Radiation

Entry 71

Just to bring you up to date I have had my appointments with Health Science Centre Radiology and am already finished. It was accomplished in 2 days. The first day's appointment was about 1 1/2 hours long and was mainly consultations and marking the spot on my hip to be radiated. Very thorough. 

The following day was the actual treatment which took about 20 minutes and was done in one session.  I'm happy to report they think they got a relatively small and localized spot on my hip with one strong radiation application. I am having little or no side effects that one extra strength Advil tablet per day can’t handle. 

I have also been taking new medications, Abiraterone and Prednisone for 3 weeks and am equally free of significant side effects from that combination. So all in all I appear to be doing quite well. 

Cancer Care Prostate Center and Radiology are all over me like a tent. They will continue to monitor me closely for the next 6-8 weeks at which time they should know if the 2 treatments are successful. We will see.

A Major Change

Entry 70

There has been a change in my health status as it applies to the prostate cancer. I have been aware of it for over a year but things firmed up over the past few weeks. Below is a relatively brief explanation of how things arrived at their current status.

So, first things first....

A little over a year ago at one of my quarterly appointments, my Urologist/Oncologist Dr Jeff Saranchuk told me he was concerned that my primary line of defence against the spread of the prostate cancer was losing its efficacy. That line of defence was Androgen Deprivation Therapy (ADT). ADT is a hormone therapy that blocks the transmission of testosterone which prostate cancer uses to enable its transmission elsewhere in the body. It is not chemotherapy. 

Ten years ago, back in 2010 when  Dr Saranchuk surgically removed my prostate gland he also removed 12 pelvic lymph nodes & found 2 tumours. I was instantly metastatic. The cancer had already escaped the prostate capsule. Not good news.

To put this into perspective, the only line of defence available at that time was ADT & on average it’s efficacy lasted 2-3 years. So I took it. As Dr Saranchuk pointed out, if I hadn’t I would have shortly been in palliative care with a likelihood of pushing up daisies in the not too distant future.

But wait ! Here it is 10 years down the road & I just told you that very same ADT regimen is just now losing its efficacy. Instead of a couple of years I got 10! The how & why of that statement would legitimately be another full entry, so in the interests of simplicity let’s just say it is not lost on me that I am a very fortunate man.

What the above explanation is in aid of is that when I went into the appointment with Dr Saranchuk on Tuesday, June 29th I knew what was coming. Truth be told, I have been expecting to hear it 4x a year for the past 10 years. 

At that same appointment he ordered additional blood analysis, a CT scan & a bone scan. 

What I could not predict was the second shoe to drop, that being what the outcome of the CT scan & the bone scan would be. Once again in the interests of brevity, the CT scan (thoracic & abdominal) showed no signs of the cancer in the soft tissue & internal organs. Whew! The bone scan, which was head to toe however spotted bone metastasis in my left hip. Not good.

So in summary, my primary line of defence, the ADT treatments, had finally lost its ability to keep the cancer at bay. The bone scan having detected cancer in my hip was proof the ADT had lost its efficacy.

So, where does that leave us?

Well, perhaps not so bad actually. 

In the 10 years that have passed since my surgery there have been several new treatments & medications that specifically address my circumstances. The ADT will remain & a new drug, Abiraterone (aka Zytiga) will reinforce it along with Prednisone to mitigate any side effects. Assuming this new regimen works it should control the aggressiveness of the cancer.

The second part to this equation is of course the bone metastasis. That will be addressed with radiation. My understanding is the bone metastasis is localized & the treatment of short duration with a good chance of success. 

I await a call from Health Sciences Centre Radiology with an appointment schedule.

Prostate Blog - 10th Anniversary

Entry 69

Hello!

This will be the first entry in the Harry’s Prostate Blog in 5 years.

Part of the reason for my lax treatment of the blog was in effect a good news story. There was nothing newsworthy to report other than I was doing fine. A nice problem to have you may say and I would certainly agree. For those of us who live with the uncertainty of cancer the old adage ‘no news is good news’ has a ring of truth to it.

So the question becomes why start again now? Well, the answer to that is that on December 9, 2010 I underwent radical prostatectomy surgery at the Health Sciences Centre in Winnipeg, Canada. This will be the 10 year anniversary of that life changing event!

As a result of the skillful work of my urologist Dr Jeff Saranchuk and the consistent, ongoing monitoring of my health at Cancer Care in the Health Sciences Centre, it has allowed me to live a very full and rewarding life.

That remarkable care enabled me to be around for the marriage of our son to a wonderful young woman and the birth of our 2 grandchildren who as you might guess we totally adore. It enabled me to pursue my passion for paddling my canoe(s) on trips both large and small, and finally it provided the opportunity for my wife and I to travel. And travel we did, sometimes on our own and sometimes with friends or family. Our travels were extensive and worldwide in their scope and we found ourselves in places I never in my wildest dreams expected to visit.

I was also exceedingly fortunate in having the understanding and unfailing support of family and friends. This was crucial and you only begin to truly understand it with the benefit of hindsight. My wife Margaret and son Tom played pivotal roles in getting me through the main event and recovery. Friends helped propel that recovery so that I was able to take part in a demanding 2 week canoe trip within 5 months of the surgery.

