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BRONZE

Patrick Callahan and Nancy live in Hawaii, USA. He was 76 when he was diagnosed in July, 2010. His initial PSA was 8.0 ng/ml, his Gleason Score was 3+4=7a and he was staged T1c. His choice of treatment was Brachytherapy with adjuvant ADT (Androgen Deprivation Therapy). Here is his story.

I live on the "Big Island" of Hawaii in a community named Kailua Kona. The island has a population of about 140,000 permanent residents, so there is an insufficient customer base for many medical specialties. Consequently, we often have to fly to Honolulu for treatment. Many of the Honolulu medical specialists come to the Big Island once or twice a month for consultation, but most procedures are scheduled for Honolulu.

Since 1987, when I was 53, I have had regular prostate exams and PSA tests. I was also treated with antibiotics for several instances of prostate infection. Also, for many years, I was taking testosterone replacement therapy. In July, 2010, my urologist became concerned with my PSA score, which had been around 8.0 for the last two annual tests. I had a biopsy a few years before, which was negative for cancer but positive for a prostate infection. After a course of antibiotics in that previous instance, the PSA went down. The urologist in the 2010 instance prescribed antibiotics, on the theory that a re-infection may have caused the high PSA.. The PSA did not go down, so a biopsy was obtained. The report came back from Bostwick laboratories positive for cancer. The Gleason score was 3+4=7. Only one of twelve specimens had cancer. Of course, the testosterone treatment was stopped. The urologist suggested a consultation with the radiologists at Kona Hospital, who have the equipment for external beam radiation. I spoke with Dr. Henry, who suggested I also get a consultation with Dr. Grimm, a famous expert in brachytherapy with offices near Seattle. I sent the Bostwick report to him, and scheduled an interview on the mainland for October 11, 2010. (I would be on the mainland on that date, returning from a cruise.)

Meanwhile, my primary care provided suggested that I talk to Dr. Stephen Chinn, a urologist who works for the Straub Clinic in Honolulu, who comes to Kona every two weeks. By this time, my research on the internet and in five books on prostate cancer that I read, I was leaning toward brachytherapy. On September 2, 2010, Dr. Chinn, a surgeon, had no objection to brachytherapy, and referred me to Dr. John Lederer, who works at the Cancer Center of Hawaii in Honolulu. Dr. Lederer does not come to Kona, so I met with him in Honolulu on October 15, 2010 for the first volume study. (I told Dr. Grimm: thank you very much for looking at my record, but that I preferred to be treated in Hawaii.) The volume study, unfortunately, found that my prostate was too large, so I returned to Dr. Chinn on October 21, 2010 for injections of Lupron depot (4 month dose) and Casodex 50 mg. (The Lupron shrank my prostate, but killed my interest in sex.)

I received a 3 month injection of Lupron from Dr. Chinn on February 17, 2011. I returned to Dr. Lederer for a second volume study on February 28, 2011. This time the test was successful: my prostate was half the size of the previous study.

I returned again to Honolulu on March 21, 2011 for the brachytherapy, which was performed at Hawaii Medical Center East (formerly St. Francis Hospital.) Dr. Lederer was assisted by Dr. Chinn. The procedure was easy: I felt no pain during or after the procedure. They presented me with a little card: 143 sources of I-125 Pd-103 were implanted. Unfortunately, I was unable to urinate! I struggled for hours, and by 6:00 PM I squeezed out 200 ml, and was discharged. My wife and I stayed in a Waikiki hotel (The American Cancer Society arranged a discount room). I still had a problem urinating, and was up every hour. However, in the morning I was still pain free, and walked across the street to a Denny's for a big breakfast. After that I went to Waikiki beach and took some pictures. When I would sit on a hard bench, I felt like I was sitting on a tennis ball, but it was not painful. I was still urinating with difficulty about every hour. In the afternoon we flew back to Kona.

I kept a log of trips to the toilet: about every hour, day and night, for about a week. Dr. Chin prescribed three medications: Demerol (which I did not take), Flomax, and Senna. As of today (May 29, 2011), the urination problem has mostly subsided: I get up twice during the night. Bowel movements are a problem: my hemorrhoids (of years ago) have returned, so I continue on the Senna. I called Dr. Chinn about the frequent urination. He said the internal radiation was causing distress to the urethra and colon which is analogous to 'sunburn', and the distress would subside in time. It got better, and I discontinued the Flomax.

On April 25, 2011 I went to Honolulu for a CAT scan with Dr. Lederer. The purpose was to check the placement of the radioactive seeds. No problems were found.

There is not sex life yet! The last (3 month) Lupron injection was on February 17, 2011 so I am waiting for it to wear off.

I have an appointment on July 21, 2011 with Dr. Chinn, preceded by a PSA test. I am confident that it will be fine.

 

UPDATED

July 2011

 

 

On July 21 2011, I visited my Urologist, Dr. Chinn, for a checkup, four months after the brachytherapy procedure. The news was good, as expected: PSA 0.1!

Some problems remain: my libido is zero. The doctor says it will take a year or more to get back to 'low normal' testosterone level. Testosterone supplements are not an option until five years have passed.

Also, I usually get up twice during the night to urinate. Flomax is of no help-- I think it makes the problem worse and I have discontinued it.

The hemorhoids which have returned since the procedure are acting up (it comes and goes). I take stool softener (Colace) and a laxative (Sennekot). I have an appointment with a surgeon to treat them.

The next appointment with the urologist is in November 2011.

 

UPDATED

December 2011

 

November 17, 2011. PSA is 0.20. My doctor did not discuss penile rehabilitation with me. I found out about it on the internet. I did ask him for a prescription for Viagra; instead he gave me a prescription to try Levitra. Viagra I have used before and found stronger, but Levitra doesn't give me a headache.

I am following the penile rehabilitation discussed at University of Michigan Comprehensive Cancer Center that includes the use of vacuum devices and Viagra. [Another suggested regimen is at Use It Or Lose It]

Patrick's e-mail address is: pc70@cornell.edu