Another Urologist Appointment: Supplemental

I got a surprise call today from my urologist’s office. Mostly to change my appointment from December 27 to January 4. I don’t understand but it had something to do with insurance and shifting it to next year.

Oh, and incidentally, my PSA was 12.6. And my new drug is to be Firmagon.

I learned more from this phone call than I did from the doctor! Lol.

First the PSA. This is sharply higher but I expected that. PSA tests are notorious for lab variability and I had suspected the doctor’s lab yielded higher results. The 4.48 and 12.6 are results from the doctor’s office; the remainder were done by the Centura Lab Services.

This is higher than I expected. Even if this is 10% high and is really 11.4, it is going up faster than I liked.

Enter my new drug. This is a relatively new drug (2008) and works differently from Lupron. Firmagon is the brand name for Degarelix. This drug suppresses the production of testosterone at the source. So does Lupron but they work differently. Lupron causes “flare up” when it makes the patient’s body go crazy making the stuff until the organs give up and quit. That is why I take Casodex. This drug inhibits uptake by cells of testosterone and I may not be taking it with this new drug. This, BTW, is an expensive drug.

Firmagon works through the pituitary gland instead of directly. The side effects are similar to any lack of male hormones: hot flashes, impotence, low libido, weight gain etc. Much like what I am enjoying with my present drug. Kinda like one of the girls.

The bad news: this drug is given subcutaneously and apparently is oil based like an estrogen shot. I will get a lump (which they call a “depot”) which will dispense the drug for a month. I may get local irritation at the site injection. On my abdomen.

I have hopes this will make a difference in the progress of my parasite.

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Cancer Musings

I do this periodically after some unpleasant news. And my rising PSA is bad news. Just how bad, I am not sure.

When I began this process, one of my several urologists told me some “milestones” in the progress of the disease. One of those was a PSA of 20 when the cancer would likely be spreading into my bones. But mine has never been above 10 and it has metastasized. So I am ahead of schedule. 😉

I went back and looked at my PETScan again. The spots on my rib cage that showed up on my last bone scan in June, 2011 were NOT there in May 2010.

So my parasite is still active “below the radar”. My PSA has been low since I went on full suppression in May of 2010, even with the 3 month break in Lupron. This implies it has already mutated somewhat.

My level was 0.2 ng/mL in August 2010. In Jan 2011, 0.56. By March 2011, it was 2.4 after my Lupron holiday. In retrospect the vacation was a mistake. But after I went back on suppression, my PSA should have dropped below 1.

My urologist told me he wasn’t concerned until my PSA goes over 10. I have a different view if it is spreading while still low. But, using his guideline, and extrapolating from these two tests, I will be over 10 in another 4 cycles or 12 months. Even if the last results were skewed and it really only went up by 1 instead of 1.5, the timeline extends out to 18 months.

I don’t know what happens at 10. But I am guessing it won’t be fun!

A PSA Call

I got a call from my urologist’s office about my PSA. I didn’t mention in my post about the Lupron injection that he had a PSA drawn as well. It seemed like an afterthought. It was 4! Oops. The last one was 2.4. So even with hormone suppression, my PSA level is rising.

Or there are other factors skewing the results: this test varies from lab to lab so his may tend to higher numbers and he also did a digital exam first which elevates PSA.

We talked about my cancer indicators and he said we would use the PSA but he would prescribe bone scans for my peace of mind. He wasn’t gonna worry until my PSA gets in the double digits. The logic of that is, even if it mutates, the new, undifferentiated cells will be mixed with the existing prostate cancer cells. If they start growing, the undiff cells will be crowding and annoying the existing cells, raising my PSA.

So I don’t know at this point if it is actually increasing. Nor does it matter at this point.

They are gonna send me a lab script to get a PSA in a couple of months.