Targeting Tuesday

It's been almost a month since I wrote my last post. At that time I was looking forward to my appointment with the medical oncologist. However, that visit was a bit of an anticlimax. The oncologist laid out a plan that was pretty much what I already expected.

He'll take over my hormone treatment. My initial injection was good for 4 months, which takes me to the end of May. That's good timing, because that should be when the radiation treatments end, and that's when he wants to see me next. He's going to switch me to 3-month injections, because he'd like to see me every three months. He also plans to add another drug that will address the risk of bone loss (osteoporosis) associated with the hormone treatment. I believe he also plans to check my PSA again at the May visit. It should be no higher than the end-of-January readings, with the hormone treatment and radiation treatment working together to kill the last of the cancer. Here's hoping.

I don't have to wait much longer for the cancer-related activity level to jump. This coming Tuesday I'll have my "radiation simulation". This is really a targeting session. I believe the protocol is for me to drink some radioactive stuff, and also have some radioactive stuff injected. Then they'll do a CT scan to get a complete mapping of where my blood vessels and digestive tract are located internally. During the radiation treatments they'll want to avoid irradiating any part of my digestive tract.

And because of the positive lymph node after surgery, they need to map out my blood vessels. As explained to me by the radiation oncologist, lymph nodes are located in close proximity to blood vessels. They can't really image the lymph nodes, but if they know where the blood vessels are, then they can irradiate around the blood vessels at a distance of just a few millimeters. This will ensure that the lymph nodes get their rads.

After the imaging we'll do the actual simulation of the radiation treatment. When they're sure everything is properly aligned, they'll apply a few small tattoos for guidance during the live sessions.

After Targeting Tuesday, I'll head to southern Illinois Thursday evening for Easter weekend. When I return, it should be time to start radiation.

Back In The Swing Of Things

I'm growing impatient waiting for the radiation treatments to begin.

Today marks 3-weeks since I got my shot of Lupron, and my testosterone level should be near zero for the remainder of 4 months. I'll be re-dosed at that time, and I currently expect the hormone treatment to continue for at least a few years.

So far, so good! Side effects are slight enough that I'm not even sure I'm feeling any.

I've got my exercise mojo back now, and that feels good. I didn't have any real trouble running, and I'm back up to doing a 5-mile run in just over 45 minutes. I'll push the pace a little further, but I'm happy with where I'm at. I also have been back in the pool, and it took no time at all to get my wind back. For my YMCA Survivor challenge the past two weeks I've done a single 5-mile run paired with two 2000-yard swims (netting a whopping 550 Survivor points for the week).

I've also returned to Tae Kwon Do, which I'm currently doing 3 nights per week, 2 of those teaching, and 1 as a student. I'm back up to about 4.5 hours per week of Tae Kwon Do. Throw in a few dog walks with TKD and the above, and I'm back to between 7 and 10 hours per week of activity, burning 4K to 5K Calories. If I can maintain this level of exercise throughout the hormone treatment and the radiation treatments coming in April and May, then I should be able to minimize any side effects.

On Monday I'll meet the medical oncologist to see what he can tell me about my condition and my treatments. I'm not quite sure what to expect from him, but I'm looking forward to learning something new.

Little enough is going on now in my fight against PC that I'm growing impatient waiting for the radiation treatments to begin. I feel like I'm ready, but I have another 6 weeks to wait. All for the good, though, because the family will gather for Easter at the end of March, and radiation therapy will begin the following week.

Angst And Hormones

I can be a bit grumpy.  I'm full of angst, and hormones.

-- Nicholas Hoult (1989-), English actor, interview in The Mirror, 2 February 2012


I find myself dosed with hormones, but not so full of angst.

On Friday 29 January I travelled to Northwestern to see my surgeon, Dr William Catalona, for my post-surgery follow-up. It turned out to be a hectic day as I spent 3 hours there. I signed up for all of Dr Catalona's research studies and I had 3 vials of blood drawn. This included a PSA test (just 2 days since my last check), and the result came back as 0.03ng/mL -- welcome confirmation that my PSA is "undetectable", well below the 0.10 threshold.

A big part of the appointment was ensuring that I have recovered well from my surgery (I have). I'm now cleared to resume activities that I'm comfortable with. I'll get back into running and swimming forthwith, and will work my way back into Tae Kwon Do.

Another part was introducing me to the direct-injection treatment that is meant to relieve the ED side effects of the surgery. That part went as well as could be expected. I'll continue this treatment at home 2 to 3 times per week for the next 18 months, or until it is no longer necessary.

But for me the most important part of the appointment was discussing my on-going treatment, and getting started on Hormone Therapy (HT). In this case, the HT is Androgen Deprivation Therapy (ADT). It starts with a 30mg shot of Lupron, which is meant to shut down my body's production of testosterone for 4 months. This treatment will be repeated to maintain the ADT for at least a few years.

Lupron, when it first kicks in, actually causes a "testosterone flare", a spike in testosterone production. Over a period of about a week the flare subsides to pre-treatment levels; at three weeks after treatment my testosterone level should drop to near zero. To counteract the flare, I'm spending 10 days taking Casodex (bicalutamide), which blocks the uptake of testosterone.

I've been concerned about the side effects of ADT. Right now I'm at the peak of the "flare" period, so it's too early to tell. But I'm optimistic that side effects will be minimal. I understand that exercise is the best way to counter these effects. I'm signed up for this year's YMCA Survivor "get-in-shape" program, and this is the second week. After work today I'll go for a 3-mile (or thereabouts) run on a treadmill. I hope to work my way back up to the 5-mile runs I did 3 times per week when I was preparing for the 2014 Illinois Half Marathon. My near-term goal is a 5K run in May; longer term, I'm shooting for my first marathon in Spring 2017.

