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| Each man's Journey is listed under his BASIC treatment. When you click on one of the names to read a particular Journey, you may see one or more different treatments in bold lettering immediately above the Journey text. You will see (Recurrence) if they are due to a recurrence. Otherwise, they will be treatments used in conjunction with the basic treatment, i.e. Lupron with External Beam Radiation or External Beam Radiation with HDRT/Brachytherapy, etc. | |
Active Surveillance Alternative (Natural) Therapy Cryoablation - Freezing Hormone Therapy Radiation - Brachytherapy Radiation - External Beam Radiation - HDRT Surgery - Open Surgery - Robotic |
To start with, I need to tell you I have Metastatic Prostate Cancer. Having that cancer, particularly at an advanced stage, has changed my life; however, I continue to be able to do the things I love. This summer (2012) I was fortunate enough to go on a two week trip to Israel where we painted, cleaned, repaired and stocked bomb shelters. We also saw Jerusalem and other sites. When I returned to the U.S., I was able to spend a few days with my son at Fort Lewis, WA. He will deploy with his team to Afghanistan for 9 months the early part of September. I just recently arrived home from cycling the Northern Coast from Astoria and am already back in my classroom and looking forward to the arrival of my 5th grade students. Now, back to the beginning of my cancer story. I had always been healthy and, like many, I rarely saw a doctor. However, in April of 2010, I went in for a routine physical in order to have a prescription refilled. The doctor ordered a basic blood panel, a PSA and colonoscopy because of my age. I was 52 at the time. Several days later, after I had to have a 2nd blood drawing because they forgot the PSA test, the doctor called me and said my PSA was 14.6. I had to ask, "What does that mean?" He said that means he would like me to see a urologist. About a month later, in May, I was able to see Dr. Bryan Mehlhaff at Oregon Urology Institute. I had no idea what to expect. Dr. Mehlhaff gave me another blood test and found that my PSA had risen to 16.9 since my original testing. He asked me some very specific questions to see if I was having symptoms that would point to prostate problems. He followed those questions with a digital rectal exam (DRE), during which he was able to feel lumps on the prostate gland that were not supposed to be there. At this time he had my wife join us, explained his findings and suggested a prostate biopsy would be a good idea before I left his office. Normally this isn't standard procedure. My biopsy consisted of taking 12 snippets of tissue from my prostate gland which would be sent to a pathologist for examination. Dr. Mehlhaff sent us home with some information on Prostate Cancer and said he would call us when the results came in. Several days later, Dr. Mehlhaff called with the results. "YOU HAVE PROSTATE CANCER!" was all I heard. The pathology report showed 9 out of 12 snippets were positive for cancer. With a Gleason Score of 8, this meant I had a fairly aggressive form of cancer. Needless to say, I was stunned! This information seemed to come out of the blue. It was a possibility I had never even considered. Cancer was for others, not for me. Sure, I had heard of other people having cancer and had even prayed for others that I knew who had cancer, but I was shocked when I found out one of these other people was now me. I had zero knowledge of Prostate Cancer or any kind other kind of cancer, for that matter. My mind was now racing. I had questions. How long do I have to live, days, months, weeks, years? Is this something that I can pass on to my wife or family? Will I be able to continue to work? Will my insurance cover any of this? Finally, what do I do next? Answers to these questions, as other prostate cancer patients know, come slowly - one urologist appointment, one test, one phone call, one treatment at a time. The rest of my Journey, beginning with "what do I do next," begins now. I refer to this as "my" journey; however, it is a journey that has involved my family, friends and my wonderful wife. By sharing my journey, I hope to encourage other men to get a baseline PSA test at age 40 as the American Urological Association recommends. I know if I had been tested earlier than age 52, I would probably be much better off than I am now. For me, getting the cancer out of my body was important. I decided to have surgery. Getting ready for this procedure included several body scans and more blood work. Surgery was scheduled for the middle of June, as soon as school was out. After checking into Sacred Heart Medical Center at RiverBend, I was prepped for surgery. I was in good spirits and knew I was in good hands. I figured this surgery would take care of the cancer. I had also told