Therapy update – month 1, doing well.
Summary: As of today, May 28, I have completed the first of six months of hormone therapy. Two months of radiation therapy will begin in June. I have no problem sharing this with anyone as long as it is not taken as a life-threatening issue in front of me now. It's not – it's the distant future I'm dealing with. I'm taking a gamble aimed for both longer and better quality of life in the next decade or more...unless I get hit with a car while crossing the street tomorrow. :–)
Details: Anyone who reads this should know, first, that I'm not dealing with an immediate cancer threat. What has happened is what is called “BCR” which mean “biochemically recurrent” prostate cancer. It happens to 20%-40% of us who have an initial local therapy – prostatectomy, in my case. There are no discernible tumors, but something is producing PSA. Although that is most likely prostate cancer cells, non-cancerous cells can also produce PSA. Therefore, simply monitoring PSA is a valid option.
Given my family history, however, I have higher odds of detectable cancer tumors at some point in coming years. If one waits for tumors to appear, there are still therapies that give men good odds of not dying of prostate cancer. Immediate therapy – when PSA is still very low – has, however, significanly better mortality odds. For those better odds though, one has to put up with months of hormone and radiation therapy ... which is no fun at all.
Similar to being asked to choose between prostatectomy or radiation for one's initial therapy, one can choose between continued PSA monitoring or hormone/radiation therapy. It is just another choice that each patient needs to make. Different medical specialists may offer conflicting recommendations. In my case, my MSK specialists recommended immediate therapy – but my primary care physician is skeptical about whether that is actually necessary yet.
As I've said before, because I have a family history of long lives, the longer I live the more likely metastasized tumors will appear – so I decided to go with MSK's recommendation.
The first of six months of hormone therapy started on April 30 with a tiny pellet inserted in the fat below the tummy's skin. Each pellet takes three months to dissolve so it will be replaced on July 30. Simple – and so far, not much in the way of detectable symptoms.
The radiation phase – 80 short weekday sessions – will be scheduled after my June 4 preparation, called “radiation simulation.” Radiation sessions are likely to start 7 to 10 days following July 4. My radiation therapy will extend to the first or second week of August. By then I will have the most significant side-effects associated with such therapy. It varies for everyone, but extensive fatigue is most likely, along with some degree of urinary and bowel dysfunction – almost certainly very temporary and generally not very serious. Recovery will extend from August into October – but again, that varies from person to person.
All I am doing is simply what is recommended – increasing my level of exercise before the therapy – and then trying to maintain it as much as possible to help the body deal with the daily 'radiation attacks'.
I'll likely do another update after the June 4 simulation session.