PATRICK'S CONCERNS
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Latest update 18 July 2018.
I saw my dear oncologist today, and we both agreed the next step is chemo, ie, Docetaxel,
which includes the refined chemical taxotere which is derived from a tree somewhere.

Psa has hit 7.8 last Friday, up from 5.2 just 30 days ago.  
I stopped Zytiga last Thursday, no need to continue, its doing nothing.

I begin that on 17 Jul, with an "education meeting" on 12 July. A friend had the 3 weekly doses
for 30 weeks and it has now stopped working but while he was on it he had few side effects
because he's under 60 and fit and healthy and played competition tennis in the last week.
I am not sure what he will try next, but but there will b a time when my chemo stops working,
and some Pca cells will continue growing, and then there are 4 levels of chemo offered
by Canberra Hospital. My doc says that many patients get a real benefit from the next level
of chemo after having Docetaxel.

I can have LU117 whenever I want it, AND maybe radium 223, and the wait time is about
"6 weeks" but that could easily be 8 weeks. I can wait to see what the first few chemo doses do.

The chemo is supposed to affect fast dividing cells, Pca is considered to be in that group but
that seems strange because Pca is a slow growing cancer, well, it is in my case, compared to
some other fellows, one of whom has gone from diagnosis with "low danger+ Pca to beginning
of chemo in 2.5 years. I had low-danger cancer back in 2005, but was not diagnosed until 2009,
but then had Gleason 9+9 high danger Pca that was inoperable, so I've taken 13 years to
get to the same point of treatment. I know another who has what might be called "wussy" Pca
and no chemo yet, and diagnosis was 25 years ago in 1993.

Last May I had a PsMa Pet gallium + CT scan which showed more bone mets than I had last
year but no more "PsMa avid" mets in my internal organs. "PsMa avid" means there mets that
appear in the scan are generating Psa and attract ligand + gallium68, so they can be seem by
the scanner. I don't know what mets I have which do not generate Psa.
Almost all Pca cells generate Psa initially, but they grow awhile, then divide ti make new Pca
and this process is natural for all living cells including cancer cells, BUT, in the case of cancer
there are varying amounts of DNA difference and the generation of new cancer cells includes
mutations and old tumours like mine tend to become dangerous because some become ADT
resistant, some become resistant to abiraterone and enzalutamide, and some become resistant
to chemo and radiation.
Pca may be eliminated from the PG, but it it has spread before the initial treatment by surgery
or local beam radiation or brachytherapy, or it spreads soon after, the RP or RT is done, then
a man is in Deep Trouble in the future because the spread cancer will most surely grow to
threaten the man again, and again, after successive treatments. So as time goes by, the man
may have lots of mets which do not generate Psa, and are resistant to all forms of known
systemic radiation including Lu117, and all known chemo drugs, and although Docetaxel is
thought by many to be fairly tolerable, the more powerful chemo drugs will tend to slow the
strongest of men. There is a point where nothing at all works, and even if Psa does not rise
much the cancer marches on and the lesions in bones grow bigger and a man becomes
bed ridden and sick, and his happy time is over, time to say farewell.

Just why does Zytiga fail? Nobody really knows, but its thought that the cancer learns to
mutate to be able to grow while Zytiga is present. Chances are that some Pca cells cannot
grow when fully deprived of testosterone, but some can, so they grow and produce
increasing amounts of Pca.

At my June meeting with oncologist it was
decided I should soon move to chemo with Docetaxel and maybe arrange for me to have
Lu117 injects which I think would be good for all my Pca because I am not yet so very ill
and have Psa below 10. But the Lu117 may not have much effect on bone mets, and I might
need Radium 223.
There was also talk of getting DNA analysis of cancer cells to see what chemo would work best.
I will believe it when I see that the docs have referred and if I am a suitable candidate for the very
latest treatments. Many men would have no possibility of such treatment and they just get standard
Docetaxel and 95% die within 5 years after the first sign of bone mets appear in CT scans.
Now I am faced with death, and the nest way to delay it needs to be found.

