RussÂ Suereth and Shirley live in Florida, USA. I was 64 when diagnosed on October 10, 2000. Initial PSA was 32.0 ng/ml, Gleason Score was 7. Choice of treatment was surgery and radiation and HDT. Here is his story:
10/5/2000: Went to lab for the tests ordered by primary MDÂ 10/10/2000 - Tuesday: Went to office visit with primary. Discussed results of cholesterol test. The total was 155. He asked me when I last had a PSA test. I said I had no knowledge of a previous PSA test, as I was unfamiliar with the term. He had ordered a PSA to be included in the test on 10/5/2000 and was surprised at the results. He told me that the PSA count was 32.0 ng/ml. I was unaware that this was bad. He started searching for previous results, but there were none to be found. He had simply neglected to order one over the three years I had been his patient. He also did not perform any rectal examination (DRE) on me at any time over those three years. He said I should see a urologist as a result of the PSA test. I asked him if he would recommend one. He did, and an appointment was made with a urologist by his office staff before I left his office. Needless to say, I was in shock over the above developments. 10/12/2000 - Thursday: Attended a seminar on seed implants today I asked the lecturing MD what were the upper limit of PSA where one would no longer be considered a viable candidate for the seed implantation procedure. He replied that about 20 ng/ml would be the upper limit. I became even more anxious and went home. Later that evening, about 7:00 p.m. I logged on to the urology center (UC) with which the lecturing MS was affiliated with. There was a comments/question box and I entered a comment stating that I had attended the seminar, that I had a PSA of 32.0 ng/ml, and that I was scared to death. Much to my surprise, the MD from the seminar called me about 8:30. He was very kind and told me he would see me the following day. Someone from UC would call me in the morning to arrange an appointment. I told him that I didn't have any health insurance because of a previous condition. After hanging up, I cried for about 15 minutes. The release of tension was overwhelming. Maybe I had found someone who might be able to help.
10/13/2000 - Friday: I was called by UC early this morning. An appointment was made with Uro and we (Shirley and I) went to the UC at about 10:00. The uro performed a rectal exam and said that he thiought I should have a biopsy. He would have done it immediately, but because I take an aspirin daily, he said we should wait until Monday. He also said that I should have another PSA while I was there as they previous one could be wrong. I agreed, and it was done. The result was 39.0 ng/ml.Â 10/16/2000 - Monday: The biopsy was performed at UC. Very unpleasant experience.Â
10/17/2000 - Tuesday: Shirley and I met with uro and a surgeon at the UC. They told me that the results of the biopsy were positive. He now said that I should have further tests to determine if the cancer was confined to the prostate. These tests were bone scans, and lymph node scans.Â
10/19/2000 - Thursday: Had the tests today. Painless, but lots of trepidation about the outcome. Now, we just have to wait until Wednesday next to get results.Â
10/25/2000 - Wednesday: Results of the tests were negative. So far. Met with the surgeon who would perform the operation. He suggested some sort of hormone treatment but so far nothing has come of it. It is expensive and I am presuming that he feels that I can't pay for it.Â
11/031/2000 - Friday: Went to the VA. Met with his nurse first and then he came out to get me. Spent 30 minutes with him discussing the reason for my visit. He gave me a routine exam, and sent off a request to the hospital that I am given the next available appointment. He also said that he marked the request "urgent".Â
11/09/2000 Thursday: Got a call from local hospital to schedule blood taking(s). Will go on 11/13, 11/20, and 11/27. Went to the UC for a biofeedback class. Exercises were described and a test was run. Passed. Must do every day up till surgery day, but not on surgery day. Talked with someone from the hospital regarding pre-op visit. Will go on 11/30 at 7:00 am.
11/20/2000 Monday: Still no word from the VA hospital. Will call the local VA office to let them know what is going on. Went to VA and asked about the hospital visit. The clerk said that the hospital was always slow. She said I had a 15-minute appointment scheduled for 2/8/2001
11/29/2000 Wednesday: Met with the physician's assistant at the UC. He explained what would happen upon hospital admittance.Â
11/30/2000 Thursday: Went to the business office of the local hospital and paid the fee of $6,000 to cover the cost of the surgery.Â
12/5/2000 Tuesday: Went to local Hospital at 5:30 am for admittance for surgery. A radial prostatectomy was performed Was sent to a room at about 2:00 PM
12/6/2000 Wednesday: Was released from the hospital this afternoon at about 4:00 PM. Went directly home. Fair amount of discomfort. Lucky me, I get to keep a catheter in for at least two weeks
Post-Surgery Lab ReportÂ
#1. Lymph Node, right pelvic obturator, lymphadenectomy: fatty lymph nodes, negative for metastatic carcinomaÂ
#2. Lymph Node, left pelvic obturator, lymphadenectomy: fatty lymph nodes, negative for metastatic carcinomaÂ
#3. Prostate, NOS - Tissue
#3a. Specimen consists of a prostate with attached bilateral seminal vesicles and vas deferens weighing 36 grams. The prostate measures 3.5 cm superior to inferior, 3.9 cm left to right and 3.3 cm anterior to posterior. The capsule appears grossly intact and shows a few inherent fibrous tags. The right and left seminal vesicle appear grossly unremarkable. The right seminal vesicle measures 3 x 2.5 x 1.1 cm. The left seminal vesicle measures 2 x 1.5 x 1 cm/ The right and left vas deferens appear grossly unremarkable and measure 1 x 0.7 cm each. Multiple sections at close intervals perpendicular to the rectal surface show a solid grey-tan cut surface throughout. No discrete tumor is present. Sections are submitted as follows: A&B, bladder neck; C&D, apex; E, superior peripheral zone; F, mid peripheral zone; G, inferior peripheral zone; H, bilateral vesicles and vas deference.Â
