Paul Hoskins' Prostate Cancer Journey

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by PaulHoskins » August 19th, 2011, 3:27 pm
Paul Murray Hoskins
DOB: 12 June 1947, Adelaide, South Australia
Worked in the Mining Industry with Rio Tinto for 30 years in Tom Price - West Australia, Bougainville – PNG, Jakarta & Sangatta – Indonesia, 4 USA Sites & Diavik – NWT, Canada.

Existing Conditions & Medication
Jun-1996 Rheumatoid Arthritis
....Methotrexate (BL) 2.5mg – 6/w; Megafol 0.5mg – 1/d;
Jul-1999 Asthma
....Fluticasone Propionate 500mg & Salmeterol 50mg – 2/d; Salbutamol B. P. – as req’d;
Sep-2002 Glaucoma
....Brinzolamide 10 mg / ml – 2/d;
Jun-2005 Myocardial Infarction (1 Stent)M
....Metoprolol 50mg – 1/d; Asprin 100mg – 1/d;Clopidogrel 75mg – 1/d; Ramipril 2.5mg – 1/d;
Nov-2006 Familial Hypercholesterolemia
....Fenofibrate 48mg – 2/d;

Prostate Cancer
Oct-2006 PSA = 9.0 Presented with lower back pain
....Ultrasound Prostate - Prostate appears slightly prominent, Normal Study.
Nov-2006 PSA = 9.0 Recheck PSA
Feb-2007 PSA = 8.5 Muscle Pain & Lower back pain still evident (Mobic)
Aug-2007 PSA = 11.9 Muscle Pain (Crestor)
....Told by GP ‘The probability of prostatic cancer increases with the PSA level. Levels rise with staging and may reach several
....thousand in metastatic disease.’ Read straight from Blood Result sheet.
Mar-2008 PSA = 19.2 Recheck PSA

Saw NEW Doctor

Apr-2008 PSA = 19.2 Previous GP failed to identify Prostate Cancer
....DRE – Lump LHS Prostate, Clinical Stage T2 Cancer
May-2008 TRUS & Biopsy – Gleason 3+4=7, Aggressive, 5yr – 10yr Survival
Jun-2008 CT Scan - Lower & Upper Abdomen & Pelvic - Prostate is enlarged and is seen to indent the bladder base posteriorly.
....Bone Scan - Multiple areas of irregularly increased tracer uptake noted. There is a prominent focus in the upper sacrum.
....Multiple abnormalities highly suspicious for scattered metastases in the thoracic spine, ribs, sacrum, pelvis and left femur.
....MRI - Multilevel vertebral body metastases (C4, T1-T3, T8-T10, S1-S2) most pronounced at the S1 (Sacrum) level where
....there is early posterior epidural soft tissue extension. Also posterior 11th and lateral 5th ribs on the LHS, the anterior iliac
....crest and the greater trochanter of the left femur.
Jul-2008 Ten (10) daily EBRT (External Beam Radiation Therapy) sessions focusing on the S1 Sacrum spinal area.
....ADT2, with Cyproterone Acetate 50mg - 2/d for 25 days & Zoladex 10.8mg Implant.
Aug-2008 PSA = 62.0 Cosudex 50mg – 1/d after Urologist visit.
Mar-2010 PSA = 0.26 Lowest PSA level during ADT2
Nov-2010 PSA = 0.55 Bone Scan - There are no new lesions seen to suggest hormone resistant metastases. No fractures or other bony pathology.
Jul-2011 PSA = 2.30 Bone Scan - No significant change in the scan appearances over the past 8 months.
....Stable metastasis in the thoracic spine and sacrum. No evidence of new skeletal metastases.
....PSA Doubling time 2.78 months
Jul-2011..Stop taking Cosudex

Current Medication Side Effects
Impotent, hot flashes, metabolic syndrome, man boobs, insomnia, foot neuropathy, body hair loss.

Future
Start Zometa (Bisphosphonates) infusions in September.

Update July 2012
Since Sept 2011 I have had ten (10) Zometa Infusions. The side effects from the first two were fairly painful (first - chest pains akin to a heart attack (I had one in 2005 so know the pain) - Second one gave me severe kidney pain) the remainder of the infusions are quite pain free the biggest chore is drinking the 2 litres of water after the infusion.
In November my Urologist (Dr. Chandra Perumalla) was talking about Chemo, reintroducing Casodex & looking for drug trials and gave me a 12-24 month prognosis with my PSA at 6.40 and a Doubling time of 2.78 months.
Since starting Zometa my PSA has done an about face from the 6.40 in October 2011 and a Doubling time of 2.78 months, my next PSA in Dec 2011 was 1.40 and April 2012 was 0.99,
Urologist (Dr. Chandra Perumalla) thinks it is a 'Hormone Relapse', my Oncologist (Dr. Michelle Cronk) is unsure.

