The Good News, The Bad News.

Its update time. Let me review how I’ve been feeling, and then I’ll go over what the latest MRI indicates.

Ever since I was in Texas, like right after the auto accident 11/10/19 and then on into 2020 here in California, my body has just hurt...... more than usual. It’s like a general bone ache, my joints feel arthritic and often times as if something sharp is being stuck in them. The feet are the usual issue, with severe pain after any excessive walking, while at the same time the top of my feet have a numbness to them. Same is true with my hands and my arms. These chemo drugs come at a cost and I'm not just talking dollars and cents.

Fatigue is an old nemesis that has not gotten any better almost a year out from the radiation. I just have to try to sleep when I can and try and make sure it’s at least seven hours a whack and I also try to pace myself as to what I do each day. If I don’t, I can find myself overextended after a couple of days and walking like a 90-year-old because of the pain in my lower extremities. Therefore, it requires pacing. And it’s not so much my back that that hurts me; what hurts me as a result of the different treatments, particularly the chemotherapy agent, docetaxel, is neuropathic pain as well as the damage the treatments have done to my bones and joints.  My new normal
.
Pain during urination is kind of hit and miss thing. I can almost always bet that my first leak of the day will be impacted on how full my intestines and colon are. If they are full, it’s going to be difficult and probably painful. On the other hand, sometimes I’m just out in public and stop in to use the men’s room and I have to I’ll grab onto the divider and grip with all my strength as it feels like little minnows that are camouflaged with razor blades are running from inside me out. There is no rhyme or reason.

The small hernia that a CT scan picked up in the area between my right leg and pelvis continues to ache and cause pain. I just don't know that I don't want to be cut on anymore.

Emotionally, I must be honest that I’ve been rather depressed. To borrow a rather trite saying, I'm sick and tired of being sick and tired. On top of that, it seems like every time I turn around someone else close to me has been diagnosed with some form of cancer. And that hurts. A VERY dear friend had 80% of her pancreas removed 2 days ago.  And she's young. My sister in law had triple bypass/open heart surgery 4 days ago; no, not cancer but still. I also am trying to stay away from the news as much as possible because the ravings of the lunatic that is currently our president drag me down as well. I’m trying a couple different types of medications to combat the depression.

Sexual function is good.  I often awaken with morning erections (a very healthy thing for a male) and sildenifil is available and highly effective if a moment becomes intimate.  My semen production is virtually nill and there has been no further blood in it.  Good news.  Orgasms are still possible and quite intense.  Did I mention I chose to keep testosterone in my body against ALL medical advice?

MRI Findings

As usual, there’s a good news/bad news approach to this MRI.

The good news is that the main lesion in the peripheral zone of the right midsection of the gland has had a reduction in size. The not so good news is that there is still a mass at the right base of the gland as well as soft tissue extending out well beyond the prostate capsule (this is what’s called an extracapsular extension). It's a problem.

The radiologist also mentioned that there’s been a development of aggressive lymph node involvement this time around. These are “highly suspicious for metastatic lymphadenopathy.” Like 5 out of 5 suspicious.  Not so good.

In summary

So it appears that we have damaged the prostate and at least reduce the size of one of the tumors via the 5 SBRT radiation treatments  But the extracapsular tumor seems to be on a bit of a roll which may explain some of the pain that I’ve had that I didn’t have a year ago. The new, dramatically enlarged lymph node is of concern.  The radiologist wrote, "There is an enlarged, bulky, heterogenous left external iliac lymph node which is new since the prior study, measuring up to a maximum of 17 x 24 mm (20/25). There is another bulky, heterogenous, new lymph node along the right pelvic sidewall, measuring up to a maximum of 19 x 18 mm (20/26)." A "normal" lymph node measures 3-6mm +/- each direction.

They grade the nodes as follows:PI-RADS LEGEND:Overall Assessment Categories (PI-RADS V2):Likelihood that a clinically significant cancer is present based on MRI parameters1. Very low (clinically significant cancer is highly unlikely to be present)2. Low (clinically significant cancer is unlikely to be present)3. Intermediate (the presence of clinically significant cancer is equivocal)4. High (clinically significant cancer is likely to be present)5. Very high (clinically significant cancer is highly likely to be present)

Striving to always be the best, I'm a 5/5.

I’m sure I’ll see the oncologist in the next week or two and we'll sit down and go over all this. But when I saw him a couple months back and when I saw the palliative care physician, they both suggested, in very diplomatic language, that I was perhaps being a bit too hard on myself in terms of feeling like I’m not doing everything I can when I’m fatigued or hurting so bad the day after a bartending gig.  They just said, "keep moving but know you have cells in your groin that demand and will take a lot of your  energy and strength."

This time in 2014 I was officially diagnosed with stage four, Gleason eight, extracapsular, metastatic prostate cancer with mets to the lungs. My lungs were just covered in lesions and they insisted that they needed to do a biopsy to make sure they were dealing with the same kind of cancer. After three biopsies, two weeks in the hospital and two collapsed  lungs, we determined that yes it was indeed the same cancer that was in my prostate. That hospital stay was in March 2014.

By the end of that same year, I had been on but then quit taking Lupron, the hormone deprivation drug, and I had been through six rounds of chemo with docetaxel.
When I quit the Lupron, my oncologist was very alarmed and even had me speak to another oncologist. Chemical castration (and for some men, surgical castration) is the gold standard for dealing with prostate cancer. But I’ve done enough reading and had eight months of my own experience to know that it’s not something I could live with. I was warned by those physicians and numerous others that if I discontinue the Lupron and didn't replace it with some type of hormone blocking drug, I’d be lucky to be alive in two years.

That was five years ago.

So onward through the fog my friends. I keep pushing along, I keep saying a prayer for those that I love that are affected by this fucked up disease.

But I encourage those fighting to listen to physicians, do your research, know that they don't know everything and go with what your gut tells you is right and something you can live with.

And to those who put up with and have stuck with me during this unpleasant journey from all over the planet, thank you.

THANK YOU AND I LOVE EACH OF YOU.