Our Walk With Stage IV Prostate Cancer: Medication changed ... and PSA down!!!!!!!!

Tuesday, May 1, 2012

Medication changed ... and PSA down!!!!!!!!

First of all, for anyone who may be reading this who is dealing with their own prostate cancer and is interested in the numbers, here they are:

When Marshall was in the hospital in early March, his PSA was 48. When he was diagnosed and went to the University of Colorado just a few weeks later, the PSA had risen quickly to 93.99, his Gleason score was 8 and the cancer had metastasized to his bones (rib cage, spine and upper right leg).

When we got to the University today, the first thing they did was draw blood. When we were in the car coming home -- around 5:00 -- the oncologist called us to tell us that the PSA had dropped to 9! I don't know who was more excited, the oncologist or us. Dr. Flaig said that he loves to be able to give patients news like that. The doctor also said that he is shooting for Marshall's PSA to get down to 2 or less.

During the visit, Marshall asked Dr. Flaig if chemotherapy and/or radiation was in his future. Dr. Flaig said he believed it probably would be, but that it would be "YEARS down the road." That was good to hear, too.

Last month Marshall's hormone injection was degarelix (Firmagon), two rather painful shots in the stomach. Today, Dr. Flaig asked Marshall how he would feel about changing hormone treatments and getting Lupron instead of Firmagon. Marshall said, "Doc, if you were sitting in my chair, what would you do?" The doctor said he would take the Lupron. So that's what Marshall decided to do.

He said with the Firmagon you had to be on a rigid schedule of two shots for the first treatment and then one shot EXACTLY every 28 days. Plus the Firmagon injections were painful. The Lupron is more flexible. You get a Lupron shot every three months, it's not nearly as painful, and the side effects are not as severe. In addition, with the Lupron, if your PSA levels stay down for a period of time, you can even take vacations from it.

So today Marshall got a Lupron injection. Even though it was a three-month shot, we still need to monitor the PSA, so we go back on June 11 for lab work to be sure the Lupron is doing what it is meant to do.

Dr. Flaig said that experience has shown that at the 7-month mark -- which for us will be around the end of September or early October -- we will know whether the hormone treatments are going to continue to work, so he says we will have a serious heart-to-heart at that time about what we will do going forward.

Hormone treatments cause bone weakening over time, so at our next visit in three months, Marshall will probably be started on a bone strengthener. Right now, Dr. Flaig advised that we should start on Vitamin D and calcium supplements in addition to very moderate exercise. He said that vigorous exercise would not be good and Marshall should stick to walking on a treadmill and maybe some stretching exercises. He also said that the bone strengthener injection he intends to give Marshall (Xgeva) is well tolerated but sometimes has a side effect of causing problems with teeth, so he wants Marshall to see the dentist before our visit at the end of July and get any dental work done that needs doing before that visit. Interesting.

On the way home, we felt so good that we stopped at Pikes Peak Harley Davidson and spent a few hours looking at Harley trikes and pricing them. Saw one we really liked...........

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Marshall's Story (condensed)

On 3/14/12 went to emergency room with severe chest pain (turned out to be bone pain)
3/17/12 diagnosed with Stage IV Prostate Cancer (metastasized to the bones), PSA was 49
3/29/12 Biopsy confirmed advanced cancer, with a Gleason Score of 8, PSA had risen to 95
3/29/12 Received a double injection of Firmagon hormone therapy (very painful!)
Early April 2012, within less than a week, bone pain subsided, and he was out of bed!!
4/30/12, PSA had gone down to 9! Hormone therapy changed from Firmagon to Lupron (a 3-month injection) Side effects: fatigue & hot flashes
6/11/12, PSA now down to 3.9! Considering a clinical trial.
6/19/12, decided against the clinical trial.
7/10/12, lab work done at request of VA regarding Agent Orange claim.
7/12/12, evaluation by a private doctor at request of VA.
7/26/12, visit to oncologist. PSA remains at 3.9!!! Very good news. Bone strengthener postponed for 6 weeks. Next appointment 9/13/12.
8/6/12, VA approved Agent Orange-prostate cancer benefits; Marshall is now considered 100% disabled. This decision will be reviewed again in six months.
9/4/12, passed out, chest pain, pale, sweating, clammy, rushed to hospital by Flight for Life. Doctors were unable to find a cause, but it wasn't cancer related. Left the hospital 9/6/12.
9/13/12, PSA went up to 6.6 ... depressing. CT scan, bone scan and another PSA test scheduled for 10/11/12.
10/11/12, Bone scan showed no change from prior bone scan; CT scan showed slight increase in "activity"; PSA up to 10.01. Casodex is started as well as megadoses of Vitamin D2.
10/18/12, Excruciating back pain, thought it was a Casodex side effect; oncologist says it is not SE. Went to clinic, got x-rays of spine, showed nothing, maybe hairline fracture, got injection of "aspirin" and started feeling better.

