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Bob Stewart lives in Kentucky, USA. He was 65 when he was diagnosed in April, 2000. His initial PSA was 6.80 ng/ml, his Gleason Score was 6, and he was staged T1c. His choice of treatment was External Beam Radiation+ADT. Here is his story.

01/15/00 - Symptoms had first appeared as a slight burning sensation prior to and after urination (but not during) within the penis near the tip; a slight lower back pain on the left side had periodically occurred; the need to urinate and the frequency of waking up to urinate had increased; a diminished sex drive occurred; a general feeling of unease or nervousness in the pelvic area took place; the symptoms were more periodic than constant. These symptoms were assumed (by me) to be the result of a bladder infection and sulfate (250mg/2 per day) was taken until a Dr. appointment on 02/01.

02/01/00 - A urine test indicated no infection with a slight amount of microscopic blood present. A digital rectal examination (DRE) indicated no abnormal swelling of the prostate. Medication was prescribed. A total of sixty sulfate tablets (250mg/2 per day) followed by forty cipro tablets (250mg/2 per day) were taken until the prescription ended on 03/21. The symptoms remained periodic - a prolonged occurrence every two or three days up to the time the prescription ended.

03/02/00 - Another urine test indicated no infection nor blood present hence bacterial prostatitis may be ruled out.

03/16/00 - A routine physical exam included a DRE, the results of which indicated no pain or swelling of the prostate. The prostate-specific antigen (PSA) test indicated a PSA level of 6.8 ng/ml The Dr. stated that this elevated PSA could be a 'spike' as a result of the DRE which immediately preceded the PSA test. A referral was made with the urologist, Dr. P.

03/30/00 - Another DRE showed nothing unusual and a urine test indicated no infection or blood present. The symptoms lessened when the medication ended. There were no symptoms during the past two days. I informed Dr. P that my father died from prostate cancer at age sixty-eight. He mentioned I may have prostatitis or cancer of the prostate. He mentioned that the elevated PSA could be the result of the initial prostatitis condition. A prostate biopsy was scheduled for 04/12 to determine if cancer is present.

04/12/00 - A prostate biopsy was performed because of both the elevated PSA and my family history. The biopsy report (04/18) indicated prostate cancer. This was one of the worst days of my life - my knowing nothing about PC. On a Gleason Score from two to ten I'm in the middle with a six (Gleason Score 3+3) in which case the cancer may or may not be significant. I was advised to study up on prostate cancer and the treatment options that are available.

04/19/00 - A bone scan was performed (two hours after an injection of Technetium which attaches to calcium in the bones) to determine if the cancer had spread to the bones.

04/21/00 - At the follow-up visit with Dr. P (with my wife present), he mentioned that the cancer had not spread and bone metastasis had not occurred. When asked whether the cancer was fast moving he said he didn't know since the Gleason score was in the middle of the range. When asked for a cancer classification he said it is a Stage T1-C since the tumor could not be felt on DRE and it was identified by needle biopsy due to an elevated PSA. The tumor appeared on both lobes. The staging is determined with the TNM system - tumor(T1-C), nodes(N0), metastasis(M0). The prostate volume (W=5.5,L=5.4,H=3.8) is estimated to be 59 cc. The PSA density (PSA/Volume) is 0.12. He outlined the treatment options available - watchful waiting, radical prostatectomy, radiation, and their implications. Since I had already studied up on treatment options and their effects, I was in a somewhat knowledgeable position to make the 'decision from hell'. I selected beam radiation in combination with neo-adjuvant AST(androgen suppression therapy). I cannot over-emphasize the importance of studying (with pencil and paper) everything I could get my hands on. Beam Radiation was selected mainly because of the lesser likelihood of permanent side effects that can occur resulting from beam radiation as opposed to those occurring as a result of radical surgery (I am also somewhat chicken when it comes to surgery). The following table shows mortality, impotence, and incontinence probabilities versus treatment preference as published by the Prostate Cancer Initiative which is a partnership between ACS and CRI (What To Do If Prostate Cancer Strikes; 1999). The figures in parentheses are from a study (10/2000) conducted by NCI Bethesda, MD. involving 1156 RP patients and 435 RT patients. The quality of life for either treatment is the same.

