Sunday, December 28, 2008

Recurring Stomach Pain

Starting July 31, 2008, four months after radiation treatment ended, I had a first episode that started with stomach pain and bloating across the abdomen after playing a round of golf at SJ CC. The pain lasted across the abdomen for a number of hours, never leading to nausea but it was followed by feeling totally wiped out as if I had the flu.

The flu-like symptoms knocked me flat on my back in bed where I had a fever (up to 102), body ached and had no energy. This lasted for several days. The stomach pain gradually subsided until it became a localized pain under the belly button. On the day the symptoms began after playing golf I had eaten a whole wheat sandwich (probably turkey) and an energy bar I think.

These symptoms weren't a concern until they re-occurred about 7 weeks later following the same pattern with a slightly lower fever (probably 100). And about 6-8 weeks later they re-occurred for a third time. And then on Wednesday evening Dec 11, 2008 they re-occurred for a 4th time after playing golf at Stanford. This time I ate a dinner that started with about 5 pieces of bread from a restaurant (next to Kepler's).

After dinner the same stomach pain began. One difference in the following symptoms that occurred were that Saturday night the stomach pains for the first time intensified (always before they steadily got better). After eating almost nothing I did eat a piece of whole grain white toast which has a number of whole grains and gluten in it. The stomach pains afterwards increased, I believe as a result of being aggravated by digesting the piece of whole grain toast.

I saw Dr Scott Matthews at PAMF on Friday and he felt it was most likely a bowel obstruction and ordered a series of lab tests. All results including a gluten sensitivity test were negative (there was an elevated level of a diabetes related test for (?) with a reading of 130 versus a high normal of 90). He asked if I had had a colonoscopy exam and it turns out I had one in September that was clear.

At this point I plan to avoid all whole wheat and whole grain breads. Another problem would likely lead to a CT scan to see if something shows up in the bowel. I also will ask Dr. Hancock if the radiation could be a contributing factor. One additional factor is that I do have more gas in the system than before the radiation and that certainly could be leading to stomach pain and the boating. I'll discuss that as well.

Monday, November 3, 2008

New Study of Secondary Cancers

In the new study below, the increased cancer risk is a "relative" not absolute risk. Bottomline is that the lifetime risk of developing rectal cancer in men is about 2% and the risk of developing bladder cancer is about 3.4%. Using the new study data below, assuming there is an 80% increase in the relative risk of developing these cancers after external beam radiation, my risk of developing these cancers is about 3.6% for rectal cancer and 6% for bladder cancer. This increased risk would occur 15-20 years out, in other words there should be no increased risk before that. All in all, this increased risk, though significant, in absolute terms is not that much.

NEW STUDY -- see

A new study, in the Journal of Urology, evaluated the cancer treatment records of more than 240,000 men who had previously been treated for prostate cancer with prostatectomy, brachytherapy, external beam radiotherapy or a combination of brachytherapy and external beam radiotherapy between 1988 and 2003. The data for this study was collected from the massive Surveillance, Epidemiology and End Results (SEER) national cancer database, which is maintained by the National Cancer Institute. This study was conducted by researchers from Columbia University and the Mount Sinai Medical Center.

In this study, the authors compared the incidence of subsequent cases of cancers of the bladder and rectum occurring in these 243,082 men. The men who underwent prostatectomy alone, and who did not receive any radiation therapy, essentially served as the “control group” for this study.

An almost insignificant increase in the risk of bladder cancer was seen in the men who underwent brachytherapy alone. However, there was a more pronounced and statistically significant increase in the risk of both bladder cancer and rectal cancer observed among the men who received either external beam radiotherapy alone or combined brachytherapy and external beam radiotherapy. Compared to the men who underwent prostatectomy alone, external beam irradiation was associated with an 88 percent increase in the relative risk of developing bladder cancer, and a 26 percent increase in the relative risk of developing rectal cancer. Among those men who received both brachytherapy and external beam radiotherapy, the relative risk of developing bladder cancer was 85 percent higher than what was observed in the men who underwent prostatectomy alone, while the relative risk of developing rectal cancer was 21 percent higher. (It should be noted that “relative risk” is a measure of the difference in risk between two patient treatment populations, and is not the same as the “absolute risk” of developing a particular disease.)

