Between late January 2024 and late April 2024 I had one MRI scan and one PSMA PET scan.
Consultant appointment on 9/5/24 when it was confirmed the PSMA PET showed cancer in iliac chain lymph nodes in the pelvis. This means the dreaded "not curable but treatable". Survival expected for several years - median 5 years.
Four options available:
1. Do nothing and monitor PSA until it reaches 10 or 20, then look at treatment.
2. HT only, leaving other treatment lines available for when this stops working.
3. HT plus Docetaxel chemo - advantage up to further 24 months.
4. Triple treatment of HT + Docetaxel + Darolutamide (a newer HT) - advantage up to a further 12 months. This is a relatively new approach to my stage.
Difficult decision to make - I've always attacked these things (as in previous lung cancer in 2014) with maximum impact treatment so decided to go for the triple treatment and take the hit of more side effects now for hopefully a long period after treatment with no more treatment other than indefinite HT.
Met with consultant 4/6/24 and confirmed my decision.
Feelings:
1. Anger - no symptoms but here I am going to have probably significant side effects for 5 months or more - maybe with some permanent?
2. Disappointment - the last thing I wanted was to be put back on what is now likely to be life-long HT with all the problems that creates, e.g. weight gain, body shape alteration, mood, emotions, potential blood sugar issues etc..
3. Now this might seem stupid but - likely loss of libido and sexual problems including major ED and penis / testicle shrinkage highly likely due to HT. The thing is that, after completion of initial treatment in 2016, my wife (since 1978) and I worked hard to restore our sex life albeit using sildenafil and a VED to a place where it has been vigorous and highly satisfying for both of us. I really fear losing this, possibly forever. I will do all in my power to keep this alive but may not be able to do so - time alone will tell.
Started taking Bicalutamide HT tablets prior to first injection of long term HT drug in 2 weeks time, and first chemo is now scheduled for 4/6/24.