TREATMENT

Mortality

Impotence

Incontinence

Radical Prostatectomy

0.1 - 0.8%

30 - 70% (79.6%)

2 - 30% (9.6%)

Radiation Therapy

< 0.1%

30 - 60% (61.5%)

4 - 7% (3.5%)

04/27/00 - An initial 3 month hormone shot (10.8 mg of Zoladex) was administered by the urologist to the abdomen. The next and last shot was scheduled for 07/20. The purpose of the hormone shot is to suppress the supply of testosterone to the tumor, i.e. to starve the tumor (apoptosis) prior to and during radiation, supposedly making the radiation treatment more effective. Zoladex is a luteinizing hormone-releasing hormone (LHRH analogue). [The zoladex actually blocks off the signals from the brain that normally tell the testes to produce testosterone. The amount produced is controlled by a hormone from the pituitary gland , called luteinizing hormone. The testosterone circulates in the blood, diffuses into the prostate and eventually is transformed into DHT-the major androgen or male hormone inside the prostate cells]. The side effects of the shot are hot flash occurrences, loss of pubic hair, and impotence. (At this stage in my treatment, sex is the last thing on my mind - or at best, the 2nd last thing).

05/09/00 - Another DRE indicated a 'firm prostate' with no abnormal swelling. The Radiation Oncologist, Dr. O, said there is a slight chance the cancer has spread to the lymph nodes, hence the entire pelvic area will be treated. According to the Partin Tables (updated 1997) and for my situation (T1C, PSA 6.8, Gleason 6), the probability that the cancer is confined to the prostate is 67%. The probability the cancer has extended into and perhaps through the capsule of the prostate is 30%. The probability that the cancer has spread into the seminal vesicles or lymph nodes is about 2%. If I was understaged and if my actual stage was T2C (tumor involving both nodes) then the probability of prostate confined cancer drops to 43% and the probability of capsular penetration increases to 46% with an increased probability of 5% for seminal vesicle or lymph node involvement.

A total of 38 radiation treatments are required. The radiation side effects include more frequent urination and diarrhea. Here are responses to some questions asked: it is permissible to mow the lawn, etc. during radiation treatment; radiation therapy is still an option, if the cancer were to eventually spread (I found out later that this is not necessarily so); the prostate condition experienced prior to the biopsy was probably the result of Benign Prostatic Hyperplasia (BPH); if the BPH were to cause problems in the future, then TURP - transurethral resection of the prostate or TUIP - transurethral incision of the prostate, or medication are three treatment options.

05/17/00 & 05/23/00 - More measurements, x-rays, tattoos and magic markers on the buttocks (thanks to Susan and Suzanne) were required for the design of the leaded 'x-ray blocks'. A CAT scan was also administered. Finally, I was at last introduced to and x-rayed by the CLINAC 2100 C/D Radiotherapy Accelerator, my great and almighty savior with whom I'll be having an on-again, off-again relationship for the next two or three months.

The complete radiation treatment package consists of 38 treatments, namely: two sets of 14 treatments each set comprising 9 pairs of anterior & posterior projections and 5 pairs of lateral or side area projections for a total of 28 treatments; followed by 10 conformal 3-D treatments directed at the prostate itself, comprising 6 obliques and 4 lateral boosters. The actual treatment schedule is presented in a Table below. For each of these 38 treatments, 180 - 200 rads (1.8 - 2 Gy) is to be administered daily, exclusive of weekends. (Note for you engineers: 1 rad=100 ergs/g or 2.39x10-6 cal/g, 1 cal=4.187 W.s, 1 Gy=1 W.s/kg. Hence, 2 Gy is equivalent to approximately 0.5 cal/kg - a negligible amount of heat transfer but don't try to convince certain DNA of that. DNA are wiped out by the radiation particles causing targeted cells to die).

07/05/00 - After the 7th treatment, I met with the oncologist, Dr. O, to discuss the side effects I was experiencing - diarrhea with mucus discharge, frequent urination, and loss of pressure upon urination. I was told that although early, I was par for the course. Medication could be prescribed, but its side effects (dryness of mouth and eyes) are worse than my symptoms. Just what mess did I get myself into?

07/08/00 - After 9 treatments, it was necessary for me to curb the intense diarrhea with a capful of Imodium.

