PSA

The 504th hour

Advanced Prostate Cancer, chemotherapy, David Emerson, PSA, University of Kansas Cancer Center -

As we sit in the treatment room this morning, I thought I’d provide a peek into what it is we go through.

This, without exception, is the worst part of the cancer treatment process, in my mind.
It is not all the days and nights of little sleep, filled with stress and worry.
It’s not the scans, x-rays, poking and prodding.
By far the worst part of the treatment process is the 60 minutes (approximately) between the time my blood is drawn and the moment when we are given my PSA number. Perhaps it’s the build up, day after day, week after week, waiting, worrying, anticipating, and questioning, “Did the treatment have an impact this time?”.
Tick, tick, tick…..is the clock even moving? Where are the results? Can I read the look on the doctor’s face when he comes in the room? So, this is what we go through every three weeks (504 hours). Very little conversation, but the stress in the room could be cut with a very dull butter knife.
Did I mention, the nurse dropped off my test results a minute ago?
PSA: 34.47
That’s down from 39.57 three weeks ago!!!!
If you are curious, Mary wins the bet this month.
Even better news, only 502 hours until we have to start this process all over again!
Peace be with you all, enjoy the next 501.75 hours….

Meet my friend Dex

Advanced Prostate Cancer, chemotherapy, David Emerson, Dexamethasone, PSA, taxotere -

A few milestones yesterday, one personal, one not.
Yesterday I had my sixth treatment of chemo. Although this will continue until the end of January, I am now half way through! The good news is my PSA was down, though only slightly, down is not up!
PSA: 39.57
Other good news, my INR (marker to measure blood thinner pharmaceuticals) was finally up to 1.8. The doc increased my dosage once again and we are pretty certain that the injections in my stomach will be a thing of the past next Monday!
On the other hand the steroids (Dex) woke me at 2:15am…..I never went back to sleep! I’ll be dead tired by 9:00pm or so and am hoping I sleep through the night!
The other milestone was yesterday was the first day of fall. As I’ve written here before I’m not a big fan of fall. Winter is the worst. Fall, except for the beauty of the trees for a brief period, represents death in my mind.
As I let the dog out this morning I noticed our elm tree had almost completely changed to purple and had even began it’s annual dumping of leaves into our backyard. The nights are cooler, the days are shorter and it seems that we went from summer to fall overnight.
Three days and counting until the golf tournament. We still have a lot of loose ends to pull together but I am not concerned that it will all come together and the event will go off without a hitch!

BIG NEWS, GOOD NEWS….BIG GOOD NEWS!

Advanced Prostate Cancer, chemotherapy, David Emerson, Lovenox, Lupron, PSA, taxotere -

I was going to drag this out, be cute, be creative, etc. but I am tired!
My PSA today was 39.98, a 25% reduction from three weeks ago!!!
WOO-HOO!!!!!!!!!!!!
As I mentioned above, I am beat. We did not sleep well last night, and we had to leave the house at 7:15 this morning to make the 8:00 appointment. I had both my monthly appointment for Lupron and Zometa and my three week chemo treatment all in the same day. We were through at the hospital 12:30ish. In the four and a half hours we were there, I had the following procedures:
– 8:35 blood drawn
> White blood count back up to over 12 !!!!
> Most other markers were back in range, red blood count was still a little low, but no show stopper
– 9:00 Met with Doctor V, the Physicians Assistant and the Clinical Trial Coordinator
Everything seems to be progressing as expected with the blood clot in my leg. The good Doctor did give me the green light to play golf on Wednesday afternoon, so I was happy
– 10:00 Began pre-treatments
– 10:40 Began Taxotere infusion #4
– 11:45 Began Zometa infusion
– 12:20 Received the Lupron shot
Mary and I made our usual stop for lunch at The Blue Koi and were home by 2:00.

I guess someone just transposed two numbers

Advanced Prostate Cancer, chemotherapy, David Emerson, PSA -

So last week I had to go see my General Practitioner and while there I asked him for a print out of the results of the first three PSA tests he performed back in 2004 and early 2005. While two of the number were as I have been reporting for years, there is one that was wrong.

It seems that instead of a high of 219, my PSA actually peaked at 271 in January of 2005.

In the grand scheme of things, this changes nothing, but I just thought I’d report it here and set the record straight.

As for chemo, I’m now fifteen days into this and I feel great. I’m not sure this means anything at this point but, all the little aches and pains that I had been experiencing over the previous few weeks are completely gone.

