Day 4,332 – Urologist Visit

Today’s visit with the urologist went about as expected—just a routine review of the salvage radiation therapy, its after-effects, and what’s next.

He was pleased with the drop in my PSA and thought that it may drop even further given how soon after the test was taken after the completion of the radiation. He stressed that we’ll have to establish a nadir in the next year to get a true starting point to determine the effectiveness of the radiation. He was okay with doing another PSA test in November in advance of my radiation oncologist follow-up visit.

Regarding my urinary frequency and urgency, he said I was pretty much where I should be after the radiation, and that it could take up to six months for things to truly calm down. I mentioned that the radiation oncologist put me on tamsulosin / Flowmax, and that it seemed to help a little with my frequency issues.

But I also told him that I stopped taking the tamsulosin over the weekend because my incontinence was up while I was on it and I just wanted to see what it’s like without it. So far, so good.

I did talk about my back and rib pain and once again asked if it could be related to the Eligard. Once again, he thought it was highly unlikely. He also ruled out the possibility that it could be metastases given where my PSA level is at. He did do a bit of a hands-on physical exam to rule out kidney stones (been there, done that, this is not kidney stones). He also made the comment, “Hey, I do plumbing”—I cracked up—and he was glad that I’ll be speaking with my primary care physician about it next week.

He didn’t want to put me on any additional medications for the urinary issues because of side effects that they may have, and we never explicitly spoke about whether to continue the hormone therapy or not. We did, though, talk about this first six-month dose wearing off in the next few months, so it wasn’t as though the topic was completely ignored.

Going forward, I’ll get another PSA test sometime in November; have my follow-up with the radiation oncologist shortly after (yet to be scheduled); and follow-up with urology on 13 December 2022. (I did avoid a 3:30 p.m. appointment like today because traffic sucked driving home.)

Be well.

Header Image: Cathedral Rock and Oak Creek near Sedona, Arizona

    Zapping Session #16 – Update

    This morning’s session had an unexpected surprise. At the end of the session, the technician told me that my bladder was “borderline” not filled enough, and I found that to be really odd. I used the same bladder-filling timeline and technique this morning that I’ve been using all along. She encouraged me to practice over the weekend.


    I met with the radiation oncologist on Tuesday, which was unusual because our normally scheduled meeting day is Thursdays. He told me he was going away for a few weeks, and I asked him where he was going. Long story short, his wife is from Germany and they were going to visit her family in a town that was about an hour from where my grandfather was born. Also, his wife studied at Würzburg, and my cousin is a professor and doctor at the university hospital in Würzburg. Small world.

    During the meeting, I mentioned that the side effects were beginning to kick in more, and he commented, “Yeah. You’re at the dosage level where they typically start showing up.” I thought that was interesting because I never considered there to be a dosage threshold for side effects. It makes perfect sense though.

    Fatigue

    The fatigue is really kicking in now, although it happens in waves of varying amplitudes. For example, after yesterday’s session (Thursday), I was energetic enough to stop by an event at my former employer and just hang out for a few hours and see how everyone was doing. By mid afternoon, I was a tad tired (70% on my internal “battery”) but was able to keep going through the afternoon, past dinner, and into the evening.

    Today, though, was a considerably different story. As soon as I was done with the session at 10:15 a.m., I ran and bought groceries, had lunch, and by 11:45 a.m. my internal “battery” was down to about 20% and I was napping until about 2:30 p.m. Hard. Even now, as it’s approaching 4 p.m. as I’m writing this, I feel as though my battery is about 50-60% charged even after the nap.

    I may attribute part of the fatigue to my urinary frequency, because it’s definitely increased through the week.

    Wednesday night into Thursday morning, I had to empty my bladder just twice. Last night, I had to empty it four times. That’s four sleep interruptions that would contribute to the fatigue.

    The doctor did offer to put me on Flomax (Tamsulosin) to relax my bladder and hopefully reduce the frequency. For now, I declined his offer because at some point years ago (perhaps even before I was diagnosed), I had been prescribed Flomax and I recall that it wasn’t a very positive experience with its side effects (extreme dizziness).

    Urinary Frequency

    As you saw in a previous post, I was using a spreadsheet to track when I was emptying my bladder, but that was cumbersome to use, especially logging an entry in the middle of the night. I found an app called “Simple Time Tracker” that has a widget that I can have on my phone’s home screen, and all I have to do is tap it to start recording when I go to the toilet and tap it again when I’m done. It automatically records the date and time, and that’s all that I’m after. (The only downside is that I can’t export the data to my spreadsheet.)

