Month 124 – Prostate Cancer a Chronic Illness?

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

“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 121 – PSA Results

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!

Day 3,521 – A Chat with the Doctor

My appointment with the doctor is scheduled for tomorrow afternoon, but after dinner this evening, my phone rang. It was the doctor calling about my appointment.

In a nutshell, VA Medical Center San Diego is trying to reduce the number of in-person visits during COVID-19, so he was wondering if I would be okay chatting with him about my results over the phone. Of course, I was.

He let me know that my PSA dropped from 0.16 to 0.14 ng/ml and that things were pretty “stable” and having a “low PSA” was a good thing. He mentioned that at some point in the future, we may need to discuss radiation, but that point wasn’t now. “For you, that could be years from now.” I’ll take that.

I shared with him my desire to do imaging before zapping if possible. I also brought up the trial at the VA Los Angeles, and he wasn’t aware of it. So I pulled it up and shared the trial number with him for his education / reference.

Bottom line: We agreed to retest in January and go from there.

Now all I have to do is make it through six months of COVID insanity…


On a related note, the VA healthcare system has gotten a bad rap over the years for a variety of things. It seems to be location-dependent, and some of the criticism is well-deserved.

I’ve been going to the VA Medical Center San Diego and its satellite clinics for about 8 years now, and I’ve had nothing but a positive experience, and tonight’s unsolicited call from the doctor just reinforced that for me.

As we used to say in the Navy: Bravo Zulu! (Well done!)

Stay well everyone!

#WearAMask #SocialDistancing #WashYourHands #StayHome

Day 3,508 – PSA Results

Apparently, getting my blood drawn in mid-afternoon adds one day to getting my results. Needless to say, I’m pleased with the 0.14 ng/ml reading. It’s down 0.02 from the last two times (excluding that oddball 0.08 reading in February).

This reading added 10 months to my PSA doubling time, so it’s now out to 48.9 months according to the Memorial Sloan Kettering PSA Doubling Time Calculator.

PSA 20200615

My appointment with the doctor is on 2 July and we’ll see how that goes. I suspect it will be another continue-to-monitor situation, and that’s fine by me.

Have a great weekend and happy Father’s Day to all the dads out there! Stay well!

Day 3,505 – Change in PSA Test Plan

My work schedule forced a little change in plan for getting my PSA test done. I was planning on going first thing tomorrow morning, but a 9:00 a.m. scheduled meeting was a little too close for comfort, and I wasn’t sure that I could make it back to the office in time, so I left work a little early to have the blood drawn.

The clinic did do a COVID-19 screening of me before I could even enter the building, including taking my temperature. Surprisingly, there was no one in line for the lab, so I was in and out in under 10 minutes. I may make going later in the afternoon my new routine going forward. In the mornings, everyone wants to be the first one there, so you can wait for about an hour to get the test done.

If COVID isn’t affecting lab processing and reporting times, I should be able to access my results online after 10 p.m. PST Wednesday.

Month 115 – PSA Time & Imaging Trial for Veterans

Wow. I just may get this post out on time this month! I tell you, this pandemic thing has really thrown me for a loop when it comes to maintaining some sort of routine. Fortunately (or perhaps unfortunately), I’ve returned to working from the office every day for the last three weeks, and that’s brought some structure back to my life.

PSA Time

It’s hard to believe, but four months have passed since my last PSA test, and I’ll be heading off to the clinic on Tuesday morning. I hope. I haven’t actually confirmed that they’ve reopened for routine things like blood tests. If they are open and they do take the sample, I should have the results late Thursday night or Friday. My appointment to go over the results is on 2 July.

Just as a reminder, here’s my PSA roller coaster:

 

PSA 20200223

I’m at the point where I don’t get too worked up about these tests anymore, even with the upward trend. It is what it is and I’ll deal with the number when I get it.

Imaging Trial for Veterans in Los Angeles

The VA Greater Los Angeles Healthcare System is conducting a phase II trial  “to determine whether a positron emission tomography (PET)/computed tomography (CT) scan using 18F-DCFPyL affects the clinical management plan in Veterans.” Some are saying that 18F-DCFPyL may prove to be even better than a Ga-68 scan.

