I will probably decide brachytherapy. Treatment expected to start in the next two months.

Later: I have decided to have brachytherapy. On May 3, 2011 I am going for a volume measurement. Then 5 or 6 weeks I will have the treatment. I will keep updating.

May 3, 2011 I had my volume study today. Volume 49 cc. Went very smoothly. No catheter. Took only 10 minutes. Seed implant in three to six weeks.

The RO told me that the implant will be in three to six weeks. But actually it took 7 weeks and I was scheduled on June 2011 at 12:30 PM. The wait was too long for me, literally counting days. I was worried about prostate enlargement. I posted my concern in the discussion room either in YANA or Healing Well. I was assured that the prostate will not change that much in this 7 weeks. My RO's nurse also assured me. But guess what, my prostate size was found to be over 57 cc on June 20. [It is very difficult to measure the volume of the prostate gland with any degree of accuracy because of its irregular shape.]

On June 19, I was on clear liquid diet and had to take magnesium citrate and two enema. This preparation turned out to be more difficult than the procedure. On the morning of June 20 I arrived at the outpatient surgery center at 11:30 AM as instructed. After the usual prep I walked into the operation theater precisely at 12:30 PM. Next thing I remember is clock in the recovery room showing 2:30. From the report I gather that the first needle was inserted at 12:42 PM and the physicians left the operation theater at 1:57 PM. Eighty eight Iodine 125 seeds were implanted. The catheter was inserted and removed when I was fully under general anesthesia.

In the recovery room, I managed to produce enough urine in a plastic bottle. So I was allowed to go home. The first day passing urine was rather painful with blood clots and blood. But there was no change in frequency. In fact, it has been like that during the last seven. I am getting up my usual one or zero time during the night. Amount of urine has reduced somewhat.

Now there is virtually no side effect. I wish I remain lucky. On July 27, I have an appointment with the urologist. And on August 4, I will have the X-Ray and meeting with the radiation oncologist.

I will keep updating.

Mazharul

After seed implant on June 20, 2011, my PSA went down to 1.1 in August and to 0.6 in December. Before treatment my PSA was 3.4. I have virtually no side effect.

I had my 3 month PSA test on March 1, 2012. My PSA has gone down to 0.4 from 0.6 in December 2011.

In June 2012, my PSA dropped to 0.3 and in December 2012 it dropped to 0.1. The drop seems to be consistent.

However, the slight discomfort I had when urinating seems to be going up somewhat. Normally, you expect side effects to go down with time. I have an annual appointment with the RO this month. Let us see what he says. If the discomfort goes up further, I will probably see the urologist.

I will report any significant change in side effects.

Not much has changed since my last update. The PSA in December 2013 was 0.1. Except for a bump to 0.2 in June 2013, my PSA has been going down steady since my seed implant in June 2011. There is virtually no side effect except for slight change in bowel movements which may not be related to seed implant.

I am going to have another coloscopy in March. I have a history of colon polyps.

Two weeks ago I had blood in urine with blood clot/debris. It was a one time event clearing up after three bath room trips. Urinalysis did not find any infection. Ultrasound found unremarkable bladder and a small cyst in kidney. I have chronic kidney disease since 1998 with creatinine hovering around 2.0. Today, I had a cystoscopy that found no problem with bladder. Urologist thinks the blood is most probably due to radiation damage. Apparently, it is not uncommon to have blood in urine more than two years after brachytherapy.

Two weeks ago, I was surprised to see blood in my urine accompanied by clots. It was a one time occurrence that cleared up quickly. However, on advice from my urologist I had a urine analysis, an ultrasound and a cystoscopy. My bladder was found to be clear. But two days after the cystoscopy I had rather frightening episodes of blood and clots in my urine. The cystoscope apparently dislodged some of the scar tissues from radiation damage. I had bright red urine with lots of clots throughout the night. I was afraid of blockage in my urinary track. So went I to ER. A Foley catheter was inserted and my bladder was irrigated. The doctor also extracted some blood clots by pumping water with a syringe and sucking the water out. Now my urine is clear.

Apparently, about 10% of brachytherapy patients develop gross hematuria two or more years after the seed implant. I suppose I became one of the 10%. Insertion of the Foley catheter was very painful for me and it was the first catheter for me when I was not under the influence of anesthesia.

It will be three years tomorrow since my seed implant on June 20, 2011. Excepts for some severe bouts of blood in urine in February this year, my side effects have been minor. I had a PSA test last week. It came out to be 0.2, slightly up from 0.1 in December, 2013. I had a 0.2 in June 2013. I suppose this slight fluctuation in PSA is not significant. I will have another PSA check in December.