But there is another reason other than the 10 year anniversary of the surgery. That reason is hope. My experience, and I hasten to add, my experience only, is that there is potentially a substantial and rewarding life beyond a diagnosis of prostate cancer. I am living proof.

Thank you for your time and attention and may I wish you a very Merry Christmas and a Happy New Year.

(Photo below taken in October, 2019 in Shetland, Scotland. Here I'm being photobombed by Shetland ponies and my brother-in-law Scott McDonald)

                                        

Lumps and Bumps in Places They Shouldn't Be

Entry 68

Well Hello!

The previous entry to this blog was 5 months ago in September of 2014 and it did not have much to say about the status of my prostate cancer other than my PSA number was increasing (not good, but not surprising) but it was doing so at a slow rate (good, oddly surprising). Not only is it moving slowly but it is doing so in a manner which is uncharacteristic. By that I mean the 2 terms urologists use to define the recurrence of the cancer in metastatic patients such as myself are 'volume and velocity'. I don't want to repeat myself so if you are interested to know these how 2 terms work please see Entry 66# in this blog from last January (paragraphs 2 thru 6) for a brief non technical explanation.

In my case the volume and velocity are both low and slow (respectively) and the velocity is uncharacteristic in that it is not 'doubling'. Again see above mentioned paragraphs in Entry 66#.

So what does this mean? Not much different than previous entries really. The cancer continues to manifest its presence but at a slow rate.  In March of last year the PSA number was just under 1 ng/ml, in July 1.33, in October 1.96, and 2 weeks ago it was 2.87 ng/ml. - increasing but not doubling.

This slow increase may be interesting but somewhat academic. The PSA reading for a prostate cancer patient post surgery, radiation, etc. is a much more accurate assessment of what the cancer is doing than readings prior to those treatment options. Quite simply if it hadn't already metastasized and/or the doctors managed to get it all the PSA reading should be .01 ng/ml or less and showing no signs of increasing with subsequent blood tests. Mine is, albeit slowly.

In case you are unfamiliar with the term metastasized (metastasis) it is defined as 'the spread or development of secondary malignant growths at a distance from the primary site of the cancer.' In my case it had spread and was found in 2 of the dozen or so lymph nodes that were removed and biopsied at the time of my surgery. Node Positive Prostate Cancer (LN+PCa) as this is termed.

It was with this in mind that I got a scare last October when while showering after a workout I detected a lump on one of my testicles. Yikes! Considering the cancer had already metastasized once and is likely to again, my brain was in catastrophe mode.

A visit to my doctor confirmed the presence of a lump. He immediately ordered a scrotal and abdominal ultrasound. Wouldn't you know it, the date for the ultrasound fell right in the middle of a month long trip to Argentina & Chile Margaret and I had previously committed to. Arrrgh! After consultation with my doctor we decided the 2 weeks difference was not likely to be that pivotal, plus he wasn't convinced it was cancerous. Turns out he was right. The ultrasound detected no 'intratesticular mass lesions' but rather 'small bilateral varicoceles'. A bilateral varicoceles in layman's terms is a swelling in the veins not unlike most of us would think of as a varicose vein. Apparently about 15% of men get them and it tends to be age related. Rarely do they pose a serious threat and if there is discomfiture, which I do not have, it can be surgically repaired.

So much for the scrotal ultrasound - the abdominal ultrasound was equally positive. They found no evidence of 'abdominal aortic aneurysm'.

Harry in Prince Edward Island 2014

So the moral of this story for any guys out there who may read this; don't automatically assume the worst if while washing or playing picket pool you notice a lump or bump that shouldn't be there. Get it checked out immediately. It may well be benign.

In summary, the lumps & bumps in places they shouldn't be are not cancer related and as such, much to my relief, are not evidence of the prostate cancer migrating (metastasizing) to places elsewhere in my body. However, and there is always that hesitation with cancer, my slowly increasing PSA number is indicative of it recurring. As mentioned earlier this is not unexpected. What it does mean is that I will likely return to the ADT (androgen deprivation therapy) sometime this summer or fall. Hopefully the ADT treatments will do what it did last time and knock the cancer and subsequent PSA number back to a negligible 0.01 ng/ml.

The surgery to remove my prostate gland was roughly 4 1/3 years ago. The ADT treatment 3 years ago. I live a relatively normal life and while there are unquestionably side effects from both the surgery and ADT therapy, for me at least, they are tolerable, indeed, so much so that it has allowed me to pursue my passion for yearly multiple week, long distance wilderness canoe trips, as well as travel the world with Margaret in month long intervals to the Maritimes, China, South America and Europe. 

All this travel happened without recourse to medical attention, cancer specific medication, or related paraphernalia such as incontinence pads etc. The incontinence that frequently follows PC surgery has not been an issue for me. In fact, and this is just unconscionable bragging, I can go to a Jets hockey game, drink 2 jumbo beers (17oz/503 ml each) and not have to pee until I get home 3 plus hours later! Hah! Take that you guys & girls stricken with TB (tiny bladder); and I'm doing it missing some of my urethra and the relevant sphincter muscle(s) therein.

