To PSA or NOT to PSA--A Man's Dilemma

...another controversial medical recommendation

Recently, the USPSTF (U.S. Preventive Services Task Force) published a recommendation against routine PSA screening for men of all ages. They cited numerous clinical studies (some inconclusive or contradictory) showing no statistical survival benefit for men getting regular prostate cancer screening with a PSA compared to those men who did not have a PSA screening.

Further, the report pointed out the risk of men having unneeded and risky treatments that could result in impotence, incontinence, infections, heart attacks, and other unpleasant side effects.

There is no way to determine from a PSA test whether a tumor is aggressive (life threatening) or slow growing (not life threatening). A biopsy can help determine the growth rate of a tumor but there is some risk of infection (albeit small) from that invasive procedure.

So, they contend, no screening is better for the 5 out of 6 men who are likely to never get prostate cancer. And of the 1 in 6 who will get prostate cancer some will have a slow growing type and will not need immediate treatment.

But what about those poor guys (like me) who have or will have an aggressive (life threatening) tumor in their prostate? Although statistically not significant, determining risk and getting treatment early would be really helpful‑‑maybe even life saving.

Maybe the problem is not with the PSA test, which can detect cancer, but with the decision making by doctors and patients after the test. Could this, perhaps, be an area for further study?

I have had and will continue to have PSA tests on a regular basis. I know a number of men who are being treated for an aggressive form of prostate cancer. To a man they are happy to have been diagnosed and treated and still be alive. Me, too. We do not believe that our lives are not significant. The discussion is not over. There must be a better solution!

axman

The Therapeutic Benefits of Good Times and Good Friends

...this probably doesn’t show up much in the clinical trials and statistical research data

In my last blog entry‑‑September 26‑‑I mentioned the group of people we met in a clinical trial last year. Last week we hosted the group at our newly renovated farm house. It rained, of course, because this is Oregon.

The meeting was a little sad because we missed John (see last blog entry) but once the group assembled (out of the rain on our new covered patio) the mood was definitely upbeat. A little wine, some barbecued chicken and a lot of conversation. Some of it was small talk, more than a little was prostate cancer related (stages, meds, hot flashes, the latest PSA, etc.), some future plans, and lots and lots of heartfelt laughter. Imagine that; sick old people laughing and carrying on like a bunch of kids!

This group of 20—now 19—has a unique ability to lift my spirits. Whatever I might call it, the real purpose of the group is people support. And it works for me.

Our backgrounds are diverse and prostate cancer is the only obvious thing we have in common (except for old age). But we also share an irreverent sense of humor, an honest concern for each other, and a determination to continue fulfilling those entries on our bucket lists. So far‑‑so good.

I’m looking forward to our next get together in December and in March and in July and... I'm sure everybody else is, too.

axman

Still Another Friend Lost to Prostate Cancer

John Helmer was a quiet, caring, and friendly man. He was a well known businessman in the Portland, Oregon area for more than 60 years. I met him in a Prostate Cancer Clinical Trial program at Oregon Health and Science University in 2010. It was an exercise program for men with prostate cancer and their spouses - to help determine the effects of continued regular exercise on the health and longevity of prostate cancer patients.

It turned out that the men and women in the program enjoyed being together, formed a bond, and we have continued meeting every few months over the past year - long after the program had finished.

John was a world traveler, mountain climber, cyclist, and marathon runner. It turns out that we both ran the Boston Marathon the same year - almost 30 years before actually meeting. He was 88, but he seemed much younger. Carol and I will miss him as will his wife Beverly, his large extended family, and his very large circle of friends.

I raise a toast to John: a good man, a friend, and a terrific example for the rest of us.

axman

How Many Hot Flashes is Too Many?

...trick question^__ you can never have enough!

Since being promoted to Lupron a couple months ago my hot flashes have gradually increased in number and intensity—at least half a dozen private mini saunas every day.

They appear mostly at night. Strangely, I wake up about a minute before it happens, then beads of sweat pop out on my forehead and the warmth moves on down to the rest of my body and for a couple of minutes I’m toasty warm all over—sometimes too toasty. I usually get up and walk around and often step outside in an attempt to cool down faster and get back to sleep.

Then, an hour or two later, it starts all over again. My posse (half a dozen friends and acquaintances who are also doing the Lupron Chemo thing) assures me my experience is pretty standard. So why am I telling you all this? Well, if you have prostate cancer and it has recurred after initial treatment, you’re likely to experience something similar sooner or later.

Lucky you! Really! If you get to the hourly steam bath stage it means you’re still alive and you’re keeping the cancer under some level of control. And the sweat is just a part of the blood, sweat, toil, and tears of life (thank you Winston Churchill for those kind words).

axman

That Elusive Happy Medium

...and I don’t mean a hard to find, but pleased, fortune teller

Most of my life has been pretty busy—raising a family, personal and family activities, and work; often two or more jobs at a time. I never really thought about it, but there wasn’t too much time to sit around and relax or ponder or even feel sorry for myself. It must have worked because all in all I’m pretty healthy and happy (It seems I missed out on the wealthy and wise part of the equation).

Retirement changed that pattern. There have been the super busy times—like building and remodeling this past year—and a few times when we just sat around and read or napped. Doing nothing for too long turns out to be really boring. And that seems to be a common thread among some retirees. Doing too much for too long turns out to be really tiring. And getting tired is easier as I get older.

Right now there are too few relaxing times but that should change in a month or two when we head to Arizona for a few weeks of R and R without much of anything to do and we can head home when it gets boring.

Right now there’s building and finishing a book and always something that should have been done yesterday. But I’m trying to look at life one day at a time and that seems to be a good mantra and helps keep the stress level down.

