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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 |
My journey started just a little over one year ago. What started as a simple visit to my primary care doctor has turned into a twisty, unpredictable road. Last year I was 62 years old, living in Langlois, OR, blissfully going through life. Early in 2012, I visited my doctor to discuss what he diagnosed as Peyronies. He recommended a visit to a urologist, but first that I have my PSA tested, as I hadn't had one in about four years. This doctor was new to me as my previous one, who had not ordered a PSA in those years, had left town. Thinking back, would I have chosen a different path had he ordered a PSA test every year? I think I would have ended up making the same choice regardless, but that's as far as I wanted to speculate on that "what if" scenario. I went to a local urologist in North Bend after my PSA. After our initial conversation regarding the Peyronies, he reviewed the lab test, performed a digital exam and finding a lump in one side that he did not like, ordered a biopsy. He wanted me to return some four weeks later post-biopsy to discuss the results, which I did. The good doctor is blunt and to the point, not that it made what he had to say any easier to accept. The biopsy was positive for cancer on the one side, Gleason 4 + 3, plus a bunch of other stuff which I was having a hard time hearing or retaining, as my mind was reeling from hearing "the big C." No one else in my family had ever had prostate cancer. Plus, lots of other horrible thoughts started racing around in my mind! He did lend me a very good book to read, "Prostate and Cancer: a Family Guide to Diagnosis, Treatment, and Survival," by Sheldon Marks, M.D. He also said I did not have to make a quick decision, he could recommend other physicians for second opinions, treated patients I could talk to, anything I needed. In addition, he thoroughly went thru all the options available: watchful waiting, radiology, chemotherapy, and prostatectomy (surgery) both regular (open) and robotic, as well as the risks associated with each. Well, the next few weeks was a serious, condensed education into the new world of prostate cancer. I talked, I read. I got a second opinion with a visit to Dr. Bryan Mehlhaff in Springfield with a stop in Florence at the local Us TOO Florence group. After my wife and I consulted with Dr. Mehlhaff, we went home and discussed everything and made the decision to go with the robotic prostatectomy with him. Surgery was set for July 25. As we approached the hospital I began to realize I was scared spitless. I had never had to stay in a hospital before and it dawned on me how big a deal this was. My wife was behind me all the way, pushing through the doors, up the elevator. So, after the successful operation: the pathologist's report didn't show any leakage through the prostate walls, nothing in the lymph nodes and nothing in the seminal vesicles. Things seemed like a great road to a good recovery. However... After my third post-prostatectomy PSA results were in (nine months post-surgery) and continued to show a rise, Dr. Mehlhaff and I decided that the writing was on the wall: some prostate cancer cells had somehow escaped the prostate and were alive and multiplying. There were no signs of the prostate wall having been compromised when the pathologist examined the gland in the lab. However, nine months and a tripling of my PSA was not good news and we had to move to the next stage: talk to the radiation oncologist at Oregon Urology Institute (OUI) about radiation treatments. We made the appointment with Dr. Forsythe, their whiz-kid radiation oncologist who received his training at Mt. Sinai in NY, and had previously undergone radiation treatment for a tumor in his chest. I think this is good for me and his other patients, because he has been on both sides of the radiation table and can relate to what we patients are going through, mostly as first-timers. At our first meeting, after Dr. Forsythe explained about the "PSA doubling rate" and why that is a bad thing, he recommended starting the radiation sooner rather than later. Waiting is not really a viable option at this stage and I'm not the type of guy who waits around hoping a problem will fix itself. As a former contractor I know that most problems will only get worse rather than fix themselves. And with cancer, the results are far worse. So, at our meeting in late May, we decided to move forward. That meant starting on hormone therapy. In my case, it was an injection of Lupron, which I received after our consultation. Dr. Mehlhaff wanted me to have two 3-month injections - one now - to be followed with another one in 3 months. This blocks my production of testosterone which will stop the prostate cancer in its tracks and "soften up" the cancer cells, making them more susceptible to the effects of the radiation beams. Drs. Mehlhaff and Forsythe like to give hormone therapy about 6-8 weeks to do its job before starting the radiation treatment. Counting on the escaped prostate cancer cells still being in the prostate bed, this will keep them right where we want them: right in the sights of the radiation