    Between 1 a.m. and 4 p.m. today, I’ve made eleven trips to the toilet, and my only fluid intake was about 1.5 liters of water before the zapping session and another 0.5 liters of soda after the session. It’s not like I’m consuming a high volume of liquids to have me going so often.

    Irritation

    My skin irritation remains about the same and applying moisturizing lotion does help. But now I have a general constant mild burning sensation in my urethra and hints of it starting in my rectum. It doesn’t hurt to urinate (yet), but the burning sensation is mildly annoying right now. I also think the irritation in my urethra is triggering my brain to empty my bladder when I really could probably wait a while longer without incident. I’m guessing it will likely worsen as the cumulative dosage increases.

    Emotions

    For one of the first times since starting the hormone therapy, I found myself to be a bit on the emotional side this week. I’m guessing the fatigue contributed to that, too. I’ll leave it at that for now, and I may write about it separately in the days ahead.

    Summary

    After Monday’s session (1 August) I’ll be halfway through the treatments. If the side effects stay at the current level, that can be manageable. If they get worse, I guess I’ll just have to suck it up and power through them like the countless thousands of radiation patients before me.

    Enjoy your weekend!

    Day 4,178 – PSA Results & Stuff

    I went for my pre-physical appointment blood work yesterday and was surprised to have the results back today. It used to take the VA two or three days to post them online.

    In any case, my PSA climbed once again from 0.33 ng/mL on 11 March to 0.36 ng/mL yesterday, 18 April. PSA doubling time dropped from 14.4 months to 12.7 months, indicating a continued acceleration which makes sense.

    I did schedule my mapping with the radiation oncologist and, in my discussions with the urologist about the PSA test, we agreed to reschedule my 10 May appointment into September after the salvage radiation therapy was completed. My schedule now looks like:

    • 21 April – Appointment with PCP for a lube, oil, and filter change.
    • 3 May – Eligard injection.
    • 16 June – Body mapping with radiation oncologist.
    • 13 September – Urology appointment

    We didn’t set an actual start date for the zapping, but I suspect it would be a week or two after the mapping and it would last through July and into August.


    My emotions in the last week or so have run the gamut.

    I can’t seem to get it out of my head that, once I start down this path, my life as I currently know it will be gone. Much of that is probably unfounded and a gross exaggeration, as the rational part of me knows that the chances for long-term, quality of life-impacting side effects are minimal. Yet the emotional side of my pea-sized brain is dwelling on that and I can’t seem to shake it.

    Of course, that leads me to anger over this insidious disease and the impact it has on your life. Aside from the aches and pains associated with my vintage, high mileage body, it’s difficult to reconcile that within me there’s the army of cells wanting to kill me even though I’m feeling generally well. The fact that you have to take drastic action to fight off those cells—again—makes the situation even more aggravating.

    Part of this, too, stems from the timing. I retired at the end of October, and there are things I want to do and places I want to go. The uncertainty of not knowing how my body will react to the hormone therapy and salvage radiation makes me hesitant to plunk down $10,000+ for a bucket-list trip to New Zealand now that its borders are beginning to slowly open. Maybe by October (New Zealand’s spring), I’ll know whether I can endure a fourteen-hour flight.

    I know that, like the countless men before me, I’ll get past this and adapt accordingly whatever the outcome. What choice do we have? In the interim, I’ll continue to play as my body under treatment allows me to play.

    Venting session over. Thanks for listening, and be well.

    Month 136 – PSA Results & SRT

    Well, kicking the can down the road is no longer an option. My PSA shot up like an Apollo Saturn V rocket (yes, I’m dating myself).

    Between 5 January 2022 and 11 March 2022, it jumped from 0.26 ng/mL to 0.33 ng/mL. That’s a 27% increase.

    Yes, I had the PSA test done about three weeks sooner than I had planned. I had to see the doctor for another issue, and they did full blood work-up for that. They included the PSA test in that battery of tests, too, so I got my results earlier than expected.

    Needless to say, I was hoping that this PSA test would have proved the 0.26 ng/mL to be an outlier, or at least to be consistent, but that wasn’t to be. It’s clear that the rate of increase is accelerating and that’s not good.

    Based on that, I called UCSD Radiation Oncology this morning to schedule an appointment with the radiation oncologist to discuss starting salvage radiation therapy. It was a tough call to make on a Monday morning.

