A disappointing change to summer plans

As predicted in the last post, at our appointment in late May the chief did again suggest trying Jevtana chemotherapy. Taxotere, the little brother of Jevtana, has surely helped to maintain control of my cancer burden these past five years. Nonetheless, I sense that my body has had enough chemotherapy. I feel I am no longer able to deal with the side effects of these “whole body poisonings.” I prefer instead to look for targeted treatments based on genetic analyses of my tumors. I’m not anxious to endure any more assaults on my remaining quality of life.
Among the things the chief discussed with us was the need for fresh samples of my tumor cells. Every intervention, such as the pair of rounds of chemo in December and January, is presumed to lead to modifications of the tumor cells. So, my NoVA oncologist ordered a new CT scan. The results were compared with those from the November 2015 scan. As the chief had predicted, the soft tissue tumors in my abdomen do appear to have migrated to my adrenal glands. (The adrenal glands are another source of “androgens”, think “cancer chow”.) The nodules on the adrenal glands showed some increase in size – but not yet enough to justify a biopsy for tumor samples.
For the first six months of this year my PSA has been meandering between 13 and 19 ng/ml. Now, every time I go for a blood test I think, “how much longer can this wonderful meandering last?” If it does continue for the next 4 or 5 months, we can then do another CT scan to see if the nodules on the adrenal glands have grown enough to biopsy. On the other hand, if PSA begins to climb rapidly once again, it will be time to scramble for    “Plan B.”
We have elected to stay close to home this summer. I just don’t feel strong enough for a long trip, such as the 800 miles to northern Michigan. We are very disappointed not to visit with our long-time friends in the Bay View summer community. If we have the opportunity to try one or both of the new targeted therapies, I would hope to gain the strength to be more adventurous next year.
We are still looking forward to a visit from the UK branch of our family. They will visit in mid-August after the twins finish school for the summer. Below is a picture of us with two of our Virginia grandchildren, Lexi and Luke.

Heidi and Bob with Lexi and Luke

Enough SE&S to continue…?

I am wondering about my body’s ability to continue this fight. While I have tired of the never-ending appointments for some time, I am willing to try new treatments in hopes of finding another silver bullet soon. And, I am concerned about my body’s strength, energy and stamina (SE&S) to absorb the side effects of further treatments and to rebound as it has in the past. I feel as though my old “get up and go” has “done got up and went.”
You may recall from the last post that the chief had wanted me to move on from Taxotere chemotherapy to Jevtana, another chemo drug in the same family. My NorVA oncologist had some reservations even last November about my SE&S to handle Jevtana. Instead, he suggested we try two more rounds of Taxotere before we considered Jevtana. These we completed in December and January.

Post-treatment euphoria
The two rounds of chemo seemed to be working, and I felt I had weathered the side effects satisfactorily. So, we went to California in early February, fully expecting to enjoy the rest of the winter in reasonable health. Alas, it was not to be………….
You can see from the chart (click on the thumbnail below) that the two rounds (six infusions) of Taxotere had limited impact. PSA & BALP 2016(Four years ago that same regimen produced a big PSA drop.) Moreover, I don’t feel, even now, that I have gotten over the funk I usually feel after a couple of rounds of chemo; to complicate things this time, edema came back, too. We chose to cut our trip short after the diuretic regime I used four years ago to counter the edema took a sharp and sudden toll on my sodium level. Further, I fell one evening and severely bruised my left tailbone. As of mid-May, my sodium level has been restored, but the bruise has not yet healed.

Reality check
Returning to the chart, you can see that my PSA is again increasing. The good news is that the rate of increase is now fairly slow. The bad news is that experience teaches it is likely to accelerate unless we do something. When we see the chief at the end of this month, we will surely discuss starting Jevtana chemo to see what it can do and whether I can handle it.
New drugs
Also from the last post, the CT scan last Thanksgiving showed so much shrinkage of the malignant retroperitoneal nodules near my spine that it would be too risky to biopsy them again. Without samples of tumor cells that can be put to molecular profiling, I cannot now qualify for access to some new drugs, e.g., Lynparza. One option is go hunting for the tumor cells generating the PSA you see on the chart. That is likely to mean more diagnostics, e.g., CT scans.

I feel so weak in general that “getting up” to do even a CT scan has become a chore. The scans are short enough, but drinking the required two bottles of glop pre-scan now causes me roaring diarrhea within a few minutes of getting off the scanning bed. Then, it upsets my digestive system for two days afterwards. It used to be so much easier.

What might be coming down the pike next?

In the past the chief has often had a rabbit hiding under his lab coat that he pulls out just in time to save our day. We very much hope he has one for us in two weeks.

In the meantime, our wet, cool, Virginia spring has given us lots of green and nurtured Heidi’s gorgeous iris garden.Heidi's Iris 3

A most welcome winter break……….

December and January were spent doing furious chemotherapy. That meant going from my low dose once a month back to the old routine of one low dose every week for three weeks with a week off before starting again. Even so, the updated chart of PSA (click on the thumbnail in the post under Recent progress) seems to belie the almost certain progress we’ve made since late November. The post-Thanksgiving CT scan and my newly found walking strength (see below) provide clear evidence that my malignant retroperitoneal nodules are really shrinking. The new drugs we described last time have been postponed, at least in part because the malignant nodules have shrunk to the point where they are now too difficult to safely biopsy. We’re going to take advantage of a break in the action to spend the rest of winter in the land of liquid sunshine!
Lower back pain link to malignant retroperitoneal nodules
Our suspicions about this link have grown stronger since the late November post. In late October I started pushing my walker for greater distances – two loops in the neighborhood, then three, etc. The pleasant temperatures we enjoyed in November and December made such walks easy. By mid-December I noticed that my lower back muscles were getting a bit stronger, and my walking was limited only by fatigue. By Christmas-time I was pushing the walker for a mile round trip. Now, with temperatures rarely as high as 50, I’m up for just a half-mile on a calm day. I haven’t yet tried that trip with just my hiking sticks for balance, but that’s coming soon – maybe when we get to California next week after the SuperBowl.

Halfway point

Halfway point in my 1 mile loop.

Birthday flowers

Heidi and her birthday flowers. She enjoyed her first birthday omelet in three years!