We saw the nurse practitioner today (we don't see the oncologist any more unless there's a particular reason). Marshall is demanding to see the oncologist when we go back in January.
Anyway, her name is Kathryn. Kathryn said the following:
* The PSA went up again -- to 2.16 -- and that is something to keep an eye on but it would need to really spike before they would react.
* She said Dr. Flaig likes to "ride the horse" until it dies -- meaning that he does not want to discontinue the medication (Zytiga) unless he feels positive it is no longer working at all. She said each medication that works adds more life so they don't want to stop anything too early.
* The PSA in a healthy man should not be over 4. But the PSA in a prostate cancer patient should be zero. However, every man is different and they have one man whose PSA has been at 100 for 5 years now and he's still on Zytiga and still doing well.
* Dr. Flaig considers PSA to be part of three things to watch: (1) whether the patient is symptomatic, which Marshall isn't and hasn't been for 10 months now; (2) what the scans show, and Marshall's scans are good right now; and (3) PSA is the last thing. So since Marshall is not symptomatic and his scans are good, we should not get worked up about the PSA.
* Whenever the Zytiga is judged to be failing, the next step will be chemo, so we want to be very very sure when we make those decisions. She said that the type of chemo that would be the next step is something called docetaxel which she explained is not as hard on the system as other chemo treatments. It would be administered once every three weeks for a specified period of time.
She also said that radiation was still an option if he develops more bone pain. He just can't have more radiation in spots where he's already had it.
All of Marshall's other lab work came out fine, right where it should be. So that's it for today. I am exhausted. Marshall had brief moments of depression today, but it was nothing like it was at the last visit. Thank goodness!
We are now working with a primary care physician, an oncologist, a nurse practitioner, a psychologist, an allergist, a dentist and an oral surgeon. And he has to periodically see the VA doctor just to be sure he stays in the VA system. It makes my head spin...
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