There aren't many joys that come from having prostate cancer, but surely one is getting a favorable PSA test when you thought the result would be unfavorable. I can vouch for that because today it happened again to me!
I'm now in my ninth year since diagnosis in December 1999, on my second cycle of intermittent triple hormonal blockade therapy (sole therapy, no surgery, no radiation), now in my second off-therapy period, having driven my PSA down to <0.01 on 12/5/2006, and starting the off-therapy period on 12/13/2006 after taking my last Casodex the day before and with the four month Lupron shot also at the end of the four months on that day. I had been on triple blockade - for me, Lupron, plus 50 mg Casodex, plus 10 mg finasteride, for 19 months; I continued finasteride and Boniva into the off-therapy period.
My PSA had gradually increased over the past seventeen months off-therapy, reaching 4.68 last November 30, and rising to 6.95 on January 23, at which point my oncologist and I decided to use low-dose thalidomide again to extend the off therapy period. I had gained six extra months with thalidomide at the end of my first off therapy period with that tactic.
On Febrary 6 I took my first low-dose, 50 mg thalidomide capsule, also taking 300 mg of vitamin B6 to help prevent peripheral neuropathy as a side effect and continuing an 81 mg aspirin to prevent thalidomide's tendency to increase the risk of blood clots. Thalidomide nicely checked that rising PSA, reducing it to 6.08 on March 7. However, a PSA on April 16 was 7.8, which was upsetting; I was afraid the thalidomide had already lost it's ability to control the cancer, and that should not have happened so soon.
However, that PSA was measured with a local test, instead of the test we had been sticking with for better comparability, and my oncologist, not too happy with his staff about the earlier test mixup, ordered another PSA using the same test used for the 6.05 result. This time the PSA was 7.44 (4/22/2008) - not great, but a lot better than 7.8, and not that far from the 6.95 where I started.
Well, my latest test was on 5/21, a week ago, and I really expected it would be at least in the 8s or higher, probably indicating time to resume triple hormonal blockade therapy. The result: 6.46!
That means that this second off-therapy period will have continued for eighteen months by mid-June, almost as long as the nineteen months I was on therapy. I would be encouraged if I can remain off therapy at least as many months as I was on therapy during the second round, which would be doing pretty well in view of my challenging case circumstances!
It will also mean I will have gained at least an extra 10 months of time (6 the first time, plus at least 4 this time, in addition to my time on hormonal blockade - 50 months total, and off blockade but not aided by thalidomide - 42 months) - time for researchers to do their thing and for doctors to learn what fresh tactics can work in the clinical setting.
It also means I'll be maintaining my quality of life for another month, and I won't have to again experience the side effects of hormonal blockade either. However, I could do without the slight sluggishness in the morning and slight (I hope) decrease in mental sharpness that I experience while on thalidomide. Some leading experts in hormonal blockade therapy believe that longer off therapy periods increase the chances that following on-therapy periods will be successful, avoiding development of androgen independent (aka hormone refractory) prostate cancer, though that is controversial. (I posted about the beginning of my second experience with thalidomide on 1/30/2008, "Hormonal blockade off period (holiday) in need of help: thalidomide".)