PCa

Where have you been?

Advanced Prostate Cancer, David Emerson, PCa -

June has not been a good month for the old blog. I’ve just been busy and otherwise mentally occupied.

On June 9th my ‘Chemo-versary’ came and went. It has now been 12 months since I started the chemo treatments. It seems like a lifetime ago.
Tomorrow would have been my Mom’s 76th birthday. I find it really strange to imagine over 6 years have gone by since she passed! Talk about time flying!
Work has been a busy distraction. The pending merger was approved and now comes the headcount reductions and people positioning themselves for a role in the new company. I’m not one for ‘playing the game’. I hope my historic results stand on their own. This is not to say I am standing by idly, but we’ll see what happens.

Next month we are finally going to take some time off with trips to St. Louis, the lake and Minneapolis. We’re just not certain at this point when we will do which.

There is also this Disc Golf event in town the last week of July. The World Disc Golf Championship (Professional and Amateur). It’s four days and six rounds, and the opportunity of a lifetime. I’m still on the fence but leaning towards doing it!

That’s all for now, have to go meet a cute blonde for lunch.

Doc, are you serious?

Advanced Prostate Cancer, bone scan, CT scan, David Emerson, Ketokonizol, PCa, PSA -

Today was my monthly doctor appointment. I am not sure where the time went…June is nearly over.

For the past weeks I have felt the same, no new aches and pains, no need for Advil or the like. As reported, my knees hurt but Glucosamine is helping a little. I think chemo pretty much trashed my cartilage. As for cancer related pain, I really have none.

So, on to the test results. A little history; after leaving MD Anderson we agreed to pay more attention to everything going on instead of focusing primarily on PSA.

My PSA today was: 66.14
This is up from 55.13 last month. I was not at all surprised considering I am only taking Lupron at this time.

The three new tests came back looking like this:

Alkaline Phosphate (bone portion) – 6 [very low!]
Circulating Tumor Cells – 0 [excellent!!]

This was all followed by the fact they once again screwed up the forth test (the urine test). I could only ask, “Seriously?”. Doc tried to lessen the blow by saying the other markers are indicating good things. I had to just bite my tongue and move on. He promised to write out very, very specific instructions for my appointment on the 14th. I’m not holding my breath.

So then we were off to the treatment center for a shot of Lupron and Zometa [a 25 minute infusion to strengthen my bones]. Turns out someone wrote the orders for next week, so it took 45 minutes to get that straightened out and then another hour to wait for the pharmacy. I’m really finding it hard to be patient in regards to the the service at the cancer center, but I will.

In the end, the plan is this; on the 14th I will have a bone and CT scan. The following week will be my usual four week appointment on the 20th. If at that time, my PSA has continued to climb we might start High Dose Ketoconazole once again. By then it will have been 17 months since I last took Keto and it MAY work again? Like a broken record, I guess we’ll just wait and see.