, radical prostatectomy: moderately to poorly differentiated prostatic adenocarinoma, Gleason score 7 (4+3) involving more than 50% of the prostatic volume. Tumor involves the apex, bladder neck and bilateral seminal vesicles. Pererineural invasion of foci extracapsular extension with involvement of the capsular resection margin are noted.Â
12/20/2000 Wednesday: Went to the UC. After several tests, catheter removed. currently wearing diapers of a sort. The surgeon said the lab report on the removed prostate showed that the urethra may have acquired some of the cancer cells. Bad news. Also said to come back in early February, as the PSA should be down below 0.40 ng/ml. If not, radiation is going to be required. It seems that my life span just got shortened considerably.Â
01/11/2001 Thursday: Still trying to cope with an incontinence problem brought about as a result of surgery. Of course, it is evident that my ability to perform sexually is over, but I more or less know that going into surgery. Better to live a little than not at all. Another problem is the lingering shadow of a worse cancer problem. Which I believe could have been avoided with early detection.Â
01/31/2001 Wednesday: Incontinence still a problem, especially if walking any distance. But getting better. Had a blood test last Wednesday on 1/24/2001 at the VA. The result of the PSA was 15.0 ng/ml, much higher than expected with the removal of the prostate. This only indicates that the outlook for my long-term survival just took another hit. Will have another PSA at the urologists tomorrow. Just to make sure.Â
02/8/2001 Thursday: Went to VA hospital They recommend radiation as well a hormone treatment. Am scheduled for MRU and cat-scan beginning on 2/22/01.Â
02/8/2001: Started Casodex: took for 28 days. At day 26 got a pretty severe rash
2/22/2002: MRU and cat scan negative
3/2/2001: Zoladex 84-day injection at VAÂ
4/11/2001 Wednesday: Started radiation treatments on 4/11/01. Will go daily, except weekends for eight weeks. 39 treatments.Â
6/1/2001: Zoladex 84-day injection at VAÂ
6/7/2001: End of radiation. No immediate ill effects. Turned up with radiation proctitus later on in the year. Still a problem, but nothing severe.Â
8/24/2001: Zoladex 84-day injection at VAÂ
12/15/2001 through 10/7/2003: PSA < 0.1 ng/ml.Â
10/7/2003: PSA 0.2 ng/ml.
1/9/2004: PSA 1.3 ng/ml.
1/23/2004: PSA 1.7 ng/ml.
1/29/2004: Zoladex injection (84 day)Â
4/27/2004: Zoladex injection (84 day), PSA <0.1 ng/ml.
7/20/2004: Zoladex injection (84 day). PSA <0.1ng/ml.
5/15/2006: PSA 1.6 ng/ml.
5/24/2006: Eleguard injection (84 day)
08/16/2006: Zoladex injection (84 day) at VA. Substantial bleeding
11/07/2006: Zoladex injection: (84 day) at VA. No bleeding. Administered by regular nurse.
02/06/2007: Zoladex injection (84 day) at VA. All ok
06/01/2007: PSA =0.10Â
I am currently on an off cycle as far as ADT goes. I have my PSA checked every three months and it has been below 0.1 ng/ml. I don't think too much about changes up or down below that. I think it is a waste of time to worry about it. I was on an "on" cycle for a year but that was mainly due to the intractability of our Veterans Administration. They can't figure out that intermittent ADT is OK and they are disturbed about it. At least that is what I get from the local VA clinic. But the URO and I think it is ok. I hope to be on an "off" cycle for at least 18 months and maybe 24. That has been the schedule so far.
We are muddling along, living our lives the best we can with the specter of this thing hanging over our heads. But, I try not to dwell on it. I find that the older I get, (I will be 71 this month) the more reluctant I am to travel anywhere. A real fuddy-duddy. Maybe that is part of the territory.
Most MD's have told me I will not die of cancer. That may be true. I suffered a cardiac event 11 years ago, but so far no recurrence. My total cholesterol is 126, ldl is 66 and hdl is 34. They all think I am going to die of some heart related malady, but I have no ill effects from the heart attack. At least none that I can see.
I am continent for the most part although I can see some weakening in the muscles, maybe due to age. Mornings are a struggle as I need to rush to the head more often than not because of ?.
At the present time I am near the end of an †œoff† cycle. My psa has started to rise and will more than likely double. I will have a test at the end of April 2009 and will know more then. But, I am not optimistic about things remaining as they are. But, I am optimistic about staying on top of the loam for a little while longer.
Hope this all helps.
08/03/2007: PSA <0.10
01/14/2008: PSA <0.10
04/30/2008: PSA <0.10
10/31/2008: PSA =0.8
01/31/2009: PSA =1.5
04/30/2009: PSA =1.1
08/06/2009: PSA =0.8
11/06/2009: PSA =1.0
03/15/2010: PSA = 0.9
As you can see from the last entry above, my psa has remained near or less than 1.0 for about 3 years. I am pleased with that so far. At any rate, we will have it tested on Aug. 08 2010 to see where we stand and then decide if some ADT is required.
Whoops, not such a good report. Looks like I am back on an "on" cycle.
06/04/2010: psa = 3.0
09/08/2010: psa = 6.9
09/28/2010: Zoladex injection (84 day)
12/07/2010: psa = 0.2
03/08/2011: psa = 0.1
04/08/2011: psa = 0.1
08/23/2011: psa = 0.1
Have had 4 ADT treatments in the past 9 months. That is pretty close to a years worth. Will discuss the next step with the specialists. I an scheduled for another injection on 09/06/2011. Maybe I will have it, maybe not. If my psa remains at or below 0.5, I probably won't have it.
Well, my psa was below 0.5, so i am now in an off cycle. We will check the psa in 3 months to check where we are.