January 2024 Check-up

Josephg

I had my 3 month checkup today, and the good news is that my PSA is still undetectable, but my Testosterone has only risen to 26. But, by far, the most important test result is that my PSA is still undetectable. Life is good.

My Related History and Data:

Post-Robotic Prostate Removal Surgery Pathology Report

A. Lymph nodes, right pelvic: Two (2) lymph nodes; negative for metastasis.

B. Lymph nodes, left pelvic: Two (2) lymph nodes; negative for metastasis.

C. Prostate, radical resection:

 1. Prostatic adenocarcinoma, Gleason grade 4+3=7, involving both lobes, at least 2.1cm and occupying 15% of the prostate by volume.

 2. No lymphatic/vascular invasion is present.

 3. Perineural invasion is present.

 4. Invasive carcinoma focally extends into extraprostatic soft tissue adjacent to the left posterior prostate (C20).

 5. The Seminal vesicles are free of carcinoma.

 6. The inked margins are free of carcinoma.

 7. High-grade PIN is present.

 8. Necrotizing granulomas are present within the prostate parenchyma; stains for microorganisms will be performed and reported in an addendum.

D. Left mid margin: Fibrovascular tissue; negative for tumor.

Diagnosis Comment: AJCC: pT3a NO

Da Vinci Robotic Prostate Removal Surgery

11/21/2011

AMS 800 Artificial Sphincter Implant Surgery

1/9/2013 - Original implant

9/28/2019 - Replacement implant (original implant failed, due to leakage)

First Hormone Therapy (Lupron tri-monthly and Casodex daily)

Started 5/4/2013

Stopped 11/6/2013 (2nd and last 3-month dosage shot given on 8/6/2013)

Second Hormone Therapy (Lupron tri-monthly and Zytiga/Prednisone daily)

Started 1/29/2021

Stopped 1/14/2023

First Radiation Therapy IMRT (38 visits, 68 Grays)

Started 6/4/2013

Stopped 8/9/2013

Second Radiation Therapy SBRT (3 visits, 30 Grays)

Started 2/17/2021

Stopped 2/22/2021

PET Scan Report - 1/21/2021

Technique: Radiopharmaceutical: F-18-fluciclovine. Dose: 10.87 mCi.

Image acquisition: Approximately 3-5 minutes following IV tracer administration via a right antecubital fossa vein, positron emission tomography was performed from the vertex through the mid thigh. Non-contrast low-dose helical CT imaging was performed over the same range without breath-hold for attenuation correction of PET images and anatomic correlation.

Results: There is focal mildly increased radiotracer uptake within a sclerotic lesion in the left inferior pubic ramus, most likely representing an osseous metastasis.

MRI – 6/21/2021

To assess the initial results of the SBRT radiation therapy to my left hip. This will also serve as a baseline for future imaging assessments in this area.

First Bone Density Scan – 8/4/2021

Baseline for future scans, to identify any changes in bone density, due to long term hormone treatment

Second Bone Density Scan – 9/21/2023

- Bone Density -

BMD BMD Change BMD Change

Site (g/cm2) T-score Z-score Since (Baseline) Since (Prior Scan)

--------- ------- ------- ------- ------------------- -------------------

AP Spine

L1 L3 L4 1.026 -0.6 0.3 -3.6% (08/04/2021) -3.6% (08/04/2021)

Left Hip

Fem Neck 0.769 -1.2 0.0 -4.8% (08/04/2021) -4.8% (08/04/2021)

Total 0.889 -1.0 -0.3 -3.1% (08/04/2021) -3.1% (08/04/2021)

--------- ------- ------- ------- ------------------- -------------------

Interpretation: Osteopenia (low bone mass).

CT Scan and First Bone Scan – 10/7/2022

Both scans were to determine if any signs of existing PCa were visible. No visible signs of PCa in either scan.

PSA History

5.22 - 6/28/2011 (59 years old)

0.05 - 12/22/2011

0.05 - 3/25/2012

0.05 - 6/22/2012

0.06 - 10/13/2012

0.08 - 12/31/2012

0.11 - 3/30/2013

0.13 - 4/23/2013

0.02 - 8/6/2013

0.02 - 11/26/2013

<0.015 - 7/28/2014

<0.015 - 1/3/2015

<0.015 - 7/7/2015

0.02 - 1/15/2016

0.05 - 8/23/2016

0.07 - 2/21/2017

0.10 - 8/22/2017

0.13 - 12/29/2017

0.19 - 6/18/2018

0.26 - 10/15/2018

0.29 – 2/11/2019

0.41 - 5/20/2019

0.43 - 9/13/2019

0.46 - 1/17/2020

0.65 - 5/22/2020

0.97 - 9/25/2020

0.98 - 1/11/2021

0.25 - 3/4/2021

0.05 - 4/28/2021

<0.02 - 8/4/2021

<0.02 - 1/19/2022

<0.02 – 4/20/2022

<0.02 – 7/13/2022

<0.02 – 10/17/2022

<0.02 – 1/11/2023

<0.02 – 4/12/2023

<0.02 – 7/12/2023

<0.02 – 10/11/2023

<0.02 – 1/17/2024

 Related Permanent Side Effects

Complete Incontinence - Prostate removal surgery (had to remove the left side nerve bundle)

ED - Prostate removal surgery (had to remove the left side nerve bundle)

Gynecomastia (benign breast tissue growth) - Hormone treatments of Lupron and/or Casodex

Hyperhidrosis (excessive sweating every time performing very minor physical activity) - Hormone treatments of Lupron and/or Casodex.

Hematuria (abundant blood in urine) - Radiation treatments caused recurring instances of bladder wall inflammation. Biopsy negative.

Osteopenia (low bone mass) – Hormone treatments of Lupron and/or Zytiga

Clevelandguy

Hi,

Good news on your PSA reports, sounds like you have been through a lot. Keep your spirits up.

Dave 3+4

Old Salt

Your last hormone therapy shot was active until (approximately) Nov 6; consequently, the drug is still 'washing out' of your system. Hopefully, your T will slowly creep up once it is totally gone. As you probably know, T recovery is slower in older men.

Josephg

Old Salt, my last Lupron shot was on 1/14/2023, just over a year ago. But, I had been on the Lupron/Zytiga/Prednisone cocktail for 2 years. My Oncologist said that it is not unusual for Testosterone to take well over a year to recover, if at all, for the length of time that I've been on that cocktail. So, I will just wait and see.

PSA is not detectable, so life is good.

Josephg

I had my 3 month checkup yesterday, and my PSA was <0.02, which is good news to me. My Testosterone was only 27, 1 point up from 26, 3 months ago. While the Testosterone number was not what I had hoped for, my PSA remains undetectable, which is by for the most important measure. I have now been off of the Lupron/ Arbiraterone/Prednisone cocktail since January 2023 (after a 2 year therapy regimen), and I'm still having all of the symptoms of ADT, due to the lagging Testosterone measure. Annoying to some extent, but well within my desired quality of life status. So, life goes on for the next 3 months, until my next checkup.

Old Salt

Good news to all of us!

Keep exercising please; that might help with the T and your overall quality of life.