my surgeon, Dr. Bryan Mehlhaff, that I felt like I had a hernia. He said he would be operating in that area and would take care of it if that is what he found. I gave my wife a kiss then went to sleep for a couple of hours. When I woke, I found myself in a hospital room. Dr. Mehlhaff had performed a radical prostatectomy and said everything had gone smoothly. He also said that I did not have a hernia. The discomfort I was feeling was actually the cancer having entered and inflamed my lymph nodes. I was in the hospital for only three days. The first day after surgery I was told that I needed to walk. Easy for them to say! I walked down the hall very slowly. I was probably quite a sight, hospital gown, carrying my catheter bag, and wincing at every step. I found out I'm not as tough as I thought I was. I took some pain killers when my "work-out" was over. I did have several friends drop by the first day, and I really appreciated it, although my wife said, "You were out of it." It's easy to kid around when you're doped up. I think the best visit was from my grandkids. They thought their Papa needed popsicles to make him better. After those 3 days, I was definitely ready to get out of there. Before leaving the hospital I had my first injection of Lupron. This was necessary since the cancer had gotten out of the capsule and into my lymph system. This shot would keep the testosterone from feeding the cancer. Finding a comfortable place to sit was next to impossible. Things did get better over the next week. I had my catheter removed after 14 days. What a relief! I was sore, but I continued to improve. I enjoyed the rest of the summer and started school with no problems. Ninety days after surgery I had a follow-up appointment with Dr. Mehlhaff. He checked my PSA level which was 0.5. That wasn't as it should be. He gave me another Lupron shot and said that he would like to schedule external beam radiation treatments. I asked if I could wait until after the first of the year for these, as my son was getting married in December and I didn't know how it would affect me. My mind was again spinning. What was next? I was already suffering from hot flashes and other side effects from the surgery and Lupron. We decided we could wait for the radiation until after the first of the year. Knowing the aggressiveness of my cancer, Dr. Mehlhaff wanted to attack it with guns blazing. First treatment was a Radical Prostatectomy, then hormone therapy and now, external beam radiation (IGRT). As you have followed my journey thru diagnosis, surgery and hormone therapy, now we come to radiation. Each disappointing report leads to the next treatment in an attempt to stop this marching prostate cancer. Looking at radiation was tough to do, but you have to make choices, and I felt this was the best choice for me. I was not going to go without fighting. To undergo 44 external beam radiation treatments over the next nine weeks was what I had to look forward to. They did give me weekends off to allow my body to recover. To do this, I was to be in Springfield every Monday through Friday for those nine weeks. This would have been next to impossible if not for the Friends of Florence Van and the wonderful people who volunteer their time to drive from Florence to Eugene/Springfield every single working day of the year. Each day began with me meeting the van at Peace Harbor Hospital at a very early hour. The trip to the Oregon Urology Institute Radiation Center took an hour and a half. I was riding with other cancer survivors who were in various stages of disease and treatment. The trip over was often enjoyable as we got to know each other quite well. The trip home was usually quiet. Most of us were already showing some of the side effects; general tiredness and loss of strength. Most days, I was asleep by the time the van was in Veneta, about halfway home. Three and a half hours of daily travel time for a 15 minute treatment can get tiring. Prior to the actual treatment there were more tests. A mold of my lower body was made so that they could hold me in a still position while firing the radiation. They also inserted three gold markers (fiducials) in my prostate bed and gave me my first tattoo (tiny marker on each hip). The tiny tattoos were to help align me on the table and the three gold markers helped the radiation beam zero in on the areas they wanted radiated - and avoid the other organs. After returning to Florence each day, I would head back to the class room for a half day of teaching. Having a great substitute made this much easier for me. Thank you Mrs. Moore! Part way into my treatment, blood tests showed that my PSA was still rising. This was concerning to the Radiologist as well as to Dr. Mehlhaff as this doesn't usually happen. This was also of a concern to me. They repeated the tests, and yes, my PSA was again on the rise. At this point in time, they