As part of my visit to UCLH on Wednesday for my outpatient’s appointment I also had a blood test and today I got the results which are for the most part ok but one of the things I keep a close eye on is the PSA or Prostate Specific Antigen.
And on Wednesday at the time of the blood test my PSA was 305 which of course is very high and has gone up 10 from 295 at the start of June.
While it has gone up, I am actually pleased that it has not gone up by much. That said I started the year with a PSA of 150 so it has doubled over a six-month period.
For those who may not know the PSA for my age should be around 4 so 305 is very high but it has been as high as 1,585 so in many ways it is in a good place.
The PSA is not an indication of cancer but a high or rising PSA can suggest some kind of problem with the prostate like an infection or cancer. But as we know that I have Prostate Cancer any rise in the PSA most likely means an increase in cancer activity (growth).
This of course all ties in with the Lutetium treatment ceasing to be effective against the cancer and so hardly comes as a surprise.
When I start my new treatment, Carboplatin, in a couple of weeks I will be looking for a decrease in my PSA and the bigger the decrease the better.
So watch this space as I will be taking a keen interest in my PSA over the coming months.
Firstly, apologies for not keeping my blog updated and I hope this is a new start to more regular posts.
I am off to UCLH today for my Outpatients appointment. There are a couple of things to catch up on with the team.
I recently had a gene test to see if I have the BRCA 1 and BRCA 2 gene mutations, if I do then it is likely that I could have PARP Inhibitors as my next treatment.
If not it is likely that they will try CarboPlatin, which I believe is a type of chemotherapy.
So a lot at stake at this appointment. I will also have a blood test and see how that looks and what my PSA is.
So back home again now and trying to take in everything that was discussed, it was a slightly longer appointment as there was a lot of ground to cover. I was also given 17 page report on the Foundation One Gene Test that I had on 9th June.
The Foundation One Test was a test to see if I have the BRCA 1 and/or BRCA 2 Gene Mutation. If I do then I would be able to be treated with PARP Inbitors and of course if I don’t then I can’t.
I will try and write more about BRCA and PARP in due course, it’s new to me and so I am still trying to take it in.
That said it turns out I do not have either mutation and so PARP is not suitable for me and so I might not go into too much detail!!!
The Foundation One report is quite complex and is aimed at Doctors and trained health care people and goes into a lot of detail to do with Gene’s. It goes into a lot of detail and just the summary looks like this!
Genomic Signatures Blood Tumor Mutational Burden – 3 Muts/Mb Microsatellite status – MSI-High Not Detected Tumor Fraction – Cannot Be Determined
Gene Alterations For a complete list of the genes assayed, please refer to the Appendix. TMPRSS2 ERG-TMPRSS2 non-canonical fusion AR amplification DNMT3A E814, R366fs41 TET2 C1271fs*29 TP53 R248W
So a bit of reading is needed to take all of this in!!
Although it does turn out I have some gene mutations but nothing that has a treatment linked to it and where they do they are common with men with Prostate Cancer.
I hope all that makes sense?
And so with PARP no longer viable as treatment options we spent sometime discussing other options, these come down to two options.
Carboplatin and Radium 223
Carboplatin is a type of chemotherapy often used with ovarian and lung cancer and sometimes used to treat prostate cancer. There is a small requirement to have certain gene mutations with this but the team thought it a viable treatment for me.
And Radium 223 is a radioactive treatment which targets cancer cells in the bones. And one of the main problems for me is the metastasese in my bones and so Radium ticks a lot of boxes. On the downside it can cause damage to bone marrow and the ability to produce red blood cells.
So after some discussion and baring in mind that I have had quite a lot of radiation we agreed that we would start with Carboplatin and then go to Radium 223 after that. This gives my body and in particular my bones time to recover more from the Lutetium treatment and while they will never fully recover the radiation will continue to decay and hopefully the negative effects of the Radium will be reduce.
One of the problems I am facing is that I am starting to run out of treatment options which, needless to say, is a little worrying.
One small glimmer of hope is an upcoming trial of something called BiTE or the BiTE study. Again more reading required and the summary of this states.
Study of Pasotuxizumab, a PSMA bispecific T-cell engager (BiTE®) immune therapy mediating T-cell killing of tumor cells in patients with advanced castration-resistant prostate cancer.
Which is all a bit of a mouthful but hopefully the Carboplatin and Radium will buy me time for BiTE to be something that I may be able to use or at least a trial I can take part in.
In the meantime I am staying optimistic and making the most of everyday, planning holidays and trips away.