My next treatment is Monday and we’re hoping all goes well and we continue to pray that I will be able to tolerate this second infusion as well as the first.

The one, but not the only

Advanced Prostate Cancer, chemotherapy, David Emerson, PSA, taxotere -

I’m in the chair waiting for the multitude drugs to be delivered:
In no particular order….
– Benadryl – 25mg
– Dex (more!!) 10mg
– Zofran 24mg
– Zantac 50mg
– Taxotere 151mg

The first four are given for swelling, nausea, allergic reactions etc.

Brad and Mary are here, my God I love them so much!

My pre-treatment PSA came in at: 52.02
Up a little, not as high as 2006, the last time I almost started chemo.

Just to give you an some insight into today’s hospital visit: I’ve been in the chair since 11:10. Treatment was schedule for 11……It’s 11:52 and we have yet to begin. So drag this out for 6 weeks….then make me wait another hour, what ever works for you!!! Sorry, just venting – thank goodness the people are so nice here.

*Live update!!
12:35pm Pre-meds have all been administered and as of three minutes ago….the Tax (chemo) is flowing!

Peace be with you each…

Scanning the horizon

Advanced Prostate Cancer, bone scan, chemotherapy, David Emerson, PCa, PSA, xrays -

I had my sixth set of scans Tuesday. Chest X-Ray (as part of the clinical trial), CT scan of my abdomen to look for organ and lymph node ‘involvement’ and a full body bone scan.

Not much to report on items one and two, the results will be discussed on Monday prior to my first chemo treatment. (By the way; 96 hours and counting).

The bone scan was the usual process; lie on my back, the first few minutes are very claustrophobic [I just say a few Hail Mary’s and keep my eyes closed] but after twenty minutes it’s over. This time they took extra pictures from the side focusing on my ribs and pelvis. These are the areas that have always had noticeable tumors.

I was able to talk the technician into showing me the x-rays! The following is only my unprofessional opinion; full body scan: looked the same; spots on my left rib, pelvis area (a.k.a tumors) and the ankle I broke last May appeared the same as in February. Best news – my spine appears to remain tumor free! Finally, no new areas showed up (again, the radiologist may say differently).

As for the side views: not much was revealed on the rib scan, the side view of both hips showed three tumors on the left side and two on the right. I hate to describe these as ‘substantial’, they are there are have been there throughout. I’ll post the scans after I get the CD on Monday.

Happy Birthday Trevor and Happy Anniversary Doug and Michelle!

that is all…..

Back to reality……

Advanced Prostate Cancer, PCa, PSA, University of Kansas Cancer Center -

After a week in Florida (pictures and a full report later) I had my monthly appointment this morning and there were a number of changes:

1) First we switched to a doctor at the University of Kansas Cancer Center.
Dr. V specializes in prostate cancer. We have met with him a couple of times previously for second opinions. He has a compassionate approach and is dedicated to supporting patients with genitourinary cancers.

2) The KU Med Cancer Center just opened in it’s current location about 6 months ago. It is fantastic. It is a state of the art facility that was definitely designed to provide the patient with a privacy and comfort during treatment. The staff was consistently polite and compassionate.
In the waiting room there is a lady with a cart and provides free bottled water, juice, etc. The refreshments were offered with a smile and a warm greeting while we waited to see the doctor.
Doesn’t sound like much, but it really was a great touch.

3) Because the lab and the treatment room are in the same facility, when they inserted the
temporary port in my hand, they drew blood for all the tests at the same time. Again, not
a big deal, a small touch but it goes a long way.

4) The treatment room or should I say rooms. These are laid out like cubicles in an office environment. No more big room with 15 chairs and 15 patients. Each room has a flat panel TV, DVD player, a door that closes providing privacy. This is going to be real important in the future when I have chemo, now it’s just a good addition to the monthly visit.

5) One of the most important benefits for Mary and I – we received the PSA results before I left the appointment! No more waiting for days and placing multiple calls back to the doctor’s office.

Now for the bad news, my PSA went up a little bit from 29.4 last month to 34.7 this month.

A few factors that we believe may have contributed:
– I was on vacation and was out of routine; no daily work outs, lots of eating out, etc.
– The week proceeding vacation was perhaps one of the most stressful I have had at
work in years
– The week proceeding vacation, I was also working 4+ hours a night on a volunteer project for our church and therefore sleeping less, etc.

Dr. V, Mary and I decided we will continue the current regimen of Lupron and Nilandron to give the Nilandron a fair opportunity to get the PSA under control. Hopefully, over the next 4 weeks we will resume a better sense of normalcy and routine. I will be back to working out tomorrow morning.

