I am a retired lawyer in very good overall health. During a physical exam DRE (Digital Rectal Examination) indicated enlarged prostate in January 2006. DRE exam did not have any indication of Prostate Cancer. Subsequent PSA test was 13.1 ng/ml. A 13 point biopsy was performed, which indicated PC with Gleason score 3+3. My doctor ordered an MR and bone scan before deciding on the treatment.

Bone scan came up positive with multiple metastasis however the MR looked OK. This was confusing and I wanted a second scan to be sure. Meanwhile my urologist started ADT immediately. A second bone scan done 3 months later still had the dark spots but radiologist could not be certain if this was metastastic or due to other causes such as Padgitt disease. I suspect having played football for many years it might have something to to with that. Radiologists ordered a PET scan for a better diagnosis. PET scan showed no metastasis to the bones and I felt relieved. My PSA went down to 0.1 n/ml after four months following the ADT and is still low.

Nov. 2006. I asked my urologist if surgery is an option to get rid of the cancer since it appears to be confined to the prostate. He advised to remain on the ADT and keep watching the PSA periodically.

Dec. 2006. I consulted an oncologist who recommended EBRT(External Beam Radiation) and said that with the new 3D IMRT machines good results are obtained with minimal side effects. The local university (University of Kocaeli) recently received this machine. I also learned that Johns Hopkins affiliated Anadolu Medical Center located 40 km. away had a similar machine and had been treating many patients for the last few years. I opted for the second facility which I thought might have more experience with the technology. I am still concerned with potential side effects which may reduce my quality of life. It is a hard decision. I might as well continue with just the ADT. Hot flushes are the only major side effect.

Jan 8. 2007. Finally I decided to go ahead with the IMRT and procedure started on Jan. 8. I will continue the treatment for 7 weeks, 5 days a week and hope for the best. My PSA still remains near undetectable levels as result of ADT. I hope to stop ADT as soon as possible and perhaps continue with intermittent ADT treatment as my doctor decides.

Feb.5 2007: I have completed the fourth week of IMRT radiotherapy sessions. Three more weeks to go. I am scheduled to receive a total dose of 7,400 cGy. I recently started to experience the first significant side effect of the radiation. Slight rectal bleeding which is most likely due to aggravated haemorrhoids which I had been treated for about five years ago. My oncologist says this is normal. There is also slight feeling of tiredness. I am still on ADT and ADT will continue for a couple months more after finishing the radiotherapy. I am looking forward to dropping ADT and all of its unpleasent side effects.

Feb.12.2007: I have completed 5 weeks of the IMRT with no serious side effects so far. Once I noticed slight rectal bleeding a week ago, however this did not re-occur. My oncologist said this was not a cause of concern. I am scheduled to receive a total dosage of 7400cGY when I complete my seven weeks of treatment.

I did some research on the optimal dosage with the IMRT. A study in the US (Penn State Univ.) showed that increasing the dosage to 7800 cGY increased the success rate of the radiotheraphy without causing any significan increase in side effects. I will discuss this with my oncologist and perhaps add an extra session or two to my therapy if that would produce any benefit for me.

I do feel tired in the evenings as I continue to work during the day and I go to radiation sessions at 15:00 in the afternoon during the week days. I am considering taking a medical leave even though I am very busy with some outstanding court cases. Because I am pretty exhausted at the end of the day.

I am looking forward to completing the treatment and switching of the ADT after a few months. Hot flashes of the ADT really bother me.

I have just finished radiotheraphy back in February 26. Feeling a lot better since then. I will go to the doctor at the end of April with a PSA score. I hope to drop out of ADT at that time. Indeed it starts getting warm here after June and would be nice to get rid of hot flashes caused by ADT. It also causes muscle aches and loss in my arms.

I wish all the best for you and will keep updating the site.

June 16,2007: I had my PSA test done on April 25. Score was 0.04 which was a relief.

So far things are going well. I have no more side effects left from the radio therapy; However, unpleasant side effects of ADT (Daily casodex pills and monthly zoladex injection) continues as hot flashes and muscle loss, also loss of body hair.

I visited my oncologist at Anadolu Health Center with my PSA results. I also had another MR taken. My doctor said that the MR and the PSA scores looked good. There was no sign of spread of the disease beyond the prostate capsule and the capsule was intact. He asked me to come back at the end of August with a new PSA score. He referred me to my urologist to decide on whether to continue ADT.