My PSA is increasing slowly: 12/11/13: 0.1, 6/12/14: 0.2, 12/3/14: 0.3, 7/20/15: 0.4. This increase is not very significant. But it definitely points towards slow growth of cancerous prostate cells. According to my urologist, growth at this rate will take 200 years to kill me. I will have another PSA check a year from now. I am hoping that reading will not show a significant increase. I do not know whether anyone else has experienced similar PSA increase after brachytherapy.

My PSA has jumped from 0.4 last July to 1.5 this July. It looks like recurrence.

I had brachytherapy for Gleason 6 prostate cancer in June 2011. As you can see from my previous postings, I had virtually no side effect and PSA nadir was reached by December 2012. After a small PSA bounce in 2013, my PSA started rising from 0.1 in December 2013. By July 2015, it rose to 0.4 and then it increased rather rapidly form 0.4 in July 2015 to 1.5 in July 2016. A biopsy and and an MRI discovered a large prostatic cancerous mass (24 mm x 22 mm x 25 mm) outside the prostate emanating from the prostate. It is an extremely unusual recurrence as stated by two RO and one MO.

I decided on CyberKnife with short period of HT to treat the cancerous mass. It might be the only chance to cure my cancer. If it fails, I would have to manage my cancer with HT for rest of my life. It is a rather unusual turnout for a low volume Gleason 6 cancer. Ironically, biopsy and MRI did not find any evidence of cancer inside the prostate. Initial brachytherapy killed the Gleason 6 cancer inside the prostate, but failed to kill completely a cancerous spot (possibly more aggressive) near the capsule not detected by the biopsy in 2011.

I already had gold markers placed inside the prostatic cancerous mass outside the prostate and first dose of Firmagon (Two injections of 120 mg). I am having hot flashes from the second day after the injections. Today is the fourth day. As I am typing, I am having a hot flash.

After being on Firmagon for two months, my PSA went down from 1.8 to 0.2 by December 2016. In January 2017, it went down to 0.1. The planning MRI for CyberKnife found the external cancerous mass attached to my prostate has shrunk considerably due to hormone treatment. I had 5 CyberKnife treatments between January 16 and January 25. So far no serious side effects from the radiation treatment. I had my first Lupron shot in January before CyberKnife. I will have another shot on April 17. Frequency and severity of hot flushes has gone down significantly. I am also less fatigued.

I am hopeful that CyberKnife would take care of my recurrent cancer (Initially diagnosed Gleason 3 + 3 in March 2011 and treated with brachytherapy in June 2011). I do not know how common it is for a Gleason 3 + 3 cancer to recur outside the prostate and attached to the capsule and grow into a ball of about one inch in diameter within a period of couple of years. My PSA hit nadir of 0.1 in December 2013, about two years after brachytherapy in June 2011.

I had ADT and CyberKnife for my recurrent cancer in extra-capsular mass between September 2016 and April 2017. My PSA before treatment of 1.8 went down to undetectable (< 0.1) in April 2017 and stayed there until April 2018. In April 2018, my PSA was 0.2. By July 2018, it rose rapidly to 0.9. It appears that treatment of my recurrence might have failed or my cancer is metastatic. I will have another PSA test in eight weeks time for a more definitive diagnosis.

A year after Cyberknife and ADT for an extra-capsular cancerous nodule (4 years after brachytherapy for Gleason 3 + 3 cancer) my PSA started to rise very rapidily with PSADT less than 2 months. A PET/CT scan finds metastatic cancer in about 10 pelvic lymph nodes. Started hormone treatment with Casodex and Lupron on November 16.

I was on Lupron + casodex since November 2018. My PSA of 4.48 at the start of treatment dropped to 0.06 by November 2019.

PSA History: Nov 16, 2018: 4.48, Feb 28, 2019: 0.17, June 1, 2019: 0.10, Sept 9, 2019: 0.07, Nov 25, 2019: 0.06, Feb 26,2020: 0.07.

I started ADT vacation in November 2019. Last 3 month Lupron shot was Sept 9, 2019. My Testosterone as of Feb 26 is 20. I still have hot flushes.

During break from ADT from November 2019 to September 2020 my PSA rose from 0.07 to 0.453. So, I had a 3 month shot in September 2020. This time my PSA fell from 0.453 to 0.116 in nine months. I have started another break in June 2021. On September 3, 2021 my PSA was 0.104 and Testosterone less than 20. I will have another PSA and T test on December 2, 2021.

Since last time I posted my metastatic prostate cancer has become castrate resistant. Now, I am on 1000mg Abiraterone + 5 mg Prednisone in additon to 3 monthly Lupron shot.

Mazharul's e-mail address is: mazharulhuq001 AT gmail.com (replace "AT" with "@")