After original diagnosis (February 12, 1996) the doctor thought that with a PSA of 349, any treatment should only be palliative so I was put on ADT (Androgen Deprivation Therapy).
The tumor responded very well to this treatment, so after a year and a half with a PSA of < 0.1 we (different doctor and I) decided to try a more aggressive treatment; so, on February 24, 1999 I had Brachytherapy (and was taken off ADT January 1, 2000).
After two years and nine months off ADT my PSA had risen to 26.2 so I was put back on ADT and given EBRT (External Beam Radiation Therapy) (October 29, 2002 to December 6, 2002) to the pelvic area shielding the prostate.
Two years later my PSA was again down to 0.1 so on December 23, 2004 I was taken off ADT. In three years my PSA had risen to 64.4 so on November 14, 2007 I went back on ADT, and on October 28, 2008 (PSA - .6) had Cryotherapy. I was taken off ADT again on May 5, 2009 with a PSA of .1. The last PSA was .8 on January 5, 2011 (20 months off ADT).
Other than some minor incontinence the problems that I have experienced are pre-cancerous lesions in bladder (probably from the EBRT) and a stricture in the prostate area of the urethra (probably from the Brachytherapy). The stricture causes problems getting the cystoscope into the bladder to check for more lesions, so on April 29, 2011 I will be going in for my second balloon dilation.
In spite of all the problems, I am now over 15 years out from my diagnosis which is longer than I had ever hoped for at the beginning of my "journey".
The 4/29/11 Urethral Dilation and Cystoscopy proved negative for lesions in the bladder.
Continued on the Off-Cycle of ADT (Now at 35 months off).
History of PSA and Testerone since last posting -
05/31/11 PSA 1.87 - T 20
09/02/11 PSA 2.61 - T 18
11/28/11 PSA 4.13 - T 16
03/06/12 PSA 7.95 - T 28
Had a third Urethral Dilation and Cystoscopy on 3/16/12 which again proved negative for lesions in the bladder.
Scheduled another visit with the Urologist for 6/25/12, at which time we will do a re-staging (CT Scan and Bone Scan) if the PSA is over 10. 16+ years and holding!!!!
03/16/12 Third Urethal Dilation & Cystoscopy proved negative for lesions in the bladder.
06/15/12 PSA 6.51 - T 30 (Free PSA .58; .09%)
10/09/12 PSA 9.22 - T 45
10/26/12 Fourth Urethal Dilation & Cystoscopy proved negative for lesions in the bladder.
04/04/13 PSA 10.26 - T 40
Even though my PSA is rising we have decided to remain off Hormone Therapy for the time being since my T is already relatively low. We have decided to do some re-staging, however, since it has been nearly 6 years since my last CT Scan (10/17/07). Probably will do another Urethal Dilation & Cystoscopy this Fall and if still negative we will go to once a year, or maybe consider eliminating it since it will be 5 years since the original lesions were found.
05/23/13 Whole Body Bone Scan "No evidence of osseous metastasis"
05/23/13 CT Abdomen/Pelvis "No evidence to suggest metastic disease"
10/11/13 PSA - 14.1, Testosterone - 16.8
10/22/13 Cystoscopy (Under anathesia) - "Except for considerable scarring the bladder looked fine."
10/22/13 Plan for future - Cystoscopy every year for five years, PSA & Testosterone every six months.
04/24/14 PSA 15.6, Testosterone - 9.7
10/29/14 - PSA 27.0, T 24.0
01/27/15 - PSA 36.4, T 17.5
02/25/15 - PSA 30.1, C-11 Choline Pet Scan at Mayo Clinic in Rochester, MN indicated Pca in a linguinal lymphnode & seminal vesicle bed. Biopsy confirmed Pca in the inguinal lymphnode. Received three month Lupron shot and began Casodex tabs (One 50MG tab per day).
06/12/15 - PSA 4.5, Received another 3 month Lupron shot and continued Casodex Tabs. Scheduled follow-up with Urologist at Mayo in 3 months, and also meeting with Radiation Oncologist for possible irradiation of affected areas.
09/09/15 - (Mayo Clinic) PSA 3.1 Received 3 Month Lupron Shot, continue Casodex
12/23/15 (Mayo Clinic) PSA 2.8 Received 3 Month Lupron Shot, continue Casodex.
02/01/16 (Mayo Clinic) Began inguinal Lymph node radiation
03/04/16 (Mayo Clinic) Completed lymph node radiation (25 Treatments)
04/04/16 (Mayo Clinic) PSA 1.9 Received Lupron Shot, continue Casodex.
07/07/16 (Mayo Clinic) PSA 1.1 Received 3 Month Lupron Shot, continue Casodex.
10/19/16 - (Mayo Clinic) PSA 1.5 MRI & Pet Scans negative. Received Lupron shot, continue Casodex
01/25/17 - (Mayo Clinic) PSA 2.1 Continued rise in PSA may indicate that disease has become refractory. Received Lupron shot, stopped Casodex.
05/04/17 - (Mayo Clinic) PSA 3.2 MRI & PET Scans revealed locally progressive disease but no evidence of metastatic disease. Will continue to monitor and if progression continues treatment with agents such as Zytiga or Xtandi will be considered.
07/31/17 - (Mayo Clinic) PSA 4.2 Because of continued rise in PSA it was decided to initiate Zytiga (1,000 mg by mouth daily) with Prednisone (5 mg by mouth twice daily). Because of cost I decided to order through the VA but they insisted on their own examination before filling the Rx. Received Lupron shot.