07/18/00 - I met with Dr. O and complained about a urinary hesitancy problem. He explained that when the bladder is full, the flow is cut off until small amounts are ejected to relieve the pressure. If possible, I should urinate often so as to not get a full bladder. I should also sit on the commode with the body bent forward and to let a faucet run. If this doesn't help I should immerse myself in a tub of hot water and urinate upwards. And finally, if that doesn't work I should drown myself. He also suggested I could take a week off from the treatments. I mentioned I would like to continue up to the start of my two-week vacation (08/22 - 09/03) instead. He said that he would have no problem with my taking two weeks off from the treatment schedule.

07/20/00 - I had the second and gratefully the last of the 12-week hormone shots. I met briefly with Dr. P. I asked whether or not prostatitis or BPH symptoms can occur after completing radiation treatment and was told that the urinary problems can still develop (man, I'm sure glad I got the answer to that question). He said he didn't want to see me until 6 months and I was to bring the PSA results with me.

07/22/00 & 07/23/00 - The dreaded diarrhea began in the evening of the 22nd with two vicious bowel movements. The next day I applied Preparation H and Anusol suppositories between three successive bowel movements and took a pain-killer to help relieve the hemorrhoid pain.

07/25/00 - I had the 21st treatment today and complained to Dr. O about my recent bout with diarrhea and hemorrhoids. Also the urination frequency increased considerably. He immediately halted my treatment until 08/03 and prescribed the narcotic oxycodone. He mentioned Prep H is the best hemorroidal ointment and I should also use Tucks.

07/27/00 - I took oxycodone the past two nights and the side effects are constipation and urine retention - two effects I don't need. I'm also taking a stool softener. I'm still experiencing urinary hesitancy in the morning or when I'm not active. It seems that being active discourages hesitancy. The only time I'm experiencing discomfort with hemorrhoids is during bowel movement.

07/31/00 - I experienced severe hemorroidal pain with diarrhea (akin to the hot - lead enema) twice yesterday. I took a pain killer and managed to insert an Anusol suppository after each BM. I felt much better today. Better than yesterday, that is.

09/12/00 - Thank someone or other, the dastardly EBR treatment (some kind of treat alright) has ended.

EXTERNAL BEAM RADIATION TREATMENT SCHEDULE* 06/26/00 to 09/12/00

DATE:year '00 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY
6/26 - 6/30 A&P A&P A&P A&P A&P
7/03 - 7/07 A&P holiday A&P A&P A&P
7/10 - 7/14 L L L L L
7/17 - 7/21 A&P A&P A&P A&P / HS A&P
7/24 - 7/28 A&P A&P suspend suspend Suspend
7/31 - 8/04 suspend suspend suspend CO CO
8/07 - 8/11 CO CO CO CO CLB
8/14 - 8/18 CLB CLB CLB L suspend
8/21 - 8/25 suspend vacation vacation vacation vacation
8/28 - 9/01 vacation vacation vacation vacation vacation
9/04 - 9/08 holiday L L L L
9/11 - 9/12 A&P A&P --------------- ---------------- ----------------

*Code: A&P - Anterior & Posterior Projection
L - Lateral Projection
CO - Conformal Oblique
CLB - Conformal Lateral Booster
HS - 2nd Hormone Shot (1st shot on 4/27/00)

December 2000 - I deliberately waited three months before reporting on my present condition pertaining to the disease and the treatment of such. At the present time (12/04/00) I am virtually free from all urinary problems with the exception of a slightly increased frequency - perhaps two or three trips to the bathroom (up one or two from what used to be normal) during the night provided I watch my fluids intake in the evening. The speed/pressure is not as much as I would like but I can live with that. The hesitancy has all but disappeared provided I make sure I don't wait for a full bladder. There is very little if any sign of dribbling. There is no urinary incontinence. I may have developed colitus (irritated large intestine); every two or three days I develop diarrhea symptoms that persist for six hours or so but only during the waking hours; the mild fecal incontinence (mostly mucus with gas) can be a problem especially when I have gas, in which case I make sure I sit on the commode to urinate. I get constipated every ten days or so; hence, I have to remind myself to drink sufficient liquids and take a stool softener once or twice a day when needed. I try to avoid laxatives and if necessary, only take a mild one. In general, the urinary tract has almost returned to normal but the bowel system has not. I am still experiencing hot flashes - as a result of the hormone shots, I think. The pubic hair is returning. I am not experiencing any discomfort or pain associated with the urinary system. My sex drive has not yet returned but I remain hopeful (so does my wife).

