Author: Dan

Day 5,118 – Urologist Visit

On By DanIn Hormone Therapy, Prostate Cancer, Radiation Proctitis9 Comments

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:

Radiation Proctitis

So the journey continues. Stay tuned for the next installment.

Header image: San Diego skyline and Mission Bay from Kate Sessions Memorial Park

Fourteen Years

On By DanIn Emotional Aspects, Prostate Cancer, Side Effects7 Comments

Yep. It really has been fourteen years that I’ve been on this adventure. That’s a good thing considering that too many men don’t make it this far after their diagnosis. Of course, it would be better if none of us ever had to go down this path in the first place, but these are the cards that we’ve been dealt and we’re forced to soldier on.

In the past, I’ve railed against people who said that prostate cancer is an “easy cancer.” My views on that may be evolving over time into it being an easier cancer. Even that may not be an accurate way of describing it.

The treatment for other common cancers can be much more aggressive, adversely impacting quality life in much harsher ways much earlier on than some of the initial treatments for prostate cancer. With prostate cancer, you may have a snip-snip here or a zap-zap there and you’re on your merry way for years with a few possible side effects. With other cancers, you may have surgery, radiation, and chemotherapy all coming right out of the gate and, in many cases, your chances of making it to five years are quite low (see five-year survival charts below).

However, with prostate cancer you can be on this ride for decades before you get to the harsher advanced treatments like hormone therapy and chemotherapy. In the interim, though, you’re dealing with the physical impacts of early treatment (incontinence, impotence, etc.), as well as the psychological and emotional stress associated with each new PSA test result every three to twelve months over those same decades. Over time, both of those impacts—the physical and emotional—take their toll.

Don’t get me wrong. I am thankful that, out of all the cancers out there, I had to get the one with one of the highest survival rates of all of them. I guess I just want folks to know that it’s still cancer, and it’s cancer that you have to deal with—in ways big and small—on a daily basis for decades.

It may be easier, but it isn’t easy.

Answering Your Hormone Therapy Comments | #MarkScholzMD #AlexScholz

On By DanIn Hormone Therapy, Prostate CancerLeave a comment

Here’s another informative video from the Prostate Cancer Research Institute with answers to many questions about hormone therapy. They have taken questions or comments from previous videos and provided answers.

If you don’t want to sit through the full 30 minutes, there are time stamps for each topic in the description of the video.

Day 5,097 – PSA Results

On By DanIn Prostate CancerLeave a comment

The trend formula on my Excel spreadsheet predicted that my PSA would come in at 0.69 ng/mL, and my PSA came in at exactly 0.69 ng/mL. Not too shabby.

To be honest, that’s a little better than I expected it to be, which I’m not complaining about. At least it hasn’t taken off like a Halloween bat out of Hell.

The one question that we’ll have to answer at the appointment with the urologist on 14 November is whether that level is high enough to warrant another PSMA PET scan to see if we can detect any hotspots that may be amenable to radiation. At my current PSA level, there’s about a 70% chance of detecting anything, but if we wait until the PSA is closer to 1.0 ng/mL, there’s a 90% chance of detection. Maybe we wait another three months and go from there? Or, maybe we go ahead with the scan now and I have cool images to include with my Christmas cards.

I’m guessing that that was a small enough increase—keeping my PSA at a low level—that we won’t have to worry about starting androgen deprivation therapy (ADT) quite yet. Of course, I could be wrong.

When I use my last five PSA tests over the last year to calculate PSA doubling time, the PSADT is 7.7 months.

Stay tuned.

PSA Chart since salvage radiation therapy
PSA Chart since diagnosis

Header image: Anza-Borrego Desert State Park, California

Day 5,095 – Let the Waiting Begin

On By DanIn Prostate Cancer2 Comments

I went for my PSA test this morning, so now the waiting begins for the results to be posted online. I suspect that I’ll be able to access them late Thursday night or Friday.

I also had about four or five other tubes of blood drawn (I can’t watch 🤢) for my annual physical with my primary care physician on 4 November. While there, I also got my high-dose flu shot for old geezers and the updated COVID vaccine. All of that turned me into veritable pin cushion this morning.

