Ahem...

If you have been wondering why the posts on this blog have 'thinned out' a little; I'll let you in on a secret ... I really don't like thinking about the fact that my future still remains uncertain. And ...

... after nearly 18 months of living with cancer, I'm tired!

Tired of all the side affects; tired of the 'shadow' hanging over me; and, just plain tired; especially since the worst of the side affects: 'Fatigue', still presents huge problems!

While I continue to try to remain optimistic (even while battling the ever-present depression), as well as trying to limit 'stress'; as this adds to my (new) cholesterol problem; I strive to maintain a healthy diet to minimise both weight gain (side affect of Hormone Therapy) and to reduce my cholesterol level in conjunction with a regular, active exercise regime.


A recent blood test (to investigate my high cholesterol readings) brought both good and bad news. The good: My PSA levels (about 6 weeks premature) showed a positive result!

A further dramatic decrease from 0.3ng/ml to 0.2ng/ml - a 33 1/3% decrease!

The bad news: My cholesterol remains very high in spite of a good healthy diet and vigorous exercise!!!


While the PSA level is very positive, the fact remains, that I need to maintain such results for another 4 years and 4 months before the doctors will be satisfied that the cancer is gone!

I have to bear in mind also, that the type of cancer I have is the most aggressive variety. And so even though my PSA readings would seem to indicate that all is well; there remains a possibility that the cancer is not gone.

Sorta ... "Every silver lining has a dark cloud"!

The Cholesterol ... well it looks like medication for this, until things (hopefully) improve naturally.


On another front, as I indicated in a recent post, it looks like I have Chronic Radiation Proctitis and am scheduled for a colonoscopy and follow up surgery in a few weeks time.

An update on the current side affects I'm tolerating includes:

Fatigue; Hot flushes; Cognitive Impairment (including short term memory loss); Muscle weakness; Depression; Erectile Dysfunction and the 'new boy on the block' ... arthritis!

That Time Again

Well the results are in again!

I received the results of my PSA level a several weeks ago, but have been too busy/pre-occupied to post them! I decided that it was time to post the results.


Firstly to recap; we were hoping for a PSA result that was very close to zero. Such a result would mean that I would continue the Zoladex implant for a further period - two to three years is recommended - without having to re-introduce the Androcur and associated side affects.

PSA level

The normal range of PSA (Prostate Specific Antigen) in an adult male aged 50-60 years, is 0 to 3.5ng/ml. Remember, I started this battle against cancer with a PSA of 84.8ng/ml just 13 months ago!!!

My previous test (August 2008) showed a level of 0.66ng/ml, a negligible amount of PSA and an excellent result! Well the result this time the result was even better!

My PSA was only 0.3ng/ml less than half the previous result!!

This is a huge 'shot in the arm' in regard to my quest for a complete cure!! These tests will be repeated in late February and I expect a similar result.

August Update

Changes:

• The fatigue continues and has worsened somewhat. This seems to occur every time I have a new Zoladex Implant (every three months). The first few weeks or so the side effects seem to be heightened.

• The hot flushes continue but with less frequency and duration. Shortness of breath continues and had worsened somewhat - see point 1 above.

• Night urinations have increased to 2 or 3 per night!! Might have to discontinue my last ‘cup of tea.’

• Sleeplessness is now almost a thing of the past! I sleep very well now (between ‘pit stops’)

• Tiredness has also increased – see point 1 above!

• Sensitivity of the skin IS a thing of the past.

• Hair loss - chest, stomach, under the armpits - continues but is not a problem. Less shaving required now!

• Breast (nipple) soreness and sensitivity are gone.

• Cognitive Impairment continues to improve; largely because I am forcing my brain to remember even small details - the old adage applies here - use it or lose it!!

• Confusion only rarely becomes a problem, because of the above strategy.

• Memory loss has eased considerably - again because of the above strategy!

• Berocca; my 'High protein' energy drink (a breakfast supplement) and Glucodin have all been suspended in favour of:

Propolis - a product of honey, which has proven results for empowering the immune system; Sage – improves memory; improved, well-balanced diet; and, a milk substitute with added calcium and vitamin D – to prevent bone thinning.


