Recurrence

In 2009, I had a radical prostatectomy after which the doctor assured me that there was no indication that the cancer had spread beyond the prostate itself. I don’t recall exactly what the Gleason score was, but it was pretty low. For a number of years, my PSA level was virtually undetectable.

A few years ago, my PSA levels started rising, and in the fall of 2019, I had a PET/CT (Axumin) scan which revealed no detectable sign of metastatic cancer. During the following year – the year of covid lockdown – my PSA rose significantly, so I was referred to a urologic oncologist at St. John’s Medical Center in Santa Monica, Dr. Przemyslaw Twardowski – one of the best in the business. (Unless you’re Polish, don’t even try to pronounce his name; “Dr. T” is probably good.)

He ordered another Axumin PET-CT scan on May 26, and this one revealed only one place where there was significant radiotracer uptake, the left external iliac chain lymph node. Dr. T felt that this was good news because, even though there may be more small undetectable tumors in the pelvic region, it’s unlikely it would have spread further (so far) and it’s easily treatable (and, he said, curable) with a combination of androgen deprivation therapy (Eligard) and salvage radiation (IMRT) therapy. Dr. T gave me the first of the Eligard shots at that time, which will be every three months. For the radiation, he referred me to Dr. Garth Green, of City of Hope’s South Bay Campus, which is only about 10 minutes from where I’m living.

On Friday, June 25, at City of Hope South Bay, I had the initial CT scan to “scope the territory” (my expression, not theirs) in order to precisely aim the beam, and got three tiny tattoo-dots on my lower tummy to enable them to focus precisely (by some sort of triangulation, I assume) on the target and avoid excess radiation to surrounding parts.

Radiation therapy will begin on Tuesday, July 6, at which time there will be a consultation with Dr. Green and the team about the details and scheduling of each session. The sessions are expected to last 10-15 minutes. With a driving time of 10 minutes each way, that’s not bad at all.

It’s anticipated that the radiation therapy will continue for seven weeks, putting us into mid- to late-august, but the Eligard injections (every three months) will go on for a year and a half. I’m anticipating some side effects, but I think there’s reason to hope that they will be minimal. The radiology technician, Frank, told me that with these latest techniques, his clients rarely report the usual side effects of the past. One can hope . . .

I think I’m in good physical, psychological, emotional, and spiritual shape for all of this, even though in September I’ll be celebrating my 79th birthday, and so entering my 80th year. I have much to be grateful for. Yes, thank God for Medicare and Archdiocesan insurance, as well as good and supportive friends – among many other graces. I realize with humility and with sadness that many, many people are not so fortunate.

I hope the only lasting souvenir of all this will be the three tiny tattoos which I’ll carry to my grave.