The relative risk of bladder cancer developing after external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy compared to radical prostatectomy was 1.88, 1.52 and 1.85, respectively. This is compared to the general United States population the standardized incidence ratio for bladder cancer developing after radical prostatectomy, external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy was 0.99, 1.42, 1.10 and 1.39, respectively. The relative risk of rectal cancer developing after external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy compared to radical prostatectomy was 1.26, 1.08 and 1.21, respectively. The standardized incidence ratio for rectal cancer developing after radical prostatectomy, external beam radiotherapy, brachytherapy and external beam radiotherapy-brachytherapy was 0.91, 0.99, 0.68 and 0.86, respectively.

In this retrospective study, which involves a relatively short duration of clinical follow-up, external beam irradiation for prostate cancer (either administered alone or in combination with brachytherapy) was associated with a significant increase in the risk of developing subsequent cancers of the bladder and rectum.

Since most studies of radiation-induced secondary cancers have shown an average biological lag time of 15 to 20 years between radiation therapy and the diagnosis of secondary malignancies, the findings of this study may actually underestimate the long-term risks of secondary bladder and rectal cancers in men who have previously received external beam radiotherapy as treatment for their prostate cancers. At the same time, however, recent and continuing improvements in the accuracy of radiation therapy delivery have significantly reduced the “innocent bystander” effect, whereby clinically significant doses of radiation are absorbed by the organs that surround the prostate gland (namely, the bladder and the rectum). As a final note, all retrospective studies that are based upon prospectively collected data, such as this study, are subject to potential biases, including the “completeness” of the clinical data that is present within large databases such as the SEER database. However, based upon a large body of clinical literature on this topic, the findings of this particular study are not at all surprising, or unexpected.

The American Cancer Society estimates that about 108,070 new cases of colon cancer (53,760 in men and 54,310 in women) and 40,740 new cases of rectal cancer (23,490 in men and 17,250 in women) will be diagnosed in 2008. Overall, the lifetime risk for developing colorectal cancer is about 1 in 19 (5.4%). Thus the risk of rectal cancer alone should be about 2% (23,490/54,310 x 5.4%). This risk is slightly higher in men than in women. A number of other factors (described in "What are the risk factors for colorectal cancer?") may also affect a person's risk.

The American Cancer Society estimates that in 2008 there will be about 68,810 new cases of bladder cancer diagnosed in the United States (3.7%) about 51,230 men and 17,580 women). The chance of a man developing this cancer at any time during his life is about 1 in 27 (and for a woman, 1 in 85.

In 2008, there will also be about 14,100 deaths from bladder cancer in the United States (about 9,950 men and 4,150 women). In spite of the increased incidence, the rate of people dying of this cancer is decreasing. Over 500,000 people in the United States are survivors of this cancer.

Wednesday, October 1, 2008

6-month PSA Results

On Sept 29th my PSA result was 1.07. To take again in 3 months and likely have a follow-up visit with Dr. Hancock.

Tuesday, June 24, 2008

3-month PSA Test Results

It's been 3 months since I completed my 8 weeks of radiation and got a PSA test to check progress. PSA was 1.81 versus about 9 before the radiation. My doctor indicated this was good and about what he'd expect. The plan now is to have PSA tests every 3 months at least for the next year.

My doctor said he's expect the next test to be between .8 and 1.0 and should continue to trend down for the next 18-24 months. He said the median to reach the nadir, low point, was 21 months but in some cases it wasn't reached for 4 years. He said there occasionally would be a "bounce" up in PSA as far out as 2 years for reasons that are not totally clear.

