On Saturday 17 September I had a booth to promote my Tae Kwon Do dojang at Monticellobration -- an annual celebration in Monticello, IL (where I have my dojang) featuring food, live music, and arts & crafts. I had 135 people stop by and break boards in just 6 hours; hopefully a number of them will sign up for classes. This picture was taken by a photographer for the local paper, the Piatt County Journal-Republican.
On the cancer front, things continue to go well.
The first and most important news is that my PSA remains undetectable (<0.01 ng/ml) as of mid-August, when I saw Dr V for another injection of Lupron. That dose will hold me for another 90 days. Around Thanksgiving I'll be headed back. At that time, I'll get another Lupron shot to keep my testosterone near zero, plus another shot of Xgeva to counter the risk of bone thinning resulting from the low testosterone.
Side effects are currently very mild. I continue to have hot flashes, but they're both less frequent and less intense than in the past. I try to get a little more sleep now to keep my energy up, and exercise has so far prevented weight gain or significant muscle loss.
In mid-September, I had my 90-day follow-up appointment with Dr Stanic, my Radiation Oncologist. I was still taking antibiotics for a case of walking pneumonia, and he provided a thorough follow-up to that, as well. He listened carefully to my chest, and ordered an X-ray for the day after my antibiotics ran out to ensure there was no remaining sign of pneumonia -- the X-ray was clear, and I'm well now.
We talked about the treatments I have gone through, and whether I had trouble with my urinary system (I don't). We also talked about sexual capacity, and he provided me a prescription for Cialis to help with the limitations I'm currently experiencing.
Dr Stanic made a point of telling me something along the lines of, "There is no evidence at this time that you have cancer." I greatly appreciate that he is trying to lead me to, once again, believe that I'm healthy. It was a tough shift of emotional state to internalize the knowledge of the presence of cancer. Once it's internalized, it's hard to get back out. I'm optimistic, but cautious.
I'll see Dr Stanic again in 6 months.
Insert Crystal Ball Here
Nomograms exist that statistically predict likely outcomes based on past results. There is a nomogram for newly-diagnosed patients that looks at biopsy results, tumor stage, and PSA level to determine whether Active Surveillance is sufficient or, if treatment is indicated, the likelihood of cure via either surgery or radiation.
Likewise, there are nomograms that statistically predict the likelihood of recurrence over time. The grain of salt here is that, to get a ten-year perspective on outcomes, you need to look at patients who were treated ten years ago. Treatments are improving every year, and the outcome for someone treated today is more promising than for someone treated ten years ago.
Those nomograms don't like the negative findings in my surgical pathology report -- Gleason score of 9, positive surgical margins, extracapsular extension, and a positive pelvic lymph node, though it was just one node, and there was no seminal vesicle invasion.
With every step that I take down the path of treatment, I enter into an increasingly specific, and therefore smaller, cohort of similar patients. I am now a patient who was stage T2c with a moderately elevated PSA prior to surgery. I'm not alone in that group, but since then I've had the pathology findings above, I've started neoadjuvant Hormone Therapy with Lupron, and then undergone a full course of radiation treatment. That puts me into a very small, very specific cohort.
Even so, from the research I've done, I believe that five years out I have a 40% to 60% chance of biochemical recurrence -- measurable PSA, indicating that there are still Prostate cells in my body, even though I've had my Prostate removed and the Prostate bed heavily irradiated. These cells would be presumed to be cancerous and systemic, or metastatic. At that point, treatments are still available, including chemotherapy. The risk of actually dying from Prostate Cancer remains pretty low, even if it comes back. I'm optimistic, but cautious.
Every PSA test that comes back "Undetectable" is a win. The next test should come before my Lupron injection at Thanksgiving. That will be the next new news in my journey. I didn't write this to be a Debbie Downer, so I hope it doesn't come across that way. I just wanted a written record of my thoughts regarding the question, "How in-remission am I, now that I'm really in remission?"
And, hey, I had 135 kids break boards at Monticellobration! That was a big day!
