March 6, 2021 – End of COVID Year

Yes, it is the end of the first year that we knew about COVID, but of course it hasn’t gone away yet.  I left you last November with a rising PSA and a desire to get a PSMA PET scan to be sure that the cancer hasn’t run amok. 

I did get an Axumin PET scan at Memorial Hospital in Savannah.  It turns out that my hospital, MUSC in Charleston, does perform Axumin scans, but I couldn’t schedule a scan before my next appointment there.  Memorial Hospital was glad to oblige.  The results were essentially the same as the results from the Axumin scan of 2018 in San Diego—no new growth detected. Given what I learned at the PSMA/PET seminar about sensitivity, I shouldn’t be surprised. My PSA is now 0.20, up from 0.15 in November. This is not enough to cause any major concern. 

What To Do Next

However, the increase of PSA starts to raise the question of when I should consider a change in treatment.  There have been studies (e.g. the ARCHES trial) that show a reduction in the risk of radiographic progression from the use of Abiraterone or Enzalutamide with Androgen Deprivation Therapy (ADT) AKA Lupron versus ADT alone.  If this is the case, at what point should I be taking one of these either with or without Lupron?  My doctor continues to say it isn’t time; that there are only so many bullets to shoot at the progressing hormone-insensitive cancer and we aren’t ready to use them.  He also hinted that the side effects may impact my quality of life.  Impact on quality of life makes sense, even though the studies showed that with Enzalutamide the side effects were minimal.  Note:  Taking either Abiraterone or Enzalutamide will cost me $11,000-$15,000/year out of picket.

Cabazitaxil is another drug that is used to treat ADT resistant cancer.  It appears to yield a better result than ADT alone.  From my reading it appears to be more like Docetaxel, my chemo drug although the studies say that its side effects are comparable to ADT which, as I have described in the past, are not a walk in the park.

Other “bullets” are immune treatments, genetic treatments, radiation using PSMA to target the metastases, and focused ultrasound to also target the metastases.  Of course some of these treatments require the ability to “see” the cancer with radiographic scans or to capture cancer cells floating in the blood stream, both of which won’t work with me in my current state of the disease.  Hence my doctor is probably right in saying we aren’t ready to try anything else yet.

I’m going to look for the very latest standard of care charts to help me sort this out.

Diet

I have been having great difficulty with bowel movements—mainly hard stools.  I have tried stool softeners without impact.  I don’t think I drink enough water but drinking water has its side effects too.  Going to the bathroom every 60 minutes or even more often is not fun.  I changed from 100% Bran cereal to Fiber One which helped a little.  Both of my doctors tell me I need to eat some of the things I’ve been avoiding because of their carb content, such as beans and darkly colored vegetables and don’t worry so much about carbs in these more complex foods.  So I have been doing just that plus the water.  I’m also cutting back on artificial sweeteners and eating an occasional apple, strawberry, etc. along with drinking more water.  This has helped.  We will now see what if anything it does to my PSA.

COVID

I have had both Pfizer vaccine doses and I am waiting until April first for my wife to have her second Moderna dose.  Within a couple of weeks of 4/1, we will loosen our own travel restrictions (no travel) a little and maybe get back a little of what we have lost this past year.  I hope anyone reading this will have the same opportunity.

Later…