Home Survivor Stories Treatments Radiation Therapy

Intensity-modulated radiation therapy (IMRT) takes the dose planning one step further than 3-D conformal radiotherapy. Studies have clearly shown that delivery of higher doses of radiation results in better outcomes.  However, if you remember from the anatomy lesson above, the prostate lies right next  to two rather important structures: the bladder and the rectum. Radiation damage to either of these organs can result in significant urinary and bowel problems that are not only unlikely to improve over time, but that have been shown to worsen over time as the effects of radiation accumulate. To avoid these problems, oncologists might be tempted to opt for delivering lower doses of radiation - at the expense of decreasing the chances for a cure.

IMRT does exactly as its name suggests - it allows oncologists to modulate, or change, the intensity of the doses  and radiation beams to better target the radiation delivered to the prostate, while at the same time delivering lower doses to the tumor cells that are immediately adjacent to the bladder and rectal tissue. With this approach, the local side effect rate is lowered further while keeping the cure rates as high as possible.  

Regardless of the form of external radiation therapy, treatment courses usually run five days/week for about seven or eight weeks, and are typically done on an outpatient basis. (Prostate Cancer Foundation - Pg. 25)  

 

 

 Good news! The PSA tests in February and late April were .01 - undetectable, the sweetest words a person can hear! The follow up PSA test will be done in August. Testosterone has recovered nicely to 500.

 

James F. Girand

May 7, 2010

 

The most recent PSA test on July 26, 2010, revealed a slight uptick to .02, from the April reading of .01. The absolute level is still very low and is a little concerning but also could be attributed to equipment variations. Too early to draw any conclusions.

Going forward, there are several scenarios that could unfold, described as follows;

  1. The combination of Lupron and radiation concluded January 14th can have two effects for the yearfollowing last treatment. First, Lupron whacks the last reading of PSA before treatment (.10) to zero immediately and if cancer is present it will gradually increase. Radiation on the other hand causes PSA to decline over time and in the absence of cancer will reach a nadir of .02 to .04, more or less about one year after the last treatment and remain in that range. During the next six months the effect of these two treatments will reach a confluence so my next PSA tests, October 26 and January 2011 will be important in determining whether cancer is still present beyond the pelvic areaand lymph nodes.
  2. In the event the PSA readings continue to increase they might have a 'signature' and follow a similar trajectory as I experienced in 2008 and 2009. Specifically, from October 2008 to October 2009 my PSA increased from .02 to .10,suggesting I might reach .10 around July 2011. The absolute number and doubling rate are the key factors to interpret thenature of my cancer but not useful metrics until PSA approaches 0.2. At that point, if the doubling time is more than one year, it  probably calls for extended active surveillance.
  3. Looking at possible scenarios, a continued increase in PSA to numbers of more than 1.0 could bring several options.First, when PSA approaches 4, I would consider a regimen of annual Lupron treatments, one year on and one off. Lupron administered in that manner has been shown to control cancer up to 10-15 years. The year 'on' would have similar effects as my 90 day regimen last winter, notably, whacking my testosterone and causing a 5+% deterioration in my cycling performance. I did not experience hot flashes or fatigue but who knows what would happen for a whole year? A second alternative would be to enter a Clinical Trial managed by Dr. Eric Small, depending on scope and availability at that time.

In summary, we have a reasonably well defined set of milestones, two important PSA tests in October and January, and, depending on the readings, more clarity as to the status of my prostate cancer. There is a broad range of possible treatments dependingon how the prostate cancer manifests itself, if at all. From a broader perspective, time is on our side as new treatments become availableover an extended period of time.

Stay tuned - the epic battle continues......!!

James F. Girand
August 2, 2010

 

 Simply stated my PSA, that had increased to .02 July 28th, has declined to 'undetectable' <.01......!!!!!

The most logical explanation, if there is one, is the July number was affected by one or more of the following;

1. Lingering effects from the Lupron injection that concluded its 90 day period January 14th.
2. Residual effects from the 34 radiation treatments that concluded about the same time.
3. Equipment variations that had a miniscule effect on my PSA reading.

