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“…PSA is an important and often useful diagnostic tool, but it is far from magical or infallible. Like many tests, it has limitations and inherent variability, especially at the low levels we see after radical prostatectomy or radiation treatment. Still, the test offers a significant advantage. A rising PSA gives us six to eight years, on average, before any scan or X-ray would show a cancer recurrence, and the time before symptoms of metastases can be as long as twenty years. If your tumor recurs in the local prostate area, radiation or salvage surgery can be curative, and hormones and investigational treatments can control the cancer, often for a man’s remaining lifetime, or at least for many, many years (Scardino – Pg. 409) “….After prostatectomy, the PSA drops to “undetectable levels”. Typically given as <0.05 or 0.3 ng/mL, that is seen to be rising on at least two separate occasions at least two weeks apart and measured by the same lab. In the post-radiation therapy setting, the most widely accepted definition is a PSA that is seen rising from nadir in at least three consecutive tests conducted at least two weeks apart and measured by the same lab…” (Prostate Cancer Foundation – Pg. 53) 

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After the radical prostatectomy I entered a new phase of the battle with prostate cancer! Was it all removed or those remaining cells devoured by natural body forces, or, just lying dormant for now? Dr. Carroll schedules me for a follow up PSA test every two months. I had an ultra sensitive PSA test in December, February and April 2007 which gave us a good idea how to proceed. Good news - the PSA readings were 'undetectable'! Now, after reading the text above you can rightly conclude there are several definitions of ‘undetectable’. Fortunately, U.C.S.F has access to the latest PSA analysis equipment that can detect a PSA count as low as .01/.02 ng/mL. For now, I take a lot of comfort that the equipment is that sensitive and I do not have to wait till it gets to .2 or .3 ng/mL to realize I have a problem. We have discussed follow up radiation which can improve the odds of remaining cancer free but are watching each reading for awhile to see if the level of prostate specific antigen changes.

Look for another update by December 15th, when I will start the 34  day radiation protocol and, remember we are in an area unique to my  prostate cancer so now more than ever use this information only to  stimulate you to ask your doctor questions, if you have a rising PSA.

James F. Girand
October 19, 2009

Here is the promised update, effective January 14th,  the conclusion of the 34 sessions of radiation. The 90 day window for the Lupron shot concluded January 9th and the effects will slowly subside. So, the next update will discuss my recovery from the effects of Lupro and radiation.

From an overall as well as detailed perspective I am fortunate! I have not experienced any of the potential side effects such as 'hot flashes, aches and pains,  bone density and muscle loss, mood swings, weight gain and loss of  interest in sex' cited above. While feelings are subjective the hard data from the  bicycle Computrainer and the Columbia, MD bike course do not lie. Here are the results of my work outs, extending from my first 'ride' after the Lupron injection October 7th - remembering my 'average' time is about 80 minutes, the fastest time about 79- minutes and, a poor performance is above 82 minutes.

                                    Oct. 14            79:24   193 watts         19.6 mph

                                    Oct.  22           78:58   194                  19.8

                                    Nov. 12           82:25   176                  18.9

                                    Nov. 20           79:57   182                  19.5

                                    Dec. 15            83:22   168                  18.7

                                    Dec. 23            79:57   180                  19.5

                                    Jan. 11             83:21   168                  18.7

Clearly, the performance of the December 15th work out was inferior  but I was gratified to correct my declining performance overall with a competent work out on December 23rd. The last work out in the 'Lupron window' was disappointing but no excuses.

I fought the effects of Lupron for 12 weeks to a draw, more or less, but succumbed the last week. Now, I will be interested to observe         how quickly my body recovers and return to a time of about 80 minutes.

James F. Girand
January 14, 2010

 Nearly four months after the conclusion of the Lupron and radiation treatments I am still working to get my time and power output on the Columbia, MD Course in the Computrainer to the previous level; 180+ watts and less than 80 minutes. Not until March 11th was I able to achieve 172 watts and 81+ minutes.   In a recent work out, May 4th I matched that time and power so, I appear to be on a 'plateau' that must be penetrated!! For longer rides of 40 miles or more I averaged 193 watts in October 2009 and recently achieved 187 watts. So, the evidence is clear I am yet to return to my previous levels of performance for distances from 25 to 40+ miles. While these deficiencies are small, to compete at the elite age group level, I cannot afford to 'give away' 1-2 minutes and 8+ watts on a 25 mile bike course.

 

The news is not all bad. I was able to place 5th out of 18 entrants and 14 finishers at the National Duathlon Championship at the end of April and my cycling time was the second fastest, even though power output of 180 watts immediately after the 5K run was disappointing. 

 

From a broader perspective, if the reader is not a serious and competitive athlete he can observe the increase in time four months after the Lupron shot is   finished, on the bike increased by 1+% and power output on the bike declined about 5%. For the recreational athlete these changes may be undetectable.   I should add, I did not  experience hot flashes and daily fatigue, symptoms common with Lupron. 

 

In summary, I still have work to do to return to the same power output as I was able to achieve until the Lupron and radiation treatments impacted me in late 2009. And, I have until early September when I will participate in my twentieth consecutive World Duathlon Championship. Be assured, if I achieve any breakthroughs between now and then i will update the website.

 

James F. Girand
May 7, 2010