I have learned to accept my disease and I have a positive attitude (most of the time) about the whole thing - for which I am grateful. Becoming aware combined with positive action is my antidote to fear.

12/04/00 - The test results indicated a PSA level of PSA < 0.2 . (The date of the PSA test was 12 weeks after the date of the last radiation treatment and 20 weeks after the date of the last hormone shot).

12/07/00 - I had the first follow up appointment with the Urologist, Dr. P. He made the following remarks: the PSA level of < 0.2 couldn't be better; I am to see him every 6 months with new PSA test results; he will not do a DRE at this time. I asked several questions and got the following answers to my questions:

the Oncologist may choose not to see me after my follow up visit;
the hot flashes will end;
bowel problems will end;
it's up to me about the sex thing - he can prescribe Viagra - I decided to wait and see;
the prostate itself is rendered useless (atrophy) as a result of the radiation (not true,I still have a prostate);
the radiation should have removed the BPH problem as well;
it is not possible to distinguish age specific or BPH specific PSA increases;
the PSA level can reach values of 1.0 or even 2.0 without there being a problem;
if problems with PSA develop in the future, he will try hormone treatment; the urine test results were perfect.
He basically told me not to be concerned with any of this and he will see me in 6 months.

12/14/00 - The follow up visit with the Oncologist indicated the following: the low PSA is a direct result of the anti-hormone shot and is quite common with his patients (he had already seen three similar cases earlier in the day); if the initial PSA was very high then the effect of the hormone shot would reduce the PSA substantially but perhaps not nearly as low as 0.2; he could not say what the PSA level would be had there not been a hormone shot administered; the real test is just how much the PSA will rise with time; if it rises above normal for my age group (say >4.5) then I will require treatment - but this will also depend on my age at the time of an excessive increase; subsequent hormone treatment (should the PSA rise beyond what is considered normal) is effective for two or three years after which there is nothing available; BPH problems will occur down the road with age; the side effects I am experiencing (irritable bowel) can be relieved with Imodium but should diminish with time.

4/04/01 - The frequent bouts of diarrhea that I was experiencing have certainly diminished with time - one or two successive days at three to four week intervals. I am also experiencing a more normal frequency of urination with only one or two sleep interruptions. I have not had any prostatitis symptoms. I continue to drink moderate amounts of liquids during the day. I am still experiencing hot flashes. I find this hard to accept since the last Zoladex shot was almost seven months ago. The sex drive has not returned.

06/04/01 - Lab Test. The results indicate a PSA level of PSA=0.3. This test was performed 6 months after the previous lab test and 10.5 months after the last Zoladex shot. The occasional hot flash still occurs - once every 2 or 3 days.

07/16/01 - I selected another Urologist (Dr U.) since Dr. P would not return my calls on 2 successive occasions. I had questions concerning the 06/04 PSA reading. The DRE showed a small prostate, also no problems. The hot flashes have disappeared, after 12 months since the last shot.

12/05/01 - Lab Test. The results indicate a PSA level of PSA=1.5. Could this increase be the result of the "wearing off" of the hormone shots?

12/12/01 - Dr U. Appointment. He expressed concern with the rise in PSA. He said he would not be concerned if the PSA were 0.5 instead. The DRE indicated a small and smooth prostate. He suggested hormone shots. I suggested we wait until the next test because of a possible testosterone rebound causing the PSA to bounce.

12/19/01 - Phone call with the Oncologist, Dr O. He insisted that no action be taken until the next PSA result. He discussed 'clinical remission' - feeling fine with no symptoms and 'biochemical recurrence' - a significant rise in PSA. He stressed that there is no need to be concerned at this time but only if the PSA continues to rise. He suggested I keep in touch regarding my situation.

04/04/02 - Lab Test. The results indicate a PSA level of PSA=1.4. I certainly feel good at this time - in 'clinical remission'. I spoke with Dr O. and he said the results (a slight decrease in PSA) are very good and I should call him again in 4 months following the next PSA test.