Readings in April and June were .01, too close to the end of my radiation treatments to be good indicators and should not to be confused with an 'undetectable' reading of <.01.

In any event, we have one new and important, positive data point. Now, we need to have the same or a similar reading in January, the first anniversary of my radiation treatments. If the value remains 'undetectable'  <.01 we will consider moving to a six month review cycle.

The summary from my July PSA test in the August 2nd narrative above has all the background information about possible treatments if my PSA starts to rise consistently over a sustained period of time and need not be repeated here.

I look forward to continue 'fleshing out' my post radiation and Lupron PSA profile in January. I have lots of races yet, including an improvement on my 8th place finish, out of 19 participants in the recent World Duathlon Championship. Specifically, I look forward to 2012, when I enter a new age group.

Promise you will know the latest PSA reading shortly after my meeting with Dr. Gottschalk on January 7th.

James F. Girand
October 13, 2010

 

Here is a summary of my most recent PSA and other blood related tests taken December 29th. 

My PSA was .01 which Dr. Gottschalk indicated is the equivalent of 'undetectable', given the resolution and accuracy of the measuring equipment. This number follows the previous five readings the past twelve months that ranged from .02 to <.01. With this most recent level close to the first anniversary of my concluding radiation and Lupron treatments, and the history of the past year we decided to move from a three month testing cycle to six months.

We also have a new data point for other elements of my blood analysis, updated below;

      Description         Range         July 28th    October 4th     Decembr 29, 2010
      WBC Count         3.4-10              3.0              3.9                    4.0
      RBC Count         4.4 -5.9            3.92           4.33                 3.99
      Hemoglobin      13.6-17.5         13.8           14.8                 14.6
      Hematocrit         41-53               39.6           44.4                 42.3
      Testosterone     260-1000        563             557                  526
      Vitamin B12       20-1100          166             617                  631

While the RBC is a little low he felt the hemoglobin level is satisfactory and overall my blood chemistry is acceptable.

In summary, a year has elapsed since I concluded my radiation and Lupron treatments. My PSA readings have remained low,  in the 'undetectable' area, except for a reading of .02 in July which was followed by two consecutive readings of <.01 and .01. This data is sufficient for me to move from a three month review to six months. Thanks to Dr. Gottschalk for his continued vigilance and keen interest in my health since the radical prostatectomy in October 2006 and the radiation/Lupron treatments in January 2010.I will probably never be totally 'out of the woods' but we could not hope for much better first anniversary results than these.

James F. Girand
January 13, 2011

 

 Here is a summary of my latest blood analysis taken at UCSF on June 9th. 

My PSA was 'undetectable', that is, less than .01 compared to the last test in December 2010 which was .01.  This latest level basically continues the string of low to 'undetectable' levels of PSA since I concluded hormone and  radiation treatment January 17, 2010. Only good news and, we agreed I will continue to get six month tests.

A similar  set of readings in January will usher me into a new age group and give ample opportunity to be the age group national duathlon champion.! The next major milestone is January 2015 which will be my five year anniversary of  concluding hormone and radiation.

The other readings are incorporated in the table below:

  Description         Range      July 28th     Oct. 4th     Dec. 29, 2010    June 9, 2011
  WBC Count        3.4-10           3.0             3.9                 4.0                     3.6
  RBC Count        4.4-5.9          3.92           4.33               3.99                   4.02
  Hemoglobin     13.6-17.5       13.8           14.8                14.6                  14.5    
  Hemocrit             41-53            9.6           44.4                42.3                   42.5
  Testosterone    260-1000        563           557                 526                   771 
  Vitamin B12      20-1100         166            617                631           
  Platelets                                                                                                   160 
   Iron                                                                                                          126 
  Transferrin                                                                                                246    

Not much to add, except Dr. Gottschalk felt the modest red blood cell count was offset by a normal hemoglobin and hematocrit.                

James F. Girand

July 27, 2011

 

 

Here is a summary of my latest PSA tests reported December 13, 2011

 

My PSA reading was .01. You will note above my PSA one year ago was .01 and last July was <.01 or, undetectable.  Dr. Gottschalk's comments were consistent with earlier visits. For all practical purposes the seasoned Radiology Oncologists cannot distinguish any difference between undetectable (<.01) and .01. My next PSA test will be in June 2012.