Not much else to share right now, that’s my story….and I’m sticking to it!!

Historic Data:
3/24/08 34.7
2/25/08 29.4 (Started taking Nilandron on 2/4/08; Started Selenium 200 mcg on 2/26/08)
1/28/08 36.2 (Stopped taking Ketoconazole and Hydrocortisone in anticipation of next treatment)
12/31/07 30.9
12/3/07 21.9
11/5/07 23.3
10/8/07 19.30
>10/8/07 Changed Lupron from 120 day dose to monthly dose> 9-12-07 Began taking .5mg of Avodart per day. Changed Ketoconazole from 600mg twice per day to 400mg three times per day)
9/4/07 21.80
8/6/07 19.25
8/2/07 16.96
7/02/07 20.30
6/04/07 17.80
4/30/07 16.25
4/2/07 17.68
3/5/07 21.87
2/5/07 20.90
1/8/07 18.90
12/11/06 24.86
11/13/06 43.61
10/16/06 51.48 (Started “High Dose” Ketoconazole and Hydrocortisone, 10/01)[at this point and for a second time we prepared for Taxotere. First my Oncologist wanted to try High Dose Ketoconazole and Hydrocortisone.]
9/11/06 83.97 (started Zometa)
8/23/06 41.77
8/18/06 54.66(no tests in June or July)
5/19/06 11.37 (stopped Casodex)
4/3/06 4.25
3/5/06 1.45 (started Casodex again)
1/27/06 0.46
12/28/05 1.85[at this point we prepared for Taxotere, chemotherapy treatments. First I had a new PSA test and new bone and CT scans, lymph nodes clear, spine clear, ribs, femur and hips stable. The PSA dropped to 1.85 and the scans revealed marked improvement. Chemo was cancelled 72 hours before it was scheduled to begin]
12/15/05 7.18
11/03/05 4.64 (Stopped taking Casodex)
9/22/05 0.8
08/11/05 0.35 [nadir]
6/24/05 0.55
4/17/05 2.51 (taken at MD Anderson, Gleason lowered to 7/7)
4/06/05 3.51 (Six weeks after starting Lupron and Casodex)Original Gleason scores (7/8)
Pre-treatment tests:
2/18/05 Started Lupron
2/11/05 Started Casodex
2/?/05 219
12/?/04 189 (Original test)

up, up and away….

Advanced Prostate Cancer, chemotherapy, PCa, PSA, University of Kansas Medical Center -

Last night, after a VERY long day at work and after attending our home owner’s association meeting, I sat down and wrote a blog entry. It was verbose and eloquent and right to the heart of the matter. It got lost in cyber space…..

My PSA: now 36.2

Another rise. Although not drastic, certainly headed in the wrong direction.

Tomorrow we are meeting with an oncologist at the University of Kansas Medical Center to discuss some options and clinical trials involving chemotherapy. As far as Advanced Prostate Cancer goes, there are not many options and none of them offer the potential for a cure. What they do offer is hope, and time.

I also have an appointment for new CT and bone scans next Tuesday. Additionally, we are attempting to get an appointment with a doctor in Virginia. He is one of the national experts on Prostate Cancer, however, he is in such demand that it may be late March before we can get in to see him.

I find myself remarkably calm about what is happening at this point in time.