 

With the lower than expected PSA my thoughts ran wild. Was it a sample error or some other factor ? I had altered my medication regime over the past few months, starting Metformin and Zometa in September 2011 and stopping Methotrexate in November 2011. Metformin has been reported as having “a direct action on cancer cells is suspected. Indeed, metformin exhibits a strong and consistent antiproliferative action on several cancer cell lines, including breast, colon, ovarian, pancreatic, lung and prostate cancer cells”, and Zometa “also has some anti-cancer effect on the cancerous cells in the bone, which helps reduce the growth of the cancer in the bones”.

I am now on 6 weekly Zometa Infusions (previously 4 weekly) and have a PSA reading next week, it will be interesting to see what transpires. I have not experienced any bone pain of late.

 

Update March 2013

Amazingly for the rest of 2012 my highest PSA reading was 1.50 (in October). I continued with Zolodex Implants every three (3) months and Zometa infusion every six (6) weeks.

 

I started 2013 with a PSA of 1.90 and a Bone Scan with results showing “A new small discrete focus of moderately intense osteoblastic (bone) activity is seen in the mid sternum and a stable osteoblastic lesion in the left pubis medially. Mild hyoid bone uptake and low level uptake irregularly throughout the thoracic spine are unchanged from one year ago”.

 

Current Medication Side Effects

After forty-two (42) months on ADT my side effects include impotency, body hair loss, hot flashes, insomnia, metabolic syndrome, foot neuropathy, gynecomastia (man boobs) and diabetes mellitus II.

 

Next month, April 2013, I will have my 20th Zoladex Implant and my 17th Zometa Infusion.

 

A lot of people look at me and say I look fit and healthy, no sign of terminal prostate cancer !

There is a lot going on in my mind and body !

 

I live my life in three (3) month blocks, waiting for the next PSA result !

 

Update End 2014 my Annus Horribilis'

 

On 30 December I had visible blood in my urine and I did a Urinary Tract infection test. Result was no infection only blood so a CT Scan of my Abdomen & pelvis was performed. The scan result indicated "there has been a significant increase in the size (+20mm), irregularity and extension of the prostatic lesion with extension outside  the capsule, into the bladder, and an enlarged lymph node (9mm) seen in the left pelvis. There is a new partial obstruction of the left ureter and kidney."

 

I commenced EBRT on Tues 18 Feb 2014. At the pre-EBRT planning session I was informed that the radiotherapy would be directed at a large area of my abdomen to ensure that my prostate, bladder and compromised lymph node would be radiated. There were ten (10) EBRT sessions carried out over twelve days. The worst side-effect was the diarrhoea, which started on the seventh day of radiation and continued for six weeks.

 

On Tuesday 8 April I presented to my GP for my 24th Zolodex implant, equating to six (6) years on ADT. My Oncologist informed me that I will stay on ADT until I die, due to the aggressive nature of my cancer.

 

April 17th at the Oncologist and my PSA was 21.0, we expected a lower result after the EBRT. Therefore a Bone Scan was scheduled for 3 June, which indicated "Progression in the size of the lesion in the upper sternum. A new lesion is seen in the medial right pubis and there has been mild progression in the lesion in the left pubis. There is low level uptake about the L5/S1 intervertebral disc. Focal uptake is once again noted in the hyoid bone in the midline, unchanged from previously."

 

My PSA increased to 23.0 and the bone pain, in my thoracic spine increased significantly. I also had my 27th Zometa infusion in June. Resulting from all of this I started chemotherapy (Docetaxel & Prednisolone) on the 10th July. I had six (6) sessions, three (3) weeks apart and the last infusion was on the 23rd October.

 

Luckily (great word) my chemo side-effects were only minimal; loss of hair, furry mouth, mouth ulcers, headaches, tingling hands & feet, finger & toe nails lifting, watering eyes and skin rashes. No nausea or diarrhoea (the luckily part).

 

During November I had a Bone Scan (#8) and a CT Scan of my Abdomen & Pelvis (#4). This week I got the results, although reasonable, were less than we (Oncologist & I) expected after the chemo. It appears the disease has been kept stable during the chemotherapy period, with possible improvements over the next few months as my body recovers.

The Bone Scan indicated "there is minimal change in the scan appearance since the prior study five months ago. A possible small new metastasis is seen in the sternum but there is no new evidence of metastatic involvement in the spine to account for the current symptoms (pain in my thoracic spine), other than new focal uptake at T9/T10 (probably the source of my pain!) on the right. The metastases in the sternum and pubis are essentially unchanged."

The CT Scan indicated "an increase in the extent of sclerotic bone disease with deposits within the pubic symphsis and multiple vertebrae. A decrease in the volume of the prostate. There are now bladder calculi."

 

My blood test indicated a PSA of 19.0, unchanged from the September result.

 

We are now back to the "Waiting Game"; waiting for the PSA to rise or waiting for an increase in my bone pain.