Timeline of my prostate related events, with commentary:-
Dec 2001. My PSA tests and DRE showed no change since October 2000.
Sept 2003. PSA 7.0ug/L. I had become a bit lax in getting PSA checks done at regular intervals whilst I was touring and fishing around southern Queensland. I was then given a referral to see a urologist, but as I was moving to NSW at that time I did not get to consult a urologist until November 2003.
Oct 2003.. PSA 10.23ug/L Free 35%, following a short course of antibiotic. I was now getting a little concerned. This result was not from my usual pathology lab and I have since discounted the result, because subsequent tests done by my usual lab over the next few months returned lower PSA results.
Jan 2004. PSA 7.7ug/L
Jan 2004. I consulted a leading senior radiation oncologist (Dr F) in Brisbane. He said he would accept me for radiation therapy. He also said he would require me to have a short course (3 months) of the anti-androgen hormone Zoladex (goserelin acetate) to shrink the prostate. However, when I questioned him about the radiation therapy proposed and the equipment to be used, it quickly became apparent that better facilities were available in Sydney or Melbourne where 3D-CRT facilities existed. I knew IMRT (Intensity-Modulated Radiation Therapy) was at that time commonly in use for prostate cancer in the U.S.A., but it seemed from my enquiries it was only available in Melbourne for selected patients - more about radiation therapy here. I decided against having radiation in Brisbane.
Feb 2004. Whilst searching of the Internet, I found the
prostate pointers website (see link on my links page) and joined the
associated mailing list
P2P (physician to patient). I posted my
medical data on the mailing list. A reply of about 2 or 3 pages
long came from
Dr Stephen Strum, a USA medical oncologist with many
years experience, since 1983 specialising in prostate cancer. He has
authored or co-authored many books and research papers. I found the
information he provided very helpful. He suggested that I take
Avodart (dutasteride) and
Cardura (doxazosin), but I
strongly advise that before taking any medication, herbal
medications or the like, you should as I did, get the OK from your
physician. Doxazosin is unavailable in Australia and
I import a generic brand. To interpret an
PSA value in a man treated with dutasteride, it is advised to double the actual PSA test result, if dutasteride
has been taken for six months or more. (see dutasteride Articles
Mar 2004. I consulted a senior medical oncologist (Dr B) at Tamworth Base Hospital, NSW. He is a visiting specialist to Tamworth from the Prince of Wales Hospital, Randwick, Sydney NSW. His comment was that I probably had low risk PCa and most men in my age group had a few cancer cells in their prostate. Advice - active surveillance.
Mar 2004. I consulted a senior radiation oncologist (Dr S) at Tamworth Base Hospital, NSW. He is a visiting specialist to Tamworth from the Prince of Wales Hospital, Randwick, Sydney NSW. His comment was that I probably had low/intermediate risk PCA. Advice - active surveillance, but radiation OK if that was my choice.
Apr 2004. Commenced doxazosin 4mg daily.
Jul 2004. Commenced dutasteride 0.5mg daily.
Feb 2005. I consulted a radiation oncologist (Dr.
F.) at the Peter MacCallum Cancer Centre (PeterMac) in Melbourne and this
was followed by an MRI with spectroscopy. Report:-
"Combination of MRI and
MRS suggest that the site of dominant disease is within the mid to
upper portion of the peripheral zone of the prostate gland posteriorly - multi focal small volume disease favoured. Findings
correspond with Stage II disease. No features suggest extracapsular
extension. The prostate gland volume is enlarged, measuring 41ml.
Gross benign prostatic hypertrophy (BPH) is demonstrated,
compressing the peripheral zone."
Dec 2006. MRI prostate and spectroscopy done at Specialist Magnetic Resonance Imaging (SMRI) in Sydney. Gland Volume 56ml (previously 41ml Feb 2005) - otherwise no significant change from the previous MRI-S study done Feb 2005 - no evidence of extracapsular extension.
OCT 2007. Per rectum (DRE) prostate examination indicates the prostate is firm, smooth and moderately enlarged.
Nov, 2007. MRI study (no spectroscopy) was done at Peter MacCallum Cancer Centre Melbourne. Prostate volume 66ml with a broad region of signal abnormality involving posterior aspect of superior prostate, presumably representing the known prostate adenocarcinoma. No evidence of extracapsular extension, seminal vesicle invasion or lymphadenopathy.
Sept 2008. Per rectum (DRE) examination shows a soft, slightly
enlarged prostate with no palpable nodules.
bicalutamide with a view to reducing prostate and cancer
volume, because radiation (IMRT) is on my short list of preferred
options. I am also very interested in the da Vinci robotic
prostatectomy and this might be the way I shall go.
Sept 2008. PSA 0.32ug/L - free 0.1, 31%. (Low PSA due to the strong effect of the bicalutamide.)