New beginnings and some news that saddens me greatly

Advanced Prostate Cancer, David Emerson, PCa -

First and foremost, an early congratulations to my niece Megan and her fiance Alex! This weekend will be absolutely beautiful and may God bless you with many, many, many happy years ahead. The days, weeks and months leading up to Saturday have been hectic and stressful but that will all quickly be forgotten by Saturday and as time passes. Enjoy your honeymoon and the beach. I’m rather jealous of the whole beach thing! Your two are wonderful together and I wish you nothing but the best!
~~~~~~~~~~~~~~~
I received an email yesterday that the teenage son of someone I knew in grade and middle school had died. We were close friend friends for a while, but that was 35 years ago. None the less, this news has really made me sad. This blog contains too many stories about death, both those that I knew or others that I was just merely acquainted with. Perhaps this was just the proverbial straw that brings me so much sadness?

If you have a moment, please say this prayer for the family and the soul of their son.

Eternal rest, grant unto them, O Lord,
and let perpetual light shine upon them.
May the souls of the faithful departed
through the mercy of God rest in peace.
Amen.

Nothing in particular

Advanced Prostate Cancer, David Emerson, PCa -

I have absolutely no idea what to write about today? So should I even bother?
Though the doc at MD Anderson said “Go home, live your life for a few months” I can’t help but wonder? At times I think we should be doing something and by something I mean treat this more aggressively. Then I begin to justify our actions or lack of action. My mind is a whirlwind of thoughts at times.This is hard, it’s not very enjoyable at times, most of the time. I don’t let it bother me for more than a few minutes here and there, this just happens to be one on those times.
I can’t believe it’s been two months since we were in Houston? Seems like yesterday.

This from Joel over at www.advancedprostatecancer.net:
The Simple Facts
* Prostate cancer is a complex and problematic disease that affects not only the male patient but also his wife or partner and other family members over many years.
* Each year about 28,000 Americans die from prostate cancer — often a slow and painful death as the cancer spreads to their bones and other organs. (Only lung cancer causes more cancer-related deaths in American men each year.)
* In addition, every year, up to 70,000 men learn that they have potentially incurable forms of prostate cancer that severely impact quality of life and may lead to their deaths.
* By 2020 the number of men being diagnosed with prostate cancer may be as high as 320,000 per year because of aging-related demographics of the American population.
* African-American men have one of the very highest rates of incidence and death from prostate cancer anywhere in the world. They are 1.6 times as likely to be diagnosed with prostate cancer and 2.4 times as likely to die of this disease as (non-Hispanic) Caucasian-American men.
* In nearly every state in America, men who are un- or under-insured are at very high risk for diagnosis of advanced or late-stage prostate cancer.
* Despite recent data and media coverage about PSA testing and prostate cancer mortality, the early detection and appropriate treatment of clinically significant prostate cancer remains a critical priority, especially among men at high risk because of family history, ethnicity, or other factors that define such risk.
* We urgently need better tests for early stage prostate cancer – tests that can discriminate between potentially aggressive cancers that need prompt treatment and indolent cancers that can potentially be managed with non-invasive treatments.
* Continuing innovation is imperative if we are to meet the urgent need for treatments that can save the lives and prevent the progression of this disease in men with aggressive and advanced forms of prostate cancer.
* No form of treatment has ever been shown to extend the survival of patients with advanced forms of prostate cancer by more than a few months.

* Every man has the right to know whether he is at risk for clinically significant prostate cancer that might lead to his death.

* Regardless of his age, every man should discuss his individual risk for prostate cancer with his doctor (i.e., his primary care physician and/or his urologist), and request the appropriate use of PSA and DRE tests until better options are available.
* Guidance issued by the American Urological Association in April 2009 (a) emphasizes that “The decision to use PSA for the early detection of prostate cancer should be individualized” and (b) suggests a “baseline” PSA test for well-informed men at age 40.
* Many other professional organizations, as well as the American Cancer Society, encourage discussion about PSA testing between a man and his doctor(s).

A calamity of errors

Advanced Prostate Cancer, David Emerson, DVT, PCa -

I like to think that I’m a pretty calm, level headed, easy going person and I think those that are close to me would agree. I have come to realize this can create problems, problems that result from people thinking it’s acceptable to provide mediocre service.

Tuesday we went to the cancer center for my four week check up and Lurpon shot. As usual, I went to the lab first to provide a few vials of blood to be sent to the lab. Simply routine I’ve done this hundreds of times, literally.

Next off was a meeting with the doc, and here is where the frustration began. It was a calamity of laboratory errors to be kind.

First, the two new tests we started last month, in order to track the two markers suggested by Dr. L in Houston, were not completed.

Yes, I wrote that correctly and you read it correctly! Even though I provided specimens in late April the lab completely screwed this up.

The urine test was never run and the lab decided that the blood test to break down alkaline phosphate was not needed. Can you believe this?

Someone in the lab decided that because the total level was within the ‘normal’ range, breaking it down further was not necessary. I was and remain furious about this one.

After this part of the discussion with the doc there was not much else we could do except provide more sample and move on. Where we moved on to didn’t make me any happier. It seems the blood samples I had provided earlier in the morning failed to include a sample for PSA. Can you believe it? After four and a half years someone forgot to request the blood draw for a PSA, it was simply left off the lab order!

By the way, later on in the day we did get my PSA; it’s up to 51.13

Next up, oh yes there is more, was my ankle. This part actually contains good news. I’ll just admit it up front; I over did things last weekend. I played disc golf everyday from Friday to Monday, I worked in the yard Saturday and Sunday and over all was on my feet way to long. By Monday night my right ankle, the same one I broke almost three years ago to the day, was pretty swollen. Due to the fear of another blood clot we discussed with the doctor and agreed to run a new ultrasound of my right leg. The good news is nothing was found. After keeping my leg elevated as much as possible over the last few days I can report that it has returned to normal.

Finally, in regards to my PSA, yes we are concerned but we have to stay on track with what we agreed to after leaving Houston. It’s a very hard pill to swallow, it creates anxiety, tension, worry, fear and more. That being said we have to remain faithful that the doctors know what they are doing and the Lord is guiding us down the right path.

Many, many thanks to all of you for your continued prayers, they are powerful and help us more than words can express.

Short, sweet and to the point

Advanced Prostate Cancer, David Emerson, disc golf, PCa, Zac Brown Band -

I’m finally resting after four straight days of disc golf and yard work.
It’s cool, cloudy and raining off and on, so I’m catching up on paper work
for the foundation and paying bills.

As I sit here I’ve got iTunes up and just fired up Zac Brown Band, the song Toes. The course contains the line “..life is good today..”

and it is my friends, it truly is good today.

Younger Men with Prostate Cancer

Advanced Prostate Cancer, David Emerson, PCa -

I know it’s been a while since I had anything personal to say, but I’m just taking the doctor’s advice and getting on with living my life (to some extent).

We are in the midst of six incredibly busy weeks; I had to travel twice on business, we had the FLHW disc golf tournament, a graduation, a very special wedding in June that both Mary and I are a part of, wedding showers, rehearsal dinner, another charity event for FLHW, well you get the picture.

Below is an upcoming article that I received from a friend, Skip’s Twitter feed.

Hope you all have a wonderful and safe Memorial Day weekend. God bless all the men and women in uniform, both past and present!

Finally – the the lady who commented on my last post, you can send me an email at: ‘info at flhw dot org’ (spelled out to avoid spammers).
~~~~~~~~~~~~~~
While young men with prostate cancer have a low risk of dying early, those with advanced forms of cancer do not live as long as older men with similar forms of the disease. That is the conclusion of a new study published in the July 1, 2009 issue of CANCER, a peer-reviewed journal of the American Cancer Society. The paradoxical findings indicate that there may be biological differences between prostate cancers that develop in younger men and those that develop in older men, and that uncovering these differences may help tailor screening and treatment strategies for patients based on age.