My goal over the next year or so is to find a balance of activity and relaxation that seems to work. Maybe I’ll call it the Geriatric Goldilocks Syndrome—not too much; not too little; but jusssst right. How hard could it be?

axman

One Year at a Time

Youth is fleeting; old is forever. Maybe it’s better not to know what all is going on in my body‑‑and how much and how fast...

As another birthday rolls by (this is number 71) Life is good. Although I feel OK now, when I look back there have been quite a few changes in a mere eight short, short years since I was diagnosed with prostate cancer (the years really have seemed short).

·       I ran my last marathon in 2005 and now have difficulty running even two or three miles. Knee surgery had a hand (or knee) in that. I haven’t given up completely on running, however. But I also jumped out of an airplane for the first time (and the last time so far) on my birthday that same year. ...almost balances out, doesn’t it?

·       I retired in 2007 and started slowing down a little in how much I can get done—I still get things done, but it takes longer. I’ve been able to write (finishing my second book since retirement—but I’ve cleverly managed to avoid making any money at it) and putter around the house and a nap every few days helps. We’ve done some major remodeling but with a lot of younger, smarter hired help.

·       Take my bladder, please! It was normal and healthy in 2003 but surgery, radiation, and hormone therapy have reduced its efficiency and predictability a bit. If you happen to have an extra one...

·       All those same events and meds have also waged war on my testosterone level (keeping it low is necessary to keep me alive, of course) as well. Oh, well.

·       I need more sleep, stronger glasses, and more time in the hot tub to ease the old joints.

I’m sure the aging process itself is to blame for some or even most of this. Most of my friends have experienced at least some of these events.

Adapt, adjust, suck it up, and carry on. There are still unfulfilled entries on my Bucket List but the list of things I have done already is a lot longer. I wouldn’t trade my life for anybody’s. I’ve been blessed with a great family, good friends, time to do most of the things I want to do, and occasionally a bottle of really good wine.

axman

Lost Another Friend to Prostate Cancer

We first met when we lived in Canada in the 1970s and our families have been friends for the past 40 years. Dennis was, at various times, my neighbor, my student, my building contractor, and my colleague (he became a psychologist). He was active, smart, ambitious, and musically talented (he played in a rock band in his 60s). He had a knack for helping others—whether building their house or counseling their marital problems.

He was diagnosed only four years ago but the cancer was already advanced. He received multiple treatments to slow the tumor growth but nothing was very successful. His church and family ties helped keep him strong and positive.

No matter what progress you hear about in cancer treatment, it all boils down to the individual person. I can only hope that somebody somewhere finds a way to slow down prostate cancer (or even cure it) before I lose more friends.

axman

The Long Hot (Flash) Summer

Not much sun, but the heat comes in the middle of the night

Three weeks after my Lupron shot I don’t feel much different than I did before. There is one notable exception – the dreaded hot flash.

During the day I keep pretty busy writing, building, pouring concrete, cutting weeds, and other manly activities with nary a flash of hot. That’s good. But once I go to sleep I can count on at least one and usually two bouts with heat and sweat during the night. Worse yet, it wakes me up-so I get up, change my jammies, go to the bathroom, turn my pillow over to the dry side, and try to get back to sleep. I usually succeed.

None of these bouts lasts more than a few minutes and they’re certainly not unbearable. My wife just smiles and says, “See, I told you what they were like”. Mostly it’s an annoyance and results in a lot of extra laundry the next day.

I’m sure many of you have more and worse side effects so this will be my last time complaining about this particular one. Probably. But if I should ever have a new one...

axman

The Next Step – Lupron

With a shot in my backside I was launched into a new phase of prostate cancer treatment...

I knew this day would come sooner or later (I’d prefer later‑‑given a choice). My substitute oncologist (Dr. G) recommended a change in medication because my PSA has gone up significantly every three months for almost a year on the old hormone meds. Lupron was her drug of choice. It’s stronger than the hormones I’ve been taking and is supposed to lower my PSA in a short time (stay tuned for my October PSA test). I know many thousands are already using Lupron, so let me know what your experiences have been.

The shot is good for three months so I don’t have to take so many pills—that’s a plus. But the side effects may be a little stronger and stranger. I can expect hot flashes, some bone pain, headaches, depression, and maybe weight gain (I can probably fight those last two). On the inside my bones will likely lose mass. So I’ll take more calcium, more D3, spend time in the sun, and get lots of exercise. Fatigue in another side effect but I’m already tired so may not even notice.

I intend to let the summer unfold, bask in the sun, keep busy building more rooms onto the house, and continue doing all the things on my Bucket List.

axman

The Medical Merry-Go-Round and Round

Sometimes no results are good results and vice versa

Over the past few weeks I’ve experienced a medical anomaly or two—nothing unusual in the aging process, however.

1                I experienced a minor TIA (transient ischemic attack) or mini stroke. My left side went weak and numb for a couple of minutes. Then everything was back to normal again. I chomped a couple aspirin and made an appointment with my doctor who then sent me to a hospital for further tests.

  2                The next day I had a couple of dizzy spells and that has continued for several weeks, although somewhat diminished. So the doctor also scheduled me to see an ENT (Ear, Nose, and Throat specialist).

  3                At the hospital they first did an ultrasound to see if my carotid arteries might be blocked. Nope. Then came the MRI of my head. The report (several days later) said, “We looked at his brain and found nothing.” That confirms the common consensus of my intellectual standing.

4                A few days later I saw the ENT, got probed, had a long tube inserted up my nose, and even got a hearing test. Nothing explained the dizziness, sorry, and good-bye.

So in conclusion; events happened, medical tests occurred, reports were written, and everything remained pretty much the same. That’s good, I guess.

axman