Blasting Prostate Cancer with Testosterone

Here’s an interesting development in the field of prostate cancer research. The headline is a bit sensationalistic, but the researchers seem to be seeing “unexpected” and “exciting” results.

Professor Sam Denmeade, from Johns Hopkins University School of Medicine in Baltimore, US, who led the study, said: “”Our goal is to shock the cancer cells by exposing them rapidly to very high followed by very low levels of testosterone in the blood. The results are unexpected and exciting.

Man ‘cured’ of prostate cancer after doctors shock tumour to death with testosterone 

Update: 3 December 2016

Here’s the link to the abstract highlighting the preliminary results:

Rapid cycling high dose testosterone (Bipolar Androgen Therapy) as therapy for men with metastatic castrate-resistant prostate cancer (mCRPC)

NYTimes: ‘Active Monitoring’ of Prostate Cancer Does Not Increase Death Rate

An interesting  read.

‘Active Monitoring’ of Prostate Cancer Does Not Increase Death Rate

Month 68 – Waiting for the Next PSA Test

This will be a short post this month—my brain has been prostate cancer-ed out after the last few months and needs a respite for a few weeks before I buckle in for the roller coaster ride that is the next PSA test.

Speaking of the next PSA test, I’m planning on going in for the blood draw right around 1-3 August 2016. We’ll have to see how my schedule looks that week.

My urologist has authorized me to get the blood draw as of 1 July, so I could go in tomorrow if I really wanted to, but I’m going to do my best to stick to the first week of August to preserve the even spacing of the last three tests—pretty close to exactly four months apart ( 3 December–6 April; 6 April–3 August).

If I lose my willpower and go early, I’ll let you know.

This week also offered up some major news on the prostate cancer front with a shift towards genetic testing to help determine how to best treat prostate cancer. You can read more about it in this Washington Post article, Leading researchers recommend major change in prostate cancer treatment.

Life expectancy, mortality, surgery, risk, and management of localized prostate cancer

Found this to be an interesting article:

Life expectancy, mortality, surgery, risk, and management of localized prostate cancer –

Month 64 – Rethinking How Aggressively to Treat Cancer

Scrolling through my Facebook feed, I came across this interesting article, Gentler attack on cancer may mean that we can live with it longer, about taking a less aggressive approach to treating cancer in order to live longer. The theory is that, if you try to kill every cancer cell with a very aggressive initial treatment, any remaining cancer cells become resistant to further treatment and can be more problematic. If you take a slower initial approach to just contain the existing cancer cells, you may be able to extend your life.

I also came across this article, ASCO Endorses Active Surveillance for Prostate Cancerrecommending active surveillance over immediate treatment for those with low-risk prostate cancer (low-risk being defined as a Gleason of 6 or less). There appear to be some common sense reality checks that allow for exceptions to their recommendation as well. It’s an interesting read.

On my own front, I’ve been doing well emotionally knowing that my next PSA test is coming up soon. My appointment with the urologist is on 19 April 2016, but I’ll probably get the blood drawn when I’m scheduled to be in the clinic for another meeting on 6 April (my weight-loss group—81 lbs./36.7 kg lost!). That means I can probably get my results online around the 9th or 10th and, with luck, they’ll still be in the 0.04–0.05 ng/ml range (or less).

Speaking of luck, my streak of bad luck in 2016 continued. On my way home from my new job on my second week there, I was cut off on the highway by some yahoo not paying attention, and I had to stand on the brakes to avoid hitting him. Sadly, the gal behind me didn’t react quickly enough and rear-ended me to the tune of $2,500 USD in damages. <Sigh> Thankfully, insurance is covering the entire cost, as it wasn’t my fault—my deductible was waived. Of course, the guy who caused the accident drove off into the sunset without stopping.


Biology Ahead!

Wow. I haven’t used that little warning symbol in a long, long time, but there is something to report (I meant to put it in my Life After Prostatectomy–60 Months Later post, but forgot).

One of the potential side effects of a prostatectomy is penile shrinkage. I’d say that I had noticed the change, but interestingly, things seem to have returned to pre-surgery size in the last few months. That’s something to discuss with my urologist in April (not that I’m complaining—just to see if it’s common for that to happen, and if it really takes five years for it to happen).

Month 63 – Study on Effectiveness of Cancer Screening

Clearing storm, Imperial Beach, California

So 2016 is off to a stormy start for me (more on that in a minute) which means that I really haven’t focused on prostate cancer all that much this month. However, there was one article that caught my interest and one that I want to read more about.

