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Fatigue Prior to Treatment

Mulhaley
Posts: 12
Joined: Mar 2017

Hello Everyone--

Glad to find this forum.  So many of you are helpfully candid and encouraging, which is welcome support when one is faced with this kind of thing.  Diagnosed this month with PC---PSA 6.3, MRI showed lesion, biopsy confirmed two areas of adenocarcinoma.  MY PSA level has been gradually rising for around 4 years, so I was not surprised by the biopsy result.  Da Vinci-assisted RP scheduled for May.  My question is about your condition before you began treatment: did you have an unusual level of fatigue?  I'm 61, overweight by about 30 lbs., but I've been exceptionally fatigued the last year or so.  Could it be attributed to the disease?  I neglected to ask my urologist about this. 

hopeful and opt...
Posts: 2012
Joined: Apr 2009

Good idea to see your Internist for a full physical. 

Heart healthy life style is prostate cancer healthy as well.........eat right and daily exercise....in fact, we are more likely to die from heart disease than prostate cancer since heart disease is epidemic.

Please list your PSA history; the Gleason score of the two cores that were positive...what did the digital rectal exam reveal? Any other tests?

VascodaGama's picture
VascodaGama
Posts: 2546
Joined: Nov 2010

M,

Welcome to the board. Cancer can cause fatigue but I would think such to occur when the cancer is wide spread showing higher PSA. Something else is causing the fatigue. You are dealing with the unknown, so it could be an underlining feeling due to stress. We all experience such anxiety after been diagnosed and during the decision period, "What's the next best step?"

In any case, you should try to be the fitness possible for the surgery as this is not a walk in the park but a major surgery. You should get an overall health check up. Surgeons play it at easy but many things can happen. I do not think that your 30lbs overweight would cause a problem for the surgery but an heart issue would. Surely you can always postpone the surgery with no prejudice to your cancer condition and treatment. Better safe than sorry.

Best wishes and luck.

VG

Clevelandguy
Posts: 208
Joined: Jun 2015

Hi,

Might want to talk to your general MD and see if your bloodwork is OK.  Could be a lot of things.  I did not notice any general fatigue with my PCa before I had my robotic prostate removal.

Dave 3+4

Old Salt
Posts: 483
Joined: Aug 2014

Very unlikely that your fatigue has anything to do with your prostate. And yes, do get a physical. I will go way out on a limb here, but low thyroid activity (hypothyroidism) can lead to fatigue.

RobLee's picture
RobLee
Posts: 136
Joined: Feb 2017

No fatigue, but lowered endurance yes, and even some depression... something I'd never had before. This was during the two year period between biopsies, which is apparently when my PCa began to wander outside the confines of the prostate and started to settle in elsewhere.

I didn't know it at the time, but looking back, all the pieces fit together. I was 63 at the time, so attributed my fatigue to age. I've heard others mention mood swings as well, even before knowing they already had cancer.

hewhositsoncushions
Posts: 112
Joined: Mar 2017

Diet, booze, weight, sleep apnoea, not enough sleep, not enough exercise, stress, Low T, late middle age, nagging missus, tough job, stroppy teenagers ....

Plenty of stuff to look at and work on before cancer comes into the picture.

Trust me on this - I've got all of the above :)

Mulhaley
Posts: 12
Joined: Mar 2017

Does sound like me.  No teens in the house anymore, thankfully. 

hewhositsoncushions
Posts: 112
Joined: Mar 2017

So what are your plans to fix them?

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 2664
Joined: May 2012

hewho,

Your post "Diet, booze..." reminds me of a favorite line of mine from the Big Sur poet Robinson Jeffers, who wrote mostly around WW II.  Jeffers was a pessimist and very brooding. 

In a poem regarding the decline of civilization, the refrain after each stanza was: "All shall be worse confounded soon."

.

Mulhaley
Posts: 12
Joined: Mar 2017

Well sir, I'm taking a moratorium on the booze, I've only taken in about 800 calories so far today (a few hours pre-dinner), and did about 25 minutes on the treadmill.  Hope to keep it up. 

Mulhaley
Posts: 12
Joined: Mar 2017

Thanks all for the input.  I have been a cardiac patient for nearly 20 years (heart, T2 diabetes and now this...), but I just saw my cardiologist, got an EKG and an exam and he deemed my heart okay.  I'll look into the thyroid issue. 

