The More Things Change, the More They Stay the Same…

It’s Christmas Eve, and I just returned from my most recent visit to MD Anderson Cancer Center in Houston, Texas. As I mentioned in a prior blog post, my PSA dropped to 2.95 on September 20, 2023, and there was a lot of high-fiving and back-slapping going on. I was the ringleader of those celebrations, as I felt as if I’d finally found a treatment that would offer a durable, favorable response. In fact, there was every indication that would be the case.

But as they say… the more things change, the more they stay the same. October brought new information and based on my history; I knew right away that it was a troubling development. My PSA was 3.30 on October 27, 2023. Although my medical oncologist was not overly concerned, I already smelled a rat, because I know what happens when my PSA starts to rise. It never rises slowly.

I know a PSA rise from 2.95 to 3.30 doesn’t seem like much and for some, a PSA of 3.30 is not a scary number. Oncologists are often more concerned about “PSA velocity” – or how quickly that number rises - than they are about the raw PSA number. On November 8, 2023, my PSA was 3.68; on December 4, 2023 it was 5.80, and it jumped to 7.30 on December 9, 2023. These are alarming increases in PSA in a very short time, especially following what had been precipitous declines in PSA while on Pluvicto.

I had an updated PSMA PET scan in Houston. The “PSMA PET” is a game-changing diagnostic imaging tool that was not FDA-approved or widely available as recently as two years ago. Prior to the PSMA PET scan, it was very difficult (if not impossible) for oncologists to identify with certainty where prostate cancer cells reside. Without that information, targeted treatments were not really a “thing.” This new imaging technique can now provide precise information to oncology teams that allow for more effective and in some cases, less invasive treatments.

The good news is that Pluvicto did its job. The scan told us that all previously existing disease sites are now smaller in size. However, it also identified bone metastasis for the first time in my spine at vertebrae L2 and T8. Coincidentally, my back has been way screwed up since September 28, 2023, when I could barely get out of bed. Although the PSMA PET scan can’t tell me whether the back problems I am experiencing are related to cancer, it now seems hard to completely rule it out given the timing.

So now I wait for an updated treatment plan from the team at MD Anderson. I don’t know the details yet, but I was told while there was that there is no time to wait… that whatever we end up doing, we need to start ASAP… in January. So once again, I’ll blow through my annual deductible and maximum out-of-pocket medical expense in January. Here we go!

Until next time,

Steve