04/17/02 - Dr U. Appointment. He is concerned with the new PSA level. He says the reading is about the same as before. He said my PSA will rise again and I will require Zoladex. I questioned this and asked what the PSA level should be if the cancer were cured. He talked about PSA rising with time as the criteria for deciding if Zoladex is required. I said that I was happy that the PSA did not rise during the last four-month-period. The DRE indicates a small and smooth prostate with no tumor.

08/12/02 - Lab Test. The results indicate a PSA level of PSA=2.4. I feel good, but get a little tired at times if I don't get enough sleep. I spoke with Dr. O and he said I should not be too concerned with the new PSA reading. It is not abnormally high. The PSA will continue to rise to a level for my age group and then will continue to rise at a rate which hopefully is less than that corresponding to a doubling time of less than 12 months.

08/16/02 - Dr U. Appointment. He said the PSA is not low but it's not too high either. He again suggested Zoladex at this time but left the decision up to me, especially if the PSA rise doesn't overly concern me. He said the PSA will continue to rise and eventually I will require Zoladex or equivalent. He said there is little risk in postponing for 6 months or so. When asked he said he could not say if the cancer has spread beyond the prostate. (Hormonal therapy will target cancer that has spread beyond the prostate gland and is thus beyond reach of local treatment - brachytherapy, cryotherapy, surgery - which I probably don't qualify for. It is a way to arrest cancer prior to metastases). I decided that I can live with a rising PSA and I am interested in its progression. I will take the Zoladex if the PSA rise (beyond a PSA = 4.5) has a doubling time of less than 12 months.

11/11/02 - Lab Test. The results indicate a PSA level of PSA=2.0. I feel good and am grateful that the PSA did not increase from 3 months ago. During the Lab Test the Lab Tech (who was very deliberate and clumsy) injured my arm while trying to draw blood - the hemotoma being so severe that a pain pill and ice packs were required when I got home. From now on the blood work will be done at the Lab of my Primary Care Physician.

11/17/02 - Dr U. Appointment. He said the results are good but obviously a lot of bouncing is taking place and not too much can be inferred from the overall PSA pattern. He will not prescribe anything at this time other than changing the frequency of visits to 4 months. The DRE results are the same (small and smooth prostate) and the urine test results are fine. When asked the question whether the cancer has returned he indicated yes but it was unlikely that it has spread to the bones.

11/25/02 - Dr. O Appointment. He implied that it is probable the cancer may not return and in any event it is in remission at the present time. He emphasized not to do anything (like taking Zoladex) - why fix it if it isn't broke. Later on down the road perhaps the cancer may return and some action will have to be taken at that time, but not now. He goes by the following criteria: PSA reading - mine is low for my age group; PSA doubling time greater than 12 months - mine is good; prostate condition - mine is small and soft (like the tip of one's nose) and smooth (tumor free); and overall health - I'm in clinical remission with no biochemical recurrence. There is nothing else to say.

03/07/03 - Lab Test.- The results indicate a PSA level of PSA=4.5. The PSA has certainly jumped during the last 4 months. I am concerned that it reached the level for my age group in such a short time. I doubt that the cancer is in remission but I'll wait for Dr. B's accessment.

03/14/03 - Dr. U. Appointment. He said the rising PSA will continue to rise with time and eventually I will require the hormone shots but the decision is up to me. He said in 6 months time I will feel the same as I do now and the same as I did 6 months ago whether I undergo hormone treatment or not. I decided to wait another 4 months since I can adjust reasonably well to a rising PSA. I asked him about PSA rise with time following Radiation treatment. He said mine was higher (about twice as much) than normal. The prostate tested small and smooth and the urine test results are fine.

03/17/03 - Dr. O Appointment. Is NOW the time to make the ADT decision? The Urologist says "yes"; the Oncologist says "no". He will make the decision if and when the time comes for me to begin chemical castration therapy. See 11/25/02 for his criteria. The PSA rise is alarming; however, since I changed Labs, the Assay is different and a new baseline for PSA has to be established before determining PSA rise with time. He mentioned the PSA can vary by as much as 1.5 between the various Labs that administer the tests. He ordered a PSA test in 3 months time. My health is fine - no aches or pains. I feel tired at times but a regular sleeping pattern helps. I began Cholesterol med as prescribed by my primary care doctor to treat high cholesterol.