 

11 cores taken, 3 positive: left apex and left base.  Gleason 4+3, grade group 3.  60-75% Gleason pattern 4 in tumor volume.  Other cores exhibited granulomatous prostatitus, which my urologist found a little surprising.  Several DREs gave my doctors no cause for concern.  When my PSA level topped 6 (after monitoring it for a few years), my urologist suggested the biopsy.

 

Swingshiftworker
Posts: 1004
Joined: Mar 2010

Anything is possible but I think it unlikely that your fatigue and depression stems from prostate cancer.

Generally, men w/a Gleason 6 level of prostate cancer (which is the lowest level) are asymptomatic and have no idea that they have cancer because there are no obviously physical effects caused by it.

So, as suggested above, please consult your physician, get a full phsyical work up and develop a plan to eat better, exercise and reduce your weight which should resolve the fatigue problem BUT depression is an entirely different matter.  For that, you may wish to consult w/a counselor or therapist. 

Good luck!

RobLee's picture
RobLee
Posts: 136
Joined: Feb 2017

Was that for him, or for me? My PCa was G8 and locally advanced... reason enough to be depressed (though I do not believe I was).

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 2664
Joined: May 2012

Rob,

I was run over by a car at age 30, but was functional again within about two years.  I was in an appointment with my Lymphma N.P. one day in my lifetime followup program, which monitors patient 'wellness'.   She said I seemed a bit down, and I quipped, "I was depressed, then I got cancer."

She laughed out loud, which made me feeel good -- the fact that she got it, and was able to overcome all the PC rules of how to think in society, and actually have a sense of humor.  Bless her, for she is a rarity.

Rationally, contracting a disease that is potentially fatal, and that will cause lifetime difficulty, struggle, and worry is damn sufficient reason for a person to get depressed.  I know the gung-ho, Semper fi mentality here is critical and necessary. But being depressed with cancer seems very understandable and not a cause of shame or reason to be viewed as weak.  I do not view myself as weak, and neither is any other PCa patient who becomes depressed.  Not you, not anyone. To be fully clear: I agree with the thrust of your post.

RobLee's picture
RobLee
Posts: 136
Joined: Feb 2017

Thanks, Max... that was a good anecdote. I certainly could have used an experience like that back when I was "down".  I was unsure whether or not Swingshift's suggestion to seeking profesisonal counseling was intended in response to my mention of depression a few posts up (http://csn.cancer.org/comment/1575279#comment-1575279) in which I mentioned "No fatigue, but lowered endurance yes, and even some depression".

At the time I had rising PSA and uro symptoms but negative biopsy and DRE. My wife would tell me "you're depressed", as though what I had could be treated by a pill... this even though I have never been diagnosed or treated for any psych or emotional problems. I do remember being somewhat moody and suspect that eventhough I had not yet been diagnosed with PCa, looking back I think there must have been some chemical reaction working on me. Once I was diagnosed - over a year later, then all the pieces fell into place and I could finally get treatment.

So while I am willing to accept that some may become depressed upon learning that they have cancer, I also suspect that simply having cancer, though yet unknown, might release some chemical into the body that could affect one's mood, as well as possibly cause fatigue and lowered endurance.

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 2664
Joined: May 2012

I agree with SSW that few PCa guys report pre-treatment fatigue.   It is worth checking out.  Fatigue is universal in Lymphoma, my first cancer; I slept 12 hours a day before diagnosis, but still could barely drag around.   I am NOT suggesting that you might have Lymphoma, merely saying that severe fatigue is symptomatic of a range of other diseases, which deserves investigation now.  The simplest and cheapest way for your GP to look into this is with blood work: a CBC and Metabolic Panel, at least.

max

Mulhaley
Posts: 12
Joined: Mar 2017

Thanks Max.  I'll look into it. 

hopeful and opt...
Posts: 2012
Joined: Apr 2009

To change the emphasis of this thread, you stated, 

"11 cores taken, 3 positive: left apex and left base.  Gleason 4+3, grade group 3.  60-75% Gleason pattern 4 in tumor volume.  Other cores exhibited granulomatous prostatitus, which my urologist found a little surprising.  Several DREs gave my doctors no cause for concern.  When my PSA level topped 6 (after monitoring it for a few years), my urologist suggested the biopsy."

