Author: Dan

Month 127 – PSA Results

On By DanIn Prostate Cancer, Recurrence13 Comments

I went for my originally scheduled six-month PSA test last Thursday and was able to look online last night to see the disconcerting results: A substantial increase to 0.21 ng/ml.

Breaking the 0.2 ng/ml threshold now officially puts me into the biochemical recurrence category, at least according to the long-held definition of biochemical recurrence.

Needless to say, I felt gut-punched on seeing the results. Sure, I’ve know for over five years that my trend has been upward, but I guess I got comfortable with it bouncing around the 0.10 to 0.16 range for the last few years. I wasn’t expecting such a substantial leap between my “surprise” PSA test in February and this one in June.

When it comes to PSA doubling time, it dropped from 67.7 months to 52.8 months with this latest test result included in the calculations. If I look at only the five most recent test results, the PSA doubling time drops to 46.5 months. Of course, all of those are great numbers that a lot of guys would like to have.

My appointment with the doctor isn’t until 6 July, and it will be an interesting conversation now that we’ve crossed that magical line of 0.2 ng/ml. In a way, I’m glad I’ve got several weeks to think this through and to come up with good questions to ask so that I’m prepared for the appointment.

Of course, salvage radiation therapy just moved to the top of the list of things to talk about. It will be interesting to see if their recommendation changes given the 0.21 number versus the long PSA doubling time.

Needless to say, there’s going to be much reflection and research in the weeks ahead.

FDA approves Pylarify for diagnosis of advanced/recurrent forms of prostate cancer

On By DanIn Prostate CancerLeave a comment

In ,a recent media release, Lantheus Holdings announced that the US Food and Drug Administration (FDA) had approved the imaging agent known as piflufolastat F 18 Injection (also known as Pylarify® or more commonly just “PyL”) as a PSMA-based PET imaging agent for identification of prostate cancer. This agent is actually approved for use in […]

FDA approves Pylarify for diagnosis of advanced/recurrent forms of prostate cancer

New guidelines for salvage radiation dimensions

On By DanIn Prostate Cancer, RecurrenceLeave a comment

It has always been troubling that only about half of all salvage radiation treatments after failure of radical prostatectomy are successful. Usually, only the prostate bed is treated. But sometimes recurrent patients (or those with persistently elevated PSA) receive salvage radiation to the pelvic lymph nodes as well, or subsequently. Radiation oncologists here in the […]

New guidelines for salvage radiation dimensions

Month 125 – Urinary Frequency

On By DanIn Incontinence, Prostate Cancer8 Comments

The only constant is change, and things have been changing for some inexplicable reason on the urinary frequency front, especially at night.

For years after my surgery, I could make it through most nights without having to get up and use the toilet. If I did, it was only once per night. In the last month or two, I’ve been noticing that I’ve been getting up two, three, and even four times a night to drain my bladder. That certainly impacts quality and quantity of sleep.

I wish I had an explanation for it. I really haven’t changed any drinking habits where I’m drinking lots of liquids all evening long or just before going to bed. It’s just happening.

Perhaps the only plausible explanation is that I have been trying to go to bed about an hour to an hour and a half earlier than I used to (I was a terrible night owl), and that means longer time in bed. I’ll just start a little spreadsheet to track it all to see if I can see a pattern emerging. (Nerd!)

My next PSA test will be near the end of June with the doctor’s appointment on 6 July 2021.

Other than that, things are slowly improving in San Diego. we’ve moved from the Purple Tier to the Red Tier and now to the Orange Tier, meaning that things have become less and less restrictive on the COVID front. Let’s hope that we continue to move in the right direction.

As far as vaccinations are concerned, 25% of all adults in San Diego are fully vaccinated, and 50% have had at least one dose. That’s good.

Stay well!

Wow! 200,000

Anyone who has ever spent more than 3 seconds reading this blog knows that I’m a numbers guy, so needless to say I’m both amazed and humbled that this little ol’ blog surpassed 200,000 views today.