There are now some advances with immunotherapy in UK where a guy went from having 3
months left to remission like status because his immune system was made able to recognize
Pca as the enemy. But such therapy is experimental, and does not work for all men on which
it has been tried, and it is years away from becoming accessible therapy.
I see my oncologist again on 3 July, and maybe things have been arranged for me, or not,
and I can't know until then.

Up to 27 February 2018.
I'm still alive folks.
Since last July, my dear oncologist started me on daily Zytiga pills, 4 x 250mg plus 2 x 5mg prednisone.

I have continued normal monthly Lucrin injections. I began the Zytiga at beginning of August 2017,
when Psa was 7.2, and 1 month after ceasing Cosadex.
After 6 months my Psa reduced to 2.2 at end of last December and doc was pleased, and said I might
get 2 years of Psa suppression. The median time for Zytiga effectiveness is 10 months, just as many
men have Psa zoom up when Zytiga fails before 10 months and the men who get a longer time of
suppression. I have no indication yet of how much more suppression I will get before needing to
move to chemo therapy with Docetaxel and then qualifying to get Lu117 systemic
radiation.

Today, 27 February, Psa = 2.3, so a slight rise. I have never known Psa tests to be inaccurate.

I still have no symptoms of Pca. I feel 22 most days, and the only discomfort is suffering bad postural
hypotension that started soon after 2 years on ADT, but which seems to have become worse due to
effect of Zytiga which may cause low sodium levels leading to low blood pressure, so that if I sit at PC for
2 hours, I am dizzy when i stand up. This is much worse in the hot summer weather in my house with
no air conditioning, so I use the fans all day.

Instead of Pca symptoms, I have treatment side effects that are remaining tolerable with same number
of night wake ups, virtually no leaking from bladder or bowel, and continuing sexual mutilation which
always occurs where PG is highly radiated and ADT has continued for more than 6 years. 

Zytiga works to block the action of adrenal glands which produce a low amount of testosterone.
This low amount is enough to allow Pca to live. But even with perfect testosterone starvation, Pca
still remains alive, and nothing stops it slowly mutating to something more difficult to treat as time goes
by. The Zytiga is supposed to stop the action / production of dihydro-testosterone, DHT 20 times
more powerful than plain old testosterone, that is produced in the slowly mutating tumours which
are responding to testosterone deprivation by things doctors do.

Just exactly what is going on in a man's body when he has Pca has not been fully described and
is not fully understood and already I may have said things that experts would disagree with, between
the times they spend disagreeing with each other.

I am not aware of one case of remission with Pca.

Plenty of men have had a Psa of say 100, or even 1,000, then begun a course of drugs and Psa has
fallen to 0.1, and they are all tempted to think they are cured, but no, cancer changes while asleep,
and sooner or later, the men are in despair until the next drug does the same thing.

Charles Mack, a man I know in USA was diagnosed in 1992, and he's now 85, and has survived 25
years after diagnosis. People like to read how he achieved that, but his slow Pca progression
is what is called "indolent", so he's had time to adapt and think about it and publish much material
about what most men and a lot of doctors need to keep in mind.

Survival for a long time after diagnosis is really just luck, and most men don't get 25 years.

I have a friend in Melbourne who has gone from diagnosis to beginning of chemo therapy in 2.5
years. He had RP, Psa went low, then soon went back up, so he had IMRT to operation site at
Epworth just like I did in mid 2016. His Psa dropped, then rises fast, so he was forced to accept
ADT but it only worked for a few months, and the addition of Cosadex caused his Psa to rise
extremely fast, so the Cosadex seemed to encourage his Pca. His docs decided his cancer was
not controllable by ADT or anything related to hormonal level manipulation, so no Zytiga, no
Enzalutamide. He's had 2 sessions of Docetaxel and Psa has fallen from 40 to 7 in 6 weeks after
2 infusions.
He's under 60, and got his weight well under control, is playing competition tennis and is very active.
He has a wife and family who love him. So his live goes on until it just does not, just like mine, or
yours, and how bad you feel about it depends on mental outlook which varies, and I have seen
friends and my father, one sister all have to cope with leaving this Planet.

I got back into cycling last June after having a double TKR just over 12 months ago.
My knees now feel really good, and other arthritis symptoms have reduced, so I can mow the lawn,
clip the hedge, and easily do enough housework to never ever need assistance from a wife or
anyone else. I seem to cope OK without any partner so far.
I have cycled maybe 7,000km since June, and this last week I have done 270km, despite some
hot weather.

