Urinary symptoms first started around 2010, slower stream, nocturia, occasional urgency. but was minor, just assumed part of the aging process. 2011, first PSA 5 with free PSA of 26%. Re-test after Cipro, 4.3.
Waited a little over one year before another PSA which came in at 5.6. Biopsy results, 8 of 12 cores positive, G6's and 7's. 5%-40% cancer involvement in various cores, both lobes, including apex and base with perineural invasion noted on my second pathology read, from Oppenheimer labs. First path report had G7 as 4+3, second from nationally known lab had them at 3+4's
Currently Prostate slightly enlarged at 39cc, latest PSA 5.9, but that's after various poking and prodding.
I have opted for the trifecta, or triple play, short term hormone, 2 weeks of Casodex, followed by a 6 month course of Lupron. Three months into the hormone therapy, I start a 5 week course of IMRT, or external beam radiation, followed by permanent Brachy therapy (seed implant)
I am about to start treatment so I will report back with my progress throughout the process. Train about to leave the station....
After a second RO opinion and a color Doppler ultrasound, it was determined that my prostate is 61cc not 39. Extracapsular extensions noted. The prostate is enlarged and loaded, both lobes. Ident in the median lobe into the bladder that resulted in severe urinary retention following the biopsy
New RO started me on Casodex, Avodart and flomax on 1/5/2013, Trelstar on 1/24/2013(6 month course). Started DART external beam on 1/31/2013, 30 treatments. 4 to go from today(3/8).
The first RO protocol was to treat the urinary symptoms first and to deal with a "knuckle" or extension indenting the bladder, maybe with green light laser prior to starting radiation. The new protocol, start hormones and radiation first, which will help shrink the prostate and avoid the possible spread of cancer cells by "not" attempting any procedures until after the cancer cells are weakened by the rad/hormone assault.
So far have not had flow issues, but frequency and nocturia continue. My hope is once the DART treatments end next week, once the prostate starts to heal, the prostate will start shrinking and eliminate the urinary symptoms so I won't need a minor laser to remove the offending "knuckle indent" prior to seeding
The Brachy implant can wait up to two months to give me time to see how I do. As for the treatment, except for urinary frequency and occasional diarrhea, the worst part is the 140 mile round trip drive. The hormone treatment, so far nipple tenderness but no hot flashes.
Other meds, estogen patch, Boniva, vitamin D, Carafte, Trentanel, ibuprofin
Had a check up with a urologist a week after ending 30 days of DART. Went back a week after that for some barbaric testing. My prostate went from 65cc to 29cc, after 3 months of casodex, avodart a shot of trelstar, and the rad sessions, so pretty good shrinkage prior to Brachy,
Unfortunately the diminished prostate did not alleviate the protrusion into the urethra as it passes through the prostate. That same week I had green light laser to remove the offending "nub", under a general anethesia. It was a good practice for the Brachy, same hospital drill, different assault on my poor lower extremities. Having urgency, some burning at start of urinating. Can't tell what it's from, green light laser, radiation or infection from the catheters. Hopefully things settle down in time for Brachy, good flow though.
Seeding scheduled for May 8th 2013. This has been one long drawn out process. See light at the end of the tunnel. Will report back after post seeding PSA;. The adventure continues...
May 8th, seeded with Palladium 103 which has a half life of app 17 days. Stopped all ADT drugs on August 1st. At almost 4 months out, I still take Terazosin and Ibuprofin. My main plumbing issue is Nocturnia, where some nights I fill a 1000 cc container kept on the nightstand, much better than getting out of bed, as I still have live radioactive seeds, and for me it appears to continue to be a minor irritant. During the day my urinary symptoms are much improved, almost normal, from what I can remember.
As I just went through 30 DART external radiation treatments, followed by a Green Light Laser "Trim", seed implantation, ADT and I having had a severe shingles outbreak at the start of all this, I'm doing pretty well. Partly I would guess, from the relief of having this behind me. I almost didn't get the biopsy, out of fear it would open this door, as it turns out, my cancer was not contained, hopefully it was caught in time, we shall see....
Still suffering lingering symptoms from the ADT. My total testosterone from an August 7th blood test was 9. I was told to expect the recovery time roughly equal to the time one is on the drugs. 7 months for me. I developed a pot belly complimented by some breast growth. I regret not taking available precautions to help prevent gynocomastia, I was advised it wouldn't be necessary for the short term therapy.
At my final treatment consult, I was given prescription for Finesteride. Kind of disappointed by that, as I don't want to continue taking any drugs unless absolutely essential. So far I have not started.
My next consult will be in 6 months. Will see what happens next.
6 Month follow-up February 2014
PSA 0.1, same as from recent test from the end of treatment in August. Testosterone from wobbly-milktoast 9 at treatments end, to a blistering 400 with weak watery ejaculate with muted orgasm, when I care..
Working out on a regular basis, aerobics/weight training. So far no lingering negative side effects.
Off of all drugs except 5mg of finesteride and D3. Overall in a much better place than last year at this time
Belated one year follow up from 08/2014. PSA remains at .1. Fairly symptom free, although nocturia persists. I had that for a year or two prior to being diagnosed, so not sure if it's from the PC or not, cause undetermined. If I had the chance, I would opt for the same treatment, so no regrets there. Time will tell.
Two years from the end of all treatment. PSA had been consistent at .1 while the current reading is down to.02. Symptom free except ongoing nocturia, which I had prior to any treatment so may be related to something else yet to be determined. Other than that, fully functional with some minor changes. Ejaculate is down to almost nothing, erection not 100 percent, but these may also be from aging as well as continuing Finesteride @ 5 mg daily., but hey, I'll take it, certainly better than metastized cancer...
For my type of PC, I feel I had the best possible treatment available, and I am glad I didn't start with surgery followed by radiation as was recommended by the first 2 consults with Urologists. Treat for the cancer you have with a treatment that offers the best chance of a cure with the least amount of side effects, from a practitioner who specializes in treating prostate cancer only. I was fortunate to live within driving distance of Dattoli Cancer Center.
Time will tell........
One year later, August 2016. Three years since all treatment ended, same condition as last year, all good. Fading from memory, but then brought sharply back into focus while waiting the latest PSA results. Less than .1 again.
Peet's e-mail address is: firstname.lastname@example.org