Thursday, July 2, 2015

Prostate Cancer Report

4 July
We're a day ahead of you, but to all our friends in the USA, have a happy day. We're both amazingly well and having a wonderful life and wish we could touch base with you on your special day.

Well, the Prostate update:  
My PSA test this week, just one month after the one mentioned below, shows a 50% increase for the month. That's higher than any increase I've had any time since diagnosis. We can't ignore that. (The increase is a more important measure than the actual PSA.)

I can extrapolate that increase forward for a couple of years and do the same with the 50% increases I had until we intervened with radiation last October. I can then compare how long it would have taken me to get to the same PSA level without the radiation. It looks as if the radiation gave me only three extra months. Of course this assumes both rates of increase remain exactly the same - that's pretty unlikely. So my prediction is a very rough guide. But interesting.

We already know that the average extra life expectancy for castration-resistant men who have chemotherapy is only about three months and we have figured the inconvenience wouldn't be worth that very small gain. Radiation was a more comfortable way of achieving what seems to be the same gain in final months. (And, of course, it was primarily designed to reduce the potential for compression on my spinal column, not particularly to slow up the general growth of cancer.)

So what about the hugely expensive Abiraterone? I am checking on that and have seen one trial report that suggested five months increased lifespan. So, on average, all these mysterious medical deals, for someone of my age and Gleason Score, don't promise a dramatically extended life. And $5000 for just one month's supply of Abiraterone could, according to this morning's paper, provide supplies for a whole term of the children's top-up breakfast programme in one school.

2 July
We got into the city in good time this morning and had a lovely lunch at the Wintergarden cafe - I don't think I've even been there before. Then we left the car in the Domain and took a pleasant walk in the sun over to the hospital for my three-monthly review.

As expected, this focussed on the sharp rise in the rate of increase of my PSA over a recent month. It was doubling in less than two months - a pretty dramatic rate. As before, we are not looking seriously at chemotherapy - the gain in lifespan is very small relative to the inconvenience and lifestyle issues in the therapy.

Aberaterone is likely to be the medication of choice now. It has recently come onto the free list - though hugely expensive, whoever is paying for it. And it's not a cure, of course. Furthermore, I'd have to take Prednisone along with it and that is not a very pleasant prospect. So we aren't keen to rush into that.

At my suggestion I am doing two more PSA tests so that in about a month we can look at the trend across three monthly tests and see if the increase is continuing. If so, then it would seem we will be availing ourselves of the generosity of the NZ public and accepting a longer stretch of a less comfortable life for a time.

Meanwhile, my only complaints are about the side effects of the Zoladex I've been taking for a dozen years. It's extraordinary to feel reasonably well and fit and yet have to make life-changing decisions to treat a condition that still hasn't made any discernible impact on me. I guess we will soon have the opportunity of balancing the issues. Meanwhile, excuse me, but I need to get on with writing a kind of history of Family Budgeting in New Zealand 1959 - 1978....

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