So the immediate plan is to start me on Carboplatin in 3 weeks time, I have had a blood test today to check if my bloods are ok and have an outpatients appointment booked for 9 a.m. in three weeks which hopefully will be followed by the first Carboplatin treatment.
Well, it took a week but I finally got my blood test results back from the blood test I had on 8th March. Not sure why it took so long but I suspect that it took time to be reviewed and processed at the GP’s Surgery.
And there is good news and bad news!
The bad news is that my PSA had gone up from 163 to 241, a rise of 78 when I was expecting it to go down following on from the Lutetium treatment. I had really hoped that the Lutetium would knock it down as it had done in the past.
On the plus side, for the most part I feel fit and healthy.
I have forwarded the results onto UCLH and will see what they say on the 24th March when I have my next outpatients call.
The rest of my blood work looked ok to me apart from a few things which looked a little low or a little high in one case.
Serum calcium level 2.11 mmol/L [2.2 – 2.6]
Haemoglobin concentration 116 g/L [130.0 – 180.0]
Red blood cell count 4.29 10*12/L [4.5 – 5.5]
Serum cholesterol/HDL ratio 4.46 [< 4.0]
Now I don’t know what this means, but it looks like my blood count is down a little and that maybe due to the Lutetium.
I don’t know how this may affect the thinking around having another Lutetium Treatment in April but for myself I think it would be worth it but of course I need to listen to advice.
I have done a graph to help track my PSA, I think it tells an interesting story. It shows that the Docetaxel that I had first of all really made a great impact as did the first set of Lutetium treatments that I had.
Everything else has been less effective although there is nothing that shows what effect the Hormone Therapy may or may not be having as I have been on that consistently since being first diagnosed.
I do wonder how long it took my PSA to reach 226 when I was first diagnosed and how that could have been caught earlier, I am sure it didn’t climb to 226 overnight and probably took a few years or more.
I do think that had I been tested early, perhaps when I was 50 then the disease may have been caught earlier and I would have been a much simpler case to treat.
But that is hindsight and for now I need to focus on treating the current problem and on staying fit and healthy.
Ok so just had my Oncology Outpatients telephone call.
In this case it was not as good as face to face as we were discussing the PSMA PET Scan that I had on the 26th January and I felt that if I would have been in the hospital I would have been able to see the image and better relate to it. That said it is much safer do the appointment this way rather than going into the hospital.
I cannot really be sent an image of the scan as it is three dimensional and needs special software to be seen.
The scan did show an uptake in activity around the area’s that had previously shown that they had cancer in them, so parts of the spine, the hips, the pelvis, back of skull which is not great news but on the plus side it did not show any new sites or much activity in soft tissue, the lymph nodes and the like.
My PSA has risen to 182 up from 150 on the 4th January and so they feel that having the remaining 2 treatments of Lutetium is more urgent and are going to look at getting that booked in.
I also said that I was experiencing increased back pain and some pins and needles in my right big toe and so they are going to send me for a MRI Scan to look in more detail at that area in my spine.
The pins and needles in my toe might indicate some kind of Spinal Cord Compression which may be caused by the increased activity in my spine.
I have had pins and needles in my left big toe for some time but that is put down to the Vertebroplasty procedure causing a little pressure on the nerves and in many ways, I had grown used to it.
I have been experiencing a few more aches and pains over the last couple of weeks but not sure if that is because I have been walking a little more or whether I have over done it somewhere or is it the effects of the increased activity. No one knows at this point.
So Now I have another telephone call booked for next Wednesday with hopefully a MRI before that. Normally scan’s take longer to get booked in so I would be surprised if I have had it before next Wednesday! But you never know 😉
I also asked again about the PSMA BiTE Therapy which was mentioned as a trial at my last appointment, and it was felt that it was better to do the Lutetium first and then look at trials.
So for now it is time to wait for the next scan and see what that shows.
Cancer certainly is a waiting game, always waiting for the next scan, the next appointment and so on.
A busy week this week, Prostap yesterday and now heading to London and UCLH For a PSMA PET Scan.
I arrived early and headed downstairs for a blood test which took about 20 minutes and then headed to the Radiography Department which was on the same floor.
The reason for this scan is that my PSA from a blood test at the start of January had gone up from around 90 to 150. And the scan is to take a look inside and see if the cancer has spread or looking more pronounced.
Well what is a PSMA PET Scan?