You also stated that you are seeking a RP.

With a 4=3=7 there may be a chance that the cancer has escaped the prostate. Have you had any image tests. A 3T MRI may show if there is extracapsular extension. Surgery is localized to the prostate, so if in fact the cancer has escaped, additional active therapy will be necessary , ie radiation and or hormone treatments. The potential side effects of each treatment type is cummulative.

Did you speak with a radiation oncologist. The perimeter of the radiaiton can be adjusted, so that it goes beyond the prostate, which is a benefit for more advanced diagnosis.

Hopefully SSW will post a list of treatment options that are available for you.

To emphasize, it is my thought that you want to do your due diligence now, and obtain complete diagnostic testing to avoid future consequences.

 

Mulhaley
Posts: 12
Joined: Mar 2017

Thanks, that's good advice.  We did an MRI about a year ago that showed one lesion.  The biopsy said two areas were cancerous.  So one made itself known since the imaging session.  My urologist advised surgery, but he did suggest that if it has extended beyond the capsule hormone therapy would be indicated.  I'll look for a radiation oncologist to consult with. 

Mulhaley
Posts: 12
Joined: Mar 2017

I took your advice and asked my urologist to order a T3 MRI to see what's going on.  If indeed there are extensions, I will consult with a radiation oncologist.  Thanks for your input, much appreciated.

hopeful and opt...
Posts: 2012
Joined: Apr 2009

Glad that you listened, and are taking action. 

Best 

h

Clevelandguy
Posts: 208
Joined: Jun 2015

Hi,

You might want to look into Proton therapy.  From what I understand it goes right throught your body to the tumor.  It does not go past the tumor like other sources of radiation.  Some types of radiation treatments hit on the way in, then the tumor, then hit tissue on the way out as the beam goes throught you body.  Proton therapy  has a fixed beam length which should limit some collateral damage on the other side of the tumor.

Dave 3+4

RobLee's picture
RobLee
Posts: 136
Joined: Feb 2017

I've heard that some insurance still does not cover proton therapy. Worth investigating before jumping in.

Swingshiftworker
Posts: 1004
Joined: Mar 2010

I investigated PBT (proton beam therapy) at the same time that I was investigating CK (cyberknife stereotatic radiation body treatmennt) and I determined that CK is by far superior to PBT.  Here's what I learned:

1) PBT was NOT covered by insurance and CK was.  That may have changed but PBT was also more expensive than CK.

2) PBT is only available at limited sites because they have to build (or alread have available) a cyclotron to generate the proton beam.  That's why you usually find PBT only at university sponsored medical centers.  This is also why PBT is more costly than CK.   CK equipment can easily fit a normal surgical room.

3) PBT required 5 daily treatments over 8 weeks, much the same as IMRT. However, unlike IMRT which is widely available, the limited availability of PBT means that you will probably have to move to the treatment location for 2 months in order to complete the treatments.  The number of treatments may have since been reduced (as they have been for IMRT) but it is unlikely that fewer than 20 treatments are required which still means a month living near the treatment site.  CK only requires 3-4 treatments over a week's time.  CK sites are available nationwide in many cities/town but, even if there isn't a CK site located near you, you would only have to stay there for a week at most -- not 1-2 months.

4) At the time I looked into it, treatment w/PBT required the patient to be fitted for and placed in a body cast so that there would be no movement during treatment AND a baloon filled with water also had to be inserted in the rectum to protect it from proton beam radiation.  I was told that the body cast is no longer required; not sure about the balloon.  CK never required such devices for treatment.  CK is accurate down to the sub-mm level and treatment can be delivered in 360 degrees and adjusted for both body and organ movement.  During my treatment, the operator actually stopped treatment until gas passed through my intestine.  Now THAT is precision!!

These were the major differences that I found between PBT and CK and make clear why I chose CK over PBT.

Old Salt
Posts: 483
Joined: Aug 2014

I am largely in agreement with the points that Swingshiftworker made.

There's no convincing evidence (published in refereed medical journals) that proton beam therapy is better with respect to curing the cancer(s) and subsequent side effects. Moreover, SBRT is so much faster (five sessions); what's  not to like, assuming you are a candidate for radiation therapy. And finally there is the money/insurance issue.

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