06/07/03 - Lab Test.- The results indicate a PSA level of PSA=2.1. I am quite pleased with this result. I have been feeling tired lately. (most likely as a result of lack of sleep). For the past 3 months,I have been on 20mg of Lescol for high cholesterol - it works. I felt some urinary track discomfort - but not serious. When I stick to water (rather than soft drinks) the slight discomfort disappears in a few days.

06/16/03 - Dr. O Appointment. He indicated all is well - that I have returned to where I was 7 months ago with the PSA between 1.5 and 2.4. The condition of the prostate is slightly enlarged (which is normal for my age); soft; non-nodular; and, feels benign. He said the condition of the prostate, and the PSA somewhere around 2 after 33 months since therapy ended would indicate things look good.

09/12/03 - Lab Test. The results indicate a PSA level of PSA=1.7. This result is very encouraging. Perhaps the PSA is finally leveling off with no more bouncing. I feel fine.

09/19/03 - Dr. U appointment. I'm looking fine. The PSA reading is great. The prostate is small and smooth. He will see me in 6 months. I'm delighted I rejected ADT (Androgen Deprivation Therapy) when it was first suggested by Dr. W. 21 months ago (12/12/01). If I had unwisely taken it then when it was unneeded, it may not work if I should again require it later on. This incident emphasizes the importance of taking control of one's own treatment procedure for PC treatment through education, support groups, seminars, etc.

12/12/03 - Lab Test. The results indicate a PSA level of PSA=2.8 (LabCor). Here we go again with another bump. Expectations can lead to disappointment. A recent 2002 study indicates that 20% of EBR treated patients experience a PSA bounce within 3 years (sometimes as long as 5 years or more) to a high value then fall to an acceptable value. Should I continue to wait?

12/19/03 - Dr. O appointment. He said don't be concerned - it looks fine. The PSA is still below the upper limit for my age group. The condition of the prostate has not changed and that is good news.

03/10/04 - Lab Test. The results indicate a PSA level of PSA= 2.2. Sure grateful it's moving in the right direction.

03/19/04 - Dr. U appointment. He said I still have 2 choices. Either do nothing or begin ADT. The condition of the prostate is small. I had loss of pressure for a few days last week which slowly disappeared with time upon taking a laxative. He said that would do it. When asked the question could an internal (inside the prostate) restriction develop, he said yes it's possible. End of appointment - all of 3 minutes. I'm to see him in 6 months.

06/07/04 - Lab Test. The results indicate a PSA level of PSA= 2.4 . Very grateful - a slight drop from the last LabCor result 6 months ago.

06/14/04 - Dr. O appointment. Nothing to be concerned about. The PSA reading is good. The prostate gland is normal.

09/03/04 - Lab Test. The results indicate a PSA level of PSA= 1.9 . Fantastic.

09/08/04 - Dr. U appointment. I said "not too bad". He said "not too bad". The prostate is fine. The urine test indicates some blood. An IVP and a Cysto/MAC are scheduled for 09/24 and 09/27,respectively.

09/24/04 - The IVP along with Blood Work (Metabolic Panel), an ERG, and a chest X-Ray were performed.

09/27/04 - The Cysto/MAC was done. The results of 09/24 and 09/27 indicate nothing unusual other than perhaps an enlarged prostate. No stones/tumors/strictures. There will be some bleeding/burning for the next 3 days. Levaquin is prescribed and the follow-up visit showed no problems and no blood in the urine.

03/10/05 - Lab Test. The results indicate a PSA level of PSA= 2.0 . Fantastic.

03/16/05 - Dr.U appointment. He said 6 months ago the reading was 1.9 and now it is 2.0 so everything looks fine - nothing to be concerned about at this time. I mentioned that perhaps it has reached its low point - he didn't agree nor disagree. I asked him "I know you would like to see the PSA around 1 rather than 2, but do you have any patients who show similar results and who are fine? He said.."sure". The condition of the prostate is fine and the urine tested OK.

09/12/05 - Lab Test. The results indicate a PSA level of PSA= 2.2 . Again: fantastic.

09/16/05 - Dr.U appointment. He said 'the PSA has increased from 2 to 2.2, but that's fine; the condition of the prostate is small and smooth'.

03/14/06 - Lab Test. The results indicate a PSA level of PSA= 2.9 (LabCor). An increase of 0.7 in a 6 month period is high. Hopefully it's another bump such as that occurred on 12/12/03 some 27 months ago when the PSA increased from 1.7 to 2.8 in a 3 month period.

