December Test Results

Got my latest PSA results back on 2 December. PSA is now 1.70. The continued drop indicates the tumor is shrinking. The plan is now to stay on Finasteride until Feb when we will do anothe biopsy. With any luck the biopsy will come back negative!

10-10-10 Update

Yesterday I golfed with my doctor, David Crawford. We talked of a couple of options. One is that they can go in and deal with, what all agree, is a very small tumor. That can be in several forms, including lasers, freezing, etc. Another option offered is that we continue treatment with Finesteride (a generic version of Advar) and continue to monitor through PSA and PCA-3 testing every four months.

I have chosen the second option. First, this cancer doesn't scare me, as I have faith in my doctors. Second, there are a few cases where this drug has eliminated the tumor. More studies are required to determine how this drug interacts with the tumor, and the opportunity to study this case set is limited. Since I will be monitoring the condition on a regular basis, the thought that my case might help guys in the future is something I don't feel I can pass up. Next tests are next month!

The non-event

Well...today was supposed to be my date with the doctor. The mapping biopsy was supposed to start at 0730 this morning. However, after Tricare decided it was an "investigative" procedure versus "diagnostic", and after consulting with my doctor, we cancelled. Instead, I'm going to become somewhat of a test case for treatment through medication. I have been on Finasteride for 3 months. It's also known as Proscar and Propecia. There have been some studies that indicate this drug (used to reduce prostate enlargement) may be successful in killing off the tumor. My PSA has dropped from 4.33 to 2.03 so that's a good thing. At any rate, we are convinced the tumor is small and confined at this point. We will continue to monitor. Maybe it saves some guys from going under the knife in the future!

MRI results

Fri 27 Aug: Got the MRI results back today. As follows:

PROSTATE MRI WITH AND WITHOUT CONTRAST 8/25/2010

INDICATION: Prostate cancer

TECHNIQUE: Multisequence, multiplanar MR images of the prostate are
performed with and without use of IV contrast. The patient received
20 cc of multihance intravenously without adverse reaction. Images
obtained with the endorectal coil.

COMPARISON: None

FINDINGS: The central zone of the prostate is hypertrophic. The
central zone demonstrates heterogeneous T2 signal. In the peripheral
zone at the level of the mid prostate at approximately 7:00 position,
there is vague area of low T2 signal which corresponds to enhancement
on postcontrast images and low signal on the ADC maps. The capsular
margin of the peripheral zone is smooth without nodule or bulge.
Groin and iliac lymph nodes are within normal limits for size. No
perirectal or internal iliac adenopathy. No abnormal signal or
enhancement from the neurovascular bundles. The seminal vesicles are
unremarkable. There is mild trabeculation of the bladder wall which
is likely due to prostate hypertrophy and outlet obstruction. An
irregular area of T2 high signal in the left femoral head insistent
with osteonecrosis . The bones are otherwise unremarkable.

IMPRESSION: MR findings suggestive of adenocarcinoma in the
peripheral zone of the mid prostate at 7:00 position. Correlate with
pathology results. No evidence of local spread or metastasis.

This last sentence is particularly important: It means the cancer is confined to the prostate. Good news!

Insurance

Thurs, Aug 26: Found out today my insurance will not pay for the mapping biopsy scheduled for next Tues. They consider it an "investigative" procedure rather than a diagnostic procedure. This mapping biopsy in fact usually results in long term savings to the patient and the insurance company, as localized treatment costs less than broader treatments such as chemo or removal of the prostate. The mapping biopsy costs around $20k. Lots to mull over the next few days!

The MRI

Wed, 25 Aug: Drove to Denver today for a Magnetic Resonance Imaging procedure. I won't go into all the details of the procedure here, but there is a good description at http://www.radiologyinfo.org/en/info.cfm?pg=mr_prostate

The procedure took a couple of hours and included a contract material injected the last few minutes of the procedure. I would imagine an MRI would be difficult for someone who is claustraphobic! I was also given earplugs and headphones, as the MRI machine is very noisy.

I should have the results back this weekend. One more test to go!

Test Results

Got my latest test results tonight. PSA is 2.03, down from 4.33. Testosterone is 270 - the PCA3 test is -21.7 (negative). From what I understand, the PSA and Testosterone is down due to the drug Finesteride, which I have been on for over 60 days. The PCA3 test, which is still experimental, is turning out to be a better predictor of cancer than the PSA. Since my initial biopsy has been diagnosed as positive, I'm doing this test as a data point, hoping that it may reduce the requirement for biopsies for other guys in the future. Golfing with my doctor tomorrow so I will discuss the results and post!