When I started this blog ten and a half years ago to keep my family and friends informed of my status in those early days, I had no idea I would be keeping it going this long, or that more than 32,000 visitors would have checked it out.

So to everyone who’s followed along, shared their own stories, hopefully learned a little along the way, and have become virtual friends, a heartfelt and massive Thank You!

Stay well.

—Dan

On By DanIn Prostate Cancer7 Comments

Month 124 – Prostate Cancer a Chronic Illness?

On By DanIn Incontinence, Prostate Cancer, Side EffectsLeave a comment

It’s tough to come up with a decent prostate cancer-related topic for this month. I guess when things are going relatively well, that’s a good thing.

I’ve gotten to the point where I think of this more as a chronic illness like arthritis than I do a potentially life-ending cancer. Last month’s bump up in my surprise PSA test hasn’t fazed me at all. It is what it is. Move on. Maybe that’s a mistake.

I will say, though, that I’ve probably packed on a couple of pandemic pounds over the last twelve months of quarantine and work from home and, when that happens, I tend to see a slight uptick in minor incontinence episodes. Nothing major. A little dribble here, a little dribble there. More a nuisance than anything. Time to get more active and shed a few of those pounds.

Speaking of getting active, I did just that after my last post. I took my first ever trip to Death Valley. I figured if I can’t socially distance there, where can I socially distance? It’s a remarkable place. Going in February is one of the best times to go. Temperatures were in the low 70s °F/ 20s °C during the day and around 45 °F/7° C at night. Not bad at all.

After visiting Death Valley, I drove to the Valley of Fire just about an hour northeast of Las Vegas. That was amazing as well. If you’re looking for a diversion, you can check out my write-up and photos HERE. My apologies for the slow-loading photos. I uploaded the full resolution versions, but if you zoom in on any of them, the detail is incredible.

I’ve got King’s Canyon/Sequoia and Yellowstone National Parks on the agenda for later this year barring any massive changes in the pandemic status. Once this is all lifted and international travel is allowed again, New Zealand has made it to the top of my bucket list. Fingers crossed.

That’s about it for this installment.

Stay well!

Month 123 – Surprise PSA Test

On By DanIn Prostate Cancer5 Comments

“How the hell did you have a surprise PSA test?” you ask. “Didn’t you feel the needle going into your arm?!?”

Yes, I did.

I was a bit overdue for the normal tests that you have for your annual physical, and my doctor’s office called a week ago and told me I needed to come in for some blood work and a urinalysis. So I did.

I was going through the results online today, and the very last test listed was a PSA test. I was a bit surprised that they ran it considering we just ran one in December. The result? It came out 0.16 ng/ml.

Obviously, that’s a step up from the December result of 0.13 ng/ml, but I’m not overly concerned about it because it’s relatively in line with my other recent results. The other reason is that I didn’t follow my usual routine for this PSA test.

When I know that I have a PSA test coming up, for a week before, I will abstain from activities that could cause it to read a little higher than normal. Because this was a surprise test, I didn’t do that and that may account for the bump up in the number.

Another reason not to be too overly excited is my PSA doubling time is 65.3 months.

Of course, because this was an unexpected test, I don’t have an appointment set up with the urology department, so we’ll just stick to the plan and see what happens when I retest in late June for an early July appointment.

On an unrelated note, because I work in a hospital, I was able to get both doses of the Pfizer COVID vaccine.

For the first dose, my arm was tender at the injection site for about 30 hours after the injection, but it wasn’t bad enough to warrant taking any pain medication like acetaminophen or ibuprofen. I had a mild headache late in the evening, but I may attribute that to just being up too late the night before.

The injection site for the second dose was less tender and for a shorter period, but I was pretty fatigued later in the afternoon and early evening (I received the injection around 10 a.m.). Nothing a good nap and a good night’s sleep wouldn’t cure.

It will be two weeks since the second dose this Friday, so I should have full resistance built up by then. I’ll continue to wear a mask and socially distance, as is recommended.

Stay well!

Month 122 – Doctor Consult

On By DanIn Prostate Cancer7 Comments

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

On By DanIn Prostate Cancer9 Comments

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!