Historical Numbers
Date – PSA
2/25/08 29.4 (Started taking Nilandron on 2/4/08; Started Selenium 200 mcg on 2/26/08)
1/28/08 36.2 (Stopped taking Ketoconazole and Hydrocortisone in anticipation of next treatment)
12/31/07 30.9
12/3/07 21.9
11/5/07 23.3
10/8/07 19.30
>10/8/07 Changed Lupron from 120 day dose to monthly dose> 9-12-07 Began taking .5mg of Avodart per day. Changed Ketoconazole from 600mg twice per day to 400mg three times per day)
9/4/07 21.80
8/6/07 19.25
8/2/07 16.96
7/02/07 20.30
6/04/07 17.80
4/30/07 16.25
4/2/07 17.68
3/5/07 21.87
2/5/07 20.90
1/8/07 18.90
12/11/06 24.86
11/13/06 43.61
10/16/06 51.48 (Started “High Dose” Ketoconazole and Hydrocortisone, 10/01)[at this point and for a second time we prepared for Taxotere. First my Oncologist wanted to try High Dose Ketoconazole and Hydrocortisone.]
9/11/06 83.97 (started Zometa)
8/23/06 41.77
8/18/06 54.66(no tests in June or July)
5/19/06 11.37 (stopped Casodex)
4/3/06 4.25
3/5/06 1.45 (started Casodex again)
1/27/06 0.46
12/28/05 1.85[at this point we prepared for Taxotere, chemotherapy treatments. First I had a new PSA test and new bone and CT scans, lymph nodes clear, spine clear, ribs, femur and hips stable. The PSA dropped to 1.85 and the scans revealed marked improvement. Chemo was cancelled 72 hours before it was scheduled to begin]
12/15/05 7.18
11/03/05 4.64 (Stopped taking Casodex)
9/22/05 0.8
08/11/05 0.35 [nadir]
6/24/05 0.55
4/17/05 2.51 (taken at MD Anderson, Gleason lowered to 7/7)
4/06/05 3.51 (Six weeks after starting Lupron and Casodex)Original Gleason scores (7/8)
Pre-treatment tests:
2/18/05 Started Lupron
2/11/05 Started Casodex
2/?/05 219
12/?/04 189 (Original test)

I love a parade…..

Boston, prostate cancer, PSA, Red Sox, World Series 2007 -

I started this entry (from Boston) thinking it would be real easy to find the Broadway show or movie that this song came from….well I couldn’t!

What I did find out was more than I ever wanted to know about Harold Arlen. Not only did he write “I Love a Parade”, but also “Stormy Weather”, “Over the Rainbow” and many, many more. My suspicion was that it came from “Music Man” but I could find no evidence to support this idea.

Anyway, I’m in Boston for a conference and while I had hoped to spend the evening in some local restaurant or pub watching the Red Sox win the World Series, the Rockies did as well as my Cardinals did against the Sox in 2004. So now I might have an opportunity to witness the 2007 World Series Parade in downtown Boston…. depends on the start time and my schedule at the conference tomorrow…..

My next monthly doctor appointment is a week from today. I find myself very indifferent about next week. Perhaps because, once again, there is no change in how I feel. This is a good thing – certainly no complaints! So, I’ll have some ‘chowdah’ with an old friend tomorrow night and some local seafood and travel home on Wednesday night. Happy Halloween and a Blessed All Saints day as well!

The Sound of Silence

Avodart, prostate cancer, PSA -

19.30 was my number. This is down slightly from last month [21.80]. Good news!

Not much else to say at this point, hence, the silence.

I had read that the Avodart can take six to eight weeks to begin working. I wasn’t expecting much at this point (after three and a half weeks), the chances of Avodart having an impact on my number is somewhat of a long shot anyway. However, you never know……
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Historic numbers:
Date: PSA:
10/8/07 19.30
>10/8/07 Changed Lupron from 120 day does to monthly dose
> 9-12-07 Began taking .5mg of Avodart per day. Changed Ketoconazole from 600mg twice per day to 400mg three times per day)
9/4/07 21.80
8/6/07 19.25
8/2/07 16.96
7/02/07 20.30
6/04/07 17.80
4/30/07 16.25
4/2/07 17.68
3/5/07 21.87
2/5/07 20.90
1/8/07 18.90
12/11/06 24.86
11/13/06 43.61
10/16/06 51.48 (Started “High Dose” Ketoconazole and Hydrocortisone, 10/01)[at this point and for a second time we prepared for Taxotere. First my Oncologist wanted to try High Dose Ketoconazole and Hydrocortisone.]
9/11/06 83.97 (started Zometa)
8/23/06 41.77
8/18/06 54.66(no tests in June or July)
5/19/06 11.37 (stopped Casodex)
4/3/06 4.25
3/5/06 1.4
51/27/06 0.46
12/28/05 1.85[at this point we prepared for Taxotere, chemotherapy treatments. First I had a new PSA test and new bone and CT scans, lymph nodes clear, spine clear, ribs, femur and hips stable. The PSA dropped to 1.85 and the scans revealed marked improvement. Chemo was cancelled 72 hours before it was scheduled to begin]12/15/05 7.1811/03/05 4.64 (Stopped taking Casodex)9/22/05 0.808/11/05 0.35
6/24/05 0.55
4/17/05 2.51 (taken at MD Anderson, Gleason lowered to 7/7)
4/06/05 3.51 (Six weeks after starting Lupron and Casodex)Original Gleason scores (7/8)Pre-treatment test:
2/?/05 219
12/?/04 189 (Original test)