beams. Dr. Forsythe explained how the Image Guided Radiation Therapy (IGRT) works. During the time allowed for hormone therapy to do its work, two gold fiducials will be implanted in my prostate bed. These markers will be imaged immediately prior to delivery of radiation to verify the tumor's exact location. They also permit detection and adjustment to any movement of the tumor during the treatment, keeping the radiation precisely on target. A week later I go in for 3 small "dot" tattoos (one on each hip and one centered on my lower abdomen) which help align me properly on the radiation table. (Dr. Forsythe even showed me his tattoos from his radiation treatment). I will also have a CAT scan and be fitted for what I am calling my own personal bean bag chair. I will be seated in the proper position in the chair, then the air will be sucked out and the beans mold to each other and the seat becomes ridged. That will be my body mold to hold me securely in place while receiving my radiation treatment. Finally, Dr. Forsythe and his team will develop my personal treatment plan and load it into the treatment console. Then, the radiation treatments will start, Monday - Friday, for 8 weeks. Each treatment session (time on the table) is less than ten minutes. Each session begins by positioning me precisely on the table using beams of light targeting the tattoos and locating the exact position of my prostate bed by imaging the gold fiducials. Following those two critical steps, the actual radiation treatment takes about 2 to 3 minutes. Sometime after the treatments end, Dr Mehlhaff will want a PSA test to monitor progress. Initially, I will be monitored with PSA tests every 3 months for a year or so, then hopefully drop to every 6 months, then down to annually. I was counting on not writing another chapter in my Journey, not because I don't like to write but because I was thinking we had eliminated my cancer. Part 2 concluded with the end of my salvage radiation treatments in September of 2013. That consisted of 40 treatments, concentrated on the prostate bed. This treatment was augmented with a nine-month course of Lupron, a hormone therapy that suppresses testosterone. The prostate cancer thrives on testosterone and the addition of Lupron before, during and after the radiation treatment makes the radiation more effective. For those who are not familiar with how my Journey began, here is a short version. In early 2012, at age 62, I saw a new primary care doctor because my previous doctor had moved away. Not having had a PSA test for 4 years (yes, my previous doctor never ordered one) the new doctor ordered one along with a recommendation that I see a urologist, which I did. I saw one in North Bend who read my PSA report, performed a DRE, and feeling a lump on one side, ordered a biopsy. That resulted in a diagnosis of prostate cancer with a Gleason Score of 4 + 3 = 7, tending to be on the aggressive side. Following a robotic prostatectomy by Dr. Bryan Mehlhaff at Oregon Urology Institute (OUI) my PSA started climbing in spite of the pathologist's report showing an "all clear" with negative margins, lymph nodes and seminal vesicles. The rising PSA necessitated the salvage radiation mentioned above. Now we pick up my Journey just over a year after finishing the salvage radiation treatment. Dr. Mehlhaff was going to track my PSA levels with blood tests every 3 months. The first one in November of 2013 showed a good number, somewhere around 0.08. We were pretty happy with that, and cautiously optimistic that we were on the recovery track. Cautious because the first number is so soon after the radiation treatment that things inside have not really had time to settle down, so better to be cautious. The second number three months later indicated a troubling trend toward a fast doubling rate. Still, we wanted at least one more to see what the trend looked like. The third test, nine months post-radiation, showed the PSA had more than doubled yet again. Dr. Mehlhaff and I decided that further diagnostic testing was in order to see if these nasty little buggers could be located, in order that we could start some very targeted follow-up radiation. The first test was a bone scan, which has a higher resolution than an x-ray or ultrasound. The results indicated "worrisome activity" in the right humerus (upper arm) and right femur. This was not precise enough for Dr. Mehlhaff or me, so we went up to the next level: a sodium fluoride PET/CT scan. The results of this high resolution full body scan confirmed just one little spot in my right upper arm. Nothing else showed up anywhere in my body. OK, so we were closing in on these nasty little buggers. The treatment consisted of 10 targeted radiation treatments. These were in conjunction with another round of Lupron, which will be for another 2 year timeframe. The last radiation treatment was in early September with my next PSA blood work due in early November. So, the November PSA results are in: 0.07. This is a significant drop from the August level of 0.8! Both Dr. Mehlhaff and I are very happy with this new number and we will track it with PSA blood tests every 3 months. |
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