Oct 18, 2008. Because of side effects of bicalutamide - breast soreness and breast tissue growth, I commenced Tamoxifen 10mg daily. I found this action to be very effective - soreness disappeared completely and also the hard tissue within the breasts cleared up completely - no further breast enlargement, but this was only minor. See article.
Nov 2008. MRI-S at SMRI; Gland volume 61ml, down from 66ml (Nov 07) - no evidence of extra-capsular extension or seminal vesicle invasion. There is nodular enlargement of the central gland consistent with benign prostatic hypertrophy and the peripheral gland is attenuated. The spectroscopy demonstrated regions of elevated choline to citrate ratio within the central gland. Note: The prostate normally has a high citrate to choline ratio and the reverse applies to prostate cancer. (See Abstract)
Jan 2009. Reduced Tamoxifen to 20mg weekly (Sunday). This was because of this article, which suggests 20mg once a week is sufficient.
Feb 2009. I am curious as to whether or not the histology of the PCa has changed since the confirmed diagnosis in Nov, 2003. I could get another biopsy done, but I am reluctant to do so simply to satisfy my curiosity. No specialist has been able to provide me with evidence that a biopsy is incapable of spreading the cancer cells within or out of the prostate. There is an interesting article about MRI-S, biopsy and needle-tracking here
Feb 2009. Stopped taking the bicalutamide and Tamoxifen. I have no problems with the combination (except the expense), but when I started I saw it as only a short course for a few months, to reduce the prostate volume (this occurred) and perhaps reduce the PCa volume.
May 2009. PSA 1.1ug/L - free 0.3, 27% - strong effect of the bicalutamide.
Oct 2009. MRI with contrast was done on a latest model Tesla 3 machine, by Qld X-Ray at Coorparoo in Brisbane. Prostate volume now 71cc, down from 78cc when first diagnosed in 2003. Comment by radiologist, " Indication is either low volume or relatively indolent disease and there is no evidence of extracapsular extension of tumour. Comparing these appearances with the patient's previous MRI study performed in December '06 shows no significant interval change."
May 2010. Renal ultrasound to assess kidneys - all OK - prostate volume 73cc.
June 2010. Ceased doxazosin which I imported and switched to locally available prazosin (Minipress). Doxazosin and prazosin are both alpha-blockers that relax blood vessels and also the muscles surrounding the urethra. Because I have high blood pressure and moderate enlargement of the prostate (BPH) this drug is of benefit to me.
July 2010. PSA 2.3ug/L - free 0.8ug/L 35%. Also, my doctor did a per rectum (DRE) feel of my prostate and said it felt normal and only slightly enlarged.
Oct 2011. PSA 2.51ug/L - free 0.7ug/L 28%
May 2012. PSA 2.7ug/L - free 0.8ug/L 30%. Per rectum (DRE), prostate firm in apex area. No significant lumps or bumps felt.
May 2012. MRI (with contrast) at Wesley Medical Imaging (Wesley Hospital) Brisbane. The Wesley has up to date equipment & methodology, and claims that overseas data shows that 3T multiparametric prostate MRI (Which the Wesley uses) can detect clinically significant prostate cancer with an accuracy of 90%.
My MRI summary: No definitively abnormal areas. A patchy area of reduced T2 signal is noted right apex - possibly lower grade tumour. Note: This correlates to the original biopsy Nov 2003 which indicated 5% of core right apex was positive PCa. Prostate volume 64ml so still down on 78ml as at Nov 2003. I guess that Avodart has had a large part to play in reducing the prostate volume.
Feb 2013. PSA 3.00ug/L - free 0.8ug/L 27% Note: PSA is increasing slowly. Effect of Avodart means that the PSA should be doubled for clinical assessment, i.e. 6.00ug/L, which is still lower than the 7.00ug/L in Sept 2003.
July 2013. Now age 77, I am feeling in good health and continue motorhoming - currently at Cairns. At the time of my diagnosis in 2003, and with a moderately/rapid rising PSA, I had reason to be concerned. As I approach 10 years from the diagnosis, I am happy with the path of active surveillance and the medications I have taken. If need be, I still have the option of radiation - perhaps even surgery.
April 2015. I should have updated My Story before this, but due to an email today asking me how I am, and reminding me that my last entry was back in 2013, I am back! I still continue with active surveillance, regular six monthly per rectum (DRE) prostate examinations and a PSA test every few months. I am happy to report that the DRE's find no real change, no lumps or bumps, prostate enlarged and firm with BPH evident. My last PSA test was done 23 Dec, 2014 and read 2.00 ug/L which is very good. However, I am still taking Avodart, which has a reducing effect on PSA, but most likely not affecting the cancer.
Oct 2016. PSA 2.7 ug/L - same as May 2012.
To be continued.