    On a lighter note, the receptionist who took my call was great (answered on the first ring and went straight to her!—no menu tree to button-push your way through). I am not a morning person, and she was far too bright and chipper for a Monday. When I told her that I was ready to schedule radiation, she responded with a cheerful, “That’s great!!” “You said that far too enthusiastically,” I responded with my stomach in knots at having to make the call in the first place. Oh well.

    The enthusiasm continued by scheduling the appointment with the doctor and the body mapping session back-to-back on the same day: Friday, 25 March 2022.

    Oh. She gave me a homework assignment, too: Try to have an empty rectum and a full bladder for the mapping.

    I will admit that part of me wants to press the doctor about having additional imaging done before we start radiation, but I also know that the cancer continues to grow while we’re waiting for the scan and its results. It doesn’t cost anything to ask the question.

    Barring any unforeseen circumstances, the next chapter in this journey is about to begin. Wish me luck.

    Day 4,117 – Radiation Oncologist Consult

    This afternoon, I took a leisurely stroll down to my local radiation oncologist’s office…

    That sounds like the beginning of a really bad joke, but it’s not. I walked the 0.9 mile / 1.5 km walk from my home to the UCSD Radiation Oncology center for my first consult there.

    My original appointment was for 3:30 p.m., but at 11:40 a.m., they called and said they had a cancellation and asked if I could come in at 2 p.m. Sure. Let’s get this over with.

    The radiation oncologist (RO) was very welcoming and very direct in talking about my options, which I appreciated very much. He’s been pretty much exclusively zapping prostates since 2010, which helped build up confidence in his experience and abilities. When he mentioned that he studied at University of Chicago (my hometown), we got off topic and talked about deep-dish pizza and Italian beef sandwiches for a moment.

    The key points from the conversation:

    • He recommended proceeding with the radiation at 70 Gy for 7 weeks (IMRT/IGRT), but thought it wasn’t necessary to begin it immediately.
    • He said given my numbers and the negative PSMA PET scan, he would zap only the prostate bed and not the pelvic lymph nodes.
    • I should not let my PSA get above 0.5 ng/mL before starting radiation. Of course, starting sooner rather than later would be better.
    • The risk of long-term side effects appears to be lower than what I had in my mind.

    When talking about the likelihood of success, the RO chuckled a little when I mentioned the nomogram numbers. Apparently, he isn’t a fan of nomograms. When I mentioned that the urologist at the VA said that salvage radiation was possibly curative, he chuckled at that, too. He was pretty blunt when he said that salvage radiation would be a “50-50 crap shoot” when it comes to long-term suppression of the cancer. The reason we do it, though, is to squash it hard enough and long enough to significantly slow its progression and buy years of life.

    We talked at length about quality of life and life expectancy. He asked if I expected to be here in 10 years, to which I replied, “I don’t know.” My dad and his mom both died unexpectedly at the age of 69—that’s only 5 years away. Will I follow in their footsteps? Who knows. He thought that not doing salvage radiation may be an option if my chances of not living another 10 years are good. But if I thought I would live beyond 10 years, then do the radiation now.

    It was interesting that throughout the discussion, he talked solely about salvage radiation without mentioning hormone therapy other than it being the next step after radiation. But then near the end of the conversation, he recommended six months of hormone therapy for me starting at the end of radiation to “really knock down the cancer.” I’m not sure I was expecting that.

    We agreed that it would be okay to wait until my next PSA test in early April to see what that shows. But he reminded me that the cancer is there and it is growing. He offered me his card and said to call if I had any other questions.

    All in all, I’m pleased with how the discussion went. The RO’s candor was refreshing and I was impressed with the UCSD staff and facility. I left feeling more at ease than I was when I went in. (In fact, little gremlins were doing a jig in my stomach a good chunk of the morning before the appointment.) Am I 100% sold that this is the path I want to pursue? Not yet. But I’m much closer to it than I was when I woke up this morning.

    The whole, “When do you think you’ll die?” conversation was a little unnerving and simultaneously thought-provoking. It’s been a while since I’ve had a full-blown physical, so it may be worth checking under the hood to see if everything is in order before starting radiation.

    In my mind, if the April PSA comes back higher than the 0.26 ng/mL in January, I’d be more inclined to start sooner. But if it comes back at the 0.21-0.22 ng/mL that it was in June, July, or October, I may be inclined to kick the can down the road a little longer. I don’t know.

    As I told a friend yesterday, it’s time to go sit on a mountain top and process all of this information.

    More to come.

