ten years later, I would have said you’re nuts. But here I am.

I’ve tried to inform and educate others about prostate cancer along the way, and to give insights to the newly diagnosed as to what you may encounter two, three, five, or ten years down the road. All the guys I spoke with pre-surgery had, themselves, only been less than a year out from their own surgery date. They had no long-term post-surgery insights to offer to me.

I’ve tried to inject a little dose of reality to those who, just like me, gleefully declared themselves to be “cancer-free” after a few undetectable PSA tests. “Not so fast.” My story is a reminder that there can be unexpected plot twists, even in the later chapters.

Along the way, I’ve met some wonderfully supportive men who have been through their own journey—some just virtually and some in person. Sadly, three of them have lost their battle with prostate cancer and they’re sorely missed.

It’s been a decade of living with prostate cancer. Living with. Let’s hope that I’m still around to write the blog post, “Two Decades Living with Prostate Cancer.”

Month 119 – Sidewalk Consult & Travel Tales

Sidewalk Consult

A few weeks ago, I ran into the radiation oncologist that I spoke with a while back outside the hospital where we both work. We started chatting and he recalled our conversation in the office and asked how I was doing.

I filled him in on my latest PSA results (0.14 ng/ml) and my PSA doubling time (48.9 months), letting him know that we punted the ball down the field until December to see what the next PSA would be. I could tell from his reaction that he would have been less supportive of that call. His preference is to start zapping at 0.10 ng/ml. But he also went into the discussion about how each case is unique and how each patients has a different risk tolerance level.

We also talked about some of the longer term side effects of salvage radiation therapy, and he confirmed that some of my urinary incontinence and ED issues could worsen post-radiation.

His wife came to pick him up and the conversation ended. I do appreciate that he was willing to have the conversation at all, let alone off the clock.

As I said, the plan is to get my next PSA taken just before Christmas with the follow-up appointment scheduled 5 January 2021.

Travel Tales

A while back I was checking my pay statement and noticed I had over four weeks of vacation on the books, which surprised me to a degree. Of course, with a global pandemic, I really didn’t have any opportunity to travel with pretty much everything locked down here in the United States.

I decided, though, that it was time to go on a trip, pandemic be damned. It had been nearly a year since I went anywhere.

The best way to be responsible in my travels was to load my camera in my car and head to some remote locations in a few of our national and state parks. That’s what I did and I was able to very easily maintain social distance 90+% of the time.

So I took a trip into Utah to visit its national parks—four of which I had never been to before. You can check out the details and photos of the trip here:

Utah’s National Parks

Enjoy!

Month 117 – Running on Pandemic Time

Is it just me, or is anyone else having pandemic days all blend together and you lose track of time? Late last night (technically very early this morning as I was tossing and turning in bed around 2 a.m.), I realized, “Crap! I didn’t even think about posting on my blog, let alone write anything!”

So here I am on my advertised posting day with three hours and one minute left to get this out on the 11th, and I pretty much have nothing. Well, that’s not entirely true…

I did come across this article on The “New” Prostate Cancer Infolink that talks about PSA doubling times with respect to prostate cancer progression in men with non-metastatic castration resistant prostate cancer.

PSA doubling time and prognosis for men with nmCRPC

Unfortunately, they weren’t able to access the full study report, and the summary that’s provided is pretty high-level, restating the obvious: Shorter PSADT is associated with shorter metastasis-free survival and shorter overall survival.

One of the things that I discovered working in a hospital is that I can sometimes access research reports like this via its computer network. I’ll see if I can access this report to learn more details about the study and, if I can, I’ll share anything I learn.

Whew! Finished with time to spare. 🙂

Stay well and keep living the pandemic life as best and as safely you can wherever you happen to be.

COVID-19 and prostate cancer management — THE “NEW” PROSTATE CANCER INFOLINK

They’re looking for someone in the U.S. whose treatment has been impacted or delayed by COVID-19.

Do you live in the USA and believe that your prostate cancer care may have been seriously affected by the COVID-19 pandemic?

via COVID-19 and prostate cancer management — THE “NEW” PROSTATE CANCER INFOLINK

Month 116 – Cancer Treatment Decisions

One of my regular readers of this blog and I have amazingly similar stories when it comes to our diagnosis and treatment. We were both diagnosed around the same age, our PSA levels were quite close to each other, and we both opted for surgery. Both of us had undetectable PSAs well after the surgery—until we didn’t. His PSA became detectable around the three year point, and mine became detectable at a few months shy of five years.