Prostate-specific membrane antigen (PSMA) imaging is a nuclear medicine exam using positron emission tomography (PET) to detect prostate cancer. … PSMA PET is very sensitive for detecting prostate cancer, with accumulating evidence suggesting it is superior to conventional imaging tests such as CT scans or bone scans.
Basically I was injected with a radioactive trace that is attracted to Prostate Cancer calls via a cannula.
The orange case around the radioactive injection is made from metal like lead and protects the radiography staff from exposure to radiation.
Once the trace has been injected I had to wait about an hour for the trace to work it’s way round my body and so there was nothing to do but have a nap 😴!
The hour quickly passed and I was asked to change into a hospital gown.
And then it was my turn to be scanned.
I was asked to lay on the scanner bed which I did but it was painful to lie flat with my back and so a couple of pads were placed between my back and the bed. They helped a lot.
Once I was all set up on the bed a frame was put over my chest and head to help keep me still and the ‘panic button was put in my right hand.
And then the bed was slid into the drum of the scanner, it seemed quite a long way in!
And then the scanner started up, it is very similar to a MRI with lots of noise as the scanner spins around.
The scan takes about 30 minutes and I was moved in and out of the scanner as different parts of my body were scanned.
I was then asked to go to the bathroom and empty my bladder which I duly did.
And then it was back in the scanner for a few more minutes while they scanned the area around my pelvis.
Once the scan was done I was able to get dressed and make my way home. Like all radiation treatments I have to avoid being too close to people and especially young children to prevent them being exposed to the radiation.
That said I did give Teddy a big hug when I got home.
Back to London again today for my Oncology Outpatients Appointment and Zoledronic Acid infusion.
The good news is that my Covid test came back negative so I am all clear for treatment and pleased to be Covid free.
The bad news is that my PSA has risen to 150 from 85 about 6 weeks ago. And so it looks like my PSA is starting that upward move again after being brought down by the Lutetium. Overall I am feeling pretty well aside from pain in my back from the fracture I had.
I was pretty disappointed that my PSA had risen so much in a fairly short time, it would seem that the effects of the Lutetium have worn off.
So the plan now is to have a PSMA PET scan and have a look at what is happening inside with a view to rechallenging the cancer with more Lutetium.
I have two Lutetium treatments left that I could have and although we are entering very much into new territory with the Lutetium it is thought it is better to rechallenge sooner rather than later. Well at least the first one and then see when to use the second one.
I did ask about what might be done after the Lutetium treatment has been used and the answer was that it would be another clinical trial. The clinical trial mentioned was called BiTE, I think and here is a brief descriprion of it.
“a PSMA bispecific T-cell engager (BiTE®) immune therapy mediating T-cell killing of tumor cells in patients with advanced castration-resistant prostate cancer”
If I understand it, it is similar to Lutetium in that it consists of two parts, the first part is attracted to the cancer cells expressing PSMA and instead of using Lutetium to kill the cancer cells it attracts the bodies own T-Cells to attack the cancer cell. I think I have a bit more to learn about this and will certainly be asking more questions next time around!
Not surprisingly by the time I got upstairs for the Zoledronic Acid Infusion my blood pressure was fairly high at 166/98 so they gave me a few minutes to relax. It also gave me time to think about what I had just been told downstairs and to calm my racing mind.
A few minutes later and I was at 145/80 and they were happy to continue with the infusion.
I had already been fitted with a cannula and while I hate to keep mentioning it, it did take 3 attempts to get the cannula in and its not the needle going in that stings, it’s the wiggling about of the needle that really stings!!!
The Zoledronic Acid infusion itself took about 20 minutes and soon the cannula was being removed and I was told I could go.
Jacket on I made my way outside and made my way home.
By the time I got home I had my next outpatients appointment booked and that is scheduled for 3rd February and so hopefully I will have a PSMA PET scan before that, it could be a busy couple of weeks!
Today I have been over to the GPs surgery for a blood test and I have to say that it went very well.
The doctor was very good and got into the vein first time and got the blood out and the vacutainers full. I was also quick to be seen, I barely had time to sit down.
This blood test is roughly at the 6 week point between my last appointment at UCLH where they are now seeing me every 3 months when I have my Zoledronic Acid treatment for my bones and the next one at the start of January.
Fingers crossed that the results will come back and show no major increase to my PSA and also nothing else to worry about.
Overall I feel fit and well and am getting around a lot better although I still use a walking stick when I go out walking.
I have tried to reduce the amount of morphine I take for the pain in my back, I now take 10mg in the morning and 5mg at night. The are slow release tablets and cover me all day. I did try stopping the nighttime dose but found it a little painful in bed and it interrupted my sleep so I have started to take them again.