In November I cycled with local Sunday ride group, see
23 Wanderers, http://www.pedalpower.org.au/rides-and-events/
But I found hot days were unpleasant so I rode alone for most of December and January and
started at 6am, not at 8am the Pedal Power start time, so I get home before 10.30am.

Temperatures are just beginning to go lower, and I will re-join my group this autumn.
There was a cool Sunday last month where I averaged 25.4kph for 85km in hilly conditions.
Among the group of maybe 25, are maybe 5 men and one lady who can of a total of 20 who
often get to the top of a hill before me. Although my knees with TKR are good, they don't like
steep any more than the rest of me which feels reluctant to raise heart rate to maximum and
endure the ride, rather than enjoy it. But these old dudes who are faster up hill often cannot
keep up to me down hill and along flat roads so I manage to get to the cafe stop first.
This activity will come to a grinding halt when my Pca gets worse and if there are bad side
effects of chemo therapy.
I used to often average 29kph at age 61 on hilly country roads north of Canberra with a full
amount of testosterone. If I still had testosterone I could expect to average 27kph at 70.
But I can only average about 25kph, so the loss of testosterone for many years plus my
plastic+titanium knee joints have doubled the normal loss of speed due to age.
I really don't mind that what I was has gone, because so many others are in a similar situation
and sometimes its good to cycle with a group.

To know how fast many older ppl can cycle, see the Age Standards for UK 
https://www.vtta.org.uk/standards
AFAIK, most time trial courses are on flat roads where fanatics gather to see who is fastest.
I am not fanatic.

Doctors like to see me dressed in lycra, with a bike against a wall near the waiting room.
My resting heart rate is 50 as I type this. They don't mind that I have BMI < 25, and am fully
familiar with my problem with Puff The Magic Prostate Grenade.

There is still controversy about Psa tests being useful, and some doctors say Psa tests are
a waste of time for most men. But I would be dead by now without Psa tests, and even with
the tests, I was DIAGNOSED TOO LATE with Pca that was a very bad tumour which made a
low amount of Psa.
I expect I probably carry Bca1 and Bca2 DNA which express themselves as Pca in men.
Its the luck of the draw that determines your longevity, but maintenance of a good frugal lifestyle
allows better coping with this horrible disease.

Psa and treatment 2014 to 2018

This shows clearly what effect Zytiga has, and it IS NOT reducing Psa much after the last
3 Psa tests, and now shows it could be beginning to rise. Very seldom does anyone see a
Psa halving rate that has a time equal to the doubling rate. But back in 2013 and 2015 and
2016, halving rates were initially fast, but always the Psa reduction ceased and Psa went up
again. Pca becomes resistant to all drugs and radiation, and you can see the typical Psa
response as each new chemical is tried, and eventually, there are no chemicals left to try.

Psa and treatment history from beginning of 2009 to end of 2013. See 2014 to 2020 below.

After some thought, I have concluded :-
1. All men should be able to have their PG removed well before Psa moves above the
"normal range" between 0.3 and 5.5. The examination should include MRI and biopsy at 3.0
for men who want it. For men without BPH or any prostate troubles, average Psa is 0.7 for 40yo,
and 1.0 for 60yo.

2. The medical system of  Australia failed to protect me when it should have. I had regular
Psa tests once a year for 10 years before diagnosis. I got told bullshit that they only think
action is needed where Psa rises slightly faster than normal when its over 5.0. Have a biopsy
as soon as Psa goes to 2.5 !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Doctors may resist this request and I suggest you keep trying to get what may save your life.

3. Digital tests, ie, a middle finger up the arse by doctor often takes only 2 seconds. I don't
believe they tell a doctor much except that your PG is swollen. One female doctor I had did
a digital exam in 2009 which lasted about 20 seconds and she felt around in all directions and
she could only feel that I had a swollen PG which had no hard lumps.