I saw my urologist a few days later with these results. He was also pleased with the progress. He advised me to continue with the ADT until the end of July. Then stop ADT for two months. He asked me to see him at the end of September with a new PSA score. I hope that there will be no increase in the score and I will be able to stop ADT altogether.

September 21,2007: I had a PSA test indicating less than 0.01 ng/ml. Both my oncologist and urologist are pleased with the result. I am very pleased indeed. So far so good.

My doctors said its OK to stop taking hormone treatment for the next three months. After this period I will have another PSA test and and MR taken and see my doctors. Hopefully the PSA will stay low.

Its a great relief for me to get rid of unpleasant side effects of hormone treatment. Now I can enjoy more quality time with my family, and play with my first grand son who is now one year old.

December 24, 2007: Total PSA=0.373 ng/ml, Free PSA=0.044 ng/ml. Some increase in the PSA. I called my urologist. He said the results were fine and asked me to take another PSA test in March to monitor. My oncologist wanted an MR and PSA result at the end of March.

March 5, 2008: Total PSA=0.647 ng/ml, Free PSA=0.052 ng/ml. Increase is continuing. I will have an MR taken and see my oncologist.

After stopping ADT my PSA readings continued to rise as follows:

March 3, 2008: 0.65
May 5, 2008: 0.69
August 1, 2008: 0.80. DRE result: good.

At this time my urologist offered me the option of re-starting ADT or waiting for another two monts and see the PSA. I opted to wait. I hope that this PSA increase will level off and even reverse at one point. If I start ADT I know that the PSA will go below measurable levels again and it would be impossible to know if radiotherapy cured the disease.

November 2008: PSA measured 1.24 at the local lab. I visited my urologist. DRE result was fine. The urologist suggested starting ADT. 10 casodex pills for 10 days to prevent flare and lazodex injection once every three months. Dr. says he can not be sure whether the increase in PSA indicates recurrance of cancer, or it is due to remaining healthy prostate cells. He thinks, to be on the safe side, it is better to start the ADT.

This is a hard decision for me as we don't know if this increase in PSA is just a post-radiotherapy bounce, which could stabilize somewhere around 2. If I start ADT I will never know the answer to this.

I had read the well documented story of professor Les Bradbury at his highly informative web site on radiotherapy . He also experienced similar increase in PSA after his radiotherapy.

To get a second opinion, I visited another urologist in Istanbul who is a well known professor of urology and founder of a private hospital (Hattat hospital specializing in urology). He had performed my biopsy few years ago which discovered pc. He took another PSA test. Result: 0.9. DRE was fine.

The professor said he was happy with the PSA numbers and there was nothing to worry about.He told me to get a PSA test again two months later. No hurry to start ADT at this time. I am happy with this outcome.

January 8 2009. PSA 0.72. A move in the right direction. I am delighted. My doctor advised to check PSA again in March.

June 2009: PSA 0.89, DRE OK.
December 2009: PSA 1.22, DRE OK.

I feel fine. My urologist says everything is ok and there is no need for any medication. Looks like my IMRT treatment has reached the target and combined treatment of ADT (started months before IMRT) and IMRT was a good decision.

My next check up will be in May 2010.

January 2010. PSA:0.92. DRE was OK.
March 2010. PSA: 0.71. DRE normal.
September 2010. PSA: 0.78. No DRE exam was done. Doctor asked me to check PSA once every six months. He said everything looks just fine.

I have no complaints so far related to prostate however a stent was placed by my cardiologist due to a 75 % narrowed artery.

Thank you for the reminder. My latest situation: PSA: 0.8 and rectal exam normal. At the time I have no ongoing medication or treatment.

Note: My son is writing these in English for me as my English is not so good. He was away for a while and I could not write updates.

My last exam was performed in April 2013. PSA 0.9 and rectal exam result normal. No complaints so far related to my prostate. I have not been taking any medication for PC since 2007. Just keeping a well balanced low fat Mediterranean diet and using nothing but olive oil. I walk regularly and remain active.

Abdurrahman's e-mail address is: avozal AT yahoo.com.tr (replace "AT" with "@")