The BMJ (formerly the British Medical Journal) published an article on 6 January 2016 titled: Why cancer screening has never been shown to “save lives”—and what we can do about it. Obviously, for those of us walking down this path, that title grabs our attention.

Because the BMJ requires registration to read the full article, here are links to a summary, the BMJ site, and an Infographic that you may want to check out. I’ll go back and read it in more detail when the dust settles after my stormy start to 2016.

IMG_20160105_132625929 (1)
Digging for roots

My rotten start to 2016 actually began late in 2015 when roots took over the sewer line coming out of my guest bathroom in my house and shut down anything flowing out of the house on New Year’s Eve. The plumbers returned on Saturday, 2 January to clear the line again, and on Monday, 4 January, they were breaking through the concrete slab in my house to get to the offending roots.

Two days and $4,200 USD later, the roots were gone, the hole was back-filled, and it all was concreted over. Of course, now I have to replace the tile, vanity, and sink, so I decided it was time for a refresh of the entire bathroom (another $6K–$8K, potentially).

You may recall that I flew to Chicago in the middle of all of this chaos to visit my sister and brother-in-law and their family. I returned to work on Thursday, 14 January and around 2 p.m. on Friday, I get a call from the Human Resources manager, “Could you please come up to my office?”

I entered the office and there was the HR manager, my boss, and her boss. “This doesn’t bode well,” I thought to myself. Sure enough, my position at the museum was eliminated in a cost-savings move, effective immediately. Bummer.  But, hey, at least I’ll have time to focus on the bathroom remodel now, right?

Not so fast…

On Saturday, 30 January, I thought I better get a job search in gear, so that evening, I came across a position which was exactly what I was doing before—volunteer coordinator—at for an organization less than half a mile from my old employer. I sent my resume off on Sunday; got an email  on Monday requesting an interview; had the interview on Wednesday; and was offered the job on Friday. I accepted and started the job this week. Oh. and it pays more, which will help with all the repairs.

See, there is a silver lining in every storm cloud!

The “best” form of first-line treatment for clinically significant, localized prostate cancer

This is a compelling read for anyone newly diagnosed, highlighting why it’s so difficult to determine the best course of treatment. To me, the most telling statement in the article was:

The loser for the ensuing 35 or so years has been the patient. We really have no clear idea at all what “the best” way is to treat a man with clinically significant, localized prostate cancer who really does need early whole gland treatment, … and we haven’t known for decades.

If the experts can’t figure out the best treatment option, then how are we as laymen supposed to be able to figure it out?


From the perspective of the disinterested observer, one of the very least edifying aspects of issues related to the management of prostate cancer has been the nearly 50-year-long “discussion” between the urology community and the radiation oncology community about the most appropriate way(s) to treat localized disease.

Prior to the initiation of the ongoing ProtecT trial in the UK, there had only ever been three, very small, “completed” trials that made any attempt to randomize patients with localized prostate cancer to radical prostatectomy or radiation therapy. These three trials were conducted by the Uro-Oncology Research Group between 1974 and 1978, and the results were reported by Paulson et al. between (if memory serves) 1979 and 1984. The trial results were based on data from small subsets of the patients, and for a summary of the list of problems said to be associated with at least one of these studies and…

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USPSTF to re-assess harms and benefits of PSA-based screening for risk of prostate cancer

This is a very important opportunity to let our voices be heard with respect to the recent USPSTF changes in PSA screening recommendations.


Yesterday the U.S. Preventive Services Task Force (USPSTF) posted detailed information about a new draftresearch plan related to screening for prostate cancer.

The USPSTF is seeking public comment on this plan, which can be reviewed here, and public comment can be submitted from now through November 25, 2015.

Prostate Cancer International has already submitted detailed comments on this draft research plan to the USPSTF through the USPSTF web site. Doing this is not complex, but it can take a little time, and we would encourage those who are interested in making such comment to be thoughtful in so doing.

Here is a list of just a few of the comments submitted by Prostate Cancer International with respect to the plan:

  • It is unclear whether the plan and the related research questions were written before its authors were aware of the data published yesterday in the New England Journal…

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Day 1,768 – More Research & More Questions

Even I thought I may have been overreacting to the change in my PSA, and that I may simply be embarrassing myself spouting off the way I have.  Still, it’s better to vent and look silly than ignore the potential problem.

Of course, I had to continue my research, and the more I dug, the more I learned, and the more I began to believe that I may not be overreacting at all.

