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This is his Country or State Flag

Eitan Lachmi and Devorah live in Israel. He was 56 when he was diagnosed in November, 2007. His initial PSA was 23.00 ng/ml, his Gleason Score was 9, and he was staged T2c. His initial treatment choice was External Beam Radiation (Intensity Modulated with ADT) and his current treatment choice is Uncommon/Unconventional (Other). Here is his story.

THERE WAS NO RESPONSE TO AN UPDATE REMINDER IN 2016 SO THERE IS NO UPDATE.

Suffered Erectile Dysfunction (ED) and increasingly frequent need to pass water- for years. Got to where I had to get up more than 6 times every night. Took over the counter prostate capsules (saw palmetto, squash seed oil, lycopene, selenium, carob, zinc) and had several months of relief, before things continued going downhill...

Getting up 8 or 10 times a night to piss is something I can do, but when I got up and could not pass water at all (despite the feeling of pressure and urgency)... I understood that things could not go on this way... Also noticed I was continuing to lose weight for the last 6 months (down from 86 to 78 kilos, on a 1.9 meter thin frame), till I had to buy suspenders to hold my pants up...

Phoned the nurse at our local clinic and described the above- she was alarmed and told me to come in to see the doctor at once. Doctor did a cursory physical (my first since entering the army, which was many years ago...) and took blood samples.

He sent me out to do ultrasound of the prostate. I had done a lot of background reading on the internet, and was already in the process of deciding which treatment for enlarged prostate was for me... When the ultrasound technician told me: "Good news! Your prostate looks perfectly normal."- I started to worry... a lot...

The next blow was the results from the blood test: PSA 23.0 ... Having done more internet research before that- I had a fair approximation of what I was now in for, and the nurse said I was suddenly very pale...

Next stop (and there are several nerve wracking weeks between each revelation here...) was the Urologist, who performed my first DRE. If he had earlier told me not to jump to conclusions from the high PSA, after feeling the prostate he stopped the banter and did not want to look me in the eye. He wrote me out the authorization for a biopsy, and stamped on it "URGENT". When I pressed him for details, he said the size of the prostate was about normal, but that all of the tissue was hardened... all of the organ.

One good thing that came out of the visit to the Urologist- a prescription for Omnic which made it a lot easier to piss...

At this point, I told my wife what was going on (this is certainly not a ecommendation on my part to act this way- just telling it like it was).

There followed a very difficult month waiting for the appointment for the biopsy. The biopsy was unpleasant, but bearable. The doctor only took 6 cores. When I asked him why not 12, he was evasive, but finally said: "There was no need..." He also marked the lab sheet "URGENT", but it still took 3 weeks to get the results (!).

That's a great cinematic moment, when the family doctor uses all of his wisdom and experience to gently inform the patient of his serious condition... all I got was a laconic notification over the phone, and a fax of the biopsy report: Gleason 4+5=9 in all the cores.

OK- got an advanced case of prostate cancer. I'm just 56 years old... I had kind of been looking forward to at least another 20 years, and had all kinds of long range plans... its a new world, now...

Gave things a lot of thought (while waiting another month to see an oncologist), and at first it did seem a little unfair... but honestly, can't complain: have been privileged to raise children, hug grandchildren, plant, build and teach... you can't expect to have everything...

After a lot of effort, got a top level Urologist to look at my diagnosis. His response: "What do you want from me? No one will operate with that PSA and Gleason- go find a good oncologist- and quickly!"

Ok. The oncologist reads over the lab results, does his DRE- and gives me a standard treatment plan that I could have written myself: external radiation and ADT for 2 years. Started me immediately on Casodex for 30 days, and on the 15th day- the first of the 90 day Zoladex shots.

At this point I told my children, and a few close friends.

I started (actually, as soon as I understood that things were serious...)improving my diet and exercising daily.

I read up on all the possible side effects of Hormone Therapy... and little by little, I have seen almost all of them. Breast growth and sensitivity, hot flashes and cold sweats, Libido going down to zero, etc.

