Posts Tagged ‘PSA failure’

Rob Harry Jim Xmas 2018 cropped

My brother (left), his grandson, and me last Christmas.

MAY 18, 2019: The inconsistency of PSA testing has hit close to home – my brother has just been diagnosed with advanced and aggressive prostate cancer, but his PSA showed little signs of change.

Prostate cancer was confirmed a couple of weeks ago, but he’s obviously had it for years. It’s out of the capsule and he has secondary lesions on his spine, pelvis and upper arm.

So far, no symptoms are showing with any of his internal organs (other than his prostate, obviously). He is peeing fine and there’s no bleeding anywhere.

However, the spinal tumour was large and extremely painful, the trouble first showing up last June (2018). His GP found nothing with digital examinations, so gave him painkillers and suggested he see a physiotherapist.

Physio gave temporary relief only, so he went to a chiropracter. No help. Back to the GP, who referred him to New Plymouth’s main hospital to be screened for a specilaist appointment.

After a delay of several months – because the hospital is chronically short-staffed and suffering from NZ-wide strikes by young doctors – the doctor who finally saw him in late March suspected bone cancer and had him admitted urgently for tests.

When I told one of the hospital specialists I’m a prostate cancer survivor (more than a decade now) and our father also had it diagnosed in his 80s, the place scrambled and my brother was soon told he had terminal bone or prostate cancer.

He was immediately transported by plane to Palmerston North (a three-hour road trip away) whose hospital has the major radiation treatment centre for the lower half of the North Island. After treatment with radiation and steroids, the tumour shrank and his doses of morphine for the pain were greatly reduced.

Back in New Plymouth a week later, he was given a digital examination by a hospital doctor, who found signs of cancer; that was confirmed by a biopsy. His Gleasons was reported as a low 3/4, but the secondary tumours are considered aggressive.

He is now on initial treatment with a combination of hormonal therapy plus docetaxel-based chemotherapy, just as my old friend Mike Scott predicted when I asked his advice last month. Mike runs that fabulous website The ‘New’ Prostate Cancer Infolink, in my view the best source of prostate cancer news and information in the world.

My brother went through the usual stages of shock, despair and denial, but moved quickly to the positive stages. Despite a stiffened arm, he has returned to work as one of New Zealand’s top freelance photographers, works the dog 4km each day and is generally positive about getting on with his life.

I would say his prognosis for years of useful life are good, despite the spread of the cancer. He can be sure of support from me (we have worked together for years anyway).

The screening of prostate cancer continues to be a worry. After I was first diagnosed in 2008, my brother has had regular digital and PSA tests every year since. My PSA never changed and my cancer was discovered by a GP with long fingers. Goes to show, doesn’t it.

BELOW: A couple of my brother’s photos that are about to be published in his 35th book. They show Mt Taranaki.

Screen Shot 2019-05-08 at 7.52.36 AM

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PART 17 of My PC Adventure (see full story HERE> )

Am I cured of prostate cancer?

I don’t know. The signs are already good, but I’ll just have to wait. I’m officially in limbo for the next 17 weeks.

I have no further appointments with the medical profession until late August, when I need to get a PSA blood test and then a few days later have a followup visit with the surgeon. Then we’ll know more.

It seems the magic “c” word is elusive. My prognosis is good, excellent even, but saying I’m cured is simply not possible, because this is a very complicated business.

About 30% of men who have a radical prostatectomy like I did will have what the profession calls “biochemical recurrence”.

Here’s the US Cancer Institute’s explanation of what that means:

A rise in the blood level of PSA (prostate-specific antigen) in prostate cancer patients after treatment with surgery or radiation. Biochemical recurrence may occur in patients who do not have symptoms. It may mean that the cancer has come back. Also called biochemical relapse and PSA failure.

How likely am I to be among the 30%?

Highly unlikely, it would seem. The reason is the cancer in my prostate was caught early, before it had time to surface at any of the margins of the organ, which is the bad thing that can happen as the cancer grows.

Once there are “marginals”, there is the chance of the tumour spreading into lymph nodes and the nearby seminal vesicles.

Here’s how MedicineNet.com defines seminal vesicles:

Seminal vesicle: A structure in the male that is about 5 centimeters (2 inches) long and is located behind the bladder and above the prostate gland. The seminal vesicles contribute fluid to the ejaculate.

Wikipedia says this about lymph nodes:

A Lymph node…is an organ consisting of many types of cells, and is a part of the lymphatic system. Lymph nodes are found all through the body, and act as filters or traps for foreign particles. They contain white blood cells. Thus they are important in the proper functioning of the immune system.

So, if you get cancer into nearby parts of the body like the vesicles or into the lymph system – and thereby spread through the body – the chances of advanced cancer increase.

There are drug and radiotherapy treatments for such eventualities, but the chances of long-term cure are proportionately lower.

Why am I waiting 17 weeks for the PSA test, and why is it done after the cancerous prostate has been removed?

To rehearse some earlier facts from my case, my PSA levels have never been high. The test prior to diagnosis showed .77, when up to 4 or 5 would have been acceptable for my age.

I have a friend whose PSA has been rising and is now about 20, but three biopsies have failed to find any sign of cancer. In my case, low PSA did not mean I did not have cancer (I did).

The wait is to allow my system to settle down, since surgical intervention can release the antigens into the system and temporarily raise the PSA in a way that is not helpful to diagnosis.

After five months (the operation was on March 25), that all should have settled down and an accurate reading should be possible.

What are we hoping for? Well, a nil result. Zilch. That would mean no biochemical recurrence…and no cancer.

The other thing in my favour is the low Gleason grade given to my tumour: at 6/10 it is the lowest meaningful result used. That means the cancer was of a low aggression type. It would have taken years to migrate out of the prostate.

So. I’m hopeful of the nearest thing to a cure you can get.

No doubt I’ll need to continue with the PSA tests for a few years just to be sure. Biochemical recurrence can occur some time after surgery. But in my case, it seems unlikely.

Here’s hoping…

A recent web item said spouses and partners end up more worried about cancer recurrence than the patients. So it’s time to find out what Lin thinks of all this.

NEXT: Another side to the story

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