    Be well!

    Salvage Radiation Therapy Nomograms

    I’ve been playing around with two nomograms that offer predictions on the outcome of salvage radiation therapy (SRT). One if from the Memorial Sloan Kettering Cancer Center (MSKCC) and the other is from the Cleveland Clinic (CC). They are similar in design, but the MSKCC nomogram requires more detailed information to be input by the patient, but the CC nomogram provides a more information at the output.

    Summary

    Both nomograms gave results that are in the same ballpark, with the CC nomogram being a bit more conservative.

    MSKCC said that I would have a 64% chance of being progression-free after 6 years after SRT; CC said that I have a 59% chance of being progression-free after 5 years, and 45% chance of being progression-free at 10 years.

    The CC nomogram takes it one step further and estimates a 6% cumulative chance of metastasis at 5 years, and a 12% cumulative chance of metastasis at 10 years.

    MSKCC Nomogram

    MSKCC Salvage Radiation Therapy Nomogram link: https://www.mskcc.org/nomograms/prostate/salvage_radiation_therapy

    In order to use the MSKCC SRT nomogram, you will first need to calculate your PSA Doubling Time, and they specify that you should use the PSA values obtained in the last twelve months.

    MSKCC PSA Doubling Time Calculator link: https://www.mskcc.org/nomograms/prostate/psa_doubling_time

    The MSKCC SRT nomogram requires you to provide:

    • Pre-surgery PSA value.
    • Most recent PSA value.
    • PSA Doubling Time.
    • How many months have passed before your PSA reached 2.0 ng/mL or higher. [Interesting note: The field only accepts values between 0 and 72 months and, for me, it took 125 months to cross the 0.2 ng/mL threshold. I’m guessing that may mean that my result will be a bit conservative because I had to plug in 72 months instead of 125.]
    • Your Gleason score.
    • Information about your:
      • Surgical margins.
      • Extracapsular extension.
      • Seminal vesicles.
      • Pelvic lymph nodes.
    • Whether your PSA remained elevated post-surgery.
    • The planned radiation dose. (I left this set at their default value of 65 Gy because I had no idea.)
    • Whether you will be undergoing hormone therapy before or along with radiation. (I checked “No” as there has been no discussion of that so far.)

    After plugging all of that information in, here are my results:

    Cleveland Clinic Nomogram

    Cleveland Clinic Salvage Radiation Therapy nomogram link: https://riskcalc.org/ProstateCancerAfterRadicalProstatectomyNew/

    The CC nomogram asks you to provide:

    • Whether you will be receiving SRT alone or with concurrent Androgen Deprivation Therapy.
    • Surgical Gleason score.
    • Extracapsular extension.
    • Surgical margin status.
    • Seminal vesicle invasion.
    • Pre-SRT PSA level.
    • Prostate Bed Radiation Dose. [It was interesting to note that CC defaulted this to a dose greater than or equal to 6600 Gy, but it does give you the option to select “<6600”. To be able to compare the CC nomogram results with the MSKCC results, I changed that to be <6600 Gy so the doses would be similar.]

    My results are below (click to enlarge):

    Interestingly, if I bump up the radiation dose to >=6600 Gy, then my percentages change to 65% free at 5 years and 53% free at 10 years. That makes sense, but do higher radiation doses translate into higher risk of side effects? I’m guessing so. Something to ask the radiation oncologist on Thursday.

    Conclusion

    Certainly, those are average to good probabilities, but are they good enough to risk impact to quality of life? I don’t know. Of course, the next step is to dig deeper into the risks of real impact on quality of life after salvage radiation.

    I’m thankful to everyone who provided information about their own experiences, either here in comments on my previous posts or in other forums. They’ve been very insightful and give me an understanding of the range of possibilities to expect. But each case is unique, and I have to remember that, should I choose this, my case will be different from everyone else’s.

    More to come.

    Month 135 – Approaching SRT Decision Point

    My visit with the urologist this week went about as expected.

    We talked about my PSMA PET scan results—negative—and he was of the mindset that those would be the expected results at my PSA level. The scan isn’t reliably sensitive enough when the PSA is hovering around 0.2 ng/ml.

    With my steadily increasing PSA, he said that there’s cancer there somewhere. In his view, it’s likely location is still in the prostate bed, but we can’t rule out that there aren’t micro-metastases elsewhere.

    In reviewing the totality of my case, he commented, “This is one of the trickier cases I’ve seen.” I don’t believe he was too offended when I replied, “No shit, Sherlock.” I guess my frustration of dealing with this over the years came out a little too strong.