As much flak as the VA Healthcare system receives, I have to admit that I’m always impressed with my local clinic. No appointment was needed for either the lab work or the vaccines, and it took just 17 minutes from the time I checked in until my lab work was completed, and another seven minutes to get the vaccines. I was in and out in 24 minutes. I challenge civilian clinics to match that.

More to come soon.

Month 167 – PSA Time

On By DanIn Prostate CancerLeave a comment

Well, it’s nearly time for the PSA roller coaster to depart the station once again. (You never get off the PSA roller coaster, you just keep riding it in never-ending loops.)

I’m not exactly sure when I’ll go to the lab—either next week (short holiday week) or the week after—but I need to get it done by the end of the month because I have an appointment with my primary care physician on 4 November, and an appointment with the urologist on 14 November. I suspect that I’ll get my seasonal flu shot while I’m at the clinic, too.

If anyone is interested, we could get a pool going to guess where the PSA test results will come in at. 😄 On 1 May 2024, it was 0.52 ng/mL. The “Trend” function on my spreadsheet has it coming in at 0.70 ng/mL using the last five PSA test results from my post-radiation nadir. My money would be on somewhere between 0.80 ng/mL and 1.0 ng/mL.

Other than that, I’m just getting ready for the palm fronds to start falling as we get deeper into autumn here in San Diego. 😂

On a fun note, I attended both of the San Diego Padres Wild Card baseball games on 1 and 2 October, and the crowd went bonkers when we clinched the best-of-three series to win a spot in the playoffs.

We’re playing our arch nemesis, the Los Angeles Dodgers, in Game 5 of the National League Division Series tonight (Friday, 11 October) to see who advances to the National League Championship Series. (We’re tied two games apiece and the winner of tonight’s game will advance. Hope I didn’t jinx ourselves by writing about this. 🤞)

Sorry for the shaky camera work. There was so much happening all over the place, it was tough to know what to focus on.

On an even funnier note, I found this perfect bed for those suffering from hot flashes while on hormone therapy.

Header image: Crepuscular rays at sunset over the Salton Sea, California while hoping to see Comet Tsuchinshan-ATLAS on 10 October 2024. (I didn’t.)

Month 166 – Expanding My Audience

On By DanIn Prostate Cancer12 Comments

Between this prostate cancer blog and my travel blog, you’ve probably figured out that I enjoy the process of writing and sharing my experiences. While I’m no Pulitzer-prize winning author, a few people close to me have encouraged me to do something more formal—to “write a book.” I always thanked them for their compliment, and then gently set aside the notion of ever getting something published.

Until June.

Yes, I’ve been sitting on a little secret for almost three months. The editor of Cancer Health magazine came across my little ol’ blog and approached me to write an essay for their Voices column for their Fall 2024 issue of their magazine.

My initial reaction was one of surprise and intrigue and—if I’m being honest—a bit of anxiety. In the initial contact email, there wasn’t a ton of information about expectations, so I went to the website and looked at some of the archived Voices columns to see what might be involved. “Oh. I could do that.”

I went back to the editor and said, “I’m in.”

Prior to this, I had a vague understanding of the publishing process and knew that there would be some discussion about topics, length of the article, and deadlines. It would soon be followed by submitting drafts and digesting feedback. Also included in the exchange was a six-page contract covering usage rights and compensation.

I’m someone who’s better known for my spreadsheets than my writing, so when the editor read the final draft and said, “Wow… this one reads really great….Honestly, there’s very little I’d change in this…” I have to admit my chest puffed out a with a bit of pride.

After the magazine went live this week (hardcopy and online), I can now add “published author” to my résumé.

Is it a book? Nope. But we all start with baby steps, and a 500-word essay is my first step into the publishing world. Is this the beginning of something larger? Who knows. I enjoyed the whole process, and the editor did encourage future submissions. In the meantime, I’ll stick to self-publishing on my little ol’ blogs for now.

