Another round

As mentioned in the last post, my post-surgery PSA test revealed that there was still some cancer: the surgery did not get it all. A new team got involved.  I met with a radiation oncologist at Mayo to discuss next steps. The oncologist was confident we could still beat my disease. The plan was radiation treatment  to the pelvic bed to catch any remaining cancer: "salvage radiation".

The first step of the new plan was Androgen Deprivation Therapy (ADT). ADT is not chemotherapy. Rather, it is "hormone therapy".  Prostate cancer is stimulated by male hormones, aka "androgens" (testosterone mostly).  Thus the cancer can be slowed down by reducing a man's testosterone level.  This is the simple approach of ADT: reduce the patient's testosterone level and slow down the cancer.  ADT is very effective.  Unfortunately, it does not last forever in most men.  Eventually the cancer finds a way without the hormones. Some studies have also shown an improvement in radiation effectiveness by having the patient on ADT during the treatment: the weakened cancer is easier to kill.

So, from Dec. 2016 to June, 2017 I did a six-month treatment of ADT.  A few weeks after receiving the ADT shot (Lupron was the specific drug) my PSA dropped to undetectable.  Yea!  Like most men on ADT I did experience some side effects.  For instance I had hot flashes!  Yes...same things that women go through during menopause.  Also, my sex drive disappeared, and my energy level dropped.  

Once my PSA level was undetectable the oncologist made a plan for the radiation.  This involved an MRI of my pelvis in order to get a good understanding of where all the parts are.  At my request we also had an additional MRI of the base of my spine.  I had been having some sciatica in the last year and I was convinced there was a connection between the cancer and the sciatic nerve.  Both MRIs came back looking good: no evidence of cancer.

With a plan in place, the radiation was scheduled: 6 weeks of radiating my pelvis.  Oh boy.

More details...

• Regarding ADT side-effects. I think most men (myself included) are pretty horrified by the thought of losing our sex drive. I can only say that, for me, it was not that bad. I didn't miss that which I didn't want.  I have a wonderful wife who was very understanding and we made things work. Not having a sex drive does not mean that sex is impossible.  Rather, it just means you have to make more of an effort to get interested. I think it was probably a great way of appreciating how the female world sees sex.