08/25/17 - (VA Hospital, St Cloud, MN) PSA 4.8 After exam Zytiga & Prednisone were prescribed.
09/02/17 Received Rx and began Zytiga & Prednisone
10/31/17 - (Mayo Clinic) PSA 2.7 New therapy appears to be working. Received Lupron shot.
11/24/17 (VA Clinic, Alexandria, MN) PSA 2.4 All other labs indicate that I was tolerating Zytiga & Prednisone well.
01/03/18 - VA Med Center PSA 1.9
01/22/18 - Mayo Clinic Rochester, MN PSA 1.6 "MRI/Pet Scan looks good. Continue Zytiga/Prednisone"
02/14/18 - VA Med Center PSA 1.7
03/28/18 - VA Med Center PSA 1.4
05/09/18 - VA Med Center PSA 1.2
05/25/18 - Mayo Clinic Rochester, MN PSA 1.2
06/20/18 - VA Med Center PSA 1.6
08/01/18 - VA Med Center PSA 1.3
09/13/18 - VA Med Center PSA 1.2
09/20/18 - Mayo Clinic Rochester, MN PSA 1.2
10/25/18 - VA Med Center PSA 1.3
12/06/18 - VA Med Center PSA 1.6
01/14/19 - Mayo Clinic Rochester, MN - Scheduled for PET/CT Scan and PSA
01/14/19 - Mayo, Rochester, MN - Choline PET Scan revealed "No evidence of PC progression" PSA 1.4
01/16/19 - VA Med Center PSA 1.6
02/28/19 - VA Med Center PSA 1.2
04/11/19 - VA Med Center PSA 1.1
05/20/19 - Mayo, Rochester, MN - Choline PET Scan revealed "No evidence of PC progression" PSA 1.6
09/18/19 - Mayo, Rochester, MN - Choline PET Scan revealed "No evidence of PC progression" PSA 2.2
01/28/20 - Mayo, Rochester, MN - Choline PET Scan revealed "Revealed spot in left Sem. Ves. PSA 3.5
02/06/20 - Mayo, Rochester, MN - MRI confirmed PCA progression. PSA 3.7
03/03/20 - Mayo, Rochester, MN - Biopsy confirmed recurrence of PCA in left sem. ves., Grades 7,8 & 9
04/22/20 - Mayo, Rochester, MN - After reviewing previous radiation records it was decided that additional radiation was not an option and that cryotherapy would be used on the tumor instead.
06/16/20 - Mayo, Rochester, MN - I had preop physical at which time my PSA had risen to 5.9
06/18/20 - Mayo, Rochester- After placing a ureteral stent in the left ureter the cryoablation ablation of the left seminal vesicle was performed using 3 cryoneedles for three freeze thaw cycles. Everything went well and the procedure appeared to be successful.
06/30/20 - Mayo, Rochester, MN - Ureteral stent was removed. Will be receiving a three month appointment including Choline PET Scan, MRI and PSA to evaluate the results.
9/23/20 Sanford Medical Center, Alexandria, MN PSA 2.1
10/14/20 Mayo Clinic PSA 1.9 - Choline PET Scan & MRI "looked good"
1/15/21 Sanford Medical Center, Alexandria, MN PSA 2.5
2/24/21 Mayo Clinic PSA 2.7 Choline PET Scan & MRI "looked good
7/7/21 Mayo Clinic PSA 2.7 Choline PET Scan & MRI "No changes"
9/7/21 Sanford Medical Center, Alexandria, MN PSA 3.3
1/11/22 Mayo Clinic PSA 4.0 Choline PET Scan & MRI showed "suspicious spot"
1/14/22 Sanford Medical Center, Alexandria, MN PSA 4.25
3/15/22 Mayo Clinic PSA 4.5 Pre Op Physical
3/17/22 Mayo Clinic - Attempted Cryo on "spot" but was no longer detectable
4/21//22 Mayo Clinic PSA 4.6 Choline PET Scan & MRI showed lesion in perirectal area
4/26/22 Mayo Clinic Biopsy of perirectal lesion revealed prostatic adenocarcinoma (Gleason 4+5=9)
5/20/22 Stopped Zytiga, began Xtandi
6/21/22 sopped Xtandi because of terrible side effects
6/27/22 Sanford Medical Center, Alexandria, MN PSA 4.0
8/4/22 Mayo Clinic PSA 5.5 Will schedule Consults with Radiology regarding radiation or cryo treatment of perirectal lesion
09/02/22 Met with Mayo Cryo doctor. "Cryo not feasible".
09/26/22 Met with Mayo radiation doctor. He said that radiation is an option. Procedure was delayed because I had a heart valve (TAVR) replacement scheduled.
10/04/22 PSA - 4.8. Mayo Dr kwon (Urologist) OK'd the radiation procedure.
11/14/22 Began 16 sessions of radiation
12/07/22 Completed radiation.
01/13/23 PSA - 1.63 local hospital.
03/06/23 PSA - 0.6 Mayo Clinic Lab
08/28/23 PSA - 0.42 Mayo Clinic Lab. Dr Kwon (Mayo Urologist) was pleased with results and said that he would like to see me in 1 year. Instructed me to have a PSMA scan locally in 6 months with images forwarded to him and continue with the 4 month eligard shots.
Sadly, we were informed that Alan passed away nearly a week ago. but he did not pass from cancer!
