Next Steps

So… what next? I have completed radiation on the cancer found in three separate vertebrae – L2, L3 and T8. Radiation to L1 will commence at some point, but not now. The radiation is supposed to relieve some, if not all of the back pain. Has it? Not really. My new regimen is trying to calibrate the minimum amount of Percocet that I can get by with each day to mitigate the back pain until we figure out what to do next. The cancer has pushed through my vertebrae and created compression fractures in my spine. There is a minimally invasive procedure called vertebroplasty that many swear by. Perhaps that is in my very near future. I hope something is.

Coincidentally, today is a comparatively good day. The sun is shining, and it is pushing 70 degrees in the Greater Cincinnati area. I was able to get outside and clean the yard up a bit (I will get in trouble with Diana for that when she gets home). Today is the best I have felt in weeks. Spring has sprung.

Next steps are to head back to MD Anderson Cancer Center in Houston to consult with my medical oncologist there. While there, we will do a PSMA PET scan (my seventh!) to see what can be seen in my soft tissue. The recent MRIs have been able to see the cancer that has metastasized to bone, but there has to be something else going on. Despite it all, my PSA is rising again and rising quickly. A biomarker that typically chugs along at a glacial pace, if at all, is now doing this:

3/04/2024 16.2

3/06/2024 18.3

3/12/2024 22.8

3/19/2024 25.1

Something evil is going on inside despite everyone’s best efforts and the PSMA PET scan will find it. The question is what to do next? I have cycled through pretty much all FDA-approved treatments for metastatic, castrate-resistant prostate cancer with moderate success. Nothing is really working now though. The most likely next step is an immunotherapy clinical trial, but there are parameters that need to be met before that is an option. Depending on the trial chosen, one’s PSA has to be below 50 ng/dl and at the rate things are going, I am not hopeful I will slide in under that wire a month from now.

In a previous chapter, I spoke of a Hobson’s Choice, or an apparently free choice when there is no real alternative. I may soon face one of these again, which is the possibility of having to start back on chemotherapy to get my PSA down far enough so that I can gain entry into a Phase I clinical trial. In a Phase I clinical trial, efficacy data is early at best and the maximum safe dose is not yet known, and the attempts to calibrate that may result in serious adverse events, including the possibility of the really bad serious adverse event that I won’t mention here. Ugh.

But all of that said, while in Houston we are going to go to a Houston Astros baseball game at Minute Maid Park and see our friends Roz and Alan Pactor, great supporters and sister and brother-in-law of my dear friend Steve Tyrell. Life goes on – gotta enjoy it while you can.

Until next time,

Steve