All kidding aside, I have seen 3 doctors and had tests done in 2 hospitals since we returned from South America on December 20th. I feel very fortunate to have had that professional care and ongoing monitoring of my health.

hstimson @ shaw.ca
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On Our Way

Entry 67

Having been encouraged by my urologist/surgeon to enjoy the summer, I will return to see him in the fall after a six month period (instead of the usual three month interval) to have a check up. The last blood test in March revealed that my PSA is still slightly under 1 ng/ml. It's hard to believe that it has been more than four years since we learned that I had prostate cancer and began to explore the options for treatment.

The summer continues to be a busy time for me. I drove with a long time friend to Nova Scotia then flew home in June, drove to Vancouver and back in July, and tomorrow I'm heading out on a paddling adventure in northern Manitoba to commemorate Harcus Strachan, the only member of the Fort Garry Horse to receive a Victoria Cross and for whom a lake in Manitoba has been named. We will be placing an engraved aluminum plaque in his honour on the shore of the newly named Strachan Lake.

We expect to be on the water from August 10th until the 22nd.

Update: We have returned from the canoe trip. I added a few pictures below that were taken by Ed Loewen, one of the paddlers in our group.

Commemorative rock cairn beside plaque

Harry cooking

The paddling group. (left to right, Brian Greenberg, Joe Greenberg, Mike Sellors, Ed Loewen, 

Bob Williams, Harry Stimson lying in front)

Bob Williams and Harry Stimson

        hstimson @ shaw.ca
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2014: Fourth Year of the Journey

Entry 66
January 8, 2014

I had my first visit of the new year to Urologist/Surgeon Dr Jeff Saranchuk yesterday and for the most part it was positive.

The PSA # (Prostate Specific Antigen number) was up again.  It has trended up over the last 9 months from a low of 0.01 ng/ml (negligible reading) to 0.33 to 0.66 to 0.96 (yesterday's readout).

The reason this reading is interesting is that the previous assessments indicate that the numbers are 'doubling' ie 0.33 to 0.66 ng/ml. In Urologist speak this means the 'velocity' (speed at which the cancer is recurring) and the 'volume', (the amount of cancer present) is doubling. This time however, it went from 0.66 to 0.96 ng/ml - it didn't double.

This at best is a minor accomplishment but in the big scheme of things it means the cancer is not moving fast, and, as measured by the PSA#, there isn't a lot of it - and that's a good thing.

To put this into perspective it still hasn't broken the solid number 1 yet. Prior to going in for the surgery to remove my prostate gland my PSA# went from 5 to 18 ng/ml in 18 months - the above numbers show it has taken 24 months just to go from 0.01 to 0.96 ng/ml! Yay!

So, all in all, pretty good news from my point of view. But - and there is always that word when it comes to cancer, the very fact that I have a PSA reading means the cancer has metastasized, in all probability into my lymph nodes. As Dr Saranchuk has pointed out, don't get too giddy about the low PSA. The doubling is the issue - it becomes a logarithmic equation. Now I don't know a logarithm from a ski pole but I do understand doubling - 1 becomes 2 , 2 becomes 4, 4 becomes 8, 8 becomes 16, 16 becomes 32 etc etc. Once it gets going it can happen in a hurry. That's why Cancer Care monitors me every 3 months.

So what happens next. Well - not much really - I keep doing what I have been doing. When the PSA# starts to ramp up again - and it will - I will go back on the ADT (androgen deprivation therapy) and hopefully it will do the same thing as last time and knock it back down to that negligible 0.01 number again. My body responded well to that treatment last time and I assume it will again. It is worth remarking that typically metastatic prostate cancer patients have to return to the ADT within a year of stopping. It would appear in my case that timeline will more than double! To me that's fantastic and a clear vindication of the route we chose to go in dealing with the disease.

One thing for sure, I feel considerably more myself off the therapy than on it. That comment may fall into the ' amazing grasp of the obvious ' category but nevertheless it's true. ADT is NOT chemotherapy - many people confuse the two - however it does come with its own set of side effects that are less than pleasant, but I hasten to add, tolerable. I find it very difficult to explain to people what it's like to function without testosterone.

We will see what the new year has in store.

Many thanks for taking the time to read this. All the best to you and yours for a happy, healthy and prosperous 2014.

Lunch with friends
Click on images to enlarge them

hstimson @ shaw.ca
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ADT Still On Hold

Entry 65
September 17, 2013

My PSA remains below 1 but not by much. The measurement increased from .3 to .66 ng/ml since my last appointment three months ago, still well below the level (5-10) that will trigger a return to Androgen Deprivation Therapy. We will revisit the blood lab and urologist in three months as we continue to monitor the PSA velocity. 

In the meantime, I am enjoying the autumn, paddling the next few days with my friend, Jim Munro. 

Map of Northwest Ontario

hstimson @ shaw.ca
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