Initial Visit

Met with Doc Crawford "officially" for first time today. Visit included a digital exam, a new PSA (blood) test and a relatively new test called PCA-3. This test is based on a urine specimen and looks for the DNA identifiers associated with prostate cancer. Although this test is not FDA-approved, it shows great promise with regards to screening and it may prove to be a better indicator than the standard PSA test. We taked about the mapping biopsy, now scheduled for 31 Aug. They will use a template to extract as many as 90 samples of the prostate, creating a 3-D image of my prostate, with the idea of isolating the tumor to as small of an area as possible. I should be knocked out for around 90 minutes. With any luck, the tumor will be confined to a small area, where it can be dealt with. We also talked through all the possible treatment options, from chemo, to radioactive pellets, to surgery, to cryo (freezing the tumor), to doing nothing at all. I will continue current meds and start Flomax around 10 days prior to the mapping biopsy.

I also agreed to be part of a long term study on this cancer. Basically it allows researchers access to samples of blood, urine, tissue, etc already being collected as part of my treatment. Hopefully it helps us move a step further towards a cure!

The media

Interesting week. Dan Chacon from the Gazette wrote a piece on his blog about my condition. It was very good and based on some email exchanges. He was certainly welcome to write about it, and in fact I encouraged him as it is one more opportunity to help make guys aware of the need to get annual exams. However, what followed was kinda like the game you play in elementary school, where you whisper something into a friend's ear and they pass it on and 20 people later it no longer resembles the original message. Suddenly Im getting questions as to why I am backing out of the race for mayor. Nothing could be further from the truth! I'm in the race for the long haul. :-)

Out of the closet

Today both the Colorado Springs Gazette and the Colorado Springs Business Journal reported on my cancer, and also noted that it may force me to drop out of the race for mayor of Colorado Springs. Cat's outta the bag! At any rate, I have no plans to drop out of the race at this time. Heck - I'm just getting started!

Appointments

I have my next appointments set. July 19th I will travel to Denver to meet with Doc Crawford and talk through the mapping biopsy procedure. Then on 24 Aug I will get the mapping biopsy. The mapping biopsy is a relatively new procedure - it's been around 4 or 5 years. Whereas my last biopsy was 12 samples, this could be as many as 90 samples! The idea is to create a 3-dimensional picture of the prostate and gain a precise understanding as to the scope of the cancer. I will be "under" during the procedure and it could be a couple of days taking it easy after the procedure. However, once the results are back we will all have a better view of the road ahead. Thanks to all for your support!

Dennis Hopper

Yesterday we lost a great actor and artist - Dennis Hopper -who passed away from complications of prostate cancer. Dennis was diagnosed last October as part of testing during hospitalization for dehydration. By the time his cancer was detected, it had spread throughout his body. Guys - get checked annually!

The Blog

Today I start medication - Proscar. One of the possible side effects is additional body hair, and I am hopeful it will target that thinning spot on the back of my head!

Now that the second opinion is here, I have told the kids. I'm not worried, and neither should they be. I have consulted with my closest friends, family, and both my doctors regarding this blog. All have been supportive. In fact, Jerry said that many men are devastated when faced with the diagnosis. I guess the fact that I have been informed for years makes this easier for me to face. I'm not dealing with it alone - I have a wonderful support team of family, friends, and doctors. In fact, Dave told me today that guys with prostate cancer golf better - I can't wait to take his skins money! I will continue to blog on my progress. Feel free to comment, ask questions, etc. I'll do the best I can to reply.

Side comments

I should say at this point that I am no stranger to prostate cancer. In fact, I met Dave at a Prostate Cancer Education Council golf tournament. As fate would have it, I was placed in his fouresome, and we became golfing pals. I also became involved in the cause to not only educate guys (and their families) regarding prostate cancer but also in the research to help treat and ultimately find a cure. Through my association with Dave and the PCEC I learned that 1 in 6 men will be diagnosed with prostate cancer. If you are a minority, the odds are 1 in 3. Nearly 200,000 American men will be diagnosed with prostate cancer in 2010, and 1 in 35 will die from it - PRIMARILY BECAUSE THEY WILL NOT GET A SIMPLE BLOOD TEST! Guys - this is not a macho thing. You owe it to your loved ones to get checked. Ladies - press your man to get checked! Catch this demon early and the odds of survival are good.

