I visited with my palliative care doc three days ago. He's really the only physician I see regularly and even with him, it's only every two or three months.
We were following up after two months, months in which I experienced a 1 night hospital stay due to infection as well as bone x-rays after inexplicable pain in my hips/thighs. No signs of mets from the waist down, thankfully. There has also been an increase in fatigue.
My PSA, however, is doubling at an exponential rate as can be seen here and was 9 in March and 26.6 in October
So my PSA has more than doubled in the last 7 months or so +/-. PSA doubling time is an indicator of PCa (prostate cancer/metastasis activity). My physician stated that the more aggressive the cancer, the lower your PSA is going to be. Since so many men have readings in the (literally) thousands, it would seem that I'm doing quite well. My PSA when diagnosed in 2014 was under a 5 and has never been higher than it is now. So what does this mean? The cancer is active.
As my primary goal is preemptive, palliative care, I spoke with my palliative physician and he suggested we do a bone scan as well as a full body MRI. Again, the goal is not to cure.....there is none at this time. The goal is to try and prevent very painful complications from the tumor.
And with that, let me run down symptoms and basic vital signs.
Fatigue: Exacerbated in the last 2-3 months.
Pain: My old friend, chemo induced peripheral neuropathy (CIPN) remains loyal and by my side. Pain killers keep it to where I can walk a good deal without it being excruciating. It's my biggest regret from chemo. About two weeks ago, I began to have severe, deep pain in my hips, wrapping to the front of my thighs. XRays show no sign of metastasis. A relative once asked as we were walking, "Why are you limping? Just because you can?" The relative meant it in a playful way, but my thought process was, no dammit! I'm limping because my feet feel like they are wrapped on barbed wire. Chronic pain is something others can't see and have trouble understanding. But it is real and it is disabling.
Pulmonary function: By and large good. Here in the Bay Area, we spent much of last month indoors as tons and tons of poisonous smoke filled the skies. One night I began having difficulty breathing, so I sucked it up and went to the ER. Quickly tested for COVID, I was determined negative but the ER doc was concerned enough, he asked me to stay for observation. I did, it was a blood infection and I was released late afternoon the next day with fistfuls of antibiotics.
G/U function: Urination is good and not problematic as long as I take the generic Flomax. Sexual function is better than I anticipated (after the SBRT) with nocturnal erections taking place more often than not.
Bowel function: No problems
Emotional: Thanks to an increase in my prozac dosage, little is getting me down mentally. From a dear relative that died to the covid craziness of the last 7 months, nothing seems to be getting me down. This its important.
The increase in PSA is noteworthy and indicates something is going on. We'll do the 2 scans and see if we can see what it is.
I'm just in a good place, whatever happens. I have a roof over my head, money in the banks (thanks to as least a couple of generous friends and the US Congress), food in the fridge and decent clothes to wear.
I am a lucky man and I don't take the extra time I've been given for granted.