After another 2 months started IMRT (Intensity Modulated Radiation Therapy)- 40 treatments, 80 gy. A lot worse than the treatments was the ongoing argument between the oncologist and the radiologist: the former ordered radiation also of the lymph nodes, while the latter wanted to do only the prostate. I agonized a lot over that decision, until deciding to go with the maximum coverage. Only after 2 weeks of radiation did I discover that the radiologist had ignored my decision, and went ahead with his minimalist plan. If I hadn't been well into Testosterone blockage, I think I would have knocked him down on the spot... I forced him to change the treatment plan.

While the ADT had made pissing easier, about halfway through the radiation things started going downhill again: urinary difficulties gradually, but steadily worsened, while bowel problems (which had never really settled down after the biopsy)began making themselves felt.

This started to be a real problem, since we don't have a car, and live in a rural area more than an hour's drive from the hospital. Hitchhiking or riding infrequent buses was an increasing strain on my bladder, which could hold out for a maximum of 1 hour... Also increasing tiredness/ fatigue- I cut down the running and exercising to 3 times/week, but still found myself running slower and a little harder each day (the last week I couldn't exercise at all)- very discouraging. At the end was having big problems with bowel control, and occasional inability to piss.

I am now (September '08) about 3 months after completing the radiation, and most of the severe symptoms have faded. Still tired all the time, but running and exercising 4 times/ week. I find that the days that I run I feel more energetic, and less likely to be depressed.

Have spent a lot of time refining my diet, and feel overall benefits from it:
No meat, sugar or added salt. Green tea throughout the day. Morning and evening:
herbal tea, fresh salad with broccoli sprouts and hot peppers, olive oil, sesame butter, pumpkin and sunflower seeds, 1 slice of whole wheat bread, seasonal fruit, low fat cottage cheese.

Morning: walnuts, 2 poached eggs
Evening: almonds, tofu, pea or lentil soup
Lunch: brown rice, cheese, tomato sauce with hot peppers and leafy vegetables, canned salmon or humus, glass of red wine

My weight is back up to 85 kilos, and steady for months. I lie down immediately after each meal for at least 10 minutes with music in the background- seems to help my digestion. Also spend 15 minutes each day sitting shirtless in the sun (vitamin D for calcium absorption).

I have stopped taking all supplements, vitamins and medications (including Omnic, which I was practically addicted to and was difficult to stop)... except for continuing to poison my entire system with the 90 day Zoladex shots.

My blood counts are still very low (apparently a hangover from the radiation), and PSA- .20 (virtually meaningless because of the ongoing ADT).

Next decision at the end of 1 year's ADT will be if to continue for the second year, or risk returning to be a human being.

Would welcome advice from anyone, and will gladly share from my experience to anyone who thinks it might help. I, personally, have benefited greatly from reading others stories.

Health to all!

UPDATED

November 2009

Now November 2009, 2 years after diagnosis. In the meantime- married off another son, and have several new grandchildren :-) Also, haven't had any symptoms related to prostate cancer (last PSA: 0.04). That was the good news...

On the other hand, I continued my 90 day Zoladex shots until 4 1/2 months ago (7 injections total), and that was one of the difficult periods in my life. The fact that I can say "was" is actually wishful thinking, since I have yet to see any improvement... What do we have (and apologies in advance for complaining- I know that some of you are a lot worse off...):

[Here I started to list all the side effects of the ADT, but then you all are familiar with them, so no need...]

In addition: Osteoporosis- more than 10% loss in bone density in the lower spine in the first year of treatment. (important suggestion: check your bone density before starting ADT, so you have a baseline for comparison!). Started taking oral biphosphate (Actonel) once a week, despite possible side effects of jaw necrosis, risk heightened by a pre-existing periodontal condition (I can live without teeth, but not without a spine...)

In addition, occasional rectal bleeding, apparently fallout from the IMRT radiation finished more than a year ago and various intestinal and digestive distress... All in all - depressing.

