Checkup Status - Post-Radiation / Existing Hormone - 8/5/2021

Summary:

I had my 3 month checkup yesterday, and my PSA has dropped to <0.02 (from 0.05 three months ago), which is now considered undetectable.  This is good news, in that my current hormone cocktail of leuprolide acetate, abiraterone acetate, and prednisone is currently effective in slowing down the bandit and potentially forcing it into a period of dormancy.  All of my bloodwork parameters are within the standard control limits, so currently my hormone cocktail is not overtly interfering with my liver and kidney functions.  I did not see a Testosterone level in my bloodwork results, so I have requested that it be added to my bloodwork script for all future blood draws.

I also received my third 3-month leuprolide acetate injection, 3 down and 5 to go, in my 2 year hormone cocktail regimen.  Apparently, the Lupron brand shortage is over, as I received a Lupron brand injection (intramuscular, injected into the butt) versus the previous 2 Eligard brand injections (subcutaneous, injected into the abdominal fat tissue).  My preference is Eligard (though, I don't have a choice, since Lupron is apparently much cheaper), as it is painful for only 1 minute after injection, while the Lupron injection is painful in the butt for 2-4 days.  That said, I am told that many folks prefer the Lupron injection over the Eligard injection.

I had a follow-up MRI in June to view the recently SBRT radiated lesion in my pelvic bone, and it did not show any new issues.  This MRI image will be used as a baseline for observing this area in the future.

I also had a bone density scan yesterday, and this will serve as a baseline for monitoring any future bone density changes, resulting from long term hormone therapy.

As always, I appreciate the guidance and support that I have received from the members of this Discussion Board, and I wish you all the best of outcomes on your PCa journeys.

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 (Eligard/Lupron tri-monthly and Casodex daily)

Started 1/29/2021

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

Reviewed the initial results of the 6/2021 SBRT radiation therapy and set a baseline for future monitoring of the left pelvic bone.

Bone Density Scan - 8/4/2021

Set a baseline for monitoring any future changes resulting from long term hormone therapy.

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

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.

Previous Related Posts (Mostly artificial sphincter and hormone/radiation experiences):

Artificial Sphincter Experiences

http://csn.cancer.org/comment/1324584#comment-1324584

http://csn.cancer.org/comment/1326323#comment-1326323

http://csn.cancer.org/comment/1339326#comment-1339326

http://csn.cancer.org/comment/1339561#comment-1339561

http://csn.cancer.org/comment/1344785#comment-1344785

http://csn.cancer.org/comment/1413239#comment-1413239

Hormone and Radiation Salvage Treatment Experiences

http://csn.cancer.org/comment/1414101#comment-1414101

http://csn.cancer.org/comment/1414282#comment-1414282

http://csn.cancer.org/node/299431