Craig
Pynn and Susan live in California, USA. He was 62 when he was diagnosed on 22
January 2009. His initial PSA was 1.53 ng/ml, his Gleason Score was 8 and he was
staged T3. His choice of treatment was Radiation + Androgen Deprivation Therapy.
Here is his story.
I was diagnosed with prostatitis and BPH (Benign Prostate
Hyperplasia) in 2001, but since my PSA level remained around 1.5 since then, my
primary care physician always assumed it was simply an enlarged prostate she was
feeling via the DRE (Digital Rectal Examination) at my annual physical.
In
September 2008 I experienced a bout of hematuria (blood in the urine), which led
to an appointment with a urologist, which led to a biopsy and cystoscopy in late
2008. The biopsy revealed 11 cancerous cores (out of 12 samples) and a Gleason
grading of 4+4=8, i.e., aggressive PCa. Upon finding a lesion in my urethra via
cystoscopy, my urologist subsequently performed a urethral biopsy, which revealed
(to quote my urologist),"extensive cancer," staging me as T3 (technically T4 per
the National Cancer Institute standards since the cancer had migrated to an unusual
location) aka "locally advanced" PCa.
In the memorable words of the same
doctor, "You're definitely not a candidate for surgery--and I'm a surgeon." At
the time of diagnosis he prescribed Casodex, an anti-androgen at triple the normal
dose (150 mg/day), which I stayed on for two months, and resulted in significant
shrinkage of my prostate. In March 2009, we ended the Casodex, and I received
a one-year implanted dose of Vantas,
a LHRH agonist, aka androgen deprivation therapy (ADT). At that time I was also
diagnosed with osteopenia,
a precursor to full-blown osteoporosis. Since ADT depletes bone and muscle mass,
I continue to receive quarterly infusions of zoledronic acid (Zometa) and take
lots of calcium and vitamin D daily.
I began Radiation therapy (RT) in
April, 2009, which consisted of 25 sessions of intensity-modulated RT (IMRT) pus
17 sessions of image-guided RT (IGRT), for a total of 79 Grays of radiation. At
post-treatment follow-up visit with my radiation oncologist, he felt the Vantas
was not forcing my testosterone level low enough, so he and the urologist recommended
that I begin Combined Androgen Blockade (CAB), which is the Vantas plus 50 mg
Casodex, in which state I remain in today, (December 2009).
My PSA has
been undetectable (<0.001 ng/ml) since the conclusion of radiation (this is good),
but my testosterone level has continued to increase (less good) and I will be
moving to a different ADT drug, Degralex, when the Vantas implant is removed in
March 2010. My urologist states I should remain on the CAB regimen for at least
three years and then, "we'll see."
At 6 months out from the end of radiation,
the well-known radiation side effects (urinary difficulty, bowel problems) have
mostly disappeared. However, the ADT/CAB side effects remain: mostly in the form
of several hot flashes each day and I wake up at least once each night with a
hot flash, although these pass within a minute or so.
Since weight gain
is yet another delightful side effect of ADT, I have cut out red meat, bleached
grains and alcohol and have been able to keep my weight steady for the past 6
months. I have lost about half of my body hair; my sexual equipment has atrophied
and sex itself is but a pleasant memory.
One
thing that's helped offset the feminizing effects of ADT is I now have a buzz
cut
haircut that reminds me of my Navy days. I also got a tattoo (the words "prostate
cancer
survivor" written in Tengwar
script from "Lord of the Rings" around
my right wrist). I guess aggressive cancer incited more risk-taking "I don't really
care what other people think" behavior than I thought I had inside me.
Resistance
exercise is the well-documented antidote to muscle mass loss due to ADT, so I
work out 45 minutes to an hour five days a week at the gym, focusing mainly on
core muscle resistance using an exercise ball and various weight machines. I am
not a free weight fan, but perhaps one of these days...
At this point it
is down to living - and enjoying - one day at a time. The thing no one tells you
about hot flashes is not that they aren't unbearable (they're annoying, but bearable),
but that every time one occurs my body reminds me "yes, Craig, you have cancer."
So be it. I'm still here - and plan to be for a long time yet.
Craig's
e-mail address is: ctpynn@comcast.net
