Archive for July, 2010

Finished with the first 3 months of my clinical trial. Maybe 15 men with prostate cancer have tried the drug, and it looks promising. Since we are in a phase 1/2 trial, the longer and more important phase 3 is yet to come. I hope that all goes well for this little pharmaceutical company and their new treatment.

To be approved for another 3 months (yes, I was approved), I had to undergo a bone scan and CT scan to monitor tumor growth (or lack thereof). As we discussed the results with Dr. V, Dorothy and I had to expand our understanding of what cancer is all about. The truth is, no single lab test or scan can tell us fully what is going on with my tumors.

First, I’m on a monthly dose of Zometa (zoledronic acid), which prevents bones from losing mass too quickly. Because of that, my bones look different on a CT scan, more dense than might be expected. Second, there can be healing of previous bone lesions from the Zometa. If bones lose density (as they do when you’re on hormonal therapy), tumor cells can settle in and then create lesions, which also reduce bone mass. But those lesions can heal over if all the medications are working, so there are bone spots that show up on a CT scan which could be new lesions or could be healed lesions.

Third, the bone scan is not just about cancer. For that scan I’m injected with a radioactive tracer that flows through my bloodstream and settles into any areas of bone injury, which can be from a previous break that healed or current cancerous lesion, or even arthritis or an infection. This scan is dependent on blood flow to the bone, so it doesn’t automatically find every instance of cancer (if a bone has poor blood flow around it the tracer won’t get to it). When they take a picture after a few hours, most of the tracer is in the bladder waiting to be washed out, and if any areas in the bones have picked it up, those will light up as well. But those hot areas indicate rapid bone growth or repair, which may or may not be from cancer.

Fourth, the bone scan and CT scan have to be compared to see whether spots on either show up on the other, and then the radiologist has to make a best guess as to which spots are active lesions. But even those results are not definitive, because the oncologist can then compare those with PSA trends, bone pain, and so on, and may decide that some scan results are not concerning (as they say). There are many factors that need to be considered, none of which tell the whole story. It helps that Dr. V is getting all the information he can. He has been monitoring testosterone levels (they’re way, way low) and has done three circulating tumor cell tests, which has come back at zero every time. Which sounds really good, but it may just be a limitation of that particular test. Maybe good, maybe not.

So, in a nutshell (a pretty big nutshell): my PSA has dropped a little, bounced up and down, but hasn’t gone higher than the initial baseline. My pain/discomfort in bones and nerves has disappeared, although muscle and joint pain from Zometa are still very annoying. The most recent scans appear to indicate that there is still substantial activity in the sacrum (tailbone), a possible new lesion on the clavicle (collarbone), and possibly still an active lesion on the L5 vertebra. Oh, and one enlarged lymph node in the chest is about the same size as it was three months ago. So, yes, it’s mostly, probably, good news, but good news that requires a broader perspective than simply looking for new lesions or PSA going up.

In other words, I’m not really any worse, possibly a little better. I like to think that it’s been three months without substantial disease progression, and that’s three months of my life that is a gift. Here’s hoping for three more.

After all that technical talk, something simpler.

[borrowed from Magnolias forever]


. . .

Cancer is a white orchid.

. . .

(A mystery quote from a future post.)

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