So my next PSA test should be at the end of September and next doctor's visit at the end of the year (appt set for Jan 5th at 1 pm). He also said there is a chance that I could have some blood in the stool down the road due to after affects from the radiation on the tissue.

A few comments on post radiation affects. Within a few weeks (2-3) of completion of the radiation I found side effects to greatly diminish e.g. no irritation when urinating, less fatigue, less urge to urinate, no diarrhea, and no unusual discomfort associated with ejaculating. Since then things have returned to pre-radiation conditions.

NOTE - after a PSA test I can call 723-5159 to get the results.

Saturday, February 16, 2008

After 2 weeks of treatments

I have had 10 radiation treatments thus far. The treatments are very easy lasting only about 15 minutes each, with radiation being administered in 7 separate beams lasting 10-18 seconds each. No pain, discomfort or problem with the treatments. They each start with two X-rays to align the beams with the gold seeds in my prostate.

After the initial anxiety about what the process would do for me and the questions about whether I had chosen the right treatment I have adopted the attitude that this is a good choice, that the radiation is a positive to treat my cancer and that I will not second guess myself.

Side effects thus far are that urination is more frequent at night, especially early in the sleep as I wake every hour or two. This compares with the pre-treatment pattern of 1-2 times per night. Urination is painless but is slower and emptying the bladder is harder with the need to wait longer to complete. Bowel movements have become a little looser as well. I am told that orgasms will be "dry" as the prostate will no longer generate the fluids that they did before. So far they are feeling less complete than before, I assume due to the lessening of seminal fluids being produced.

Other than that I feel fine with no sense of fatigue thus far. I plan to ask the doctor about whether the urination frequency will change after the treatments are over.

Tuesday, February 5, 2008

First IMRT Treatment

I'm 60 years old having been diagnosed with prostate cancer a few months ago. My Gleason score was 6 (3 + 3), which is a low grade cancer so my doctors said all treatment options were available. I met with 4 doctors, a surgeon, two radiation oncologists and my urologists plus spent considerable time researching on the web various approaches including watchful waiting. My health is excellent with normal sexual function, using no meds and am 5' 10" 150 lbs.

My decision was to go with IMRT, a form of external beam radiation administered over 39 sessions, 5 times per week. The cure rates seemed comparable with prostatectomy, brachytherapy and other approaches with side effects, at least in the next 10 years or so somewhat less than alternatives. In preparation for the radiation treatments I had an MRI, Cat Scan and gold seeds implanted in my prostate, all for the purpose of improving targeting of the radiation. I had three very small black dot tatoos placed on both sides and center for the later treatments.

The first treatment session at Stanford Hospital lasted about 20 minutes, half of which was for set up. The technicians X-rayed me twice to locate the gold seeds, I assume, then laying on my back for about 10 minutes of on and off treatments from a rotating circular machine in a very large open room. Although the 3 technicians were quite friendly and seemed very competent, for a first session of a long treatment process I would have preferred a little more background info --- even 5 minutes more to describe what would happen, how the machines would work, asking if I had questions would have been appreciated. It wasn't a big thing but would have been comforting. When the treatment started I felt nothing at all and the technicians were quite nice and did answer my questions about dosage level, number of treatments (just in case I asked to make sure I was getting the right treatment).

After the treatment I met with a doctor who went over a consent form discussing possible side effects ranging from nausea to urinary problems (burning sensation most likely), fatigue, sexual function problems, possible long-term radiation induced cancer (10-20 years out) among others. Later that day I had several minor but noticeable affects including slight chills and more of an urge to urinate. My thoughts went to what was going to happen over the next two months of treatments, how bad might the side effects be, maybe I out to opt for surgery instead. It was not the best night of sleep that I've had wondering about how would my body be reacting over the cumulative effects of this treatment path. I found my mind ranging from normal to worst case scenarios, not something I'm used to in normal circumstances.