Into Battle Once More

This is an update on some of the unknowns I wrote about in my previous entry. The results of my second PET-PSMA scan have come back and we met with my oncologist on August 20. 

My first PET-PSMA scan occurred on March 27, 2024, prior to receiving any form of treatments to battle the cancer. The scan showed a concentration of cancer in my prostate, plus metastasis (spreading cancer cells) in my hips, a spot on my ribcage, a spot on my shoulder, and a spot on my spine. 

I'm bringing this back up because I was shocked to find that this disease spread like wildfire throughout my skeletal system after that scan until the chemotherapy and hormone suppressants started to take effect. The written report from my second scan (8/14/25) states the following: "Widespread, nonactive foci of osteoblastic metastasis now noted throughout the skeletal system which has significantly progressed since previous study." Of course, the word "nonactive" is the imperative there, referring to the state of the cancer. I sure hope it stays that way because, apparently, my entire skeleton is riddled with "nonactive" cancer cells. If those ever become active again, I believe that will be the end of this story. 

I'm trying, very hard, not to think about that. 

If there was "good" news from the latest scan, its that the cancer that's currently active was found only in my prostate. My oncologist feels that we can avoid more chemotherapy (for now) and hit the focus of activity with radiation treatments. I was glad to hear that, but was taken aback when my radiologist said that we would need 45 radiation treatments, one each day of the week (Monday through Friday) for nine weeks. It's not like there aren't any side-effects from radiation, so this is going to take me down several notches. I keep reminding myself that at least they're not recommending chemo, but that thought only helps a little. 

At of the time of this post, we have yet to schedule those radiation treatments. There are a couple things that need to happen first. On September 5, I'm scheduled to have a procedure where they inject a kind of gel that's supposed to protect certain vital functions "down there" from being irradiated. Then, on September 8, we have an appointment for a CT Simulation, which is where they make a map of the area to focus in on specifically where they want the radiation to hit. Shortly after that, I assume, I'll begin the treatments.

Emotionally, I'm not nearly as relieved to set chemo aside as I thought I would be. To be clear, I am relieved, but I have this sinking feeling that nine weeks of daily radiation treatments is going to take its own kind of toll on my health, such as it currently is. I suppose it boils down to the fact that I was only just starting to feel partially recovered from last year's intense chemo and now I have to somehow mentally prepare to take several steps backward. 

One could argue that, hey, at least I'm still alive, but the quality of my life pales in comparison to where I was in 2023 and earlier. I can only hope that, by the time the radiation treatments have ended some time in November, I can finally start taking steps toward living a more normal life. That's the hope I'm clinging to, anyway. 

A ruby-throated hummingbird foraging for nectar in our garden

Here we go again?

(What you can't really see here are the dozens of pollinators flitting around those flowers.)

 

Since I ended chemotherapy, late last year, I have "check-up" appointments with my oncologist every three months, with bloodwork done a few days before. I mentioned in my last post that my April bloodwork revealed my PSA (Prostate-Specific Antigen, the blood marker for prostate cancer) had gone from 0.2 at the start of this year to 0.65. While that is still well within the "normal" range for PSA (4.0 or less) it worried me because it had tripled in three months. My oncologist told me not to panic, and that we'd only start talking about more treatments if it got up past 2.0.

Three months after that, my PSA registered 2.14, meaning that it had (more than) tripled again, Cancer was clearly still growing, somewhere, and we should start to investigate where and how much. My oncologist put in an order for an expensive PET-PSMA scan, something my insurance balked a bit about when one was requested at the start of this nightmare in the spring of 2024. I expected more balking this time, but the scan was approved right away and we were able to schedule it within a week. I just had that scan on Wednesday (8/13) but won't know the results until we meet with my oncologist next Wednesday (8/20).

One thing is clear: I will need more treatments.

The thought of this depresses me. Although I've been trying to exercise and stay as active as I am able, I'm still nowhere near what anyone could call "recovered" from the cancer-and-chemo induced trauma from last year. The exercise has been helping, and I do feel like I've been getting stronger, but I still have numerous maladies and physical limitations. For example, on any given day when I have some sort of event on the calendar, that one thing is about all I can do that day. I haven't had a day when I've felt up to doing two or three activities (okay, maybe super low energy level activities like doctor's appointments) since before my diagnosis. Also, when I do have the energy to participate in something more enjoyable than a medical appointment, I'm only good for a couple hours before I wear out.

I've been tolerating this because, well, because I don't have much of a choice. Beyond that, though, the thought that has been keeping me feeling positive (most of the time) is that I am s-l-o-w-l-y getting better. In my mind, better days were ahead, I just needed to help bring them on by exercising and staying positive. Throughout most of June and July, I've been feeling like I could see the "old me" on the horizon, and it was a welcome sight to see. The regrowth of some of the cancer and subsequent discussion of more treatments has pretty much drained me of any such positive outlook. 

In the past few weeks, my energy level has gone way down. I find more difficulty in getting out of bed and, much more often than in the preceding months, I have trouble motivating myself to do exercise on my little home gym. I feel so tired, most of the time, that I don't even feel like trying to do things. At first, I was writing this off as the fault of cancer regrowth, but the more my wife and I talk about it the more I realize at least some of it is rooted in depression.

Whether or not I have to go through chemo again (an absolute nightmare last time) will be determined by my oncologist's take on the scan I just had. We've already talked about this, pre-scan, and we're all hoping that the growth is happening in a single location (or two) that can be irradiated. I'm also somewhat encouraged that this oncologist -- a different doctor than the one with whom I started this nightmare journey -- is up on current research and willing to discuss a variety of treatment options. 

Still, I think I spent the first half of this year thinking that I was on a slow road to recovery. I could see it and I could feel it. If I needed more treatments of any sort, it would be a couple years away. 

Not, as it turns out, right now.