I also take 10mg of Amitriptyline at night and wonder if I could get away with not taking this any longer. I think I will discuss it with my Oncologist in January in case there are side effects coming off it.
The Acupuncture that I had has been going well but I think it was more effective when I was having 3 sessions a week rather than one a month. So I am thinking of stopping them.
As I say I am feeling a lot better and what I really need to do is continue to build up my strength and endurance by walking more. I still need to be very careful with my back and in particular with bending and lifting as the vertebrae above and below T12, the one which partially collapsed and I had cement put in are both very vulnerable to collapse as well although I hope the Zoledronic Acid is helping to strengthen them 🤞.
So I am hoping the results for the blood test come back soon and show good news.
Back up to London today for my Oncology Outpatients appointment and for my Zoledronic Acid infusion.
Given I was on the 09.07 train from Stortford it was fairly quiet although the tube was busier.
I made it to the hospital in good time. On arrival I was asked to wear one of their masks which was different from when I was here on Monday.
I checked in and made my way to the first floor reception.
My name was soon called and I was pleased to see that my appointment would be with Dr Mark Linch, the main man, I hadn’t seen him for months 😀.
He asked how I was and I told him I was feeling well apart from my back although I also said I was feeling much better.
He looked up my PSA and told me it was down slightly to 85 from 90 and a high of 1,585 a year ago.
Overall he was pleased at how the Lutetium Treatment had gone. The PET Scan showed that tumours had reduced in size and activity which was great news.
He also said that he felt that the Immunotherapy treatment I had 18 months ago may have helped to prime my immune system to help out with the Lutetium. He also said that the immune system can develop memory and may continue to attack cancer cells now that they have been shown what to do.
I have been wondering about the effects of immunotherapy and how long it stays in the body and active. Is it a permanent change or does it fade over time? I don’t think they know yet?
So now I am to go onto what is called Active Surveillance and keep an eye on my PSA. I am go have a blood test in around 6 weeks and if it is stable I will have an Outpatients Appointment in January 2021. If there is a rise then I should let them know and I will have an appointment sooner.
I also raised the point that I seemed to bruise easily and that my skin seemed very fragile, he thought this may be down to the Dexamethasone and so reduce my dose down to 0.5mg from 1.00mg.
So once the appointment was over I headed upstairs for my Zoledronic Acid infusion. While there wasn’t a lot of people around I did wait a while before being called into the Treatment Room.
I was then fitted with a cannula, again it was a struggle to get it in and while the piercing of the skin is not too bad the wiggling around and trying to get it in the vein makes me wince.
Again it took two attempts to get it in, both in my hand. They started with the bigger pink needle but then used the smaller blue needle the second time.
Once the cannula was set up I then had another wait for the infusion and it was about 12.10 before the infusion was started. Its 15 minutes for the infusion and another 10 minutes for the flush.
The infusion was no trouble at all and soon the cannula was being removed without the same amount of fuss as going in!
And then I was free to go and hopefully I will not be back at UCLH until next year 🤞😁.
I am really pleased with the news I had today and just need to think about what else I can do to help myself.
My back is getting better and I feel stronger so longer and more frequent walks. I need to be very mindful of my back as it is still very fragile so exercise that will not be a threat to that is a must.
I think I will also look at my diet again both in terms of health and cancer prevention but also with a view to losing weight.
So back on the train feeling happy and looking forward to the future.
Well it’s an adventure today, I am off to UCLH for a PET Scan and I have decided to go by train and tube. The PET Scan is a follow up on the Lutetium treatment I have been having and will take a look inside to see how things are. My PSA has been stable at around 90 and the scan will help decide what I do in regards to treatment.
Of course my big dilemma was what to wear and take, it was cooler than it has been and wet. In the end I opted for shorts and a light fleece and a waterproof which should cover all options. Then I needed masks, gloves, etc.
I left a little early as I hadn’t been on the train for a while and I knew that there was building work going on at the station. I was pleasantly surprised that I got parked very easily and used my Blue Badge to get a disabled parking space close to the station entrance. That said the car park was not busy so I guess not many people are using the train.
The train was not that busy so I found a seat and settled down for the first part of my journey.
The train to Tottenham Hale was quick and smooth.
On arrival at Tottenham Hale things had changed a little as there was also building work going on there. But my transition onto the tube was also quick and easy.
Tottenham Hale was not that busy as you can see.
The tube train itself was a little busier and would fill up as we go into the city. The tube was very hot so shorts were a good choice.