And my wife says that I am hard to live with... (actually, she has been saying that for as long as I can remember...)

The long awaited "achievement" is that I have stopped the Zoladex shots (the oncologist wanted 2 more- let him take them!), as well as the Actonel, and am now awaiting the transformation into a normal human being. No results yet...

Things that have helped me some:

sticking to a healthy diet (and working in the garden daily, which helps at least as much as the fresh vegetables...)

frequent, planned rests (resting at pre-determined times, and not waiting to be overcome by fatigue)

regular exercise program

long daily walks (adds interest to the day, not just exercise)

regular listening to "guided imagery" recordings

As we come out from under the shadow of the ADT, will be closely watching the PSA changes - they say if you can get through the first 18 months without a jump... it is a good sign...

May we all see many good signs!

UPDATED

March 2011

Off Zoladex (Lupron) since July 2009. Started to feel a return toward normality in the spring of 2010. Slowly returning libido, less depression and aches, etc.. Went on a crash diet and exercise program, and managed to lose 18 kilos in less than 3 months. Starting to rebuild upper body muscles...

Only complaint was several months of Gynecomastia- swelling and very tender- and all this more than six months after stopping the Zoladex, and with Testosterone returning to normal! My theory is that there was a lot of Zoladex or Casodex stored up in the abdominal fat which I burned off in a short period of time - releasing it back into my system. Oncologist does not buy the explanation...

Most important- after more than 2 months the tenderness started to fade and my chest returned to more normal proportions... That was the good news- my body successfully rebounded from the hormone blockage.

Here is the other side of the coin - the last five PSA tests at 3 month intervals:

December 1, 2009 - 0.02
March 4, 2010 - 0.25
May 27, 2010 - 0.36
August 19, 2010 - 0.48
October 13, 2010 - 0.60

"Double, double, toil and trouble..." ...something else has rebounded as well... Really, really do not want to return to ADT...

Due for another blood test next week...

Health to all!

Eitan!

UPDATED

April 2012

Now April 2012- most ADT symptoms have faded, muscles continue still slowly rebuilding. Blood counts remain low. Still tire much faster than before, but rarely feel depressed.

Spent last Summer in an alternative treatment group which greatly helped improve my state of mind, will be doing similar things this Summer.

Children continue bringing new grandchildren- which is certainly the best medicine I know!

But...

PSA continues climbing, at an ever increasing rate- latest was 5.86, with a doubling time of only 5 months! Not encouraging...

Oncologist wants me back on ADT- so far I have been putting him off...

Good health to all of us!

UPDATED

December 2012

Now December 2012.

PSA continues doubling every 5-6 months, latest: 15.22.

Experienced steadily worsening LUTS over the last 6 months, despite taking Saw Palmetto, Omnic twice a day and recently Avodart.

CT and bone scan still negative. Ultrasound showed more than 500cc urine retention.

After (too) much deliberation, decided to do a TURP. Three weeks before the scheduled operation- complete urine blockage- went to emergency room for a catheter- 1000 cc passed in the first hour (this after I hadn't had any food or liquids for 20 hours!).

Advice to anyone in similar situation- don't wait till you stop functioning! They said I was very lucky to have avoided kidney damage.

TURP was 1 hour procedure with 3 days hospitalization- not bad, but took a long time to heal inside- now 2 months later and have just recently been able to restart running and weight excercising. Still some minor side effects, twinges, and a little less control than before.

Am now free of the catheter, and able to piss similar to several years ago- still about once an hour by day, and getting up 3 or 4 times every night.

Biopsy of the tissue from the TURP was all Gleason 4+5=9, same as the biopsy at diagnosis some 5 years ago. That's a profound failure of IMRT with 2 years of ADT.

I am continuing Avodart (as well as Resveratrol, Curcum, Quercetin, green tea, red pepper and other supplements), but the PSA continues rising at its previous rate. What is producing all that PSA? The TURP removed 70% of my normal sized prostate! I strongly suspect an additional source, despite the scans being clean.

