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.

c76ae-cautionsymbolsmall

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 59 – Resigned

It’s been an interesting month, that’s for sure.

The emotional roller coaster ride of learning that my PSA moved upward has come to an end for now. In fact, I’ve pretty much resigned myself to the fact that it is what it is, and there’s little that I can do about it other than wait.

Have I resigned myself to the idea that the cancer is coming back? I don’t know. Perhaps. I certainly don’t want it to come back, but I’m coming to terms with the fact that it’s within the realm of possibility in a way that it hadn’t been before the increase in PSA. If I’ve resigned myself to anything, it’s that I’ll have plenty of PSA tests going forward, along with the associated anxiety that comes with each.

I remember my surgeon telling me there’s an 80% chance that I’ll be cancer-free at 10 years, so that means that there’s a 20% chance that it will be back. For some reason, my gut instincts are telling me that I’ll be in that 20%. I don’t know why. Perhaps it goes back to my first solo trip abroad.

I was flying from the United States to Japan as a midshipman going on my summer training cruise, and I was flying on a military charter that landed at Yokota Air Force Base. On arrival, they told us that 20% of us had been selected at random to go through a thorough customs inspection. I was one of the 20%. They dumped my duffle bag’s entire contents onto a nice stainless steel table, went through everything, and told me to repack it in less than 5 minutes. Just my luck.

I know. A silly comparison. Still, it’s how my luck runs sometimes. December will be an indicator as to whether that rule will apply or not.


I’ve been battling an early season cold for about two weeks now, and it just doesn’t seem to want to let go. The stress incontinence was remarkably good during the first week, but when the cold moved into my chest the second week, I went back into pads for protection as I coughed and coughed.

Perhaps the stress of the PSA results weakened my system a tad, but most likely, it’s just that I work in a museum where lots and lots of people–especially kids–come through.  Oh well.

DJTPC

Life After Radical Prostatectomy: 54 Months Later

So it’s been four and a half years since my radical prostatectomy.  How am I doing?  (Remember, what follows is a graphic description, so proceed only if you want to read…)
Continue reading “Life After Radical Prostatectomy: 54 Months Later”

Month 55 – Sick of Being Sick

I hate getting sick.

The week before Memorial Day weekend, I came down with a nasty end-of-spring head cold that kept me home from work a couple of days.  It also put me back into incontinence pads.

Heavy coughing certainly increased the likelihood that I would have stress incontinence episodes, so I started wearing pads as insurance.  I’m glad that I did, because several times they were definitely needed.  I will admit, however, that I did better than I expected in many cases, and I attribute that to my recent weight loss.

The one thing that I’ve had difficulty controlling is stress incontinence while I’m standing.  If I’m standing or walking when I sneeze or cough, there’s a much greater likelihood of leakage, no matter how hard I try to control my pelvic floor muscles.  That’s where the pads came in really handy.

The unfortunate thing with this head cold is that, even though the worst of it lasted only a couple of days, the nagging cough lingered for a good week and a half after.  Ugh.

The moral of this story: Keep pads on hand for those unexpected times when you may need them.

This recent Prostate Cancer Foundation article, Excess Weight Linked to Worse Prostate Cancer Diagnosis, reinforces my will to keep losing weight.  Sure, it may be a case of me closing the barn door after the horses have escaped, but getting to a healthy weight can only be a good thing in the long run for a whole host of reasons.

 

 

Month 54 – Walking for Better Outcomes

I came across this article, Walking Boosts Outcomes for Prostate Cancer Survivors, on the Prostate Cancer Foundation website a few weeks ago, and it struck a chord with me.

When I began my weight loss regimen back in December, I made a concerted effort to increase my physical activity, mainly in the form of walking.  I’m not close to the level of activity that is talked about in this article, but it has helped with losing weight and with mitigating some of the minor side effects I had been experiencing post-surgery.

I know it’s only anecdotal observation on my part, but I feel that the number of stress incontinence episodes are down and, when I do have them, they’re not as significant as they once were.  I’d like to say, too, that it’s improved my erectile dysfunction, but, if I’m being honest, I’m not so sure that it has.  If it has, it’s only been slightly.  At least things aren’t getting worse.

Month 52 – Less PSA Testing; Rise in Prostate Cancer

Wow.  It didn’t take long for this to happen.

You may recall that in 2012, the U.S. Preventive Services Task Force (USPSTF), recommended abandoning PSA screening of any men of any age.  (In 2009, they recommended no screenings for men over 75.)  Now there’s early research showing a 3% per year increase in intermediate and high-risk prostate cancer cases.

The article, Did PSA Test’s Decline Spur Rise in Prostate Cancers, cautions that this is only one study, but that there was a measurable difference since the change in USPSTF guidelines:

Between 2011 and 2013, the study authors noted a 3 percent per year increase in the percentage of prostate cancer patients who had a PSA level of 10 or higher at the time of their diagnosis. PSA levels of 10 or more signify intermediate or high-risk prostate cancer.

Further studies, of course, are needed to confirm these findings.  But if they are confirmed, this could be quite troubling.

