I have avoided blogging lately - as you will have seen, it is ages since I posted about our being in Wanaka - and we were there back in March and I didn't post about it until late April or early May ... And lots has happened since then.
I haven't written about David's post operative prostate status much in the last few months, but he has been having monthly PSA tests and after a couple of months early on where the reading went down microscopically, it has since then risen microscopically but steadily.
His first test after his operation was 0.15 when it should have been about 0.03 or 0.05. So it was between 3 and 5 times higher than it should have been.
Since then it went up once and then down a couple of months in a row. But in the last 5 or 6 months it has risen to 0.33 - so it has more than doubled since his first test. While that seems very low to men who still have their prostates in situ, for someone whose prostate has been removed, such a reading is a sign that there is residual cancer.
So I think it was back in November that David had a PSMA PET scan, when the reading had hit 0.20 - the trigger for further investigation. And once it had reached 0.29 in May, we decided it was time to act. So we had another appointment with the radiation oncologist, Han Kim, and a further PSMA PET scan was scheduled for 10 days later. They can only be done on Thursdays because that is the only day that the radioactive isotopes are available... I am not sure if they are imported or what, but Thursday is the day!
Han told us that the avidity of the lymph node that had shown up on the first scan had not increased in size or brightness on the second scan, which was very good news. However he recommended that David go ahead with both hormone suppression therapy and with radiation. His rationale was that once the PSA gets up to 0.5 in a man without a prostate, it is very hard to reverse the spread of cancer to other organs - the bones especially.
So David is now in Week 3 (nearly 4) of the ADT (Androgen Deprivation [??] Therapy). For the first two weeks he was on tablets with one drug, and in the second week he started a monthly injection of another drug. That is administered with a large needle as it is an ampoule that sits under the skin of the belly and the drug is absorbed into the body over the month.
The worst of the possible side effects was likely to be a sense of lowered mood similar to menopause. Another was hot flushes. AAARRRGGGHHH!!! The latter hasn't occurred, and the former is not manifesting itself either. We had discussed that David needs to be open with me about if he is feeling low so we can take care of that - magnesium, B vitamins or CBD oil if required.
I have regularly been checking if he feels the urge to do dusting yet - that would be a possible sign of feminisation. But alas, no dusting mania has yet manifested itself ... 😜😜😈😈 However I live in hope!
On Wednesday last week, we went to Wellington Hospital for his assessment interview to prepare for the radiation treatment. He now sports three tattoos - I had mistakenly thought they were for aiming the radiation and was distressed to see there was one on each hip and one below his navel. Doh!! No, they are for the radiation therapists to line him up with the right spots on the table below the radiation treatment zapper.
He had to drink a litre of clear fluid before we got there, then pee and then drink 500ml so his bladder was suitably distended to lift the small intestine out of the way. However he needed at least another 200ml before he felt any pressure in his bladder. So he was getting a bit stressed that he would miss his assessment time - not so. They just waited. We now know that 700ml does it for him!
Radiation treatment is likely to commence in a three weeks or so, and will be Mon to Fri for 6.5 weeks, i.e. 33 sessions.
David plans to catch the train and bus in and out of town each day apart from Wednesdays when I will take him in because that is the day he will see Han each week for a check on progress. And I would like to be there for that.
It is likely he will get very tired towards the end of the treatments, so I may end up driving him in each day, but we will see.
We also stopped in to look at a hotel across the road from the hospital - if push comes to shove, he can stay over on the odd night if he feels too tired to come home.
I am going to find out what things he needs to do/eat/modify to lessen the impact of the radiation on his system, and we will put those in place. He will continue with the vegan diet and the juice which both Han and the urologist said will have been helping to keep the cancer cells from growing rampantly.
We didn't want David to have to have radiation, but faced with the choice of the cancer spreading or being demolished at this early stage, demolition seemed the most sensible option. Of course, we know radiation comes with its own risks, but they will hopefully not manifest themselves until some years down the track. Whereas a PSA rate that doubled within 9 months is too risky to leave to its own devices.
In terms of his state of mind - he is in really good shape. Almost always upbeat and stoic, if those two things go together. He's had a couple of times where he has said he feels a bit low, but each time it has been situational rather than hormonal. I do check each time if he feels the urge to dust yet, and he always laughs delightedly.
And by the way, I am probably doing enough stressing for both of us ...
