Prostate cancer: part 2
At the end of 2008 we moved from Lane Cove to Torquay, so Stricker referred me to a new urologist, in his words ‘the Phil Stricker of Melbourne’ (Dr Mark Frydenberg). PSA was monitored every 3 months, and in the autumn of 2010 it started to rise. I don’t have the numbers, but once it got going it was rising quite quickly, doubling about every 8 weeks.
I had bone and CT scans (negative), and discussions with radiation and medical oncologists (Prof Gillian Duchesne and Dr Jeremy Shapiro). I also had an FDG PET scan (negative - although I had been warned that they don’t often show anything for prostate cancer, especially with relatively low PSA).
After all that I went back on Zoladex late in 2010 and responded immediately, with PSA falling to <0.04 (minimum reading at a new lab). I had 2 implants, followed by further 3-monthly PSA monitoring.
Late in 2012 I went through the same cycle of rising PSA followed by two Zoladex implants, although the hormone therapy didn’t get the PSA down quite so low this time.
Second half of 2014 – same thing, rising PSA and more Zoladex. But this time after the second implant the PSA rose from about 0.6 in September to 1.2 in December (again, I don’t have the exact numbers).
Around this time a new PET scan was being developed, based on prostate specific membrane antigen (PSMA). One of the world leaders in this was Michael Hofman at the Peter MacCallum Institute, then in East Melbourne. So I was booked in for a PSMA PET scan at Peter Mac, which I had in February 2015. Back then they had to get the relatively stable precursor radioactive material (germanium-68) from Lucas Heights, then extract the required fast-decaying gallium-68 and make up the PSMA solution in their lab just before it was injected. That scan showed a spot in the prostate bed plus a single lymph node, with no bone involvement.
As a result, I was referred to radiation oncologist Dr Pat Bowden at the Epworth Hospital in Richmond. By the beginning of May 2015 I had completed stereotactic treatment of the lymph node and 7 weeks of IMRT to the prostate area. PSA immediately prior to the start of radiotherapy was 1.84.
As I had radiotherapy each weekday, the Epworth put me up in the Quest Apartments nearby in Wellington Parade (East Melbourne). For my morning walk on most days I went over into the park around the MCG and sometimes over to the tennis centre. I went to an ODI world cup match, India v Bangladesh, and had the full run of the MCC Members stand, which was good. And I went to Fed Square for the team parade after Australia won the cup, and ran into an old MU footy club friend, Peter Brukner, who was then the Australian team doctor. We had a good chat about the old days, his time at Liverpool FC as the team doctor, and sadly also about the Phil Hughes disaster which he was heavily involved in. Later, Mark came to stay for a bit and we went to a Hawthorn/Essendon footy match.