I live on the "Big Island" of Hawaii in a community named Kailua Kona. The island has a population of about 140,000 permanent residents, so there is an insufficient customer base for many medical specialties. Consequently, we often have to fly to Honolulu for treatment. Many of the Honolulu medical specialists come to the Big Island once or twice a month for consultation, but most procedures are scheduled for Honolulu.
Since 1987, when I was 53, I have had regular prostate exams and PSA tests. I was also treated with antibiotics for several instances of prostate infection. Also, for many years, I was taking testosterone replacement therapy. In July, 2010, my urologist became concerned with my PSA score, which had been around 8.0 for the last two annual tests. I had a biopsy a few years before, which was negative for cancer but positive for a prostate infection. After a course of antibiotics in that previous instance, the PSA went down. The urologist in the 2010 instance prescribed antibiotics, on the theory that a re-infection may have caused the high PSA.. The PSA did not go down, so a biopsy was obtained. The report came back from Bostwick laboratories positive for cancer. The Gleason score was 3+4=7. Only one of twelve specimens had cancer. Of course, the testosterone treatment was stopped. The urologist suggested a consultation with the radiologists at Kona Hospital, who have the equipment for external beam radiation. I spoke with Dr. Henry, who suggested I also get a consultation with Dr. Grimm, a famous expert in brachytherapy with offices near Seattle. I sent the Bostwick report to him, and scheduled an interview on the mainland for October 11, 2010. (I would be on the mainland on that date, returning from a cruise.)
Meanwhile, my primary care provided suggested that I talk to Dr. Stephen Chinn, a urologist who works for the Straub Clinic in Honolulu, who comes to Kona every two weeks. By this time, my research on the internet and in five books on prostate cancer that I read, I was leaning toward brachytherapy. On September 2, 2010, Dr. Chinn, a surgeon, had no objection to brachytherapy, and referred me to Dr. John Lederer, who works at the Cancer Center of Hawaii in Honolulu. Dr. Lederer does not come to Kona, so I met with him in Honolulu on October 15, 2010 for the first volume study. (I told Dr. Grimm: thank you very much for looking at my record, but that I preferred to be treated in Hawaii.) The volume study, unfortunately, found that my prostate was too large, so I returned to Dr. Chinn on October 21, 2010 for injections of Lupron depot (4 month dose) and Casodex 50 mg. (The Lupron shrank my prostate, but killed my interest in sex.)
I received a 3 month injection of Lupron from Dr. Chinn on February 17, 2011. I returned to Dr. Lederer for a second volume study on February 28, 2011. This time the test was successful: my prostate was half the size of the previous study.
I returned again to Honolulu on March 21, 2011 for the brachytherapy, which was performed at Hawaii Medical Center East (formerly St. Francis Hospital.) Dr. Lederer was assisted by Dr. Chinn. The procedure was easy: I felt no pain during or after the procedure. They presented me with a little card: 143 sources of I-125 Pd-103 were implanted. Unfortunately, I was unable to urinate! I struggled for hours, and by 6:00 PM I squeezed out 200 ml, and was discharged. My wife and I stayed in a Waikiki hotel (The American Cancer Society arranged a discount room). I still had a problem urinating, and was up every hour. However, in the morning I was still pain free, and walked across the street to a Denny's for a big breakfast. After that I went to Waikiki beach and took some pictures. When I would sit on a hard bench, I felt like I was sitting on a tennis ball, but it was not painful. I was still urinating with difficulty about every hour. In the afternoon we flew back to Kona.
I kept a log of trips to the toilet: about every hour, day and night, for about a week. Dr. Chin prescribed three medications: Demerol (which I did not take), Flomax, and Senna. As of today (May 29, 2011), the urination problem has mostly subsided: I get up twice during the night. Bowel movements are a problem: my hemorrhoids (of years ago) have returned, so I continue on the Senna. I called Dr. Chinn about the frequent urination. He said the internal radiation was causing distress to the urethra and colon which is analogous to 'sunburn', and the distress would subside in time. It got better, and I discontinued the Flomax.