I arrived at the hospital early with the view that I would get a blood test before my scan. I made my way to the first floor and found where the blood tests were done. I normally have blood tests done in the Macmillan Cancer Centre but would try the main building .
I took a ticket and waited .
No luck and I had to give up and head to Nuclear Medicine for my scan. If I can I will try for a blood test after the scan.
I arrived at Nuclear Medicine at the right time and filled in the questionnaire.
It was not long before I was taken to a prep room and fitted with a cannula. Sounds simple but it took three attempts to get it in, the actual penetration of the needle is not too bad, it’s the wiggling it around to get the needle into the vein that gets me!
Once the cannula was fitted I was then injected with the radioactive element that would be attracted to the cancer and then show up on the scan, showing the tumours and there size, in the past they had reduced in size.
I had then to wait an hour for the radiation to circulate around my body before the scan.
The lights in my room are lowered so there is only one thing to do… zzzz.
The hour passed quite quickly and I was soon in the scanning room. I had difficulty lying flat on the bed which hard but managed to get into a position I could hold.
Once more I closed my eyes and slowly I moved through the scanner. Fortunately this was nice and quiet, not like a MRI.
Then it was time to get dressed and go.
I decided not to go for a blood test after all I don’t know when my next outpatients appointment is yet and so will try and get a blood test closer to that date so it is more relevant .
The journey home was quick and easy.
All I need to do now is wait for the results of the scan.
So I was up bright and early today for my ride into London and my appointment at the London Clinic near Regents Park. The roads did seemed a little bit busier to me with more traffic on the roads and definitely more pedestrians in London although the journey was much quicker than normal the city did feel busier.
I arrived at the hospital just before 9 a.m. and went inside to see that all the Covid precautions were still in place, with hand sanitation stations near the door and screens around the reception staff. I was soon checked in and directed upstairs to my room although before heading up I headed off to the coffee shop for a flat white, a nice treat for me to have and a decent coffee made by someone else.
I got to my room and settled in and soon the nurses turned up to do my observations, my blood pressure, temperature and weight.
Another nurse came in and fitted the cannula and she also took some blood for the blood test. Things were going quick this morning as she was followed by the catering lady who took my breakfast order.
And then it was time for something new, it was time for the Covid 19 Test. The nurse that was doing it was not a fully qualified nurse but a nursing assistant although I was happy for that person to do the test as they need to get the practice in.
The test consists of putting in a swab up and to the back of your nose and another swab into the back of your throat, not a very pleasant experience but very necessary. Hopefully the results will be back shortly and will tell whether I have coronavirus or not.
I was then informed that treatment would not start until after both the blood test and the Covid test came back from the lab which takes about 90 minutes. I kind of understand waiting for the blood test although I did have one only a week ago. But the Covid test seems slightly out of sequence, surely part of the reason for doing that is to protect staff and I have already seen a number of those and even more if you include reception staff and those at the coffee shop?
Only one thing for it, I will have a snooze 💤💤!
And then suddenly everything changed and it was all systems go, the nurse was in to hook me up to the drip and start introducing the saline solution, I also had add a visit from the radiography consultant who asked me a few questions before saying we could go ahead with the treatment.
Treatment only takes about 30-minutes but today it took three people although one of them was just here to see what happened and you can see a picture of the trolley with all the equipment on it it although they were visiting another patient after me.
Once the treatment was over I had a chat with the consultant about future steps. The feeling is is that the next step is to have a PSMA PET scan in a couple of months time to see how things are inside. Because the PSA is continuing to drop she is confident that the treatment is working well but the scan will help to clarify that so we just need to wait and do it at the right time for this latest treatment to have had time to take effect.
She is effectively handing me back to UCLH who will continue to manage my treatment going forward and make decisions as to what the further treatment will be. Typically lutetium treatment consists of six treatments and this was my 6th treatment. Although in some countries and institutions further treatments have been given but they may be held back until they are needed .
So now it’s a bit of a waiting game while we just let time pass, they will continue to do blood tests and monitor my PSA. I am due to have my next oncology outpatients appointment in about 6 weeks time and I guess by then we will have had another blood test and know where the PSA is at.
One piece of good news from today is that the Covid-19 test came back negative so I know that today I do not have Coronavirus which is nice to know.
So is this my last visit to the London Clinic in the short-term in that I will not be back here for at least a couple of months. I suspect I will be back for treatments 7 and 8 at somepoint.
That said I need to have a good chat with my consultant at UCLH and discuss what other possible treatments may be available.