In this instant Internet information age, it’s easy to find tons of material.  In my Month 58 – Welcome to PSA Anxiety post, I quoted a Dr. Chan from Johns Hopkins University:

On a technical level, in the laboratory, Chan trusts the sensitivity of assays down to 0. 1, or slightly less than that. “You cannot reliably detect such a small amount as 0.01,” he explains. “From day to day, the results could vary — it could be 0.03, or maybe even 0.05” — and these “analytical” variations may not mean a thing. “It’s important that we don’t assume anything or take action on a very low level of PSA. In routine practice, because of these analytical variations from day to day, if it’s less than 0. 1, we assume it’s the same as nondetectable, or zero.”

On closer examination and research, though, that quote came from early 2000, over 15 years ago. There have been advances in technology in 15 years.  Lesson learned: Even though the information came from a trusted source, it may not be the most current.  Read the dates!

There have been subsequent studies by UCLA and even Johns Hopkins that suggest that today’s ultrasensitive PSA tests (uPSA) are more reliable and can, in fact, be good predictors of biochemical recurrence (BCR).

From one article on the Prostate Cancer Infolink website:

Ultrasensitive PSA reliably predicts eventual biochemical recurrence (a UCLA study)

Researchers at the University of California, Los Angeles (UCLA) looked at available evidence that the uPSA test might afford radiation oncologists the opportunity to treat patients late enough that they are assured to be on a path to clinical recurrence, yet early enough that waiting for treatment does no oncological harm. Kang et al.conducted a retrospective analysis of data from 247 patients treated at UCLA between 1991 and 2013 who were found on post-op pathology to have aggressive disease characteristics — stage pT3-4 disease and/or positive surgical margins — and who received uPSA tests….

Kang et al. found that a uPSA ≥ 0.03 ng/ml was the optimal threshold value for predicting biochemical recurrence (BCR). Other findings included:

  • uPSA ≥ 0.03 ng/ml was the most important and reliable predictor of BCR. It predicted all relapses (no false negatives: no one was under-treated), and hardly ever predicted relapses incorrectly. Only 2 percent would be over-treated by waiting for this cut-off.
  • It was especially prognostic if found on the first uPSA test after surgery.
  • Even if the first uPSA test was undetectable, any subsequent test where uPSA ≥ 0.03 ng/ml predicted BCR.
  • Other lesser predictors of recurrence were pathologic Gleason grade, pathologic T stage, initial PSA before surgery, and surgical margin status.
  • At 5 years of follow-up, 46 percent of patients had a BCR using the “standard” PSA ≥ 0.2 definition, 76 percent using the PSA ≥ 0.03 definition.
  • Treating when an ultrasensitive PSA level reached 0.03 ng/ml gave a median lead time advantage of 18 months over waiting until PSA reached 0.2 ng/ml.
  • It was necessary to monitor PSA for at least 5 years post-op, and to test at least every 6 months.

That study used the histories of men with aggressive prostate cancer; mine was not.  I didn’t have positive margins and my tumor was classified T2c, so perhaps these findings are less applicable to me.  Still, the line:

Even if the first uPSA test was undetectable, any subsequent test where uPSA ≥ 0.03 ng/ml predicted BCR.

…is something that I definitely want to talk to the urologist about given that I’m at 0.05 ng/mL.  But I’m not going to get too worked up about it (I hope), because the Johns Hopkins study seemed to be broader in scope with less scary results.  However, both studies seem to indicate that the 0.03 ng/mL can be a threshold for predicting BCR.

On the other hand, Walsh writes:

Radiation also was not likely to help men who had negative surgical margins. “This is logical,” explains the Johns Hopkins radiation oncologist Danyy Y. Song, “because patients with negative margins whose PSA persists after surgery are more likely to have residual disease outside of the prostatic bed, as opposed to those whose margins were positive at surgery, where disease is likely to remain in the area.” (and thus can be targeted with radiation).

I had negative surgical margins, so this can take the discussion with the urologist in a entirely different direction.  Another question for the list.

I know that all this research in advance of the meeting with the urologist is a form of self-inflicted torture causing anxiety, frustration, and confusion. But I’d rather ensure that I’m knowledgeable than go into the meeting with my head in the sand. Knowledge is power.

The bottom line: I’m going to keep researching and learning (with a critical eye and more than a grain of salt).  If, in the end, I’m proven that I overreacted and had nothing to fear, then I’ll be happily embarrassed and a bit smarter about uPSAs and biochemical prostate cancer recurrence.

On the other hand, if God forbid, I do have to journey down the BCR path, I’ll be steps ahead of the game and can advocate for myself with my medical team.

Is it Tuesday yet???