On April 25, 2011 I went to Honolulu for a CAT scan with Dr. Lederer. The purpose was to check the placement of the radioactive seeds. No problems were found.
There is not sex life yet! The last (3 month) Lupron injection was on February 17, 2011 so I am waiting for it to wear off.
I have an appointment on July 21, 2011 with Dr. Chinn, preceded by a PSA test. I am confident that it will be fine.
On July 21 2011, I visited my Urologist, Dr. Chinn, for a checkup, four months after the brachytherapy procedure. The news was good, as expected: PSA 0.1!
Some problems remain: my libido is zero. The doctor says it will take a year or more to get back to 'low normal' testosterone level. Testosterone supplements are not an option until five years have passed.
Also, I usually get up twice during the night to urinate. Flomax is of no help-- I think it makes the problem worse and I have discontinued it.
The hemorhoids which have returned since the procedure are acting up (it comes and goes). I take stool softener (Colace) and a laxative (Sennekot). I have an appointment with a surgeon to treat them.
The next appointment with the urologist is in November 2011.
November 17, 2011. PSA is 0.20. My doctor did not discuss penile rehabilitation with me. I found out about it on the internet. I did ask him for a prescription for Viagra; instead he gave me a prescription to try Levitra. Viagra I have used before and found stronger, but Levitra doesn't give me a headache.
I am following the penile rehabilitation discussed at University of Michigan Comprehensive Cancer Center that includes the use of vacuum devices and Viagra. [Another suggested regimen is at Use It Or Lose It]
On my appointment on March 15, 2012 with my urologist, Dr. Chinn, one year after the seed implant, my PSA was 0.3. I am still taking Flowmax so that I don't have to get up at night to urinate; however, I do wake up at around 5:00 anyway, so I don't see much benefit in the Flomax and I am experimenting to see if I can discontinue it.
My sex life is somewhat disapointing. With the use of Viagra (50 mg) I can get an erection sufficent for penentration, but I don't have an orgasm very often-- maybe twice a month. The orgasms are dry.
My uroligist is checking my PSA every four months. I inquired of my primary care doctor if he would check the PSA instead of continuing with the urologist; he said he doesn't do PSA checks anymore! I talked to the urologist about this, and he pointed out that 28,000 men died from prostate cancer last year, and the number is decreasing, so the PSA test and subsequent treatment is both necessary and working. Three cheers for PSA!
I don't need the Flomax any more.
I seldom can get an erection without taking 50 mg of Viagra. I don't blame this on brachytherapy, it's old age. Orgasms are infrequent and dry. I think all the cells in my prostate, both cancerous and regular, are gone!
I don't like the side effects of Viagra--- I feel spacy and tired afterwards.
3/22/13 PSA is down to 0.1, I am to be checked again in six months. Status changed to: previously had prostate cancer.
My PSA test on October 15, 2013 was 0.1 again.
As of October 28, 2014, my PSA is "<0.1".
I forgot to mention: on September 2, 2011, my wife and I were returning from a cruise to Alaska at Pier 91 in Seattle. We were stopped by a Customs officer, and asked to proceed to a side room. We were questioned about our itinerary, and about recent medical treatments. I informed the officer of the brachytherapy: 143 radioactive seeds! The radiation had set off an alarm. After several phone calls to his superiors, the officer let us back into the USA. (I had neglected to carry the little card the doctor gave me that explained the procedure.)
Still alive and kicking at age 81. My urologist left town, so I don't have a current PSA. A bone scan was done recently for a hip problem, no signs of metastatic cancer.
Still alive and kicking, going on 83. This year I had gall bladder removed, right hip replaced. I sleep through the night, no getting up to urinate. No sex anymore, although my wife sleeps beside me. I have arthritis, but don't need any pain medication.
Patrick's e-mail address is: pc70 AT cornell.edu (replace "AT" with "@")