started me on another hormone type of drug, "Casodex". I finished the radiation in February of 2011. I continued to have PSA tests every 60-90 days. Nothing was holding the prostate cancer in check. This part of the journey, as in any part of my journey, would not have been possible without the support of family, friends, and those praying for me. At my monthly Us TOO Florence meeting, Dr. Mehlhaff was sharing information about a new "Immunotherapy" treatment that was extending the life of patients. Was this a hint about my next course of treatment? Yes it was! Bob Horney, our Us TOO Florence Chapter Leader will take over for a bit and explain what Dr. Mehlhaff had in store for me...an immunotherapy Sipuleucel-T, usually called by its trade-name Provenge. (Bob) So, what is this Provenge? Approved by the FDA in 2010 and often described as a vaccine, Provenge is an autologous cellular immunotherapy, which means it uses a man's own immune cells (autologous) to battle prostate cancer. The patient's immune system is trained to recognize prostate cancer cells as targets to be destroyed. The full course of this treatment consists of three basic steps: First, a patient's own immune cells, a key component being the antigen-presenting cells, are extracted in a leukapheresis procedure, lasting from 3 - 4 hours. Next, those immune cells are sent to a Dendreon manufacturing facility where they are incubated with a fusion protein consisting of the antigen prostatic acid phosphatase, which is highly expressed in more than 95% of all prostate cancers and granulocyte macrophage-colony stimulating factor, an immune cell activator. Finally, the activated immune cells are returned from Dendreon to an infusion center and re-infused into the patient. There they activate certain types of immune cells, in this case T-cells, causing those cells to multiply and move throughout the body, now able to recognize and target prostate cancer cells by identifying their unique antigens. Of all the immune cells charged with recognizing and destroying prostate cancer cells, T-cells are the strongest defense. A major goal of Provenge immunotherapy is the generation of a tumor antigen-specific T-cell population which act on tissues expressing these antigens. Once the T-cells recognize the prostate cancer cells, that sends a signal to other immune cells and help is on the way. The activation of the T-cells is critical because prostate cancer is an immunoevasive disease. This means it is able to inhibit (or evade) the body's normal immune processes making it possible for the cancer cells to grow and spread largely unchallenged. A complete Provenge treatment repeats the above process three times over the span of a month, with two weeks between successive courses. Because each personalized dose of Provenge has a short shelf life, men who miss an infusion appointment must undergo another leukapheresis so clinicians can prepare a new dose of Provenge. The entire process from leukapheresis to Dendreon's manufacturing facility to re-infusion is absolutely time sensitive with no room for error. In order to qualify for Provenge men must meet strict criteria: (1) Asymptomatic or minimally symptomatic prostate cancer. This means a man has no cancer pain or if cancer pain is present, it is not severe enough to require treatment with narcotics. (2) Cancer has metastasized. The prostate cancer has spread beyond the source tumor in the prostate to other areas of the body, such as the bones. (3) Resistant to hormone therapy. The patient's prostate cancer has worsened since undergoing treatment with drugs that stop the production of testosterone. Tim met these criteria and will now take us on his Provenge Journey. (Tim) The next step in our journey would be Provenge. I had heard about Provenge for a short amount of time already. My wife had been researching it and wondering if it was something that I would be venturing in to. Dr. Mehlhaff had already been tracking me for this new treatment...unbeknownst to me. Once I had 3 increasing PSA scores, I was set to pursue Provenge. Paperwork was submitted to our insurance company and we began a short wait to see if they would cover this procedure. At a cost of $93,000.00, we wanted to make sure that we had financial assistance before going forward. A short wait, and a few more tests to make sure that the cancer hadn't progressed to my bones or brain, and I was set to go. Since I would need to have my blood withdrawn on 3 different occasions, and the veins in my arms were disappearing from other treatments, I decided to have a central line (port) installed in my chest. This would allow direct access to my blood without having to poke my arms twice each time I went for treatment. Plus, the size of the needle that was used to infuse the Dendreon treated T-cells back into my body was also larger than normal, so this would help with that