    What puzzled him about my case is how long after my surgery the PSA returned and how slowly it was increasing over the years. That led to a discussion about PSA doubling time and how my doubling time is shortening at an accelerating rate.

    As part of that discussion, I asked him how many data points should be included in the PSA doubling time calculations, and he typically uses only the last three to get a current snapshot of where it is now. (I re-ran my numbers when I got home, and using the last three PSAs, my doubling time is 19.9 months.)

    Of course, the engineer in me had to play with that a little, so I went through my PSA spreadsheet and calculated the PSA doubling time if I used the last three values after each test. The results were all over the place:

    His recommendation, of course, was salvage radiation to the prostate bed.

    He thought that salvage radiation still had a chance of being curative at this point, and given that I’m 64 years old, he thought that I would have plenty of years ahead of me should I choose to go down that path.

    We talked about long-term side effects. He thought that there was a 20% to 30% chance that my stress incontinence would worsen, as would my sexual function given where it’s currently at now. He wasn’t confident enough to speak about the chances of rectal issues, at least in the numbers that I was seeking. I expressed concern about the incontinence, and he reminded me that they can take care of that with an artificial sphincter. Great. Another surgery.

    I did ask how much longer I could kick this can a little farther down the road, and he didn’t seem to think that that was a good idea at this point. My stomach turned into knots.

    We agreed to set up the consult with the radiation oncologist, as well as retest my PSA in early April.

    Wednesday afternoon, I received a call from the scheduler trying to set up the radiation oncologist referral. She gave me the option of going to Naval Medical Center San Diego—where I used to work and had a previous referral—or going to University of California San Diego (UCSD). As good a medical treatment facility as NMCSD is, I opted for UCSD. If nothing else than for a second perspective, plus I believe UCSD will have more state-of-the-art equipment and a lower turnover rate in medical teams.

    Thursday, morning, UCSD called and we’re set up to meet next Thursday, 17 February 2022. I was a little surprised when they told me that it would be at their Radiation Oncology center that’s about three-quarters of a mile (one kilometer) from my house instead of their main hospital in San Diego.


    As you regular readers already know, I’ve been fearful of getting to this point for a while now. Whether my fears are irrational, unfounded or not, I don’t know, but they’re real for me.

    My fears center more on having very real, quality of life-impacting side effects from the radiation than on whether or not the radiation will be curative. For some inexplicable reason, my gut intuition is that something will go awry and I’ll be in that 1% or 3% or 10%—or whatever it is—group that gets to experience those side effects impacting quality of life. The radiation oncologist is going to have to give a strong sales pitch to convince me the risks are minimal.

    There will be ton of soul-searching and thinking in the days and weeks ahead.

    Stay tuned.

    Day 4,054 – PSMA PET Results

    They were late. I hate tardiness. 🙂

    Again, going into this, I knew that there was a 50-50 shot that the PSMA PET scan would be able to pick up anything at my PSA level, and it appears that I fell into the “we didn’t see anything” category:

    ONCOLOGIC FINDINGS:

    History of prostate cancer status post prostatectomy with biochemical
    recurrence with:
    – No focal PSMA-uptake in the prostatectomy bed.
    – No PSMA-PET/CT evidence for distant metastasis.

    The fact that they didn’t see anything in my prostate bed and elsewhere is both a good and bad thing. Good, in that whatever cancer may be there was so small that the scan couldn’t pick it up. Bad, in that the scan wasn’t sensitive enough to pick things up at my PSA level (0.22 ng/ml).

    As a reminder, I’m just looking at the printout of my results online, and am not yet in a conversation with my doctor about the results, so I’m a little reluctant to come to too many conclusions about some other comments in the report without the benefit of his expertise. There was a section labeled:

    INDETERMINATE FINDING:

    – Focus of intense PSMA-uptake at the left lung lower lobe (fused 4-263)
    without CT correlate, likely a PSMA injection thrombus, not favored to
    represent metastatic disease.
    Attention on follow up.

    I added the emphasis above, but it’s something that raises an eyebrow and probably warrants further monitoring or investigation as suggested. That’s something I’ll speak with the doctor about.

    Speaking of speaking with the doctor, when I had my appointment in early November, we agreed to schedule a follow-up appointment to go over the scan results in January. However, the first available appointment wasn’t until the first week of February. I’m going to work on moving that earlier, even if it’s a call-in appointment instead of an in-person appointment.