Unchanged:

• My attitude is increasingly positive!

• Bowel movements remain good.

• I have maintained a weight loss of 2.5kgs - still 6kgs to go!


While it is important to exercise sufficiently each day to stave off bone thinning and muscle atrophy; it is also important to allow your body sufficient rest each in regard to the Radiation Therapy!

I have had to ‘work’ at balancing these two; it was only when I considered just how much my body was damaged during the Radiation Therapy that I was able to fully understand the importance of maintaining this balance!

Results of Blood Test

Well the results are in!

I received the results of my PSA and Testosterone levels a couple of weeks ago, but have been too busy/pre-occupied to post them! Just this morning, I had a gentle nudge from my niece Kathy and decided that it was time to post the results.


Firstly to recap; we were hoping for a PSA result that was very close to zero. Such a result would mean that I could discontinue the anti-androgen (and therefore reduce the number of side affects) but still continue the Zoladex implant for a further period - two to three years is recommended.

The Testosterone level too, it was hoped, would be very close to zero. This would confirm that the Zoladex was suppressing the testosterone nicely and therefore starving any cancer that may still be present.


Testosterone

A 'normal' reading for adult males in regard to Testoterone is: 2.8 to 8.0ng/ml. For an adult FEMALE, the range is: 0.06 to 0.82ng/ml.

My result ... 0.51ng/ml!!

That means, I fit neatly into the 'normal' range for an adult female! Which explains a few things!! (Long term readers would be aware of the 'feminising affects of my meds).

But all is not lost, my result also puts me squarely in the range of a pre-pubescent male (7 to 12 years)!!

I've managed to turn back the clock!

Now before you scoff, such a proposition is not as fanciful as you might think - consider.

1) I no longer have any hair under my armpits!
2) My skin complexion is that of a pre-teen!
3) The hair ALL over my body (except on my head) is falling out!
4) The hair on my head is thickening and growing back!
5) My testicles are 'shrinking'!

I think you get the picture...


PSA level

The normal range of PSA (Prostate Specific Antigen) in an adult male aged 50-60 years, is 0 to 3.5ng/ml. Remember, I started this battle against cancer with a PSA of 84.8ng/ml just 11 months ago!!!

Well my test showed a level of 0.66ng/ml, a negligible amount of PSA and an excellent result!

Coupled together, these results are a 'shot in the arm' in regard to my quest for a complete cure!! These tests will be repeated in early November and I expect a similar result.

Changing Medication

Regular readers will be aware that my wife and I recently moved to Chile, South America. One consequence has been, that we have had to source out my medications, and their availability, here in in Chile.

Well, two things became apparent quickly, firstly the only med that wasn't readily available was Androcur (Cyproterone); and secondly, the price was going to be astronomical - given that: the price here, reflected the lack of ready availability; and, I no longer qualify for the PBS (Pharmaceutical Benefits Scheme) while I'm out of Australia; so importing the meds was out of the question.

This led to a series of emails and phone calls back to Australia to: Medicare (re my PBS status), our Oncologist (re: my options), and our Pharmacist. The upshot being that I was to switch to Casodex 50mg (Bicalutamide) which was readily available in Chile rather than sourcing Androcur (Cyproterone) from neighbouring Argentina!

This outcome however, led to futher discussions re my current progress - 3 months after completing the IMRT. It was decided that I should have my PSA levels tested, and if the result indicated: 'no detectable PSA', then I would immediately stop the anti-androgen altogether!

And so today, I'm off to have both my PSA and Testosterone levels checked; I'm quietly confident that the results will be favourable! More to come next week...

For those of you who are not familiar with Casodex I have sourced out the following slide presentations; available for download from ... here.


Slide Presentation 1: Are all Anti-androgens the same?

Slide Presentation 2: The Efficacy of Casodex (Bicalutamide) 50mg in Combination Therapy


Decision Making

Management algorithms are often used to help to clarify the different options for each stage of diagnosis, disease staging and management of prostate cancer. An example of such an algorithm is shown below.

You Found Blood Where - Part 2

Some time ago I wrote about the presence of blood in my semen (or ejaculate) an excerpt follows:

Now this I wasn't expecting ... I was told, that after the Biopsy I could expect to find blood in the urine. I was also informed that I could discover blood in the semen.