4. The Gleason score I got later was 9, with 9 out of 9 samples positive, and urologist who
does 100 RP a year said analysis showed aggressive cells, "young man's cancer", and it then
took 4 months to the date for operation. My PG could not be removed because there was too
much cancer outside the capsule. I should have begun ADT when diagnosed.
I felt the Medical system had failed badly, so as a result of their incompetent protocol, expenses
so far have totalled about $150,000, funded mainly by Medicare with 13% from my pocket.
I can expect expenses to be another $100,000 before I die in about 4 years time.

5. If the Govt lowered the Psa threshold to 3.0 for examining PGs they would have treated my
cancer early enough to get a cure. It seems to me that all men who have Pca continuing on after
surgery have a long expensive battle until they die. Men with inoperable cancer like me have the
worst prognosis. I was told that for Gleason 9, there was no cure. 

6. I would have had a Gleason 5 tumour well before 2009 when I was diagnosed, perhaps in
2004. As time goes by the tumour in PG mutates and its lethality and Gleason score increases
so that men like me with Gleason 9 and inoperable Pca cannot expect more than 10 years after
diagnosis.

7. I estimate I have far more metastases than could be seen in my last PsMa Gallium68 scan
last June. The gallium68 scan is good, but cannot show small tumours < 2mm. I guess many
mets began during last 10 years and some may have begun well before diagnosis.

8. If I had been diagnosed in 2004 with Gleason 5, I could expect the RP op to spare my nerves
around PG which would have allowed continence, and erectile function. If there had not been
spread, surgery with Gleason 5 would have been more likely to give a cure. Without ADT,
extermination of my sexuality would not have occurred and I would have had far better bone
density and a higher fitness level due to continuing testosterone.
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14 July 2017.
My prostate cancer is progressing, and last Psa on 20 June was 2.2, with doubling time of 2 months.
I began Casodex in July 18 2016, but it only worked for 6 months. I have continued with Lucrin ADT.
I stopped Casodex 2 weeks ago, and my oncologist suspects it promotes Psa rise once it stops working.
A PsMa scan in Canberra on 26 June found numerous metastasis in upper lymph nodes in chest, and in
spine and other bones. I suspect all these mets have been there since before I began treatment in 2009.

The PsMa PET/CT scan has detected all these mets about 3 years before previous CT or PET scans
were able to. The usual prognosis once previous scans found bone mets was 3 to 4 years of life, with last
year full of pain and not worth living. I am now pausing Casodex, and Nilutamide will be tried, plus other
things after I see another specialist in Sydney with more experience with Pca, and where there are some
trials of latest treatments.

Meanwhile, my knees have recovered after double knee joint replacement last February, and I feel very well,
and have been able to cycle 200km during last 2 weeks and at average speeds I have not seen since 3
years ago. Knees are still a bit stiff, but they are likely to improve further.

I have read where doctors have said that when Pca begins, it immediately begins to spread. And a man of
45 could have minute amount of Pca in PG, and then elsewhere, but because Pca is slow growing, it may
be many years before Psa rises.

For men without any Pca, and unlikely to get it, normal Psa is 0.7 at 40 and 1.0 at 60.

If I had been examined in 2004 when Psa was 3.0, they may have found Pca, a small pea sized tumour,
but it still may have spread to may places. So Pca looks to be a much more difficult cancer to treat.
Men like to think their Pca in their PG is easily treated and then its gone. Well why have all the fellows I
know who an RP operation get rise in Psa afterwards? Some had Pca continue on near site of operation.
So they get radiation, and that's only 50% successful, and I know fellows who had Pca continue after RP
and RT.
In my case, my Pca generated low Psa for the size of the tumour in PG. So docs abandoned surgery
after opening me up, too much cancer. I was in the small number of patients.

In July 2016 about 1 year ago, I had IMRT with Calypso at Epworth Hospital in Melbourne.
This treated PG and the two lymph node mets they found during PsMa scan. The recent PsMa and the
report says that the 45G I had to 2 lymph nodes may not have done much, but that the 31G I had to PG
had reduced original PG tumour. This has allowed me better urinary and bowel functions. But to really be
sure of killing a Gleason 9 PG tumour, Brachytherapy with 150Gy is probably best. EBRT and IMRT
cannot deliver high enough radiation levels without damage to surrounding organs.

