Tag: PSA

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

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.)

Day 4,923 – PSA Results

On By DanIn Prostate Cancer, Radiation Therapy, Recurrence6 Comments

No surprise here. In my spreadsheet, I put a placeholder value of 0.50 ng/mL for this PSA test based on the previous trend, and the actual result came in slightly higher at 0.52 ng/mL.

The PSA Doubling Time is dropping as well. Using the last five readings and the Memorial Sloan-Kettering PSA Doubling Time calculator, my PSADT was:

  • 6.7 months on 6 December 2023
  • 6.2 months on 19 January 2024
  • 5.1 months on 1 May 2024

It seems safe to say that the salvage radiation therapy failed to do the trick.

I am trying to describe my reaction to this hour-old news. I guess words that I might use would be: numb, indifferent, resigned. I don’t know. It’s a bit weird. I certainly had zero expectation that my PSA would go down or even hold steady given the previous trend.

You may recall the conversation with the medical oncologist suggested that we monitor and do another PSMA PET scan in six months, which would make it August. The question now is, based on these results, do we stick with that plan? Or do we move to the discussion on the type of androgen deprivation therapy and the timing of ADT?

I did ask the phlebotomist if he was drawing blood for a testosterone baseline test and he said yes. I don’t see the results posted online yet (my record is still going through its once-a-day update as I type this).

Well, it’s after midnight. I’ll sleep on this and perhaps I’ll be a tad more focused in the morning after having processed this.

What’s next:

  • 9 May – Appointment with primary care physician (annual physical)
  • 14 May – Appointment with urologist

Header Image: Scenes from San Diego Bay, San Diego, California

Day 4,878 – Medical Oncologist Meeting

On By DanIn Hormone Therapy, Prostate Cancer, Recurrence1 Comment

This will be a Reader’s Digest version of a future longer post. My computer died Sunday night and I’m not keen on trying to type out the full report on my phone’s itty-bitty keyboard.

The bottom line for now is to watch my PSA for the next three to six months, perhaps with another PSMA PET scan in six months if my PSA has increased sufficiently to be reasonably assured that the scan could detect something. I’m okay with that approach.

If my next PSA has a sizable increase, we’ll reevaluate.

The meeting lasted around 30 minutes, so there are more details to share once I get access to a computer again.

I’ll go for a PSA test (and get a testosterone baseline) on 1 May in advance of a 9 May meeting with my primary care physician and a 14 May meeting with the urologist.

With luck, I’ll have a full update by the end of the week.

PCRI Video: Combining First and Second Generation ADT

On By DanIn Hormone Therapy, Prostate Cancer1 Comment

Another timely video from the Prostate Cancer Research Institute talking about the recent EMBARK study that examines combination ADT + enzalutamide therapy versus Lupron alone or enzalutamide alone. (The study was funded by Pfizer and Astellas Pharma, the manufacturers of enzalutamide.)

There were 1,068 patients divided into three groups that were followed for five years. The groups were combination therapy (leuprolide + enzalutamide); leuprolide alone; and enzalutamide alone. The metastasis-free survival rate for each group:

  • Combination therapy: 87.3%
  • Leuprolide alone: 71.4%
  • Enzalutamide alone: 80.0%

One thing the study summary doesn’t address is whether combination therapy accelerates or delays the cancer developing a resistance to ADT. That would be interesting to know. While it doesn’t explicitly say in the summary, it appears that the patients were on the treatments continuously for the five years.

This is something that’s been added to my list of discussion points for my visit with the medical oncologist on 19 March.

Day 4,832 – PSMA PET Scan Results

On By DanIn imaging, Prostate Cancer2 Comments

No evidence of recurrent prostate cancer or metastatic disease.

I know I should be excited but, at the same time, I don’t think I’ve been so frustrated by “good” news. Thanks to the steady increase in my PSA, we know something is happening somewhere, and I was really hoping this scan would end the game of cat-and-mouse that we’ve been playing trying to determine where the cancer is and what to do next. It didn’t.

Even though I recognized going into the scan that, at my PSA level (0.37 ng/mL), there was an approximate 40% chance of detecting something, I was hopeful it would come up with something this time. Silly me and my expectations.