However, what I wasn't told, was that my first semen sample (4 weeks after the biopsy) would be the colour and consistency of (black) tea.

Now that was a shock! I was ready for evidence of blood, albeit dark; (as bright blood would indicate present bleeding) but to all appearances, what I was observing was not semen at all!

Even now, I am surprised at the profound impact that this unexpected occurence had on me. I guess ... anything to do with the male reproductive system, is closely linked to a man's perception of his 'male-ness'. Therefore any sign that something may be amiss in that area, causes alarm responses to reverberate through to the very core of a man's self-identification.

Well, I did promise to keep you updated; but I must admit ... this is the only area of research (re Prostate Cancer) that I have deliberately avoided - not precisely sure why?

This is of course a very sensitive subject for most (if not all) men and I'm certainly no exception; but in the interest of research I finally decided to pursue the matter further.

Imagine my surprise, after finally discussing the discolouration of my ejaculate with my wife ... that she had known all along! She simply said ... almost as an aside:

"Oh, I know ... it's been discoloured for sometime"!

My shocked reaction was: "How did you know"! I was genuinely surprised, and started thinking: 'women's intuition ... we guys don't have a chance'!

But then it dawned on me: "of course she would know ... she was there"!!


Anyway, that started me thinking:

'If the ejaculate was blood-stained BEFORE the TRUS (Trans Rectal Ulta Sound) then what had caused it'? 'More research needed - but a different hypothesis'!

Then I found this (courtesy of Doctor's Lounge):

"A brownish or reddish ejaculate indicates blood in the semen and can cause concern to the men who experience it. The condition is common, and many episodes go unnoticed because ejaculation is usually intravaginally. It may be benign or the first indicator of a urologic disease.

It can occur in persons of any age. Most men with this condition are young (average age less than 40 years) and have symptoms ranging in duration from 1-24 months. Blood in the ejaculate that persists for more than 10 ejaculations or 2 months requires further evaluation by a urologist or genitourinary physician. Often, the condition is self-limiting within 2 months.

The patient's blood pressure should be checked because severe Hypertension is associated with this condition, and may have a similar basis to the association of Hypertension with nosebleeds. Other conditions that could cause blood in the ejaculate include:

*Lesions of the urethra that bleed and contribute to the ejaculate, such as polyps, warts and strictures.

*Infections of the urethra (urethritis) which may be sexually or non-sexually transmitted. Urethritis has long been recognised as a cause of bloody semen, especially in younger men.

*Inflammations of the prostate, such as prostatitis.

*Other conditions of the prostate such as bleeding after a prostate biopsy (which resolves on its own), Prostate cancer, prostatic varices, prostatic stones. Blood in the ejaculate of men older than 50 years is occasionally a harbinger of Prostate cancer.

*Cysts, infections and malignancy of the seminal vesicles (a pair of male accessory sex glands that secrete most of the liquid component of semen).

*Systemic diseases, most important of which is severe Hypertension as previously mentioned. Others in this category include bleeding disorders, chronic liver disease and Lymphoma".

The most obvious culprit? "Blood in the ejaculate of men older than 50 years is occasionally a harbinger of Prostate cancer".

That's another item to add to my 'discuss with the Urologist list!

On that note; I am seeing my Urologist this Thursday for another LHRH implant and the results of my latest PSA blood test.

Oh, and by the way ... my ejaculate is still blood stained! I know because ... I asked my wife!

Ponderings ...

I've been back at work for nearly three weeks now and much has happened. Firstly, I feel so much stronger! This is of course, very welcomed news for my wife and I. Although officially, I'm still looking at a prognosis of 3-5 years. I am pleased to say however, that the way I feel, belies this!

On 8th February, I'm due to have my next PSA (blood) test. This will hopefully show that my PSA reading has fallen even further.

I began this journey (with cancer) on 27th September last year with a PSA reading of 84.8!! This was later confirmed, and weight was added to the gravity of my circumstances; when I was found to have a 'Gleason Index' of '9' (out of 10) thus indicating that my particular cancer was the most 'aggressive' kind!

Now after two months of continuous 'hormone therapy' I'm beginning to find more reason for hope.