In general, a younger cancer patient has a better prognosis than an older patient with the same type of cancer. Few studies have analyzed the health of younger vs. older men after diagnosis and treatment for prostate cancer, though.

To investigate the impact of age on prostate cancer prognosis, Daniel Lin, M.D., of the University of Washington and colleagues designed a study to examine the association between age at diagnosis and health outcomes in men diagnosed with prostate cancer in the United States. Mining the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, the investigators identified 318,774 men diagnosed with prostate cancer between 1988 and 2003. Men aged 35 to 74 years were stratified by age at the time of diagnosis, and the researchers examined differences in tumor characteristics, treatment, and survival within each age group.

The analysis revealed that, over time, men are being diagnosed with prostate cancer at younger ages, likely due to more extensive screening. Also, younger men are more likely to be treated with prostatectomy, have less aggressive cancers, and have a better chance of survival after 10 years compared with older men. However, among men with advanced prostate cancers, the youngest men (aged 35 to 44 years) have a particularly poor prognosis compared with older men. These young men are more likely to die from cancer or another cause sooner than older men with similar forms of cancer.
While the reasons for this unexpected finding are not clear, the researchers suspect that young men with advanced prostate cancer may have biologically more aggressive forms of the disease than the forms that are diagnosed in older men. Additional studies are needed to determine what, if any, underlying differences exist between advanced prostate cancer found in young men vs. those found in older men. These studies may help clinicians improve screening in young men and could ultimately lead to the development of better treatment strategies for these patients.

###

Article: “Treatment and survival outcomes in young men diagnosed with prostate cancer: a population based cohort study.” Daniel W. Lin, Michael Porter, and Bruce Montgomery. CANCER; Published Online: May 22, 2009 (DOI: 10.1002/cncr.24324); Print Issue Date: July 1, 2009.

