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.

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!

My Shoulder

Yesterday my shoulder was very painful where my cancer lives. I used acetaminophen for some relief. This happens when my bursitis acts up. My joint swells and there ain’t room enough in that joint fer the both of ’em. At one point I reached over my shoulder and touched where it hurt. WOW! I barely touched it and pain filled the shoulder! I didn’t do that again!

Later, I was lying in bed when Donna came in and lay next to me to talk. While we were talking, Stubbs came in and got between us! Since my back was to him (and Donna)(I sleep on my right side.), he snuggled up against me and his weight on the back of my shoulder hurt. Finally Donna pulled him over some so he was lightly laying against me.

Then he started purring thinking she was gonna pet him. The vibration from the purring was actually painful!

It is much better today; I can feel the tenderness when I move that arm but I haven’t needed any analgesic today. Obviously it just wants to be left alone!

But it did get me to thinking: how will I know when it mutates and is no longer prostate cancer? We have been using my PSA as an indicator; even the colonies are still prostate tissue, just gone nutso! Once it becomes a more generic form of cancer, that indicator will no longer be accurate. I gotta ask one of my doctors how we know when the s**t has hit the bloodstream.