The Last Shot

Hormone Therapy Vacation Prostate Cancer PSA Lurpon
In retrospect trying to get the nurse holding the horse syringe to laugh moments before she sticks it into your butt is probably not the best idea.

“There’s a very high probability that your cancer will return.”  

My 3-month checkup with my oncologist, Dr. Stewart had just ended. Jodie and I were waiting for what hopefully would be my last shot of Lupron before going on a hormone therapy “vacation” and I couldn’t get Dr. Stewart’s voice out of my head. 

“What are the odds of …(pause)… you know what? Never mind. I don’t think I want to know.”, I responded.

And I really don’t.  If someone told you that it would be nearly impossible to succeed at something, how hard would you try? I need hope and it’s friend, optimism on my side – even if it’s unfounded in reality. 

To quote Jim Carrey’s character, Lloyd, in the movie, Dumb and Dumber: “So you’re telling me there’s a chance.”

But Dr. Stewart is right. Statistics don’t lie. So,  for the rest of the appointment I refocused on what treatments I could expect if I were to relapse after being taken off of hormone therapy. Unsurprisingly, I would be put back on hormone therapy immediately. If my PSA level, a blood marker used to detect prostate cancer, were to exceed .5 ng/mL, a PSMA Scan would be performed on me. If the acronym PSMA sounds familiar it’s because Dr. Stewart wanted me to undergo one two years ago at UCLA when I was newly diagnosed. At the time the scan was going through FDA approval. Recently approved, UCSD had one installed just days before my appointment. The upsides of FDA approval are that insurance would probably cover it ( it was $3000 out-of-pocket two years ago ). The downsides are that I might not want to see what the scan has to show me. It’s incredibly precise and has the potential to pick up metastasis missed in my prior CT and MRI scans. Ignorance is bliss, right?

“And if my PSA were to rise and the PSMA scan were to pick up something? Then what?”, I asked Dr. Stewart.

“If there’s not too many spots we’d radiate them.”

“…and if it’s in a place that has already been radiated?”, I pushed.

“Then we’d have a longer conversation with your radiation oncologist. Dr. Rose.”, he replied.

“It’s like ‘whack-a-mole’.”, he continued, using an analogy.

“And we’d just keep hitting the new spots over and over?”, I asked.

“Yes, as long as the cancer responds.”

“And if it doesn’t?”

“Then we look at other therapies.”, he replied.

Dr. Stewart also told me that I had the option of staying on hormone therapy. I quickly dismissed the idea. 

First off, my body needs a break. In my last post I wrote about how hormone therapy can cause bone loss. Well it can also cause muscle loss, fatigue, and liver problems. In addition to 3-month Lupron shots I’m also on Zytiga, another pill-based form of hormone therapy used for advanced prostate cancer, and a steroid, Prednisone – both of which require monthly blood panels. A month hasn’t gone by where I haven’t seen an abnormal reading. 

Second, by staying on hormone therapy I’d never know if I was really in remission, or if the hormone therapy was just suppressing the cancer. No, it was time to pull the blocks and take the prostatectomy-ied, radiated, and “hormone-therapy-ed” “car” out for a drive and see what happens.

Third, hormone therapy becomes less effective over time. Hormone therapy works by stopping your body from producing testosterone. Initially, prostate cancer requires testosterone to thrive, but eventually the cancer adapts and starts producing it on its own. The clinical term for this is “Castrate Resistant Prostate Cancer”, or CRPCa. CRPCa is much more difficult to treat and the longer I’m on hormone therapy, the greater the chance my cancer will become resistant to hormone therapy. 

( Knock! Knock! )

“Ready for your shot?”, my nurse asked from behind the exam room door.

“Yup! Come’on in!”, I replied, grimacing.

While my nurse donned her protective gear and prepared the shot I fumbled with the exam table’s foot pedal to raise it up to white-knuckled-grabbing-position. 

“This is my last shot!”, I said, and then stumbled a little, “…. hopefully…”

“I hope so, too.”, she replied, smiling.

It was my seventh time getting stabbed in the ass with a horse needle full of Lupron. My first injection, a different but similar medication called Degarelix, was administered to both sides of my belly almost two years ago. This time I barely felt it at all. 

The Lupron will remain in my system for three months. In December, for the first time in two years, I won’t receive a follow-up shot. I will stop taking Zytiga, too. A week or two later I will go off of the steroid, Prednisone, and then my hormone therapy “vacation” will begin. I am looking forward to the vacation, but I’m more than a little scared. too. Currently my PSA is .01 ng/mL, or undetectable. If my PSA were to increase it would indicate a recurrence; that somewhere inside of me the cancer is still alive and growing. It would also imply that, until there’s a cure, I’ll likely be fighting it for the rest of my life. 

In the past I’ve referred to the whole cancer journey as a trip down a dark tunnel. It’s scary. It’s dark. And it seems to go on forever. As with any tunnel there is light at the end. Those are your family, your friends, and your supporters waving flashlights and urging you forward. The thing is there’s light in the tunnel, too. You just need to look harder for it. This light is from cancer survivors who continue to fight. Although they haven’t made it out yet themselves, they, too, urge you forward. They’ve been down the same path. The path forward is possible. It’s been done. You just need to follow the light to find your way. 

So wave those flashlights, people – and tell you what, I’ll wave mine, too.

Take care. Stay healthy. Live life.

-Scott

Previous: Walk the Walk

My PSA ( ng/mL ) as of 10/11/2021
Prostate Cancer PSA

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