 

Rather than post an update to my blood readings, suffice it to say, they are all in an acceptable range.

 

Now, serious training for the duathlon season is underway. In my new age group I will have a distinct advantage yet can take nothing for granted. I am pleased to add, I won the bronze medal at the World Duathlon Championship held in Gijon, Spain, September last year - my first medal in an Olympic Distance World Duathlon Championship. Now, on to Nancy, France – the Worlds site in 2012 with stops along the way in Regional events and the National Duathlon Championship in Tucson, Arizona, April 28th.

 

I have often said, prostate cancer is a life long relationship and, all I can do is keep the latent cells, if any, quiescent in my body. The battle rages on and we are holding 'P.C.' at bay.

 

James F. Girand
January 20, 2012

 

 

My first reaction to the most recent PSA reading was - alarmed!

As background, the text above describes the recent history of PSA tests:

 

     July 27, 2011  'undetectable' - less than .01
     January 20, 2012  .01
     May 26, 2012  less than .015 with the added comment.

      ".....Minimum detection limit assay is 0.015 ug/L. Performed using the
            Siemens Immulite 2000 Chemiluminescence method"

 

My alarm stemmed from the obvious increase from test to test, two consecutive to be precise. Without taking the reader through the drama, the Siemens equipment has been upgraded to resolve beyond .01 to .015 to be precise. So, there is a new definition of 'undetectable', .015. The message to all site visitors is to ask your doctor the definition of 'undetectable' for the equipment being used to measure PSA. If more than .015 get the test done by Siemens or, comparable.


Anticipating the day when my PSA may rise above 'undetectable', I asked Dr. Gottschalk at what level would he be concerned. .05 is the threshold, depending on other recent readings. And, that number would not be classified as 'life threatening'. Rather, PSA would need to rise to 0.2 to cause major concern. At that level, the rate of doubling PSA comes into play - once/year would be observed while doubling every three months would warrant intervention, such as, hormone therapy, depending on other information.


The main conclusion now is I am a long ways from from something less than .015 to 0.2 and the trend of my PSA and absolute levels can be observed in depth over an extended period of time. Speaking of 'time', it is clearly on our side as advances in research favor us!


James F. Girand
June 11, 2012

 

 

Yet another small false alarm. My PSA June 11th, was recorded as <.02. In recent measurements PSA has varied from less than .01, less than .015 and now, less than .02. Dr. Gottschalk said that reading is 'undetectable'. I questioned the inconsistency with earlier readings and he said, UCSF had to send the blood sample to a different lab whose best resolution is '<.02'. So, the message to you is; whenever you get a PSA test and the results vary, even a little, verify the equipment, lab used and resolution at 'undetectable' or any other value.
 
Stepping back from the individual PSA readings, two years and eleven months have elapsed since my lupron and radiation testing in January 2011. I inquired, with each successive measurement at six month intervals, and continued 'undetectable' readings, whether my chances of cancer recurrence diminish with time?  Dr. Gottshcalk observed the science is not certain but when I finished my radiation the chance of recurrence was 30% and now about three years later it is about 10%.

He added there is a phase 2 Clinical Trial underway at UCSF which is testing a vaccine for men who experience a rising PSA after radical prostatectomy and radiation. To qualify the participant must have a PSA of 2.0.

 

James F. Girand
December 21, 2012

 

 

 

I am blessed - the most recent Ultrasensitive PSA Test reported '<.015 or undetectable' the same as the May, 2012, test. This is the second test with the 'Ultrasensitive' equipment. And, the 'full disclosure' notes acknowledge a 'new reference range and change in methodology effective March 25, 2013'. This test was performed using the Abbott Architect 12000 chemiluminescence method. The December 2012 results did not include the equipment manufacturer and May 2012 was done by Siemens Immulite2000 Chemiluminescence. I make this point because the equipment will only become more sensitive and the levels of 'Antigen' more finite, miniscule differences in measurement technology will yield slightly different numbers so, we patients, me included, should not react immediately to small changes, rather, get your radiologist' interpretation.