The second opinion

Got the results of the second opinion today. Results as follows:

Prostate, right base, needle core biopsies:
- Prostatic adenocarcinoma, Gleason grade 3 + 3 (score = 6), microfucus involving <5% of 1 / 2 cores (see comments)

A, B, C, E, F) Prostate, left base, left mid, left apex, right mid and right apex, needle core biopsies:
- High grade prostatic intraepithelial neoplasia, focal in right apex
- Acute inflammation, moderate in right mid
- Prostatic tissue with no evidence of malignancy (0 / 10 cores)

Comments: In contrast to the outside pathology report (with diagnosis of ASAP), we consider that there is enough number of malignant glands to confirm the diagnosis of a small focus of adenocarcinoma. Accompanying immunoperoxidase staining for HMWCK+p63 cocktail shows lack of basal cells in the malignant glands. Specimen from right mid shows moderate acute inflammation, which may explain, at least in part, a possible increase of serum PSA. A close follow-up, which may include mapping biopsies of the prostate, is recommended if clinically indicated. Dr. S. Lucia has reviewed this case and concurs.

Lots of big words! I immediately start to research all the big words on the web, in an attempt to tie down just what this doctorspeak is telling me. It's easy to get panicked about the various definitions on the web, but after speaking with both Dave and Jerry, I am reassured that we are moving on the right track. The second opinion has confirmed the cancer. The next step is a mapping biopsy to really nail down the scope of this "bug". We schedule for Aug with Dave.

The results

The results are back, and I'm back in Jerry's office at Ft Carson. Mostly good results. However, the biopsy sample for the Right Base reads: "Small focus of atypical glands, suspicious of malignancy". The comments include "The small focus of atypical glands is suspicious for malignancy and repeat biopsy is suggested." We talk it through and feel that a second opinion is in order. Can Dave's pathologist take a look at the results? I call Dave and he is eager to help. We make arrangements to send the data to Denver.

The biopsy

Biopsy went fairly well today. I had been warned that this would feel like somebody shooting a strong rubber band against my butt, and that pretty much sums it up. 12 samples taken. Doc Limoge and the nurse continue to talk to me through the procedure, primarily to keep my mind off what is happening. Doc said he didnt feel any more abnormalities,and ultrasound was clean. Dizziness after sitting up, but that went away after around 5 minutes. Will get biopsy results next Friday.

I did have some interesting side effects a couple of hours after the
procedure. I went back to work. Started sweating really bad. Whiteouts - I looked out the window and couldnt distinguish anything. It was snowing, but everything was extremely bright. Was drowsy and dizzy but got to my bookcase to grab a golf towel to wipe off sweat. Put my head down on a shelf.
Thought it was only a few seconds but was actually closer to 10 minutes.
All symptoms went away after around 45 minutes. Residual pain subsided maybe 6 hours after procedure. After initial blood in urine, all is now clear. I sent Dave a note describing the side effects, and he said it was a vasovagal event. Basically, I fainted. I always thought that fainting means you just kind of collapse. I never knew there are lots of pieces/parts to fainting!

Telling the family

Picking up the wife tonight in Denver. She has been gone for a few weeks with a family health issue in California. We are heading to the Michael Buble concert in Denver, where we have front row seats! Conversation turns to the testing before we ever really get out of DIA. I tell her what has transpired, and what I think is going on. Then the convo turns to the kids. Should we tell them? I say no - not enough info at this point. Don't worry them. I am considered hard headed.

The exam

I meet Dr Jerry Limoge, who will be performing the physical exam. He immediately strikes me as a good guy, and for this kind of exam, that's important. This is a rectal exam, where the prostate will be examined for abnormalities, such as a lump or hard spot. The procedure is painless, and is over in under a minute. Jerry tells me that there is one area that seems abnormal, and recommends we set up for a biopsy. I find out that he knows Dr Crawford and thinks highly of him. Later, I e-mail Dave and relay Jerry's name to him. Dave's reply: "Limoge is the best, couldn't recommend anyone better." That's really good to hear! Biopsy is set for 23 April.
Later that night, while talking to a friend on the phone, the reality of where all this is going really hits me for the first time. I have a little meltdown, and quickly recover. First time using the "c" word. I needed to get this moment out of my system.

Dr Crawford

I fired off a note to a good friend, golfing partner, and world-reknown urologist, Dr Dave Crawford, who lives in Denver. I'm scheduled for a physical exam next week, and wanted to get his take on things. Although Dave offers to perform the exam, I decide at this point to go ahead with the referral at Evans Hospital.

The checkup

It's time for my annual checkup! Last week I submitted blood samples for this checkup, and today I get the results. I'm expecting to hear the same thing as last year - cholestrol could be better, I need to exercise more, and all the other normal stuff. In and out in 15 minutes! But...the doc has some other news - my PSA level has elevated to 4.49. I know that PSA levels are just an indicator, and not a confirmation that things have taken a turn for the worse. However, more investigation is warranted, and the doc sets me up for a referral.