15 Years Since Diagnosis

It has been a while since I’v posted to my friends on this site. It was 15 years ago that I was diagnosed with prostate cancer at age 54. (PSA 34, G9, stage T3b NOMO). The local medical oncologist painted a rather gloomy prognosis while I was at the time preparing to walk my beautiful daughter down the aisle.

I was put under the care of the University of Iowa radiation oncologist and treated with IMRT with 41 fractions (73 gy). The radiation treatments were completed August, 2008 following three years of Luprone treatments (April,2011). PSA baseline lowest at 0.2 ng/ml. From 2011 to 2013 the PSA rose at a doubling time of 5-6 months.

We changed from university doctors to Dr. Charles Myers Nov.2012. Ferroheme scans and F-18 bone scans still indicated that the cancer was localized (Feb,20113). After attempting to control with metformin, statins, and aspirin a subsequent C-11 acetate PET scan indicated cancer mostly in the mid to left apex. No other soft tissue or skeletal metastasis (Sept, 2013). Salvage cryoablation was attempted by Dr. Silverman (Mar, 2014). PSA continued to rise to 1.0 ng/ ml (Jan,2015)

After eight years from the initial radiation to the prostate, it was decided to again radiate the prostate ( yes - it can be done). A spaceoar was successfully inserted between the gland and the colon (ouch). Scripps clinic (July, 2016) performed subsequent proton beam radiation which caused the PSA to drop below detection limits(<0.006)

All follow up blood tests have indicated PSA results below laboratory detection limits.

Thanks again to all on this site who helped me through weeds and encouraged me to keep on.

DougS
Indeed, you have had quite a journey. Thanks for sharing and keep in touch. You can inspire others here!
May you now stay forever "undetectable'
Wings

Doug, congratulations on your undetectable results. You are fighting a tough battle and are ahead of the enemy. Continue the battle and be victorius!

Ron (Boomer)

Hey Doug, great news. And if I am reading your story correctly, after initial treatment, all apparent rises in PSA were taken care of without additional ADT. That is terrific.
Your story gives hope and positivity to all of us.

Great information and results. You show how important it is to have effective doctors. My wife also had two radiations of the same breast tissue 14 years apart, so it can be done, as with your experience. Great to see that radiotherapy has been a very effective treatment for you, as it has been for me.

Best wishes for many more years.decades of undetectable PSA.

Interesting report; thanks for sharing, Doug.
Could you be more specific about the second round of radiation? As you mentioned, it is often stated that this can't be done, but I guess it all depends on the dose that a certain area received (or did not receive) the first time around.

Fiddle, the cancer still being localized doesn’t mean specifically it was in the prostate, so the microscopic specifics of DougS aren’t in front of us. Localized cancer includes immediately surrounding areas outside the prostate and should not be confused with encapsulation. Remember he was T3b at diagnosis, indicating cancer was already outside the capsule. We don’t have the initial and subsequent radiation field specifics or doses in the post. The first radiation field may have missed some cancer (comparison to positive margins found in a surgery) or the dose may have been a bit too weak for the specific cancer, or some of the cells simply repaired and survived. Several years ago before the advent of IMRT, radiation doses were generally lower to limit toxicity and local recurrence was not uncommon ( 5-10% at 10-15 years in some studies I remember) . With the current higher doses used in the past 20 years local recurrence is nearly eliminated.

You are correct that in in most all cases, when PCa is radiated either as initial or salvage treatment, any recurrence would be outside the radiation field. Radiation has long proven to be a most effective treatment for PCa, however it is not an absolute in every case. There are strains of PCa that are very radiation resistant like small cell and neuroendocrine. There are also conditions an individual may have that reduce radiation sensitivity and may enable some cells to survive radiation. This is why it is so often suggested that a round of ADT precedes radiation as it is proven that ADT sensitizes most PCa to radiation. Also, most radiation oncologists will require a patient to stop anti-oxidant supplements as these can strengthen the resistance of the PCa to the radiation.

As in most all aspects in life, once in awhile things slip through the cracks and a second attempt is required. Thankfully, for DougS it appears his do-over is working. In 13 years on the forum, this is only the second time I can recall that a man that used radiation as the initial treatment had a local recurrence. The other was a high volume G6 that used seeds and several years after treatment a local tumor was found.

The doctor performing in charge of performing the proton beam radiation at Scripps was Dr. Rossi. His review of all scans (MRI, F18, and C-11 Pet) revealed that the increase metabolism within the gland was adjacent to the area of previous cryotherapy. He discussed the increased risk of developing a fistula between the gland and the colon but that this would be reduced upon the insertion of the ‘Spaceoar’. Little did I know that previously radiated tissue loses pliability and that this procedure became a difficult one.
I forgot the fact that prior to PB radiation, I was put on Xtandi and Firmagon to help reduce the size of the gland. Dr. Myers still had me taking Avodart as well.
The gland was radiated (fractioned) with a maximum dose of 75.6 Gy and a minimum dose of 72.6 Gy.y

wow — what a miracle and an inspiration! wishing you many more years of undetectable!

JNF -- Thanks for that thorough response. You know a lot!