October 5, 1984
I am diagnosed with prostate cancer and undergo a radical prostatectomy. The prognosis: A 40 percent chance of living up to five years and a 15 percent chance of living up to ten years.
I undergo 6600 rads, six weeks of radiation to prostate bed, post-surgery, with margins of the surgically removed prostate not being “clear” of prostate cancer cells.
The cancer returns. A new test, the ‘prostate-specific antigen,’ has shown a gradual rise, from 0.6 in 1988 to 2.1 in December, 1989. The only source of this antigen has to be cancer cells since my prostate had been completely removed. The prognosis: “In a relatively young man like this, with a terribly aggressive disease, the only option is castration.”
Three years after the initial early signs of a rising PSA, it was now up to 6.3. Time to move into action with Dr. Nicholas Bruchovsky’s approach of intermittent chemical castration.
My PSA has risen to 9.9. After meeting with Dr. Bruschovsky in Vancouver, Canada, I start a brief period of chemical castration in December. Within twelve days my PSA dropped from 9.9 to 2.7. Seven months later the PSA was down to undetectable levels, less than 0.06. The prostate cancer was temporarily in retreat.
Twenty years after my initial diagnosis, surgery and radiation, fifteen years after the first clear-cut rise in my PSA, fifteen years after the first signs of invisible metastatic disease, I was dealing with the first sign of a visible and palpable metastasis. I had been waiting for this day: Eventually the cancer will latch onto bone, spread into my lymph nodes, become visible. It has been lurking for two decades—ready to pounce. CT scan of my chest: Although there was no sign of spread to my lymph nodes, there was a highly suspicious mass in my right lung. Originally assumed to be a primary cancer in my lung (“Prostate cancer does not generally appear in the lungs,” said several specialists), a return to chemical castration made the tumor disappear. The PSA dropped steadily, and a new CT scan showed a rapidly receding tumor. The new consensus: Prostate cancer gets funky after sitting in your body for twenty years. This two-decade-old disease had found some nice little niches after all these years.
With my PSA down to 0.2 and the remaining cancer cells having been debilitated by the chemical castration, I underwent three days of cyberknife radiation to the lung lesion – a highly focused treatment with little chance of collateral damage. In subsequent CT scans, the tumor has disappeared, never to return to that specific location again.
With my PSA rising while off treatment and noncastrate, we found on my CT scan a lymph node in my mediastinum (the upper chest, just under the sternum) that was enlarged and probably cancerous. A few weeks later the thoracic surgeon who had previously referred me for cyberknife radiation removed the lymph node along with a smaller adjacent node. The enlarged node was indeed filled with prostate cancer cells, no doubt trucked over from the prior lung lesion. The lymphatic system and its nodes provided a drainage system for these foreign cancer cells. We now, however, had more definitive proof that the lung lesion, radiated but un-biopsied, was an actual prostate cancer metastasis.
Another mediastinal lymph node was found and quickly removed. This time the margins of the node were not clear; cancer cells appeared to have extended beyond the border of the node into the tissue outside of the node, the muscle and fascia. So, another round of the cyberknife—radiation to the right mediastinum to eliminate any of those errant cancer cells and bring them to justice.
Another skull lesion, probably some rogue cells from the previous skull metastasis in the left parietal-occipital area, was discovered. At the same time, a small metastasis was found in the thoracic spine—the T8 vertebra, to be exact. We gobbled up the cells in both spots with the cyberknife in February and March 2010.
We found a small metastasis in my brain, in the periphery of my left parietal-occipital region, perhaps again due to some rogue cells not fully killed by the prior radiation treatments to the adjacent skull. Within a week after returning to androgen-deprivation, the treatment began to work again. Like magic, the cells went into retreat. Five months later, with the PSA close to zero and the cancer cells at their nadir in strength, I got the brain metastasis radiated. There were no signs of any recurrence in the brain four years later.
A C11-acetate scan was able to detect tiny prostate metastases in the L3 region of my spine and in my left parietal region of my skull, even with my PSA at a very low level. Within six weeks we were able to radiate the lesions with the cyberknife. The lesions — gone and kaput. All I can continue to do is be vigilant and wary.
The C11-Acetate PET Scan in Arizona continues to be a revelation – with its ability to detect tiny prostate cancer lesions with the PSA still quite low. Accordingly I am able to get cyberknife radiation to a bone lesion at T11 of the thoracic spine in September 2014.