I'm going to go into a lot of detail in this post for the prostate cancer survivors that follow our travels. It might get pretty boring to anyone else!
I got up at 4AM this morning to get to Denver in time to be with Marshall for his tests. When I got here, I found that he had been nauseous all morning, couldn't keep any food down (not even coffee), and couldn't take his meds. Not a good start to this day.
We got over to the Radiation/Nuclear Medicine Department by 9:00AM and Marshall was so exhausted from the nausea that we needed a wheelchair immediately.
They took him back for x-rays of the femur. It was supposed to be quick, but they had equipment problems and it took over an hour. I was sitting in the waiting room wondering where the heck he went.
They brought him back to me with a bucket in his lap, so I knew the nausea had not let up.
He drank the contrast material for the CT scan and they inserted the IV for the injectable contrast. I kind of got fuzzy on which test these contrast materials were for.
He finally went for the CT scan around 11:30 and then at 12:30 he went for the full body bone scan (the sign said "Nuclear - PET.") The technician doing the full body scan asked Marshall if he had injured his back since the last bone scan.
By this time he was exhausted and he still hadn't eaten anything. I went to the cafeteria and got him some Saltines.
At 2:00 we showed up for our visit with the oncologist and when they saw him come through the door in a wheelchair with a bucket in his lap, they quickly found him a private room (they didn't need a waiting room full of nauseated people!). They gave him a Zofran (anti-nausea pill) which helped a lot. Their verdict was that the nausea was caused by the opiates (oxycodone and morphine) he was taking yesterday on an empty stomach. They stressed that he needed to take pain meds with food.
Then Dr. Flaig and Dr. Breaker came in and went over all the tests. If you remember, we just had most of these tests done at the emergency room last week where the emergency room doctor told Marshall that "a fracture was imminent" and that he should get a wheelchair and stay off of that leg.
Our first question for the doctors was why did the technician think that Marshall had a back injury -- what showed up in the scan? Dr. Flaig said that the radiation that was done to that area of the spine in December caused it to "light up" more than usual. We had a little laugh about glowing in the dark.....
Then in no particular order:
**The tests definitely did NOT show signs of an imminent fracture. In fact, quite the opposite. They said the left leg looked good and the bone structure looked strong and healthy. There was cancer present but it was not causing any problems with the integrity of the left femur. The right leg -- the one that has been giving him excruciating pain -- does not show any increase in cancer and looks pretty much the same as it did on the last tests several months ago. I don't know if I can describe this in correct terms, but I understood Dr. Flaig to say that the femur in the right leg had cancer inside it, but the outer sheath was stable and showed absolutely no signs of the cancer breaking through it and causing a break or a fracture. He said, of course, anything can happen, but he sees no signs whatsoever of imminent fracture.
**As to what is causing the pain, both Dr. Flaig and Dr. Breaker said it would be very unusual for cancer pain to come and go the way Marshall's pain has been behaving. They believe that it is possible that the intermittent pain is being caused by the withdrawal of the Casodex (the drug Marshall was taking for a few months and they discontinued three or four weeks ago).
**We are scheduled to come back to see Dr. Flaig on March 1st for a PSA test to see if the withdrawal of the Casodex caused a drop in the PSA (which happens in 30% of men when Casodex is withdrawn). So they want Marshall to persevere with the pain until then by using the oxycodone and/or morphine as soon as the pain starts. The pain may start to fade away as the Casodex fully works its way out of his system.
**On March 1st, if we learn that the withdrawal of the Casodex has caused a drop in the PSA, and if the pain has started to letup, we will probably continue with just the Lupron hormone therapy and the Xgeva bone strengthener. However, if the PSA has gone up -- and Dr. Breaker says she feels like it probably has -- Dr. Flaig wants to put Marshall in a clinical study of an estrogen therapy called GTX. They gave us a packet of information to bring home and read. This would not be a blind study -- all of the participants would be getting the actual drug and they would be very closely monitored. Dr. Flaig is the study's leader.
Dr. Flaig says that two pluses of the estrogen therapy are (1) the hot flashes would let up -- which is a huge selling point for Marshall (ha); and (2) it is a bone strengthener. As I read up on this estrogen therapy (which, by the way, would be given in addition to the Lupron and the Xgeva), I will try to get some information here on the blog for those who are interested. The only men who qualify for this study are those men whose PSA is rising and not responding to just the Lupron. So far, without reading the packet of materials, I really like the idea of being closely monitored. So we'll see.
So we are both feeling much much better about things right now. The doctor in the emergency room last week had Marshall at death's door and it only took 30 minutes with Dr. Flaig and Dr. Breaker to do a reality check and get us all calmed down.
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