Giddyup !

Entry 74

This is a note to let you know there has been a change in the current status of my prostate cancer. 

The PC has upped its game and the challenge now is to adjust my treatment regimen to address  it. As a result, my Urologist for the past 11 years, Dr Jeff Saranchuk has handed me over to the Medical Oncology department at Health Sciences Centre in Winnipeg to develop a new course of action.

That has happened and I am now totally in the care of Dr. Joel Gingerich. Margaret and I had >1 hour consultation with him which went very well and left us totally impressed. My other health care workers speak very highly of him and reference how smart, caring and professional he is. I think I am in good hands for the next 40 miles. 

I have been up to my ass in tests to confirm the treatment regimen Dr. Gingerich described to us. Two tests this week with a bunch more to come including redoing the CT and Bone Scans to see if the PC has made further incursions. At this point the lesions on the pelvis remain sclerotic and not lytic - the lesser of two evils.

At this point I am experiencing no pain and feel fine. 

My PSA went down yet again. Dr. Gingerich cautioned me not to get excited about the drop because it was likely caused by the December radiation treatment on my hip.  The unexpected decrease was fortunate in that it will give us time to plot the treatment schedule instead of rushing it.

That treatment will include chemotherapy- docotaxel. Not surprising.  Every 3 weeks for 30 weeks. Depending on when it starts that will last into mid to late summer. Clearly travel is not an option for me.

I’m also registered for a clinical trial and did the tests for it yesterday. Interestingly they take blood samples as well as tissue samples from your prostate gland. What? But I no longer have a prostate gland! He reminded me that I had agreed to put my prostate gland in a tumour bank at Health Sciences Centre after it was removed 11 years ago - research purposes. Completely forgot.

I am wait listed for the clinical trial of Radium 223 and probably won’t get in, but now that I am registered and tested, all my DNA information is on file for future immunotherapy treatment. Assuming I need it.

Additionally, last week I underwent a bone building/strengthening process that is administered by IV drip over 30 minutes every three months (for the foreseeable future). It will help mitigate the bone loss due to the cancer. The drug is called Zoledronic Acid or trade name Zometa.

That’s about as much as I know at this point. None of it is overly surprising to me. We knew the cancer was making its break for freedom and now we know it has been successful. We will see if medical science can slow it down. 

My new mantra comes courtesy of the poet Robert Frost when he said, " The only way out is through".   Giddyup!

Time to Transition

Entry 73

Greetings! Just wanted to give you an update on a change in the direction of my prostate cancer treatment.

As you may recall back in July of last summer a CT Scan and Bone Scan detected the prostate cancer had migrated into the pelvic bone of my left hip. Shortly after, the spot was radiated at Health Sciences Centre and it seemed to address the problem. 

Unfortunately, another CT Scan and Bone Scan in mid November found that the cancer had returned. Once again, cancer showed in the left hip and once again it was immediately radiated at the Health Sciences Centre. 

The second set of scans also picked up additional small lesions in the pelvic bone structure. Early stages, but nevertheless, it calls into question the continued efficacy of the medication I am on. 

Statue of the angel polar bear looking in the window toward the Hematology Lab of Cancer Care

So where do we go from here?

As of this week Dr Saranchuk, my urologist for the past 11 years has handed me over to the Medical Oncology department at Cancer Care. That just occurred a couple of days ago so nothing has happened as yet. That Oncologist, when appointed will take over my treatment in its entirety, both medication and radiology. 

With that in mind and in discussions with Margaret, Dana and Tom, we thought it prudent to scale back our Christmas interactions to immediate family only. This is a shame but in light of the potential impact of the Omicron variant of Covid, probably for the best.

I have been reminded that my immune system is under stress and I should be careful. Several times a week, I've been keeping fit with walks in the ~4 km range along with stretching and weight bearing exercises for about 50 minutes at a time.

I'd like to take this opportunity to thank Dr. Saranchuk and all the staff at the Prostate Centre in Cancer Care who have been instrumental in maintaining my health since prostate cancer was diagnosed eleven years ago. Dr. Saranchuk has been a very caring and skillful professional in this part of my experience from the original prostatectomy in 2010 until I transition to the Oncology team in January, 2022.

Results and Followup of Treatment

Entry 72

This was a pivotal week with regards the change in status of my prostate cancer. To say I was nervous would be an understatement.

Appointments with the doctors at Cancer Care Prostate Centre and Cancer Care Radiology on Tuesday and Thursday respectively, assessed the results of the change in medication and the radiation therapy. 

The news is good.

The new medication Abiraterone has not only stopped the rise in the PSA number but in fact dropped it by a full point in the space of 1 month. The key take away here is that it’s working. If it did not at least stop the rise in that number we would be looking at Plan B.

Additionally, l am experiencing no significant change in side effects. 

With regards the second part to this equation, the radiation therapy, the news is equally positive. It has been 2 weeks since the application of a single dose of radiation to address a relatively small and localized occurrence of cancer. 

The pain normally associated with it has been minimal. When needed one Advil tablet per day has sufficed. As in the case of the medication, any side effects from the radiation have been minimal.

This was the first assessment since the diagnosis and treatment in July. It is very encouraging. I will see Dr Saranchuk of the Prostate Centre every month for the foreseeable future to continue to monitor the efficacy of the Arbitrarone on my PSA. Radiology will do the same according to a slightly different schedule. 

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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