 

James F. Girand
May 8, 2013

 

 

 

Blessings continue. My most recent PSA test was <.015, read 'undetectable', utilizing the same ultrasensitive equipment as in May. Dr. Gottschalk observed I am one month shy of the fourth anniversary when I underwent a combination of radiation and Lupron to combat a rising PSA, described above. Still not possible to predict the future but each successful six month PSA test adds a bit of confidence going forward. Beyond PSA, the other blood tests were in the normal range.

James F. Girand
December 13, 2013

 

Met with Dr. Gottschalk after a full blood panel - the latest reading on the Ultrasensitive PSA equipment continues to be <.015 or, undetectable. Now, more than four years after the Lupron and radiation testing and eight years after my radical prostatectomy, Dr.’G’ was reluctant to speculate on the probability of a recurrence of rising PSA, except as said before - each successful ‘undetectable’ reading diminishes the probability ‘a little’. Had a scare about a month ago when I observed blood in my urine, after a couple of hard work outs.  It stopped and Dr. ‘G’ said not to be concerned.
   
James F. Girand
June 11, 2014
 


Survivor Stories Heading

Additional Treatment: In May ADT (Androgen Deprivation Therapy) four month depo Lupron  (anti testosterone) with only minor side effects of hot flashes.  ADT sort of holds the cancer steady or kills some cells by denying the fertilizer of testosterone. It is best to get the incontinence solved before the radiation. In September started 7 ½ weeks of adjuvant radiation even though the PSA was still 0.0.  Radiologist explained there are slightly better statistics by starting now before the PSA rises.  External Beam Radiation Therapy (EBRT) - Intensity-Modulated Radiation Therapy (IMRT) finished in November with no side effects except a week of loose stools handled with BART  (Bananas, Applesauce, Rice and Tea)  It is important to get a good team for planning and doing the radiation and of course good equipment. There have been major advances in radiation therapy and under certain circumstances it may be a good alternative to surgery. 

73 year old male
December 30, 2007

 I started IMRT on November 30, 2009 and concluded the 34 treatments on January 14th. The protocol is to deliver two Gy/session for a total of 68. Why 68? The answer was 'experience'. As delivery has become more efficient, the total number has been increased from 65 and will probably be higher in the future. Each session takes about 15 minutes and there is no discomfort. I did not have any discernible side effects the first week and Dr.  Gottschalk said, they are best compared on a weekly basis. At this time my testosterone has been whacked to less than 50 and PSA is undetectable, read, less than .01. On January 7th I had been taking Lupron for three months. Dr. Gottschalk reexamined whether I needed to take the last 30-day Lupron shot and concluded it was not necessary.

 As each week passed the 'grind' to drive to San Francisco wore on  me and I did experience a feeling of total dependence on the radiation equipment. The saving grace was the two men who administered the treatment each day, Michael Sanchie and Robert Chen are consummate professionals. Weekly meetings with Dr. Gottschalk were informative as he assessed my reaction to the combination of Lupron, Casadex and radiation. U.C.S.F processes 25 radiation patients or more/day and most are in far worse shape than me. Still, Mike and Robert were always positive, cheerful, upbeat and very efficient. I never felt hurried or part of a mass operation. With two weeks remaining I began to experience diarrhea and a strong burning sensation when I urinated. Also, I had to go more often. Minimizing fiber in my diet helped but I could not do anything about the stinging during urination.  After reviewing my blood status we agreed I would just 'tough it out'.

 At the conclusion of the 34 radiation treatments, Dr. Gottschalk is optimistic, the combination of my pathology coupled with early an aggressive treatment once my PSA started to rise, will give me a 90% chance of a cure. I have follow up PSA testing scheduled for February, April and then, three month intervals the first year. The overall goal is to have PSA remain undetectable - forever - and testosterone return to the normal range in six months or less, read, 200-700. If I do have a recurrence the treatment would consist of periodic Lupron shots to 'whack' the cancer because we have used the radiation 'bullet'. Look for updates after these periodic check ups.

James F. Girand
January 14, 2010