A New Regime

On the last day of 2018 we saw Dr Tyldesley. Psa is up to 46 which means it is back to doubling every five weeks. He showed us the recent bone scan and an x ray. The cancer has spread to some more ribs and also my spine. The main concern however is that now my right femur and right side of the pelvis have significant cancer and there is an increased risk of fracturing my legs. He even mentioned the possibility of inserting rods as a preventative measure, however he thinks the radium therapy might be enough at this stage.
On the second day of 2019 it was back to the Vancouver General Hospital for the radium injection. First we saw a second radiation oncologist who is also a nuclear medicine specialist. He trained in Philadelphia, lectures at the University of British Columbia and also spent 2 years in Brisbane. He explained the process in detail and answered all of our questions. We both feel very confident with this man even though we don’t recall his name. He did mention that the treatment could be continued beyond 6 months if it is beneficial.
Next was the injection. First they inserted a canularĀ  into my arm and connected it to a saline drip. Then comes the radium solution in a syringe which is carried inside a lead container. The solution is then injected slowly into the IV line. I felt no immediate effects. So now I am radioactive. The half life is 10 days. The radioactivity is highest for the first week and any excess is excreted through feces and other body fluids. I miss the French kisses!
Next week it is back to the cancer clinic for a CT scan and more radiation.
After that, who knows? Fatigue and weakness are also becoming major problems. Today I have had a couple of dizzy spells. Is it the radium? Is it due to changes in medications, or none of the above? Time will tell. For now it is fingers crossed and hope for the best.

Decision time….again

Up at 6.0am this morning for the slow wet drive into Vancouver in the dark. I don’t think the sun came up at all today and it’s still raining.

We saw Dr T. and what a change! Whenever we have seen him before he was abrupt, clinical and in a hurry to finish. Today he was totally opposite. The results. The bone scan shows more activity as expected. PSA is up to 20.2, not bad considering.

He discussed 2 options, chemo and radium 223. Radium 223 (Xofigo) is 6 injections of a radioactive isotope that finds rapidly dividing bone cells and kills them. It is not a cure but can give an average additional 3 to 4 months of quality life compared to doing nothing. The injections are 4 weeks apart, cost $5000 each and are flown in from Europe. I would be radioactive, especially Dumpy would be, but not a danger to others and I quote “providing it is not swallowed”!!

The other treatment, chemo, he said would have similar effectiveness re survival time, however, he minimised the side effects. He said the cancer is confined to bone, though if it metastasizes to soft tissue (liver or lymph nodes) radium 223 can’t be used. I asked him what would he do if it was him? He said he would have the radium 223 and then he could have chemo later if need be, but not the other way round. Sounds reasonable to me.

He also discussed giving a single shot of radiation to treat a spot on one rib that gets painful at times. Next it was off to x-ray. They took about 15 x-rays of my ribs, hips and legs. I will see Dr Y. next week and hopefully he will show us the scans and x rays.
Meanwhile I am still feeling reasonably well apart from some blood pressure issues, very high, due to Zytiga. I get tired very quickly and I don’t seem to have the energy I had in the summer. I will have to stop Zytiga before starting the radium223, so hopefully the blood pressure will improve. So, another decision to be made re treatment choices. I suspect I will go with the Radium223.