February 17, 1999

For more general information on prostate cancer (PCa), see the Prostate Cancer Infolink.

The graph below shows my PSA history since my first indication of prostate cancer in October, 1997. A six needle biopsy in November showed a cell Gleason score of 9 and 10 and some extension outside the prostate. As is common these days with PCa, I immediately started a combined hormone therapy which shrinks the prostate and stops the growth and apparently kills some types of cancer cells. This treatment worked initially but failed after two months, and I started a 3D conformal mapped version of External Beam Radiation Treatment EBRT followed by a two day procedure known as High Dose Brachytherapy HDR (temporary implants). In my opinion this treatment was most effective in achieving local control with minimal side effects, but unfortunately it now appears that I had one bone met when my cancer was first diagnosed. No local treatment could have affected the subsequent progression from that, but others could have left me with considerable side effects. I am currently without symptoms other than those related to hormonal and chemo therapy.

In early June 1998, I started on a reduced and extended version of the Logothetis chemotherapy protocol that was completed near the end of December, 1998.  Because of the rising PSA, I restarted a one month Lupron shots at the end of November in hopes of reversing the trend, but a couple of days later we learned that my testosterone was less than ten so it seemed doubtful if the Lupron would make much difference. In fact, it didn't, but I took another shot at the end of December and will continue with three month depot shots.

The Logothetis chemotherapy began to fail in October, 1998, and my PSA has undergone a rapid increase since then. An attempt to stop or slow the rise with continuous Ketoconazole (Nizoral) apparently had little effect which is just as well since after about a month it left me with a continually upset stomach and serious malaise. This condition cleared about three days after stopping the Ketoconzole. During this treatment I also awoke one morning to mild confusion and partial short term memory loss, but a CAT scan and neurological exam showed no specific cause, and I returned to normal after a few hours. The condition was labeled Transient Global Amnesia by the neurologist.

My current plans are to wait until April then start an experimental vitamin D protocol of Dr. Trump (University of Pittsburgh Cancer Institute).

On March 7, 1999, Lloyd Fortney died. He had noticed bruising the week before, and it was determined that he had Disseminated Intravascular Coagulation (DIC) caused by the metastatic cancer. He was hospitalized on March 3 and treated for DIC, but the treatment was not effective. His health declined rapidly in the two days before he died; a brain hemorrhage was the final cause of death.

Click on the plot for an analysis of my PSA while on the Logothetis chemotherapy.

PSA: Prostate Specific Antigen is released by most actively growing prostate cancer cells in varying amounts depending on the Gleason score and other factors. It serves as an imperfect measure of the advance or decline of the cancer.

CHT: Combined hormone therapy: in my case 3 month Lupron injections plus Flutamide (Eulexin) pills 3 times daily.

EBRT : External Beam Radiation Therapy: 3D conformal done at Duke Medical Center, under the direction of Dr. Mitchell Anscher, Department of Radiation Oncology.

HDR : High Dose Radiation (brachytherapy by means of temporary radioactive implants) done by Dr. Mate at Swedish Hospital in Seattle.

Chemotherapy: Chemotherapy at DMC based on a protocol from Dr. Logothetis at M.D. Anderson Cancer Center in Houston. The DMC physician in charge of my treatment is Dr.Gockerman.