Despite my oncologist's protests, I am not hurrying back to ADT (had very difficult side effects from the Zoladex last time), but plan to wait out the next 2 PSA tests, and pray for a lessening of the progression rate.

Good health to all!

Eitan

UPDATED

May 2013

Since last update- PSA continued to rise to 32. Had bouts of nausea. Linguinal lymph nodes were suddenly felt as small, hard lumps. Did not feel good...

Two months ago, I gave up on stalling, and opted for Firmagon shots. First injections (2) themselves were not painful, but within a few hours developed the mother of all belly aches (combined with a back ache)- first night was very difficult, but pain dissipated in the course of the next 3 days. Second shot after 30 days was less painful, but was also felt for 3 days.

Now the good news- a week later felt as good as I had in years, and PSA at the end of 14 days dropped to 5.43!

Now the bad news- Alkaline Phosphatase- 169, Creatinine- 1.31 and Urea- 56-all had been in normal range before. CT shows possible blockage of kidney ureter, as well as strong suspicion of pelvic mets. US shows left kidney shrunk to 3/4 its size just 6 months ago with hydronephrosis.

2 months into Firmagon- all the familiar ADT side effects are back. Have tried useing Estradiol patches for the last 2 weeks- with no noticeable effect.

Looks to me like I may have waited too long before restarting ADT :-(

Currently waiting to see if the Firmagon will shrink whatever is blocking kidney function, before letting the nephrologist dissect me...

Health to all!

Eitan

UPDATED

February 2014

To pick up where we left off last Spring: PSA continued dropping, ADT side effects increasing, and kidney function stabilized (though still over the red line...). Gave up on the Estrogen patches after gynecomastia was causing continuous breast pain.

After the 6th Firmagon shot- PSA was down to 0.86, and I was ready for an ADT vacation. I thought...

2 months later, PSA already rose to 3.9, which is quite a rate of increase. Oncologist conforted that it was just a one time jump from the Testosterone returning- no concern.

2 months later, PSA reached 37.4. That's a doubling time of 21 days! Being very stubborn- I re-checked the PSA after just 6 weeks: 54!

Very uncomfortable feeling of being in free fall, with the ground coming up very rapidly...

Restarted Firmagon, yesterday. Wish I could get the nurse to improve her technique: one side just hurts some, but the other side now has a lump the size of a golfball, and feels accordingly...

Some ADT vacation!

Now for the good news: married off the last of our children 2 months ago, and a new grandson born last week. Worthwile sticking around for, yes?

Health to all!

Eitan

UPDATED

March 2015

Just read over the earlier entries- a lot of time has passed...

All the children have now brought us grandchildren, and that is the most important thing...

Failed Firmagon- PSA 27, ALKP 211.

Scans show lots of skeletal mets, starting to ache.

Entered the Prostvac trial- had big hopes for that. Had a strong reaction to the injections, but was willing to deal with it. But, after 3 months- PSA up to 90 and scans showing bone mets spreading- had to stop the Prostvac trial.

Immediately started Zytiga with Prednisone. Only small drop in PSA, but after 2 weeks started seeing blood in urine. After 2 months- blood almost all the time in urine, and PSA starting to rise.

Also notice strange round swelling patches on thighs- oncologist thinks they may be starting parrallel bone fractures- imediately stopped Xgeva...

Currently with PSA 60.53, ALKP 566. Additional pains in both legs, with swelling of the entire right leg- sent me off to the emergency room for suspicion of DVT- but ultrasound did not show veinous clots or blockage.

May well be lymphedema, caused by swollen lymph nodes.

Awaiting results of latest CT and bone scan. May enter Xofigo trial. Do not want to start chemo.

Another possibility- to cease treatment and try to enjoy what time is left.

Eitan

Eitan's e-mail address is: yana AT tsel.org (replace "AT" with "@")

NOTE: Eitan has not updated his story for more than 15 months, so you may not receive any response from him.


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