The rationale behind eliminating PSA screening was that too many men were being over-treated and suffering life-long side effects impacting quality of life, when they could have lived a relatively normal life with a slow-growing cancer inside them that would have never killed them.

If I were starting this journey today, I’d want to have the formerly routine annual PSA tests and then scrutinize my treatment options very carefully.  I would not want to wait until I became symptomatic and discover I have a PSA of 10 or more on initial diagnosis.

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As far as my personal status is concerned, I continue to lose weight (now 23 lbs. / 10,4 kg since 1 December 2014), and my occurrences of stress incontinence continue to decline.  (The were pretty infrequent before, but even less so now.)  Sexual function seems to be about the same or just a tad better.

Month 51 – Weight, Incontinence & New Screening

Last fall, I could feel my clothes getting a little tighter, but every time I stepped on the scale, it showed me right at my usual weight.  But when I went to the doctor and stepped on his scale, I was startled at what it read.  Bottom line: My scale was inaccurate and I had managed to creep up to my heaviest weight ever.  It was a real wake-up call.

I have to wonder if my weight was impacting my stress incontinence.  It seemed as though I was having more incidents of it than normal.  Sometimes, I simply attributed it to being tired, because I do know that when my body is tired, the incidence level goes up.

I’ve made a concerted effort to lose weight.  Since 1 December 2014, I’ve managed to lose 17.9 lbs (8 kg) and I feel much better and my stress incontinence has returned to what it was before.  I’m still well above my optimal weight, so I’ll keep at it to see if I can continue to lose weight and hopefully make improvements.

I know this is all anecdotal, but I’ll keep monitoring it and discuss it with my urologist during my next visit (which isn’t until September, so hopefully, I’ll have lost some more weight by then).

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The Prostate Cancer Foundation recently reported the findings of a study that uses MRI technology in conjunction with biopsies and ultrasounds to be able to better distinguish between high-risk and low-risk prostate cancers.  This is exciting news.  If proven out, this could minimize overtreatment of patients with low-risk cancers, and allow those with high-risk cancer to be treated more aggressively.

Month 44 – LARP at 42 Months

On July 4th, I was three and a half years out from my surgery, so I added a new page:

Life After Radical Prostatectomy – 42 Months Later

It’s pretty much a reflection of my new normal, so please check it out.

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Interestingly, about a week ago, I had three consecutive nights where I was running to the bathroom to pee about 4-5 times each night.  I’m not sure what was up with that, but it made for some cranky, sleep-deprived days afterwards.  I wasn’t drinking any more than I normally do, so it wasn’t as though there was extra fluids to process.  Odd.  Oh well.  Back to sleeping through the night.

Month 41 – Biological Update

We’re going to jump right in with this post…

BIOLOGY AHEAD
 
My niece and her three and a half-year old daughter came to visit for their spring break, and we were able to get out and do a lot of fun things together. By the second day, my niece was chiding me about how many times I was going to the bathroom, and that got me to thinking, “Am I going more than usual?” Or was it just her perspective.

In retrospect, I probably was running to the bathroom a tad more frequently. Mainly because we were on the go, outside in cool air a good chunk of the time, and I never knew where the next bathroom might be, so I took advantage of using the ones nearby. (And, no, I’m not talking every 20 minutes. It was every couple of hours.)

As I explained to my niece, it’s more that I have the urge or sensation that I need to go, than I actually do. When I get to the bathroom, not much comes out. Fortunately, the urges aren’t the, “Oh my God, I need to find a bathroom in the next 30 seconds or I’m going to pee in my pants,” kind of urges. But they’re there and they’re telling my brain it’s time to go when my bladder really could last a bit longer. That can be frustrating.

And on the sexual function front, I’ve been quite pleased there. I’ve had much better erections (near 100%) in the last month–all without chemical assistance. Not bad for having only one nerve bundle. As I’ve said before, be patient; let nature do its thing.

So that’s it for this month. Quick and simple.


Late update: I’d encourage those recently diagnosed to read a comment left by another reader, J.R., on the “Life After Radical Prostatectomy – 36 Months Later” page.  It’s an interesting perspective, and I tend to agree with him.  Losing sexual function is more difficult to adjust to than many people, including myself, thought it would be.

Month 39 – Encouraging News on Ability to Determine Aggressive Prostate Cancer

For those who have been regular readers of this blog, I hope you like the new layout.  Things were getting a little too cluttered, so I added a new column just for the blog’s administrative links (left column) and kept all the prostate cancer-specific links in the right column.  It should make it a tad easier to navigate.

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Well, I’m past the head cold that I had and back to normal activity without pads.  I will have to admit, though, that even after the worst of it passed, I seemed to be a little more leak-prone for some reason.  But that’s calmed down, too, thankfully.

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There’s encouraging news about having a better ability to determine whether prostate cancer is the aggressive type that can kill you, or the less aggressive type that can be observed under active surveillance.  You can read about that in the previous post (re-blogged from the Prostate Cancer Foundation site).

This is important.  It will help avoid over-treatment of prostate cancer, subjecting men to some of the side-effects of a treatment regimen that they may not have needed in the first place.  Of course, men will still have to overcome the thought of living with cancer inside them, always wondering if and when it may spread into something much more difficult to deal with.