April 18, 2014

"Celebrating" 20 Years with Prostate Cancer

You needn't send a "Happy Anniversary" card.

Actually, I keep forgetting I have prostate cancer. I get the reminder every six months for my regularly scheduled appointment with my urologist. He administers the blood and finger tests, then I worry for a day or two while I await the results. That's about it.

I had my spring checkup last Monday. Results later.

My Prostate Cancer History
I learned about my prostate cancer in 1994. After reviewing options with my urologist, Dr. Nicholas Constantinople, I chose surgery. That was in January, 1995 -- a strange way to celebrate my first month of retirement. The operation also marked my first use of Medicare.

Post-operative PSA tests showed some remaining cancer cells. One of the key -- and most difficult -- questions with prostate cancer is whether it's relatively slow-growing or more aggressive. Fortunately, mine has proved to be the former.

Since 1995, I've checked in with Dr. Constantinople every spring and fall. My PSA reading went from near zero in March 1995 to a little over 4 in March 2011. Then the number began bouncing around, starting with a big jump to 9.4 in October 2011. Urologists become concerned when PSA readings more than double within a year or so.

I wasn't concerned. I was panicked, expecting Dr. C to recommend hormone treatment or some aggressive, unpleasant therapy. Instead, he said "Let's wait and see what happens next March." I was relieved when that number came in at 7.1, and Dr. C said that number was in the normal range for me.

Then in the fall of 2012, my PSA number jumped above 11. Coincidentally, my pain doctor recommended that we search for the cause of my continuing back pain. So, I had a full body scan -- not just an MRI -- to see if the cancer had spread to my bones.

The scan was negative, and it didn't explain the back pain. My pain doctor recommended holistic remedies, and I ended up working with my physical therapist on core muscle strengthening exercises. My back pain went away, and I keep it at bay as long as I do the exercises.

Last year, the PSA readings fell in the 6-7 range. The number last fall was 6.25. Last Monday's blood test showed 6.95. So, we're back to slow growth for now.

What's the outlook for my prostate cancer?
I asked Dr. C that question yesterday. I got the answer I expected: There's no way to know where or when the PSA ball will bounce next. He said we'll likely continue the current "watchful waiting" strategy until the PSA reading exceeds 20. Then we'll probably do another scan to see if cancer has spread to the bones. If it has, we'll look at hormone therapy or other treatments.

Given my age and my Parkinson's, it will be a race to see which gets me first: age, Parkinson's, or cancer, If I have a choice, I'd like to go the way my dad did. He was found in his backyard with a lawn chair on one side and an open book on the other. Victim of a sudden heart attack. He'd played a round of golf the day before.

Promising Breakthrough on the Horizon
With my 20 years of slow-growing cancer, I can't help but wonder whether the prostatectomy was really necessary. I remember Dr. C's associate visiting me in the hospital after my operation. He said urologists sometimes ask that question themselves when post-op biopsies show less cancer than expected. He also said my biopsy results indicated the operation WAS necessary. Still . . .

It would be great if -- before patients and doctors have to make decisions about operations or treatments -- a test were available to identify a just-discovered cancer as aggressive or slow-growing. When I made my own decision over 20 years ago, no such test was available. Dr. C said there's been surprisingly little progress on the issue . . . until about a year and a half ago. Gene therapy has led to work on several potential tests that show great promise. He expects a test to become available within a year and a half.

Hooray!

But What About the PSA Test Itself?
Two years ago, the U.S. Preventive Services Task Force -- an agency of the Department of Health and Human Services -- recommended discontinuing routine PSA tests for healthy men. The task force reported that the tests were unnecessary, might actually cause harm, and certainly added a needless burden to the already-soaring cost of U.S. healthcare.

In a post on this topic from October 2012, I quoted Dr. C, who described the task force's recommendation as "outrageous." But in cases like mine -- where cancer cells remain after removal of the prostate -- most medical authorities agree that regular PSA tests are necessary to track the progress of the cancer.

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