Let The Bell Ring

My meeting with an Oncology doctor this past Monday to review the results of my CT and bone scan went fine. Their results included both good and bad news. THE GOOD NEWS: the scans didn’t show the presence of any cancer or that it had spread to my lymph nodes or bones. THE BAD NEWS: while the scans didn’t show the presence of cancer, it is very likely that it is in my blood system; the reason my PSA level is rising.

The doctor said it is just a matter of time before the cancer shows up, 8-10 years, depending on how fast my PSA level rises. We talked at great length about what to do in the meantime. He said, in most instances, you wait until it shows up and then start a treatment plan. Presently there is no therapy for my stage of prostate cancer in which the PSA level is rising but the scans don’t show any evidence of cancer. I told him that I didn’t have the patience to wait.

He offered me a chance to participate in a clinical trial or research study here at University Hospitals and Clinics. The study is looking for new methods to treat prostate cancer by testing a prostate cancer vaccine. The vaccine will try to help cancer patient’s own immune system fight against cancer. The vaccine side effects are redness, swelling and tenderness where I would get injected, fever, and chill.

The vaccine itself is a DNA genetic material that contains the genetic code for a protein that is made by the prostate gland. In people who have prostate cancer, the protein is made by the cancer cells and is found in the blood stream. The theory behind the vaccine is that it will help the immune system try to fight the cancer.

The study will involve thirty people and will take two years to complete. My participation would last about four months. If I participate in the study, the first thing I would have to do is go through a procedure called leukapheresis. (I have no idea how to pronounce it either) Anyways, this leukapheresis is a procedure where my blood would go through a machine (like kidney dialysis, that’s the only way I can explain it) that separates and collects some of my white blood cells. A needle is put into a vein in each arm to allow blood to be removed for one arm and put back into the other arm. (You need to have big veins because they use big needles) The collected cells would be used to measure my immune response presently. I would repeat the leukaphersis procedure again at the end of the study to compare the white blood cells before and after to see if my immune system responded.

I will decide over the weekend if this is a study I want to be involved with. Right now, I am leaning toward participating in this clinical trial because it is trying to find a treatment method that puts the onus for a cure where it should be, on the body and the immune system. Cancer is a disease of genes. If medical science is to advance, we can no longer continue to just cut out the bad parts. I believe the cure for cancer rest with the discovery of a vaccine. Just like the discovery of vaccines for smallpox, measles, mumps, malaria, and tuberculosis just to name a few.

For the past eighteen months I have been waiting for the bell to ring. In some respect I was waiting for the next round, but in another respect I think I was waiting to see I was going fight the next round or going to die. When I first learned that I had prostate cancer none of it seemed real. I felt like I was wrapped in a bubble, dreaming. That I would wake up and the cancer would be gone. I was waiting for someone to wake me up and say, “Mr. Thomas we are sorry for all your inconvenience, but you really don’t have prostate cancer.”

That was until Monday. Until Monday I was always under the belief that you get cured from cancer. But you don’t. The cancer disease will always be in the body someplace, detected, not detected or in remission. There is no cure for cancer, yet. So the goal of any treatment is to keep it inactive or in remission. It really didn’t or doesn’t matter how high my PSA level is, 15.9 or 15, 900. But what does matter is that it remains constant or level. An actively rising PSA means active cancer.

The hardest part about having gone through radiation and hoping to be “cured” is to find out that your PSA is rising. With that I started to second guess my decision because I wasn’t “cured.” It was a dumb feeling. I felt dumb when my Urologist asked me twenty-two months ago about having surgery to remove my prostate and I asked, “Are there other options besides surgery?” I will never forget the look on his face. A look that said “Are you kidding.” I felt dumb when I talked to other men who had surgery and saw the look on their face when I told them I had radiation instead. Looks that said, “Boy you made a dumb decision to not have surgery.”

After Monday I don’t feel dumb anymore for choosing radiation therapy instead of surgery. Research data still says that there is no significant difference between the outcome of surgery and the outcome of radiation. The rate of cancer recurrence of both is equal. What I am saying is that I spent a lot of time second guessing my decision; however, in the end it is a personal decision. A personal decision based on ones lifestyle, age and quality of life.

I have said a lot. Some of it may have been interesting, and some of it may have been boring. But it’s stuff that has been dragging me down and cluttering up my brain. Writing helps me talk and talking helps navigate and process decisions and emotions. It was my process of grieving. Monday helped me turn the corner and turn a new page in my prostate cancer book.

Let the bell ring and let the next round commence.

Waiting For The Bell To Ring

It has been seventeen months since I went through radiation therapy for prostrate cancer. During these past seventeen months I have been taking blood test every three months to monitor the level of PSA in my blood. Remember in November, 2005 I told you that my PSA scores were 12.1 and 9.9 before radiation therapy. After treatment it should have dropped to near zero. Well, it never really got down anywhere close to zero. Six months after therapy, my best lowest number was 6.4. Unfortunately since then my PSA level has been rising consistently.

While my PSA has been rising, my doctor and I took a “let’s wait and see” approach rather than making a decision before we had more information. He said that a rising PSA score alone and without clinical symptoms don’t show the complete picture. So, taking blood test and having prostate examinations has been the order of the day. The hospital receptionist and parking attendants know me and my Tahoe on a first name basis.

My Oncologist and I decided that if the March PSA was still rising, I would need to have some scans done. He said that while my prostate feels normal, it may be that some of the cancer cells survived radiation. If this is the case, we need to find out why it is rising and from where it is coming. He said it could be coming from another place other than the treated source. And if the cancer has moved outside the prostate the more likely places it will go are the lymph nodes or bones. But he reminded that my Gleason score and MRI scan before treatment indicated early stages of prostate cancer and that it was confined to the prostrate.

Wednesday I underwent a CT scan and on Friday (3/9) I had a CAP scan. The CT scan looks at body tissue and CAP scan looks at bone mass. Wherever the source, old or new, the scans will tell. Monday I meet with Oncologist to look at the results of the scans and talk about treatment options, depending on what the scans found.

When I started radiation therapy twenty months ago surgery, radiation therapy, seed implants, hydrotherapy, hormone therapy, and chemotherapy were some of my options for treatment. I entered into a protocol or clinical trial where the number of my treatments was reduced and the dose of radiation I got was increased. It wasn’t cutting edge, but it was relatively new.

Today, twenty-months since I was diagnosed, there are so many new treatment options. Laparoscopic is the newest type of robotically controlled surgery to remove the prostrate. A cancer vaccine combined with hormone therapy can help patients with recurrence of prostate cancer. A lot of the clinical trials and treatment options are dealing more with helping your body immune system fight the cancer rather than radical surgery. I remain very optimistic.

Sitting and waiting for ten months has not been easy. It has been dreadfully tough. When I was going for daily treatment, I felt like I was fighting back. I was active. Waiting is not proactive. Waiting is not fighting. It’s like sitting on the stool in your corner between rounds waiting for the bell to ring. Waiting for the bell to ring signaling you won the fight or signaling let the next round commence.

What ever it may be, “Let the fight begin!”

Later, on down the road.