as well. Part of this process meant that I had to go to the hospital 2 times during the week that I was not being treated. They had to flush the port to ensure that it did not close up or get infected. I was able to have that done by the staff at Peace Harbor Hospital right here in Florence. The closest place for the leukapheresis procedure is in Vancouver, Washington. Once my Provenge treatment started, we would be traveling to Vancouver three times - the first, third and fifth Tuesdays. Appointments for this procedure began at 6 am, so we would drive up the night before and stay at a nearby hotel. There weren't many to choose from, and the hotel we chose DID NOT have access to the DUCK football game. Needing to eat as well as finding a place to watch the game, we headed over to a great pizza parlor. I went to my first leukapheresis appointment with some genuine hesitation. My technician did her best to relieve me of any stress. I was hooked up to the machine, given Benadryl to avoid any reaction with the stripped blood reentering my body and was set to go. Leukapheresis takes certain cells (T-cells) out of my blood and sends them to a bag of their own. This is a three and a half hour procedure. Everything is timed, documented and watched with a close eye for accuracy. I believe with the expense of this treatment, everything needed to go perfectly. Thirty minutes into the procedure, I began to feel odd because of calcium depletion, a rather common side effect of the leukapheresis procedure. They gave me a couple Rolaids (calcium) which took care of this problem. For the remainder of the process I watched a movie which helped the time go faster. I was never left alone. The technician was always attentive and at my side, covering me with a blanket when I was cold or providing me with juice when I was thirsty. When I was finished my wife drove us home. At that time I felt a bit tired but otherwise okay. My blood products were packed, iced and ready for the courier to transport to the Portland International Airport for a direct flight to the Los Angeles International Airport. From there, a courier would transport it immediately to the new Dendreon factory in Seal Beach, California. My T-cells must enter the manufacturing process there within 18 hours after the end of my leukapheresis procedure or they are discarded, meaning another trip to Vancouver for me. Knowing my blood arrived in time, I had a couple of days to wait before I would head to Oregon Urology Institute in Springfield for my 1st infusion. It takes 3 days for the Dendreon factory process to be completed and ready to reenter my body. As with my blood getting to Dendreon within 18 hours, now it has the same time frame from leaving the Dendreon factory to infusion back into my body. Friday, I headed to OUI to receive that infusion. We again were tracking vitals, taking Benedryl and an aspirin to prevent any adverse effects. The package was to have arrived before us, but had not. Waiting for it to arrive was terrible. Like I said previously, everything is timed, and if the package didn't get here on time, it would be discarded. After a long wait, it did finally arrive. The product was removed, examined for cloudiness and massaged to remove any clumps. Since it was cold-packed, it was set aside to warm to room temperature. Infusing it directly from the cold-pack into my body, especially with the central port, could have serious consequences. My IVs were already inserted, so we were ready to go. No problem with this part of the process, once again, just a little apprehension on my part. My only response to this treatment was some tiredness. One week off. Well, not really off as I had to have my port cleaned a couple of times. I was still teaching, going to church, and living as normally as possible. The port kept me from doing anything that would entail me getting wet. As it was, before each shower, I would have to seal my chest with Glad Cling Wrap (good stuff for those with dialysis and other treatments). Monday, after school, we headed to Vancouver for my 2nd treatment. This trip was difficult as it had begun to snow. My son is stationed at Fort Lewis, and we had arranged to meet him and his wife for dinner. Due to the adverse weather, this dinner only lasted a very short time. The snow was piling up fast. Tuesday morning, we managed to drive the short distance from the hotel to the Red Cross without too much difficulty. There was quite a bit of snow on the ground. Everything went smoothly. This time we brought a movie from home to watch and settled in for the 3-1/2 hour wait. The drive home was a bit tricky, but we were glad that we could leave and not have to stay a second night. The weather in Florence however, was quite different. It had been raining and would continue to do so for the week. As Friday got closer, and talk of flooding began to circulate, I