You may read the article here:

How to Navigate Conflicting Cancer Treatment Advice

Header Image: August Moonrise over San Diego, California skyline

September is Prostate Cancer Awareness Month

On By DanIn Prostate CancerLeave a comment

It’s that time of year again. It’s time to remember that September is Prostate Cancer Awareness Month, and you should take a little time to educate yourself about this disease that’s been impacting my life for nearly 14 years.

Here are some great free resources to learn more about the disease and its treatment:

Of course, I’d like to think this little ol’ blog of mine has been a pretty decent resource, too. (Shameless self-promotion.)

Please take some time in September to increase your awareness about prostate cancer before you get diagnosed. Understand the risks—family history, race, age, diet—and how they may influence your decision to get screened for prostate cancer.

Be well!

Month 165 – Two Years Post-zapping

On By DanIn Prostate Cancer4 Comments

Yeah, this month’s post is late. I was really struggling to come up with something to write about to hit my normal publish-on-the-11th-of-the-month date, and then I remembered that it’s been two years since my salvage radiation therapy ended on 26 August 2022.

So here’s a quick update on how things are going post-radiation.

Impact on PSA

Of course, the biggest and most disappointing thing is that the radiation didn’t do what it was supposed to do, and my PSA dipped for a bit and then continued to rise to a level higher than when we started the SRT (0.52 ng/mL vs 0.37 ng/mL).

I’ll take my next PSA test in October, and we’ll see if another PSMA PET scan is in order to determine the location of any hotspots. If it’s identified, we’ll look at whether additional spot radiation is needed/desired, or if we consider starting androgen deprivation therapy. More to come.

Side Effects

For the most part, I believe that the side effects two years out from the SRT have been relatively minor.

Urinary Issues

I’m not sure if the radiation really impacted my urinary issues much at all. If anything, I have a slight increase in stress incontinence and sometimes a slight increase in urgency.

Frequency, on the other hand, seems to be all over the place. Some days, I go multiple hours without needing to urinate; other days—especially at night, unfortunately—I’m running to the toilet about once an hour. That can be quite annoying and have quite the impact on my sleep. It’s not every night, thankfully, but enough to have noticed a change.

Bowel Issues

A few months ago, I talked about how my bowel patterns had changed from a once-a-day movement to three to five movements a day. Thankfully, that has calmed down, too. I’m back to one or two trips a day now, and that’s a good improvement. Hopefully, it stays that way (or gets better).

Summary

The radiation failed to do what it was supposed to do and, thankfully, the cost of that failure in terms of long-term side effects caused by the radiation seems to be relatively low so far.

I have an appointment with my primary care physician on 4 November and one with the urologist on 14 November, so I’ll get another PSA test done the last week of October in advance of those appointments.

Be well!

Header image: Sunset at Imperial Beach Pier, Imperial Beach, California

Day 5,000

On By DanIn Prostate Cancer9 Comments

You know the nerd in me had to observe this milestone of being 5,000 days into this adventure of living with prostate cancer. 😂

In those 5,000 days, I have:

  • Learned more about prostate cancer and its treatment than I ever thought I would.
  • Had my emotions run from outright fear at diagnosis to elation with each undetectable PSA test after surgery back to fear as my PSA returned.
  • Adapted to my new normal with the side effects from surgery and radiation.
  • Shared my story in ways I never expected.
  • Learned who stepped up to provide support and who couldn’t do so for whatever reason.
  • Formed meaningful connections with fellow patients and caregivers from around the globe, and have been inspired by their stories.

That last point is important to me. Those readers who regularly engage with me, share your stories, and who offer your support have been a bright spot in this entire adventure, and I cannot thank you enough. Sadly, some of the men that I connected with over the years have succumbed to this insidious disease, and I miss our interactions.

Thank you again for putting up with my rantings for 5,000 days. Here’s hoping for 5,000 more.

—Dan

In case you’re wondering, 5,000 days equals:

  • 13 years, 8 months, and 9 days
  • 164 months and 9 days
  • 714 weeks and 2 days
  • 120,000 hours
  • 7,200,000 minutes
  • 432,000,000 seconds

Sleep better tonight knowing that. 🤓😂