    Am I happy with the results? Sort of.

    We know from my rising PSA that there’s cancer somewhere in some quantity. While this may be a “false negative,” it’s nice to know that I didn’t light up like the Rockefeller Center Christmas tree. That would have been bad.

    Will this cause me to run to the radiation oncologist to start salvage radiation right away based on my PSA alone? Nope. I have another PSA test in January, and if that stays in the 0.21-0.22 range, I’ll be content to continue my monitoring. But if it shoots up drastically, that may cause me to reconsider.

    Was it worth $3,300 out-of-pocket? I don’t know. I’m going to get back to you on that one. 🙂

    So that’s my PSMA PET scan story, and I’m sticking to it.

    If I don’t post again before Christmas, I hope you have a great holiday season!

    Be well!

    Eleven Years

    It was eleven years ago today that I received my diagnosis and began this little adventure, and I’m glad that, eleven years later, I’m still here to write about it. Of course, the fact that I’d be writing about it eleven years later never even crossed my mind when I started this little ol’ blog back then. Even so, I’m glad that I’ve kept it going.


    On Tuesday, I had my appointment with the urologist to review my latest PSA results. In all honesty, it was probably a waste of both of our time and should have been postponed until after the PSMA PET scan.

    Because today is Veterans Day, a federal holiday, they didn’t book any appointments in the clinic for today, so that meant that they overbooked appointments on Tuesday. That meant that the doctor was really pressed for time, and I was okay with keeping the meeting short.

    The whole conversation went like this:

    Dr.: Hi. What’s the status of the PSMA PET scan?

    Me: It’s scheduled on 30 November.

    Dr.: How are we going to get the results?

    Me: I don’t know. I have to figure that out with UCLA. Not to sound rude, but given how new this is, are you going to know what to do with the results?

    Dr. Oh, yeah. Not a problem. You can just hand-carry the results if you want. Everything else okay?

    Me: Yep. Fine. So if the PSMA scan shows the cancer is still in the prostate bed, and given my PSA doubling time is 45 months, what do you see as the next step?

    Dr.: Radiation. (Said without a hint of hesitancy.)

    Me: Uh, okay.

    And that was basically the conversation, with a few other minor details and questions not worthy of putting in writing. I don’t think she picked up on my reluctance to get zapped or, if she did, it was something that she, as the physician, wanted to overrule.

    We agreed to schedule a follow-up in January with another PSA test in advance of the meeting and, hopefully, with the PSMA PET scan results in hand for all. For some reason, they get slammed just before and after the holidays, and the first available appointment was 8 February. I’m generally okay with that, but if the scan and the early January PSA tests reveal something compelling, I’ll try to reschedule sometime earlier.

    So that’s about how I expected the appointment to go (even without the rushing).


    Oh. I almost forgot. I’m now retired from work! Woo-hoo!

    Yes, I took the leap, perhaps a little sooner than I expected, but that’s okay. I added everything up and it was just time.

    I’ll be 64 years old in January, and there isn’t a whole lot of longevity in our family. Dad died at 69; his mom died at 69; and mom died at 73. I can’t say that the past is prologue, but you get the picture. As cliché as it is, tomorrow isn’t promised and, after 40+ years in the workforce, I wanted to reserve my tomorrows for me. Selfish, I know. 😄

    Given where I’m at in my cancer journey, I also wanted to use as many good tomorrows as I can before radiation, hormone therapy, or the disease itself turns them into bad tomorrows.

    Finally, frustration at work exceeded fun and rewards, so that was another good indicator that it was time to start the next chapter of my life.

    My last day was 29 October, so I’m still adapting, trying to find a new routine. (It’s challenging going from 100 m.p.h. to zero!) I’m sure I’ll figure it out. I have another trip in the near future, and I’m excited about that.

    So that’s it for this post.

    Be well!

    Exceptions to “early salvage” radiation treatment for recurrence after prostatectomy — THE “NEW” PROSTATE CANCER INFOLINK

    Here’s an interesting article about salvage radiation.

    Three major randomized clinical trials and a meta-analysis have proved that for most men waiting for early signs of recurrence after prostatectomy (e.g., three consecutive PSA rises or a PSA of 0.1 ng/ml) to give radiation gave the same outcome as immediate (“adjuvant”) radiation (see this link). But there are exceptions. In some men, adjuvant […]

    Exceptions to “early salvage” radiation treatment for recurrence after prostatectomy — THE “NEW” PROSTATE CANCER INFOLINK