wondered if we were going to make it to Springfield. With roads closing all around us, we paid close attention to "road reports" and decided that we needed to leave Thursday afternoon. All roads to the North and East of us were closed. All that was available to us was driving to Coos Bay and heading inland towards Myrtle Point. Unbeknownst to us, we just made it through. They closed the highway right behind us. We spent an unexpected night in a hotel with much anticipation as to how the weather would affect the flight from Los Angeles to Portland and then the transport by courier to Springfield. Would my box of treated cells arrive or would we have to pitch them and have to make another leukapheresis appointment? Friday morning arrived, and we headed to OUI to check in. The receptionist was glad to see us. They did not know if we would make our appointment. They had tried to get hold of us and no one could reach us. The box of cells arrived shortly after we did. YEAH! Infusion was successful and we again went home to wait for a week. The final leukapheresis appointment had finally arrived. We took off Monday after school, just like we had done twice prior. Driving up the highway, we noticed that our car was not driving as it should. We made it to our hotel and saw that the engine was smoking. Too late in the day to do anything about it, we went to bed. My wife had not been well over the weekend, so she had decided that she wouldn't come in to the appointment with me. She was afraid of contaminating the process and didn't want anything to go wrong. This turned out to be a blessing as she was able to locate a dealership that would take a look at our car. A cracked fuel line was the diagnosis. They were surprised that we had made it there without a fire. God's grace covered us once again. Needless to say, we would have no way home at this point because they had to order in the part and it would take at least 3 days for it to arrive. Our good friends, Ted and Patty, from church, came and rescued us the next day. We are very thankful for our church family. This 3rd and final appointment went without a hitch, medically. I was glad to not have to make this trip again. The Provenge treatment only allows for 3 infusions. Our final trip to OUI went without any difficulties. In 2 days I would return to McKenzie Willamette to have my central line removed. I was excited to be finished. Now we began the wait. It would take at least 6 months for the treated Dendreon cells to begin to attack the cancer. There is no way currently to measure the effect of the treatment except, as Dr. Mehlhaff says, "You are still here." However, I do recall that during the 2011 flu season I breezed right through it while others, including Debbie, were down for days with the nasty stuff. Considering that I had my first leukapheresis procedure on January 3rd and final infusion on February 3rd, my T-cells had lots of time to build up my immune system. In spite of that, we have a hard time not reacting to changes in my PSA scores even though we know they are virtually meaningless in measuring the effects of Provenge. At our January 8, 2013, Us TOO Florence meeting, one of our members told Dr. Mehlhaff that he had just started taking Zytiga, through his HMO, at the beginning of the month. Zytiga is taken in pill form and stops the growth and spread of prostate cancer by inhibiting an enzyme needed for the production of testosterone, the most important male sex hormone. It had been approved in April, 2011, for treatment following failure of the chemotherapy Docetaxel. It received FDA approval in December 2012 for use with metastatic castrate-resistant prostate cancer as a pre-chemotherapy treatment. The pre-chemo approval opened the door for this man and many others, maybe even me at some point. This is wonderful news for those of us who need more treatment choices and don't look favorably at chemotherapy. So far, he hasn't noticed any side effects. I really appreciated listening to them talk about the treatment and his lack of side effects. That, alone, made attending the support group totally worthwhile. If you have followed my Journey from the beginning, you are well aware that there was much more involved than just being treated. Snow, floods and automobile mechanical problems all became issues that jeopardized my treatment. However, we succeeded in spite of them, although they did make life interesting. As I wrap up my Journey to his point, I want to emphasize how much I appreciate the personal care and compassion Dr. Mehlhaff has shown Debbie and me. He has always been "right there" for us - thinking ahead - having the next step in his long-term plan for me always at the ready. This is also demonstrated by his attendance and enthusiastic participation at our Us TOO Florence meetings. I would recommend to every man who is listening to those nay-sayers of PSA