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Posted 4/21/2017 3:53 PM (GMT 0)
I had been enjoying my third ADT vacation; working, travelling, marrying my sweetie of 5 years and generally limiting my thoughts of PCa to monitoring this forum. We returned from a winter vacation researching music history in the dive bars and bbq joints of Nashville, Memphis and Clarksdale to find my 6 month PSA had gone from 1.05 in Aug/16 to 29. Reality landed with quite a thud.

My oncologist ordered CT and bone scans and a PSA retest (32). The bone scan, remarkably, was clean and the CT found just one substantially enlarged lymph node that had been noted as suspicious on previous scans but never seemed to grow or shrink while on or off ADT. Treatment, as expected, is more of the same. I've started a month of 50mg Bicalutamide and will restart Eligard injections in the next week or so.

I feel like I should be doing something more than waiting for castration resistance to set in but don't expect anything but conservative treatment from my current oncologist. I asked about radiating the hot lymph node but she said that wasn't a good idea due to previous SRT and proximity to large and small bowel and I understand the one visible node is unlikely be the only one. I suffered enough collateral damage from SRT to be wary of any further radiation unless the payoff is pretty certain. I thought of raising the idea of Bipolar Androgen Therapy but as usual the appointment was rushed and the answer could be anticipated. With my busy farming season just days away travelling and/or intensive treatments are off the table for 6 months anyway and we'll see if I continue to respond to ADT and research other options later.

So the plan is another year (at least) of ADT, work and exercise in spite of fatigue, don't eat anything that tastes good, try to remember to show some affection for my lovely bride and never miss an opportunity for some two wheel therapy.

All the best,
Posted 4/21/2017 4:06 PM (GMT 0)
Sorry for that news, but great attitude. I hope somewhere on that farm you've a vegetable garden. Best to you going forward. "Music History" tour sound GREAT! And a new bride....

Wilderness
Posted 4/21/2017 4:15 PM (GMT 0)
What can I say...that sucks...the good news...you are far from dead...the line of life continues up and down...no flatline in sight...double down on the good stuff you are doing...as I said...no flatline..
Posted 4/21/2017 6:19 PM (GMT 0)
Hi Biker-

I haven't yet seen an announcement of a follow-up study on BAT for hormone sensitive/recurrent men. The major clinical trials for men in your situation are for early use of Xtandi and the Prostvac trial at NIH:

/pcnrv.blogspot.com/2016/12/recurrent-pc-non-metastatic-hormone.html
Posted 4/21/2017 7:21 PM (GMT 0)
I think I see a rainbow. reflection of light.

Nothing makes a man feel better than manual labor, a good woman, and two wheels.

You'll outlive us all.
Posted 4/21/2017 9:36 PM (GMT 0)
Biker,
Sorry you are heading back to ADT. But I wanted to commend you on your music history research tour. My wife and I did the same Nashville, Memphis, Clarkesdale trip two years ago. Almost as impressive as visiting the actual Robert Johnson "crossroad" was the trailer / RV campsite at the Clarkesdale fairgrounds. Full hookup for $12 a night and payment on the honor system - put cash or check in an envelope and drop it in the slot.
Jim
Posted 4/22/2017 1:44 AM (GMT 0)
Sorry to hear of the rise. You have a good perspective and seem to understand the options well. Also, I like to hear about two wheel riding. Sold mine when I go married and kids 20 some years ago. Now with PCa and other pains I have recently been thinking of getting back on the iron horse. May your harvest be plentiful.
Posted 4/22/2017 3:51 AM (GMT 0)
Thanks everyone for your kind and thoughtful comments. This forum is a great place to vent, share, think out loud and learn.

Wilderness: I really do like vegetables! The problem is they go so well with steak and potatoes. And beer!

TA: Thanks for the link on Xtandi and Prostvac. As you note there are not many options for those of us still hormone sensitive and non metastatic but probably not for long. Will keep an eye out for BAT news too.

Logos: Trying to live your advice and example, but there were times when failed treatments and miserable side effects really had me down. No doubt one of the reasons the first Mrs. Biker moved on. I eventually realized you get the hand you're dealt, up to you to play it out as best you can.

IT: I have to confess that farming at my place is more air conditioned tractor seat time than manual labour, but you're absolutely right about the other two!

Bohemond: Glad to hear we share similar tastes and experiences. Our plan was Nashville to Natchez, MS via the Natchez Trace Parkway, on to Memphis via the Blues Highway 61 and back to Nashville, all by motorcycle. Due to uncertain weather it became a car trip and we realized it was the right call as we waited out a thunderstorm and tornado warning in Jackson, TN. We settled for a one day bike ride to tour the Jack Daniel's distillery. Clarksdale was one of the highlights for me, amazing local talent and blues history. We stayed at the Shack-Up Inn, an old plantation converted to a funky hotel. Daily live music in the bar, of course.

Gear: Lots of us old guys back on bikes again. I also parted with my ride when the kids came along and didn't ride for 20 some years. Didn't realize how much I missed it til I started again. You'll be hooked too.

All the best,
Posted 4/22/2017 4:47 AM (GMT 0)
Sorry to hear this news. Would the single lymph node ever be able to be surgically removed?
Posted 4/22/2017 3:03 PM (GMT 0)
Hi Annie,

I asked my oncologist about radiation rather than surgery but she didn't give any indication surgery was a potential option either. There have been extensive discussions on some recent threads about surgery or radiation being used to potentially cure PCa that has spread to a single site. Compiler, I believe, consulted with several specialists and had one or more identified nodes radiated. Unfortunately, his serious injury has put that issue aside for now.

My limited understanding is that it is extremely rare for cancer spread to be confined to a single lymph node. Its just the one that was visible now with a basic CT. So if the treatment was surgery, the surgeon would take the identified node plus all the others in the area, making for a pretty invasive surgery, significant recovery time, likely an ongoing lymphedema problem and probably just a temporary remission. Again my limited understanding is that radiation would pinpoint one or a few nodes, hopefully with few side effects, and reduce PSA til other nodes began to act up. Unlikely to be curative when my cancer has pretty clearly been systemic since SRT completely failed 10 years ago. If I was to pursue this I would need to find docs with expertise and more sophisticated scans, without any encouragement from my oncologist. And she is probably right that we are already on the only logical treatment path other than being open to clinical trials that might fit.

All the best,
Posted 4/22/2017 3:23 PM (GMT 0)
Hi again Annie,

My apologies for not acknowledging your husband's serious diagnosis. Hope his treatments are effective. I'm pretty fortunate to be here complaining 11 years later.

All the best,
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