Surrounded by clouds, a man walks through a door way into the unknown.

PSMA Scans and My Next Chapter With Prostate Cancer

In a way, the discovery of a boney metastasis 25 years after my original prostate cancer surgery both was a disappointment and a cause for gratitude. Clearly, if we hadn’t discovered my cancer in ‘97, I wouldn’t be telling this story. Also, the rapid advancement in treatment and diagnosis gives me cautious hope for the future.

What a PSMA PET scan found

My PSMA (prostate-specific membrane antigen) PET scan in July 2021 revealed a probable metastasis in my S2 sacral vertebra. An MRI confirmed that there was a hole slightly smaller than a dime in the body of this vertebra. In October 2021, I underwent 5 SBRT stereotactic radiation treatments to the metastasis. There was a hope that this would “cure” the cancer or at least lower my PSA. However, two months after treatment my PSA had, disappointingly, gone from 0.41 before the SBRT treatment to 0.52.

Even with all I have learned and with my work with others fighting this disease, I dropped into a bit of depression and denial. Having planned a long awaited vacation to Europe and admittedly worried that this vacation might be the last one before the hormone/chemo/additional radiation started, I chose to wait several months and put the whole thing on the back burner until mid-April when we returned from our trip.

In mid-April, the PSA had again climbed, reaching 0.64. Clearly there was more cancer, and maybe more boney or other metastases. Denial wasn’t going to get the job done!

Getting more information

Knowing that the disease wasn’t gone, I ventured to the University of Oklahoma to stay with a good friend who is also a radiation oncologist at OU. At the University of Oklahoma Medical Center, I underwent a second PSMA and had a consult with a renowned urologist.

The news was pretty much all I could have hoped for. The boney metastasis in my sacral bone now revealed only slight activity, and the only other finding was a lymph node in my left lung. It was only slightly larger than a year earlier, but almost certainly filled with prostate cancer.

So here we are 26 years after that day when the news of my initial diagnosis of cancer dropped my to my knees. I scheduled my next PSA soon, as of my writing this, followed by a possible repeat MRI at that time to look more clearly at the tailbone and the lung metastases. More radiation and hormonal treatment is almost certainly still in my future depending on the PSAs and PSMA scans.

Facing the future

I realize how lucky I am to have such a slow-growing cancer. However, there can come a time as the disease spreads and changes that it can become more aggressive and even stop making the PSA marker that we depend on to follow the progress of the disease. When and if this happens, it can be harder to track the cancer, and the cancer can also become more resistant to some treatments.

The lesson here is that even the those of us with the most support and education about the disease can still drop into avoidance behavior. Even if you don’t feel like dealing with with your diagnosis and what is happening to you, still get help. Don’t wait! There are just too many good therapies and advances out there for you not to take advantage of them.

The most challenging part of my journey lies ahead, but I’m staying positive and grateful as I face the future. So stay tuned and wish me luck on this journey, as I wish you luck on yours!

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