screening, to hook up with a urologist at Oregon Urology Institute so you don't end up like me - depending on new treatments because I was diagnosed with advanced disease (at age 52). Detect it early, get cured and get on with your life. Now to bring you up-to-date: I am currently enrolled in STRIVE, a phase 2 randomized, double blind clinical study at Oregon Urology Institute. The purpose of the study is to determine the safety and efficacy of Enzalutamide (Xtandi) vs. Bicalutamide (Casodex) in asymptomatic or mildly symptomatic patients with prostate cancer whose disease has progressed despite being on androgen deprivation therapy (ADT) also called hormone therapy. I am getting one of those drugs, but neither Dr. Mehlhaff nor I know which one. When we talk of androgens, we are referring to all male hormones, of which the primary one that we hear so much about is testosterone. Androgens function as a "sort of food" for prostate cancer. Xtandi and Casodex both work as a blockade of sorts, denying the cancer cells this "food," but they do it in different ways. Xtandi blocks the androgen receptor, thus inhibiting the cancer cell's ability to absorb and use these androgens. Casodex has a problem - it is a blockade that leaks. The study I'm in is seeing if Xtandi can stop those leaks by approaching it from a different angle. The current FDA approval for Xtandi is specific; it has been approved (only) for men who are castrate resistant after they failed chemotherapy. If STRIVE and other studies now in the works prove the benefit of pre-chemo use of Xtandi, we hope the FDA will approve it for that so men could make use of it earlier in their treatment. The more treatments we can do before chemotherapy - the better. I'm pleased to be a participant in this study, because I know it is the only way to prove what works. Being the recipient of treatments that resulted from clinical studies that other men have completed is all the more reason to do my fair share for those following me. Of course, I also hope to benefit from the results of the current study. I'm in good hands, too, because the safety and tolerability will be assessed by the recording of adverse events, monitoring of vital signs, physical examinations, and safety laboratory evaluations. It looks like win-win to me. Presently, except for my participation in the clinical study, I have returned to my normal life. PSA scores and other tests are still a part of my life. Looking ahead, there are several new treatments on the horizon and each one is spelled HOPE for those of us with advanced prostate cancer. God will continue to guide us in the right direction as we continue to put our trust in Him. UPDATE ON TIM, DR. MEHLHAFF and DENDREON CORPORATION'S PROVENGE: Prominently placed on the cover of Dendreon Corporation's 2012 Annual Report is local prostate cancer survivor, Tim Daugherty. To put a positive face on PROVENGE (sipuleucel-T) and what it means to men with advanced prostate cancer, Dendreon couldn't have chosen a better man to symbolize the hope it represents. On a recent April 26, KEZI 9 segment, "Treatment Helps Prostate Cancer Patient," which noted the three-year anniversary of PROVENGE receiving FDA approval, Tim said, "Right now I'm happy. I'm healthy. I'm able to teach, able to ride my bike. I surf. I get to do everything I want to do, and I'm enjoying life." Being young and in "otherwise" good health, he is likely to gain maximum benefit from PROVENGE. A great choice by Dendreon! This all came about through the convergence of three incidents: First, Tim had his very first PSA test in April, 2010 at the age of 52. It was much too high at 14.6. Second, he was referred to urologist Dr. Bryan Mehlhaff, and in May 2010 the results of a biopsy determined he had prostate cancer. Nine of 12 cores were positive for prostate cancer and his Gleason Score was an aggressive 8. Tim underwent open surgery in June which revealed cancer already outside the prostate in a lymph node. He started hormone therapy (Lupron) in October followed by external beam radiation in January/February 2011. His PSA continued to rise even though he was still on Lupron. Third, Dendreon Corporation had finished clinical trials on PROVENGE, an immunotherapy for advanced prostate cancer, and had received FDA approval in April 2010. Following its approval, Dendreon set to work establishing a manufacturing facility in Seal Beach, Ca to treat west coast patients. Prior to Seal Beach being built, a patient's white blood cells, or immune cells, had to be flown to the Dendreon facility in New Jersey. With an exacting time schedule for the immune cells to get from the patient to the treatment facility and back into the patient, a manufacturing facility on the west coast was a top Dendreon priority. Dr. Mehlhaff was the connecting link who brought this together. He worked closely with Dendreon to make sure