So, where from here? Well, later this year, all the results of a trial of theranostic treatment with Lutetium 117
at Peter McCallum Hospital in Melbourne will become published. This offers hope, but side effects are
ruined saliva and tear glands. I heard there were problems with liver and possibility of future leukaemia.
But the Lutetium 117 is targeted radiation, and it appears my tumours generate enough Psa to be targets.
Where Psa mets do not generate Psa, there is no way to target radiation or other chemo drugs which bind to
Psa where it is being produced. The timing for Lu117 treatment is not urgent, because tumours could be
10 times larger and still be able to be treated. And then there is the likely fact that although maybe 20 met
sites have been found, there could be hundreds of tiny mets yet to be detected because they are so small,
and while so small, they have no effect on general health.

I was told there is some immune therapy being trialled in Sydney. There was an article in local paper
about a young man under 40 with rare gall bladder cancer, and he had immune therapy which appears to
have been successful but it cost $230 per day, or $84,000 per year. Lu117 is offered by a Perth base clinic
and is $10,000 per treatment, and maybe 4 are needed over a year. It will be years before such treatments
become mainstream in public hospitals, and health insurance may not cover all costs. As you get older, be
prepared to pay huge amounts of dough to stay alive; its much more important than buying a new car, or
making sure the grand-kids get big payout from your will.

The fact of life is that some underlying condition of cancer, bad heart, bad lungs may exist at age 50,
and then take 30 years to cause death. I lost a sister from ovarian cancer, and from symptoms to her
passing was 2 years. I had a customer get pancreatic cancer, and he died within 18 months. The doctors
are not magicians or Gods, or miracologists. 

3 June 2017.
In my February update I said :-
"""My Psa has risen from 0.39 to 0.45 over last 3 months which shows that Psa is not continuing to fall and that
the radiation I had last July and continuing ADT with Lucrin and with continuous Cosudex from last July was not
enough to stop the Pca from progressing. I have always feared that last year's treatment would only delay the
inevitable and sure enough, Psa is now beginning to rise again rising.""""

The Psa test was 0.7 on 10 April 2017, and it looks certain that my prostate cancer is on the march again.

The graph applies to myself only. Anyone else may find that their Psa levels and Pca history are nothing like
mine if their cancer cell type and treatment were very different.

The rise of Psa at far left side indicates Calypso IMRT radiation at Epworth Hospital in July 2016 plus addition
of continual Cosudex since last July has not killed the cancer. Before getting the additional treatment, last year I
suspected my cancer was radiation resistant, ie, it would take perhaps 200Grey levels to fry the bastard to death,
and I have only had a total of 100grey to PG, and 45Gy to two lymph node spots.  
Cancer often defeats whatever doctors do, and not all cancer cells are the same, and while some cells may be
killed by each treatment, others survive or mutate into something harder to treat any further.

I think this cancer will continue to chase after me for the future I have left.

My next discussion with my good oncologist in June 22 will have to deal with my castration resistant Pca;
despite ADT with monthly injects of Lucrin, and addition of 50mg of daily Casodex pills, ie, bicalutamide, since
last July, Psa is zooming up.

My last oncology consultation was with intern oncologist instead of the specialist doctor on 13-4-2017; my
specialist was overseas. The intern said there have been some improved access to new treatments.

My next Psa test is due 17 June. I expect about 1.5. It probably will confirm the trend of rising Psa. But this is
still LOW Psa compared to many who were diagnosed 8 years previously. A decision will be made about getting
another PsMa scan with Gallium-68. now available in Canberra.

I do not know if treatment with Leutetium117 is now available at Peter Mac for $40,000 in Melbourne, but a
clinic in Perth offers it. Usually, you cannot phone to find out about this sort of thing; all inquiries must be via
doctors, and at some cost, and always to ensure that the treatment is appropriate and does minimum harm.
In other words, before being considered for Lu117, you need to get over hurdles of "eligibility", which may include
having tried all other treatments and you are facing death soon. I have not seen anyone recommend Lu117 to
treat early stage of Pca like mine, which is so far asymptomatic, ie, I don't have symptoms of pain or multiple
metastasis, and there are no known cancer lesions in bones.
I heard LU117 was being trialled in Sydney, but I am not sure where. My Psa graph indicates the present rate
of Psa doubling is 3 months, and the speed of Psa increase may increase.