For patients with biochemical recurrence, they want your PSA to be at least 0.2 in a post-radical prostatectomy situation, so unless my PSA jumps up again next week, I’m not eligible. (No, I’m not wanting it to jump up.) The cost is free to veterans and only veterans are eligible. You can learn more about the trial here:

18F-DCFPyL PET/CT Impact on Treatment Strategies for Patients With Prostate Cancer (PROSPYL)

So that’s about it from a toasty 90° F / 32° C San Diego.

Wear a mask. Stay apart. Stay well!

Day 3,394 – Doctor Visit

Well, I didn’t expect that…

I met with the urologist this afternoon—a new one to my case—and he was personable but very direct.

We talked about the goofy PSA reading and he wasn’t all that concerned about it. It appeared to be lab error and dismissed it as pretty much meaningless. But what followed caught me a little off-guard. “The one thing you absolutely do not want to do is start treatment.” He was quite emphatic. His reasoning was several-fold.

First, he talked about over-treatment given my numbers and pathology. He was looking at how long it took for the PSA to return post-surgery (nearly five years) and how slowly it’s been increasing (PSA doubling time / velocity). Those were positive indicators to him. Treatments like radiation and hormone therapy have side effects that impact quality of life and can be avoided with minimal risk for now.

Second, he expressed concern that if we started treatment too soon, specifically hormone therapy, it would be less effective when we may need it the most.

Third, he mentioned the absolute value of my PSA and how imaging wouldn’t be able to detect where any cancer may be at that level. That’s nothing new to me. We talked about the Ga-68 PSMA trial up at UCLA, and he confirmed that at my PSA level, the chances of finding something meaningful were small (<30%).

Finally, he was very much aware that continued monitoring is needed to make sure that this doesn’t get away from us, and he was content with PSA tests every six months considering how slowly the PSA was increasing. I wasn’t quite comfortable with that, so my next PSA test will be in late June with an appointment on 2 July 2020.

I did mention to him the issues I’ve been having with my back and sciatica, and that I had an MRI last night to have that checked out. I’m 99.5% certain that the problem is related to a back injury that happened in 1986, but that other 0.5% of me was wondering if there was metastasis to the spine. He pretty much dismissed that possibility out of hand given where my PSA level is at. (Hey, my mind wanders into some pretty dark corners sometimes, but given that one of the first place prostate cancer likes to metastasize is the spine, it’s not too far-fetched an idea.)

Again, I was a little taken aback by how emphatic he was concerning not pursuing any treatment at this moment. I got the sense that he really values trying to balance avoiding over-treatment versus quality of life versus knowing when to step in and act. For now, I’m comfortable with continued monitoring with another PSA test in four months.


So, I’ll leave you with a little urology “humor” that has men cringing everywhere.

As I was sitting in the exam room waiting for the doctor, I looked over on the desk and saw the tools of the trade—some lubricating jelly and toilet tissue—at the ready for the dreaded DRE. (The rubber gloves were in dispensers hanging on the wall.)

Then I reminded myself that it was a DRE during a routine physical that discovered the mass on my prostate and started this adventure. Thirty seconds of discomfort can save a life.

IMG_20200225_131804422
Urologist tools of the trade.

The New York Times: Debating the Value of PSA Prostate Screening

So I’m sitting in the waiting room at the doctor’s office scrolling through the news on my phone and this pops up. Go figure.

The New York Times: Debating the Value of PSA Prostate Screening.
https://www.nytimes.com/2020/02/24/well/live/prostate-testing-PSA-cancer-screening.html

Day 3,392 – PSA Retest Results

My last PSA test on 4 February showed a 50% drop in my value compared to the previous test in September 2019, which is a major, unexplained swing considering that I haven’t been doing treatments of any type to lower my PSA. It just didn’t sit right with me, so I asked for a retest.

PSA 20200223I went in on 20 February for the retest, and the PSA came back at 0.16 ng/ml, exactly where it was in September 2019. (At least that’s the silver lining in the cloud: it didn’t go even higher.)

We’ll probably never get a good explanation for the dip in my PSA earlier this month, and I guess that’s just part of dealing with this beast. I’m going to leave the errant data point on my chart just to show how wacky this can be at times.

The one thing that this has done, though, is drive my PSA Doubling Time down to 39.7 months according to the Memorial Sloan-Kettering PSADT Calculator (excluding the 0.08 reading). That’s still a very good number, but it’s downward trend over time is becoming more concerning.

I’m really glad that I was able to get the retest done before my appointment with the doctor on Tuesday. It certainly will make for an interesting discussion.

More to come…