Words to live by…

David Emerson, PCa, wordle -

It’s been a long time since I created a ‘wordle’. If you are familiar go to www.wordle.net. You can link to a blog or just provide a list of words. This was created using all of the tags I have used in my blog over the years. Click for a link to a larger version.

Wordle: Prostate Cancer

Eggs, and bunnies, and candy oh my!

Advanced Prostate Cancer, David Emerson, disc golf, PCa -

We made it home safely on Friday, but not in a timely manner. Southwest Airlines, who I usually find to be reliable, did an absolutely miserable job of getting of us home. I’ll forgo the details, but it involved delays, missed connections and arriving home six hours late.

I played disc golf yesterday and today with the gang. I really need them and appreciate them in my life. I am trying my best to take the doctor’s words to heart and just get on with my life. Easier said than done!

Today is about the Lord and family and now relaxation with just Mary and Brad – this I also need!

Happy Easter everyone, peace be with you all.

When “nothing” makes you happy

Advanced Prostate Cancer, bone scan, David Emerson, MD Anderson, PCa -

The taste of saline was strong, stronger than I remembered. It had been awhile. The tears themselves started from laughter and evolved to tears of sorrow.

Mary and I watch “Marley & Me” last night here in Houston. I won’t talk much about the movie so as not to spoil it for those of you who may not have seen it yet, however, it was a great movie. It won’t win any awards mind you, but for those of us with dogs, and Labradors to be specific, the reality is spot on. As the movie evolved on the screen the tears of laughter turned to tears of sorrow. It was not just about the fate of the dog, but the thoughts of death itself.

It all hit too close to home for me.

It was the culmination of the day’s events, and the fact that it is Holy Week.

Yesterday we spent the day at MD Anderson Hospital in Houston. Through a few contacts we were able to secure an appointment with the Chair of the Genitourological department, who I will refer to as Dr. L. More on him later, but in a nut shell, what an incredible doctor, man, care giver.

After checking in at 10:00am and going through the paper work process we headed to the lab so the vampires could extract seven vials of my blood. The lab area was a stark shot of reality; packed with cancer patients in various stages of treatement. From wide eyed newly diagnosed patients to those poor souls that chemo has obviously ravaged. Silent Hail Marys streamed through my concious thoughts as we waited.

After the finishing up at the lab, we ate lunchand then returned to the seventh floor to wait for our 1:00pm appointment with Dr. L. As is typically the case, we did not follow the planned schedule… we actually met with the doctor at 2:15pm. The wait was a much different experience. Much of the time was spent completing a lengthy review and clarification of my status, x-rays and scans with his nurse practitioner, so the hour flew by.

Our time with the doctor was approximately thirty minutes, no more. The thirty minutes were, for the lack of a better term, incredible. After four years, we think we know a lot about prostate cancer, but we learned more in that thirty minutes than most of the last four years combined. In this case it was specific to me, but it really opened, or re-opened my eyes to my current status.

Since I’ve rambled quite a bit, here is the bottom line – his recommendation? Do ‘nothing’ for now. On the one hand, this is fantastic, on the other, as someone with a demon called cancer living inside him, doing ‘nothing’ is one hard pill to swallow. After listening to and letting his recommedation sink in, it really makes sense. The highlights are this; the bone tumors are ‘attached’ to the bone, not attacking or destroying from within the bone. Two, chemo is still working, we need to allow it to complete it’s full course before we jump into the next treatment. The doctor advised us to approach our treatment strategy as one would any chronic illness. To fully consider my symptoms and current condition when making treatment decisions and making sure we reap the full benefits of each treatment. He was quite complementary regarding how we and our doctors have managed my case to date. So we return to Kansas City with orders to watch a few new blood markers because given my condition, the PSA level should not be the exclusive marker to track the activity of the cancer cells. Details of the new markers will be shared in a future blog.

The doctor also provided a lot of hope for the future. There a number of drugs in clinical trials that are or may become available when I may need them in the months and years ahead. It is the current research and clinical trials that reinforces our hope.

Our experience with MD Anderson this time was so different than in 2005. 180 degrees different and in a wonderful way. The compassion, and strategic approach that the staff shared with us was exceptional. Primarily, we credit this experience to Dr. L and his staff. The other factor is that Mary and I have matured in our knowledge and approach to managing this beast called prostate cancer.