Thursday, October 19, 2017

Was the Cancer Cryotherapy Successful? Good Question (The PCA-3 Test)

On arriving at UC Health in Aurora on Oct. 11 for my 4 month post op assessment, following the prostate salvage cryotherapy treatment in June, see. e.g.

I was optimistic that the  PSA test would reveal a reading lower than  2.0 mg/ dl which was the level one month after the therapy. We had to arrive by 1: 30 so I could first go to the on site Oncology hematology lab for the PSA and % free PSA test.. I had to wait about 30 minutes and this meant the results would be roughly an hour delayed in getting to the urology professional assistant (Kristen) with whom I had to meet by 2:30.  

The test was done expeditiously by a medical tech and she said it would immediately be sent for analysis.  Meanwhile I went up to the 2nd floor Urology center to wait to be called for my appointment with Kristen. 

On being called right on time, I first had to have weight and BP taken by the RN assistant, then turned in a sheet with ratings for different urological -sexual functions, e.g. frequency of urination, retention of urine, erectile quality etc.  This data was then entered by her into a computer for the Urological PA to access.

Ten minutes later, Kristen appeared with her computer screen open and we went through the responses. She remained concerned about the urinary and erectile difficulties but assured me this was often a side effect of the cryotherapy - especially for older patients undergoing a salvage treatment (i.e. a second treatment, usually after a primary radiation treatment).  In my case, the primary treatment - the HDR brachytherapy done in September, 2012 at UCSF.

Again, she reiterated the erectile issues were not merely sexual but the importance of getting blood into the tissues, to remain healthy.  Hence, she prescribed a  low dose (5 mg) PDE inhibitor .  Recall the chemical pathways here: the cavernous nerves close to the prostate gland secrete nitric oxide which stimulates release of an enzyme (cyclic GMP) inside the smooth muscle cells. This promotes relaxation of smooth muscles and erection. An enzyme known as PDE5 prevents this,  else there may be a prolonged erection. Hence, a PDE5 inhibitor works to suppress secretion of the PDE5 enzyme.

About fifteen minutes later after the free PSA and PSA test results arrived on her laptop, she informed me of the results: 2.09 PSA and 4.8 % free PSA.  As she explained to wifey and me these results were not sanguine, especially the latter. In the case of free PSA you want the % as high as possible to indicate most of the prostate specific antigen is bound up with normal prostate cells.  The combination of the two results, she noted - using an on site software program developed by Dr. David Crawford - yielded a 55 percent probability the PSA was due to malignant cells.

This then led to her doing a urine test called the PCA-3, which is well explained by this UK site,


"The test is in two parts. You have a rectal examination and then a urine test. A rectal examination is where the doctor puts a gloved finger into the back passage (rectum). It is possible to feel the prostate gland by doing this. You need to have a rectal examination because this massages the prostate gland and helps the PCA3 to go into the urine. You have to give the urine sample straight after the rectal examination. You normally get the results within a few days"

So with this in mind, she had me prepare and bend over her examination table, warning me in advance this would entail not only the usual DRE but also a prostate massage to force the biomarker into the urine tract.  Hence, there would be a degree of discomfort.  In this she wasn't kidding, and  while the entire procedure lasted just  over three minutes it felt like three hours.  While not painful like a trans-rectal biopsy it was definitely no 'walk in the park' - even a short one.

As she massaged the gland she told me what she felt, including "lumpiness" which was a "result of the cryotherapy".  She said that the process of the massage should also relieve pressure on the nerves as well as pushing fluids into the urinary tract.

Immediately following the procedure she handed me the specially labelled cup to produce a urine sample, using the bathroom across from the exam room. I confess it took seven or eight minutes to produce a stream of urine even adequate to get 1/3 the cup filled.  She later explained this was normal and was a result of the massage.

With the sample delivered, we left - prescription in hand - and booked the next three month visit on the way out. As I mentioned to wifey, I just hoped the numbers - including from the PCA-3 test- would be much better next time. Else, what was the point of going through yet another prostate cancer treatment?

Any positives? Anything? Well, after turning in on the night of the procedure I experienced the first nocturnal emission in nearly fifty years.  While irritated about having to change underwear, sheets, I did consider that the prostate massage -though extremely uncomfortable- did produce at least one  seeming positive "return".  In fact, on four successive nights I also experienced nocturnal erections that had been absent since the cryotherapy on June 20.  As wifey joked, "the trick is to translate them into day time erections".  Well, one step at a time!

See also:
And a detailed published paper on the PCA-3:


Darrin Rychlak said...

Thank you for the update. If prayer worked, you'd have mine. I'm following your progress and I hope for the best for you and your wife. I'll be watching and keeping you in my thoughts. Way to go on the wet dream. What I wouldn't give to have those again. My wife's a cancer survivor (breast) and the entire dynamic of intimacy changes after the surgeries and treatments. But after that, we're still here alive and kicking and that's what we need.

Copernicus said...

Thanks for your thoughts, Darrin, and best wishes to you and your wife.

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