Detection Rate on a Patient Basis Stratified by PSA and Region Tr indicates prostate bed only; N1, pelvic nodes only; M1, extrapelvic only. Proportion of patients with 68Ga-PSMA-11 PET positive findings were stratified by PSA range and region of disease in accordance with PROMISE. https://pubmed.ncbi.nlm.nih.gov/30920593/

The other thing I’m beginning to wonder is if I’m in that 10% of patients for whom PSMA PET scans don’t work. (You may recall that being mentioned in this video from the PCRI: Rising PSA After Prostatectomy.) I have to dig into that more to see if it’s just PSMA PET scans that use Gallium-68 as the tracer, or if that applies to any PSMA PET scan regardless of the tracer used. I’m guessing it’s the latter.

Choline and Axumin scans are another option, but they don’t start reliably picking up cancer locations until the PSA is at 1.0 ng/mL or higher. Assuming my current PSA doubling time (6.2 months) remains steady, that means waiting another 11 months before I hit 1.0 ng/mL for those scans to have a chance of seeing anything.

I’ll be putting together my list of questions for the urologist appointment on 13 February (I’m open to suggestions). I suspect we’ll have a good discussion on subsequent PSA testing, the value of knowing where the cancer is located at this point, and when to start hormone therapy.

Again, the silver lining in this is that my scan didn’t light up like the Las Vegas strip. I need to keep that in mind.

Happy Friday!

Day 4,820 – PSA Results

On By DanIn Prostate Cancer, Radiation Therapy, Recurrence2 Comments

Okay. I got antsy and went for my PSA test on Friday instead of next week. As expected, my PSA increased from 0.33 ng/mL on 6 December 2023 to 0.37 ng/mL on 19 January 2024.

The silver lining in that cloud is that the rate of increase slowed a bit and it didn’t increase as much as I expected it would.

Sometimes, I get too nerdy for my own good. There was a 91% increase between the May and October readings, and there was a 57% increase between the October and December readings, so I averaged the two increases (74%) and projected that this increase would land me at just over 0.5 ng/mL. This increase ended up being just 12% over the previous December reading. Fickle PSA.

I ran the numbers through the Memorial Sloan-Kettering PSA Doubling Time calculator again, using the five values from March 2023 (0.13) on. My PSA doubling time dropped from 6.7 months to 6.2 months, and my PSA velocity increased from 0.2 ng/mL/yr to 0.3 ng/mL/yr since calculating it back in December.

I went for the test early because I really wanted to know the PSA value going into the PSMA PET scan that’s scheduled on 31 January 2024. Plus, if it dropped, I would have had time to ask the urologist if it was worth going ahead with the scan at a lower PSA level. (Remember, I went for a PSMA PET scan when my PSA was 0.22 ng/mL, and it didn’t show anything at that PSA level. Why subject myself to another dose of Gallium-68 if the outcome may not produce any useful information?)

My follow-up with the urologist to review the PSMA PET scan and PSA results is on 13 February, and we’ll map out what’s next from there.

So that’s the latest and greatest. More to come.

Header image: The famous Torrey Pines Golf Course, San Diego, California, home to the Farmers Insurance Open golf tournament

Day 4,815 – Bone and PSMA PET Scan Update

On By DanIn imaging1 Comment

Just a quick update.

You already know that I completed my bone scan, which the VA required (for some inexplicable reason) before ordering a PSMA PET scan. This morning, I was able to schedule the PSMA PET scan with the VA, and it’s set for 31 January 2024. That was much faster than scheduling it with UCLA two years ago.

I’ll go for a PSA test the week before the PSMA PET scan, perhaps on 24 or 25 January. It will be interesting to see how much it’s increased. As a refresher:

9 May 2023 – 0.11 ng/mL

31 October 2023 – 0.21 ng/mL

6 December 2023 – 0.33 ng/ML

Should I get a pool going to see what it will be this time?

I have an appointment with the urologist on 13 February to review the results and map out next steps.

More to come.

Header image: Sunset over the Pacific Ocean at Carlsbad Beach, California