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Seidman Cancer Center
Orange Place
Beachwood, Ohio

Sunday, September 11, 2016

The news was not so great this time.

My PSA (Prostate Specific Antigen) score last week shows a sharp rise the past couple of months. Only on July 14, it was 2.9; on September 6, 5.7. The score virtually doubled in less than two months. Not a good sign.

Of course, I should have no measurable PSA at all. I have no prostate gland, that cancerous organ exiting my body via surgery in June 2005. So when the PSA becomes measurable again, it means that some prostate cancer cells have survived--and are back at work.

As many of you know, I underwent six weeks of daily radiation treatments down at the Cleveland Clinic in January 2009. And--for a bit--the number dropped near zero again.

Then returned. And reached such a level by June 2013 (22.9) that my oncologist at University Hospitals told me it was time to commence quarterly injections of Lupron, a drug that zaps my testosterone, thus denying the cancer cells the "food" they crave. And once Lupron started, the PSA virtually disappeared.

For almost exactly two years (fall of 2013-fall of 2015) my PSA was "undetectable."

And then it wasn't, starting with the lowest measurable level (.01) two years ago. It percolated along for a bit, and then, recently, it seems more eager to rise, an eagerness which means the cancer is back online and determined to get about its business of killing me. You see, the cancer cells believe in evolution. They adapt, figure out how to get me despite Lupron's best efforts.

My oncologist--Dr. Hoimes at Seidman, a man I greatly admire, like, and trust--has told me that in the next few months I will probably add bicalutamide to my regimen (link to info about that drug)--another drug that zaps testosterone, another drug whose side-effects are virtually identical to those of Lupron, a drug I will take for the rest of my life, a drug that (as I've written before) diminishes my energy, causes periods of heavy perspiration (not "flashes"--"infusions" is more accurate), brings my emotions to the surface, encourages depression, stimulates weight gain (I have fought hard against that effect), and destroys my libido. My body hair has virtually disappeared (but I've still got a good growth on my head--and chinny-chin-chin and cheeky-cheek-cheeks).

I sleep a lot more than I used to (lights out about 9; up about 6), and if I don't, well, then it's Nap Time the next day.

Working out, which I used to enjoy, is drudgery now. I hate it. On the exercise bike, I have to stop and rest far more frequently than I used to. And, sure, I'm nearly 72 now--and energy and endurance do not remain with us forever. But I can date my decline easily: It was the day I got my first Lupron injection, back in July 2013. Within a matter of weeks, I felt like a squeezed sponge--most energy gone. Forever.

Anyway,  as I write this on Sunday afternoon, I'm not sure what Dr. Hoimes is going to tell me tomorrow morning (appointment at Seidman at 10:40 a.m.), but I'll append his advice to this post tomorrow after I get home ...


Monday, September 12;1:15 p.m.

We’re home after a long morning up at Seidman. Dr. Hoimes repeated what he’d told me in an email late last week—that it will not be long (a matter of months) before I’m on bicalutamide, a drug that, he assured me this morning, will replicate but not intensify the side effects I’m already experiencing from Lupron. Perhaps a few more sweating periods (nice). We also talked about our “down-the-road” options, which, of course, will narrow as I work my way through these drugs of delay. (Prostate cancer has no cure.)

He likes my exercising, my weight (under control, for the nonce), my diet. These help. (The cancer likes fat cells.)

He’s also scheduled me for another bone scan. Prostate cancer loves to move into the bones (“The better to take you down, My Dear!”), so every now and then, just to see, I get a scan—a procedure that requires a shot of some radioactive stuff (Spidey!), a wait of an hour or so while the Spidey-drug circulates (we zoom to a Starbucks, where I can drink coffee—but also lots of water) before I head back for the scan, which requires me to lie supine and still while I glide slowly  through a machine out of Star Trek. (I pass the time by reciting in my head some of the poems I’ve memorized.)

I’ll see Dr. Hoimes again in twelve weeks for a reassessment—and for a shot of Lupron (I got one this morning, too.). By then I will have had two additional PSA tests—just to see if the little dickens is growing any more quickly than it has been. Or ought to be.

Twelve weeks … More time to worry, of course. Something I try not to do—its being counter-productive and all. But I can’t always help it. So I throw myself into reading and writing and exercising and baking and spending as much time as possible with Joyce, who keeps me alive in every way it’s humanly possibly to do so.

She was at my side today, again. What greater gift could a human being ever receive?