Firstly, the (many) side effects that I was suffering, have for the most part, abandoned their quest and left me with ... of all things ... more energy! Almost to good to be true, but I'll take it!

Secondly, I have begun to lose weight - slowly. This I attribute to two things:

(1) A very healthy (and strict) diet.

(2) A lot of exercise (mostly at work).

A Weight Lifted

Now, with the weight of the adverse side effects 'lifted', I am not so constantly reminded of my condition. This means I have actually been able to trully forget that I could only have 3-5 years to live and dare to embrace ... LIFE ... again.

And so, over the past couple of weeks, I have had time to ponder what the future might look like.

I may for instance:

Find myself once again in Ministry. A position has beckoned and we have begun the process of determining if this is the way forward.

Or, I may find myself heading up the English Department of a Medical University in Chile. Here too a position is beckoning!

Of course, there is always the possibility of a 'wild card' i.e. something from 'left field' may suddenly intrude and demand our attention.

Smart Money

Right now however, the 'smart money' is on the Chile option! Why you ask?

Well ... the first possibility, while it contains an opportunity for my 'faith' (in 'Church' i.e. the 'church system' and 'Christians' - there are christians and there are Christians!) to be restored; it also contains a risk. If this is not the correct path, many are likely to be hurt; myself included. I'm not sure that I'm sufficiently healed to take the chance - for ALL concerned! (See Heart Unburdened)

The second possibility however, well ... that is 'where my heart is'. The risk associated with this? I may disappoint those dearest to me!

I ache with an intensity, I've not known before; my 'calling draws me one way; but my heart wages valiantly against it'!

But the heart (the bible declares) is deceitful above all things! Who can really trust their heart; especially when so much is at stake? I am afraid that the wounds of the past still affect my present judgement and my confidence!

The third possibility; well who knows?

But, one thing I do know; come June we will have an answer. Should all other options remain unresolved; we head off to Chile!

Why?

Well ... my 'job' will soon contain increased responsibilities, which my body will not be able to 'keep up with' - at least not for long, without adversely affecting my health. And without the job we can no longer afford to live where we currently reside.

Therefore a 'move' would be imminent.

Added to this; with so much uncertainty surrounding our future, we need:

(1) Closure regarding our past; and

(2) A sense of direction (i.e. some certainty) regarding our future.

We are no longer willing (or able) to live without these ... come what may!

PSA Test Results

Last week, I attended our local GP's surgery for another blood test. Specifically, this blood test was to:


• Determine whether my PSA reading [previously 84.8] had begun to drop. Thus showing that the hormonal therapy I had been undergoing for a little over 4 weeks, had in fact begun to have the desired affect; and

• Determine whether my cholesterol readings had improved as a result of my [now] 'extremely healthy' diet.


I was told that it is quite normal for the PSA to rise after a trans-rectal biopsy. I was also told to bear in mind, that I had only begun the hormone therapy 4 weeks prior to the blood test. [Orally for the first two weeks, followed by an LHRH implant and continuing the oral regime until two weeks after the implant procedure].


Well ... the results are in!

And, as often happens, there is good news and bad news. The bad news relates to the fact that one of my readings had not altered at all!

My 'cholesterol level' has refused to budge!!

The good news ... well my PSA levels have gone down - very significantly!

My previous PSA was 84.8. It is now 12 [only one month after receiving the LHRH implant]!!

PSA Test

Today I attended our local GP's surgery for another blood test. Specifically, this blood test was to:


• Determine whether my PSA reading [previously 84.8] had begun to drop. Thus showing that the hormonal therapy I have been undergoing for a little over 4 weeks now, has in fact had the desire affect; and

• Determine whether my cholesterol readings had improved as a result of my [now] 'extremely healthy' diet.


I am told that it is quite normal for the PSA to rise after a trans-rectal biopsy. I also have to bear in mind, that I only started hormone therapy 4 weeks ago. [Orally for the first two weeks, followed by an LHRH implant and continuing the oral regime until two weeks after the implant procedure].

Having said that; it sure would be a 'shot in the arm' [pardon the pun] to receive a lower PSA reading! I am due to receive the results in a few days.