10/25/12, Lupron injection; Xgeva injection; flu shot. SE from Lupron was pain at injection site for several days.

11/21/12, PSA 10.22, Xgeva injection.

12/17/12, Kavanaugh (radiation oncologist)

12/20/12, 12/21/12, 12/22/12, first 3 radiation treatments

12/27/12, 12/28/12, last 2 radiation treatments

1/1/13, called 911, stomach pain, taking laxatives per instructions of Dr. Yeh, radiation oncologist. In hospital 3 days, diagnosed with radiation colitis. PSA 12.3. Colitis can't be treated, needs to resolve itself. Sent home 1/3. Advised that white blood cell count was low, get it retested.

1/7/13, went to clinic for lab work

1/8/13, appointment at clinic, white blood cell count heading back up but sugar very low and dehydrated. He was put on intravenous fluids for 40 minutes, felt better.

1/17/13, PSA 13.2, Vit D in normal range, Lupron shot, Xgeva shot, discontinue Casodex, white blood cell count almost back to normal after radiation.

1/28/13, went to emergency room with excruciating pain in right leg; no blood clot, no hairline fracture, no sciatica. Advised that fracture was imminent and to get wheelchair.

2/7/13, saw oncologist to get tests after emergency room visit. They do not agree that fracture is imminent and thought pain may be caused by withdrawal of Casodex. We go back on 3/1 for PSA test and discussion of clinical study of GTX (estrogen therapy) added to the treatment plan.

3/1/13, saw oncologist; PSA almost tripled to 31.06; started process to participate in clinical study for GTX-758.

3/4/13, not accepted in clinical study, bloodwork showed "low threshold" for clotting; will start Zytiga & prednisone on 3/12/13, started Zytiga with Prednisone;

3/17/13, FIRST PAIN FREE DAY IN MONTHS!

4/7/13, STILL PAIN FREE

4/8/13, visit to hospital for lab work; all good; PSA DOWN TO 10.23!!

4/22/13, visit to hospital for lab work; all good. Received Lupron shot. Xgeva will be stopped until calcium levels go up. STILL PAIN FREE.

5/8/13, lab work; all good. PSA down to 5.1. Got Xgeva shot.

6/12/13, lab work; PSA down to 1.45. Dehydrated, hemoglobin low. Need to come back in a week to re-check kidney function.

6/18/13, lab work, kidney function back to normal; need to start iron supplement for anemia caused by Zytiga.

7/9/13, PSA down to 1.04 !!!!!

7/31/13, PSA down to 0.88 (woo hoo!)

8/28/13, PSA 0.88, got Xgeva shot

10/7/13, PSA 1.28, Xgeva discontinued because of side effects

10/16/13, CT scan, bone scan, MRI

10/21/13, results of tests showed healing in the bones, no evidence of new metastatic disease

11/13/13, lab work normal, got referral to psychologist

12/11/13, PSA 2.16, doctor says not to worry

1/6/14, saw psychologist, went well

2/4/14, CT scan, bone scan

2/6/14, PSA 2.8, scans look good, CT showed healing, got Zolodex injection, still off of Xgeva

3/5/14, PSA 2.45, all lab work normal

4/7/14, PSA 4.64, lab work normal, doubling the antidepressant, saw psychologist

5/15/14, PSA 3.72, lab work normal

6/19/14, PSA 7.46, lab work normal, bone scan showed new activity in upper spine

7/17/14, PSA 9.4, repeat scans set for 8/12

8/14/14, PSA 11.23, cancer progressing slowly, may start chemo in a few months.

9/15/14, PSA 20.8, new scans set for 10/14, then we find out what happens next.

10/16/14, PSA 33, Zytiga discontinued; started on Cytoxan; radiation scheduled for early November.

11/18/14, PSA 35.6, Zoladex injection, could he be suffering from radiation "flare?" Radiation oncologist says no.

12/1/14, discontinued Cytoxan.

12/22/14, PSA 28.0, he is in nursing home for physical therapy.

1/15/15, PSA 33, scans scheduled for February

2/9/15, scans cancelled; emergency surgery to remove tumor wrapped around spine; PSA 40

3/9/15, PSA 43, spots found on liver

4/13/15, PSA 45.62, spots on liver are probably fatty tissue. We will watch closely. Continue on oral chemo Cytoxan.

5/13/15, PSA 64.9

6/4/15, PSA 65, got quarterly Zolodex injection

7/2/15, PSA 262, will get radiation and will try Zytiga again

7/9/15, Hospice.
7/22/15, R.I.P.