He opted to begin salvage radiation therapy (SRT) along with androgen deprivation therapy (ADT) when his PSA hit 0.08 ng/ml. And, if you’ve been following my blog for any amount of time, you already know that I’ve been punting that decision after nearly every PSA test, with my PSA bouncing around in the 0.14-0.16 ng/ml range without seeking SRT or ADT yet.

Who made the right decision?

Both of us.

When cancer is initially introduced into your vocabulary—and even long after—you’ll be faced with a myriad of decisions to make. Is treatment warranted, or can I go on active surveillance? If treatment is needed, do I opt for surgery, radiation, or one of the newer methods available? Which doctor has the most experience? Which hospital has the right equipment? The list goes on and on.

Many of those same questions are applicable in the case of recurrence, too.

When it comes time to make some of those decisions, remember first and foremost that it’s your body, your family, and your circumstances. You—and not anyone else—have the final say.

Do your research using reliable, trusted sources and don’t be afraid to ask the doctor questions or call them out on something you’re not comfortable with. Seek multiple opinions from the doctors that could provide the different treatment options to you (keeping in mind, of course, that some may push their own specialty over others).

Talk to other patients or read their silly blogs to see what their experience has been, knowing that each individual cancer case is unique and will not apply directly to your own situation.

Don’t let the words “prostate cancer” scare you into acting immediately. Unless your Gleason score is an 8 or 9, you do have a bit of time to do this research and consulting with different specialists. I made my decision to have surgery rather quickly and never consulted with a radiation oncologist to see if that would be a viable first treatment option for me. Do I regret that? No. But, with a Gleason 6, I should have slowed things down and have had the meeting anyway.

One of the options that is often overlooked is to do nothing. Okay, it’s not exactly doing nothing—you’ll definitely want to be on active surveillance—but you don’t have to leap right into a treatment option if your cancer is  low grade / not aggressive. My sense is that more and more doctors are beginning to embrace that approach to avoid over-treatment.

That brings me to my final point. Once you make a decision, don’t look back. Embrace it and move forward. If you’ve done your homework correctly, you’ll know in advance what the consequences of that decision may be, and you’ll be more accepting of them if and when they do come.

If my PSA continues to slowly increase and, at some point my body scan lights up like a Christmas tree because I haven’t started SRT, I’ll probably curse like the sailor I once was and say, “I knew this was a possibility. What’s next?” But I’ll also know that I will have had six or seven or more years of high quality of life without any short or long-term side effects from SRT and/or ADT, and that is of great importance to me. As much science as there is in the treatment of prostate cancer, in the end, it’s an educated crap shoot.

Who made the correct decision?

Both of us. One of us. Neither of us.

Time will tell.

Stay Well! Wear A Mask! Wash Your Hands! Stay Home!

Day 3,521 – A Chat with the Doctor

My appointment with the doctor is scheduled for tomorrow afternoon, but after dinner this evening, my phone rang. It was the doctor calling about my appointment.

In a nutshell, VA Medical Center San Diego is trying to reduce the number of in-person visits during COVID-19, so he was wondering if I would be okay chatting with him about my results over the phone. Of course, I was.

He let me know that my PSA dropped from 0.16 to 0.14 ng/ml and that things were pretty “stable” and having a “low PSA” was a good thing. He mentioned that at some point in the future, we may need to discuss radiation, but that point wasn’t now. “For you, that could be years from now.” I’ll take that.

I shared with him my desire to do imaging before zapping if possible. I also brought up the trial at the VA Los Angeles, and he wasn’t aware of it. So I pulled it up and shared the trial number with him for his education / reference.

Bottom line: We agreed to retest in January and go from there.

Now all I have to do is make it through six months of COVID insanity…


On a related note, the VA healthcare system has gotten a bad rap over the years for a variety of things. It seems to be location-dependent, and some of the criticism is well-deserved.

I’ve been going to the VA Medical Center San Diego and its satellite clinics for about 8 years now, and I’ve had nothing but a positive experience, and tonight’s unsolicited call from the doctor just reinforced that for me.

As we used to say in the Navy: Bravo Zulu! (Well done!)

Stay well everyone!

#WearAMask #SocialDistancing #WashYourHands #StayHome