03/22/06 - Dr.U appointment. He said the PSA was increasing but not too high as yet. He mentioned my starting the ADT treatment. I said I was not too concerned with that - the PSA is still below that acceptable for my age group; my health is fine; the prostate gland is fine; and the PSA doubling time is acceptable. He did not disagree. He communicated more than usual - about 3 minutes. We both agreed that I see the PSA reading as just one indicator and is not the be - all and end - all. The next appointment is 06/19/06.

06/13/06 - Lab Test. The results indicate PSA levels of 1.9 ng/ml/2.1 ng/ml. Amazingly, the prior reading of 2.9 ng/ml was an abnormal bump caused by who knows. The two latest readings were made on the same sample at the same Lab. The 1.9 ng/ml reading was made on 06/13 and the 2.1 ng/ml reading was made on 06/15. It indicates a +/- 10% accuracy of a PSA test. I will assume the correct PSA level is 2.0 ng/ml.

Dr. U. said the PSA reading is good; my thoughts were - what an understatement! I'm absolutely delighted. The condition of the prostate is fine but there is blood in the urine sample. He said the urine sample will be tested for cancer cells and that another CystoMac would not be necessary. The results came back negative. My overall health is fine. Still exercising, dieting, and trying to get to bed early to avoid fatigue.

The next appointment is 12/18/06. I don't have to think about ADT for another 6 months.

12/12/06 - Lab Test. PSA = 1.8 ng/ml I'll take it. Dr.U said fine. I said fine. The prostate is small and smooth. No blood in the urine. (My sex drive is heading south at an alarming rate. I can still lust though). Next appointment in 6 months.

11/06/07 - The latest PSA is 2.5 ng/ml. The urologist said "patients like you either do nothing or begin ADT, so what do you want to do"? I said"do nothing". I'm feeling fine, the prostate is small and smooth, and the PSA level is acceptable.I have NOT taken ADT since during treatment 7 years ago and that was intermittent(administered twice).

UPDATED

February 2008

10 Dec 07 - PSA = 2.0 ng/ml. Other than saying "prepare yourself for the DRE" the doc said nothing. When asked, he answered "the prostate is small and smooth". Next appointment in 6 months.

UPDATED

November 2008

My latest PSA reading is 1.8 as of June 2, 2008.

UPDATED

May 2009

My latest PSA (09Dec /08) reading is 1.6.

UPDATED

March 2010

My latest PSA readings are 2.5 on June 8, 2009 and 2.2 on Dec 8, 2009. No DRE was done on the last visit. I guess the Doc decided it was not necessary.

I'm feeling fine and continue to keep in pretty good shape. I enjoyed the latest viewpoint/study re PC.

UPDATED

March 2011

After nine and three quarter years since treatment ended my PSA was 2.0 After 10 years since treatment ended my PSA was 3.2 After 10 and a half years since treatment ended my latest PSA is 2.7. All is going well.

I continue to have micro amounts of blood in my urine, but nothing to be alarmed about. I went through a 20 sec long Cysto exam in the Doc's office. It was nerve racking but better than being put under in a hospital.

I still can't get IT up but the thoughts are still there.

UPDATED

April 2012

After 11 years following treatment my PSA was 3.3. After 11 1/2 years (March 1/12) following treatment my latest PSA is 2.9. The bouncing around is probably due to a combination of PSA test accuracy and slight infection from common head colds and sinus problems.

My nadir is around 1.5, so it would appear the PSA has doubled since the nadir was reached about 10 years ago. A PSA of 3 sounds a little high but I'll take it. Although I can't piss the bark off a tree, I am urinating not too bad except when constipated.

UPDATED

March 2013

At 12 years following treatment, my PSA was 3.8 and the latest PSA (March 2013) after 12.5 years following treatment is 4.1 I'm a little concerned with the slight consecutive rises but am grateful the PSA is still below 10. I'm feeling fine as they say but am having constipation problems and sex has flown the coop.

UPDATED

March 2014

My latest PSA, after 13.5 years since treatment ended, is 3.8 with a doubling time of 4.3 years. Still managing to avoid chemical castration. Sex is but a dream, sweetheart.

Bob's e-mail address is: bobstewart@twc.com


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