Oregon Urology Institute was in the loop and ready with its patients as soon as the Dendreon facility in Seal Beach to treat the immune cells was operational. He also had Tim as a patient who met all the qualifications necessary for receiving PROVENGE. Dendreon's completion of its manufacturing facility in Seal Beach in June 2011 coincided nicely with Tim's need for it. This is a real tribute to Dr. Mehlhaff's personal drive to seek out the latest treatments for his patients with advanced prostate cancer, and it hasn't stopped with PROVENGE. Tim Daugherty's recognition by Dendreon is a direct result of Dr. Mehlhaff working closely with the corporation and his patients. We who have been diagnosed with prostate cancer, regardless of the stage, have experienced what it means to have Dr. Mehlhaff and everyone at Oregon Urology Institute providing our prostate cancer care. TIM DAUGHERTY'S EPILOGUE Diagnosed May 18, 2010 at age 52; Died August 21, 2014 at age 56 Written by Us TOO Florence Facilitator, Bob Horney and Urologist, Dr. Bryan Mehlhaff Tim and Debbie started sharing Tim's prostate cancer journey with our community in the September 12, 2012 edition of the Siuslaw News, in the 3-ring binders throughout Florence and on the www.ustooflorence.org website. Tim had been diagnosed with prostate cancer in May 2010 at the age of 52. Nine of 12 core biopsy samples were positive for the disease and his Gleason Score was an aggressive 8. Tim's urologist, Dr. Bryan Mehlhaff, performed open surgery in June 2010 which revealed cancer already outside the prostate in a lymph node so was started on hormone therapy (Lupron) in October followed by external beam radiation (IGRT) in January/February 2011. With Tim's PSA continuing to rise even while on Lupron and following surgery and radiation, he qualified for Provenge, a newly FDA approved immunotherapy. This therapy involved 3 trips to Vancouver, WA for withdrawal of white blood cells (Leukapheresis), having them treated in Seal Beach, CA and then flown to Springfield to be reinfused into Tim. Although dealing with snow, car problems and flooding, Tim (with Debbie's wonderful assistance) completed the therapy. Tim's last update on his Journey was in the April 10, 2013 Siuslaw News. At that time he was enrolled in a clinical study, STRIVE, which was a phase 2 randomized, double blind study at Oregon Urology Institute. The purpose of the study was to determine the safety and efficacy of Enzalutamide (Xtandi) versus Bicalutamide (Casodex) in asymptomatic or mildly symptomatic patients with prostate cancer whose disease had progressed despite being on androgen deprivation therapy (ADT) also called hormone therapy - like Lupron mentioned above. Eventually with some enlargement of an abdominal lymph node, another medication called Zytiga was added. Through all of the above, Tim continued to teach his 5th grade class at Siuslaw Elementary. He taught the entire 2013-2014 school year and even the 2014 summer school session and looked forward to being in the classroom again in September. Following his completion of 2014 summer school, Tim was seen for his quarterly study visit with routine CT and bone scan. This showed significant spread of cancer to his liver that was not seen just three months before. Biopsy proved this to be prostate cancer. This was a surprising increase in his disease because at this point his PSA level was undetectable. Presumably this was because his prostate cancer had now become so genetically mutated that it no longer produced any PSA. Tim was referred to a medical oncologist. He was well aware of the potential side effects of chemotherapy, declined to pursue it, and simply expressed a value for quality of life rather than quantity. Dr. Mehlhaff encouraged him to possibly try this treatment as some patients respond well and experience minimal side effects, but Tim was resolute. With his family and support of his church he decided to enter hospice care. This allowed him to choose the final path of his life with his family at his side. In less than 4 1/2 years Tim had gone from diagnosis of prostate cancer to death. Screening for prostate cancer failed to catch his disease early enough to prevent its spread. If screening had been done earlier possibly his prostate cancer could have been cured, but this remains unknown without the earlier testing. Throughout his disease, Tim continued to live a full and vibrant life with his family, and as a teacher. For four full years, Tim and Debbie attended Us TOO Florence meetings, full of confidence and optimism about the future. Together, they touched many lives, but Tim's case and story particularly affected Dr. Mehlhaff, who learned much from Tim's spirit and gentle nature even with a particularly aggressive form of prostate cancer that progressed despite all efforts to stop it. |
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