Yesterday Was A Good News Day

When I hit this detour, I started at a sprint.

For six weeks I went to a bunch of medical appointments, and did a ton of research. The biggest chore was just lining up the appointments, and dashing from one to the next. I regularly had two or three appointments per week. I brought a notebook to all my appointments (which I'm still using) to take notes, so I wouldn't lose the information I was being given.

It wasn't until I missed my first surgery date that I finally had time to catch my breath. And now I've had weeks of recovery time. There have been milestones along the way, but I haven't had to dedicate as many brain cycles to the cause. Lately, the pace has picked up a bit, as I research the use of Hormone Therapy (HT) combined with Radiation Therapy (RT) after Radical Prostatectomy (RP).

Yesterday was an important day - Day 30 after surgery. I got my first PSA test done, and the result was an awesome 0.04ng/mL. Any value  less than 0.10 is considered "undetectable", and achieving this low a PSA level is the goal of surgery. Mission accomplished.

Tomorrow is an important day. I drive to Chicago for my post-surgery follow-up. The recovery has gone well, so I don't expect any surprises. And tomorrow I'll get my first hormone treatment.

Yesterday I also met with the Radiation Oncologist who will manage my radiation treatments in April and May. We had a very reassuring discussion about the technology and treatment. This guy sounds like he knows his stuff, and he should be easy to work with. He also set me up with a consultation with a Medical Oncologist, where I expect to get an overview of where I stand, and all the treatment options that are available and appropriate.

Seatbelt fastened; I know it's going to be a bumpy ride.

Back To Work

I'm glad to be getting back to work (as a software developer for the University of Illinois) next week.

I'm in limbo in a way that I did not anticipate, since I'll have to return to work with the cancer still present. I hope to be cleared to return to Tae Kwon Do at my end-of-January appointment with my surgeon.

Research over the past week or so has reassured me regarding the proposed follow-up treatment. That treatment is expected to be 4 months of hormones starting in February, with 6 to 7 weeks of radiation starting in April. A PSA test I have scheduled for the last week in January will tell me more.

The Journey Continues

My recovery during the current week has been steady, and I'm feeling much better.

On Wednesday of this week, 9 days after surgery, I had my catheter removed, so I'm no longer hooked up to a bag like the one pictured. That did a lot to make me feel more human. I don't have to carry the bag around anymore, and I can now take showers without that thing at my feet. It also means that I can now drive my car again, and I'm glad of that.

On Monday evening I got a call from my surgeon with the results of the pathology report on my excised tissue. Although the news was all good right after surgery, it's clear that my detour is not yet over. The report shows extracapsular extension, one positive margin, and one positive lymph node of 12 that were examined. Together, these findings indicate that I need further treatment to eliminate the cancer.

The way forward, subject to second opinions and further research, appears to be four months of hormone therapy to deprive any remaining prostate cells of the androgen they require to grow and reproduce. The hormone therapy should start at the end of January. After two months I'll be halfway through the hormone treatment, at which point I'll start radiation treatments for five days each week for six to seven weeks. The calendar tells me that this radiation treatment will be during April and May of 2016. Fortunately, I'm young and healthy; I remain hopeful that side effects during this period will be manageable.

I have my 1-month follow-up appointment with my surgeon on Friday 29 January, at which point I'll learn more about my future treatment. I'll keep you posted.

Surgery Was Monday

Surgery was Monday and it went very well.

I spent Sunday night (12/27/15) at a hotel across the street from the hospital so that I could arrive bright and early at the hospital at 7AM for my 9AM surgery. I had spent all of Christmas Eve baking Christmas cookies, and I had a tin of cookies with me for the surgical team. There was nothing remarkable about the prep for the surgery. Everyone was very professional and very good at their job. They gave me something "to help me relax", and then it was time for me to wake up in the recovery room.

The surgery itself took 4 hours. Waking up wasn't much fun, but as soon as I was alert they were able to provide effective pain meds. I spent a couple of hours in recovery, and then waited another couple of hours in recovery for a room to be ready for me.

When I made it to my room, three of my daughters were waiting for me. It was good to see them, though I was still groggy.  Even though it was the same day as surgery, the nurses helped me out of bed and had me walk once around the hospital floor, just to get me moving again.

Some of my visitors left soon after for the long drive (3+ hours, in bad weather) back to Bement, IL. My oldest and youngest daughters stuck around a little longer, long enough to be there when the surgeon stopped in to check on me. He gave me some of the details of the surgery, remarking both that the lymph nodes removed during surgery were not visibly affected my cancer, and that the prostate itself looked healthier than he had anticipated, based on the biopsy report. He did tell me that he got one of the Christmas cookies that I brought with me that morning.

Unfortunately, Bement picked up several inches of rain on Monday. I didn't know about it at the time, but when Alyssa, my 17-year-old daughter, got to the house (by herself), she found a few inches of water in the basement, and the pilot light out on the furnace. Sadly, she was stuck with quite a mess at a very inopportune time. I'm proud of the way she handled the cleanup.

Tuesday I was on my own in Chicago, and I managed enough laps around the hospital floor (13) to complete one mile. Pain management was very effective, and I have no complaints.

Wednesday morning I confirmed that I would be released that afternoon. I got lots of instructions on taking care of myself. The bandage over the incision and the drain tube were removed. And then I got to take a shower. That made me feel a lot better.

My friend Mark and my oldest daughter Tia drove up that day to pick me up and bring me home. The drive was uneventful, and I was home by 7PM.