I (Davis) Have Been Fighting a Six and a Half Year Battle with Prostate Cancer. It is a Battle I think I Have Won. I Examined Several Treatment Options in Detail, Eventually Trying Two of Them. This Is The Third of a Multi-Post Series on Prostate Cancer in General, and my Experience in Particular.
Once prostate cancer is suspected, it will usually be confirmed with a biopsy. Besides indicating its presence or absence, several pieces of additional information are collected. In particular, the cancers aggressiveness is encapsulated in a number called the Gleason score, ranging from 6 (mild) to 10 (very aggressive). Additionally, the number of biopsy needles that contained cancerous tissue, along with the size of the tumors they pierced, is recorded. Similar information can be obtained with a specialized MRI.
A low-grade cancer, Gleeson score six or 7, and found in less than half the needles, can simply be closely followed. This is called “watchful waiting.” Many cancers in this category will not develop further and may remain contained and stable for many years, even decades.
My Own Diagnosis
My PSA had been fairly stable at value of around 2 ng/ml . In 2004 it started creeping up and passed 3 ng/ml. Dr. Mike pointed this out, and after a heavy course of antibiotics failed to bring it back down, he sent me, in 2007, to have an ultrasound. The doctor performing this, Dr. Duke Bahn—a prostate imaging specialist—said he could see no tumors, but did see calcifications that indicated a chronic infection. He said I should try to get rid of the infection, as it would likely lead to prostate cancer. In fact, we probably had gotten rid of it, and the cancer had already started, but the tumors were still too small to be spotted with an ultrasound. By 2009, my PSA had crept up to 5, and again visited Dr. Bahn. Though still unable to see any tumors, he had no explanation for the high PSA and did a biopsy. As I left, he assured me that he didn’t think I had cancer, but a week later called me up with the biopsy results. I had a Gleeson score of six, and five of nine biopsy needles had tumor material in them. The diagnosis: low or intermediate grade prostate cancer.
Of course, at first I panicked. But being the consummate data freak, I very quickly absorbed all the relevant online knowledge I could find. It seemed that there were a bewildering choice of treatment options, all of which seem to work. I felt a lot safer now. It didn’t look likely that I was going to die from prostate cancer, but what to do?
I was borderline. A bit milder case could be watched (watchful waiting), If something was to be done, the choices sorted out into these categories:
Getting Rid of Prostate Cancer
Category #1. Knock it out cold for a year, and then monitor it closely afterwards to see when and if it returns, and if it does, how aggressive it is. This is called Androgen Deprivation Therapy, and involves only drugs. So no surgery or radiation or other intrusions. More on this in a moment.
Category #2. Remove it. This is the “classical” method, and involves surgery. Given the location of the prostate, it is massive surgery indeed. A newer technique, called Da Vinci, involves performing the surgery with little gadgets inserted through tubes, and though less invasive, the outcomes are less effective, at least when top surgeons are compared.
Category #3. Kill it in place. The most common method is radiation, which destroys the prostate cells’ ability to reproduce by damaging the cell nucleus. This come in two flavors, external beam, and implanted radioactive seeds. Another method is called cryotherapy, which freezes the prostate, and there is also a method using high intensity sound, which fries the prostate.
At this point, I was leaning toward the Da Vinci surgery, but Dr. Mike thought it a good idea to have consultations from the various specialists. We started with Dr. Mark Scholz, who is an expert at treating patients with Androgen Deprivation Therapy. Dr. Scholz wasn’t at all keen on surgery, and thought that if the prostate were to be killed, radioactive seed implants were the best way. However, the Androgen Deprivation Therapy, at least his version of it, had a couple of major advantages. First, no surgery or radiation, and hence, no long-term side effects. After the therapy (one year), I would still have a working prostate. The disadvantage is that the cancer usually comes back. He said it always comes back, but the literature I read seemed to suggest that 20% of the time it was gone forever. Also, it is quite possible that it could return in a form that was slow and manageable, or maybe there would be new and better therapies. Dr. Scholz predicted that after the one year drug course, therapy, I would have around 3½ “normal” years and then might have to do it again.
Androgen Deprivation Therapy (ADT)
This is also called Testosterone Inactivating Pharmaceuticals, Androgen Ablation Therapy, and various other names. The idea is to shut down the body’s production of testosterone, dihydrotestosterone, and starve the prostate.
I did it.
It involved a quarterly shot, and two different pills a day. Expensive, and insurance doesn’t cover this because it is non-standard. US pricing was $20,000 total for the drugs. Canadian pricing was a little under $10,000. Same drugs. Within two months, my PSA dropped to unmeasureable levels – essentially zero. This meant that 99% of my prostate cells were killed, including the cancerous ones. But what else would be happening? Dr. Scholz had, in effect, read me the riot act on side-effects from these drugs. I would, he said:
Loose muscle mass.
Loose bone density.
Feel miserable all the time.
Have no libido.
Have hot flashes.
He said that some had reported that resistance exercise would partly ameliorate these effects.
I was expecting the worst, but it failed to transpire. It wasn’t such a big deal. On Dr. Mike’s advise, I added a third weekly exercise session and tossed on more weight to the resistance exercises. I took no drugs to combat bone loss. The net result was: I built muscle, gained no weight, increased my bone density, and felt fine and energetic. I did have hot-flashes: one every 31 minutes exactly. I also lost a lot of libido, and I felt somewhat stupider than normal.
I Recovered, But So Did the Prostate Cancer
I was glad when the year ended. My PSA took a long time to return. I was not back to 2 ng/ml for three full years. Now, would my PSA simply stop there? No such luck. After four years it hit 2½ , and at the 5 year mark, 3 ng/ml. I got an MRI, and one tumor was spotted about the size of an almond, and another somewhat fishy area was noted, which I assumed was a second tumor in training. So now what? I had gotten 5½ years from the ADT, but the $%^& cancer was back. It didn’t seem to be in any great hurry. I decided to wait a few months. By the end of the year, it was still heading up, so I resolved to do something. But what to do? I could always do another year-long round of ADT, or could look for a permanent solution. In the five years that had elapsed, there weren’t really any new breakthrough technologies, but a group of doctors had gathered a very comprehensive amount of data comparing the long-term prospects of the various therapies. The results were very illuminating and are the subject of the next post on the topic, but to see the paper first hand, click here.