Since April, I phoned a relevant research doctor at Canberra Hospital and no Immune Therapy is available in
Australia for Pca. I searched for BAT in Australia and it is now only begun to be trialled in USA by research
doctor Sam Denmeade.
See the video at https://www.youtube.com/watch?=fwestwwRTUNo
I think I definitely qualify for Bipolar Androgen Therapy because I am asymptomatic and have had ADT for
last 5 years which has probably made my cancer cells generate many more receptor cells to accept testosterone,
so it can get enough to grow from the tiny amount in bloodstream despite the ADT reducing. The adrenal gland
and muscles produce testosterone, and its impossible to completely suppress all presence in any man. BAT
involves having repeated injections of 400mg of testosterone to give a high level which does not last very long,
and this floods the much increased receptor cells in Pca, causing trauma to Pca cells killing many cells.
Survivor cells regain their tendency to be sensitive to low levels of testosterone so they shut down until they
begin to generate more receptor cells. Si it seems BAT can extend the time that ADT is effective.

During months of BAT, Psa is measured. After a high level shot of testosterone, Psa does rise, but then in
most patients Sam Denmeade mentions, it then falls rapidly, and after a few such "cycles" the levels of Psa go
lower than at beginning of BAT. Some patients responded with Psa becoming so low as to be unmeasurable.
One could say that playing with testosterone levels is like Russian Roulette, but just what else do the doctors
have to offer me? It may be more aggressive ADT with Ezalutamide and Abiraterone, or chemo therapy, but I
know where all that leads, a succession of Psa reductions then failures, and the medicine cabinet is soon
emptied after one drug fails after another, and finally the Pca spreads and flourishes and the side effects
of treatments become intolerable. Morphine begins to look real good.  

Since last August, bladder and bowels seem to have fully recovered from last year's RT, and from a double
 knee replacement last February. I have also been taking daily Flomaxtra pills to try reduce PG swelling and
constriction of prostatic urethra. During the day when I am up and about being busy and now cycling 100km a
week, I have good continence, and a good flow rate. But at night, when sleeping, I am woken 6 times in 8 hours
to pee, but I go back to sleep within a minute or two. Being horizontal and not active seems to cause bladder et
all to be a bit over active.

I suspect that that even though there are small amounts of Pca in the lymph nodes, they would still require the
same very high amount of RT to kill the Pca cells. There isn't any harmless way of delivering "pencil beam" X-rays
because even if tumours are small, the beams spread out to be much wider than a pencil. This is the nature of beam
radiation; beyond the theoretical pencil beam there is damaging radiation extending outwards 10mm to 20mm,
and radiation continues on to tissues beyond the target.

My doc said that the Lutetium 117 treatment can safely deliver 200Gy of beta to areas where Psa is being
generated, ie, to tumour sites, and and this most definitely overcomes any "radiation resistance", and the beta
can only penetrate 1mm beyond the molecules of Lu117 held steady by binding agent to sites where Psa is produced.

Trials of Lutetium 117 were underway on 30 patients with Pca at Peter Mac last August, while I was in
Melbourne. A video was made of the treatment known as "theranostic radiation". The video showed results on one
patient riddled with bone cancer and with months to live. The initial results were nothing less than miraculous for this
patient. But I have now heard not all patients did well, and the full results of the trial will not be released until later this
year, probably at least 12months after the last guy was treated in the trials, so maybe we hear something official by
next October. Time is needed before announcements because the side effects need to be followed up.

It seems that when Pca spreads, it sometimes mutates into a cancer which does not produce Psa.
Therefore a Psa in a blood test may not indicate the activity or the spread of the cancer, and that MPsa scans will not
show where metastasis has occurred, and Lu117 would NOT be effective because it could not be delivered by
the binding agent depending on Psa as the target.
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Back in Early February 2017, I was able to ride over 200km a week on my bike at average speed of 22.5kph.
I could still ride, but walking or working was painful for my knees. Weight was steady at 83.9Kg, resting heart rate < 50,
and not many uneven beats. I was looking forward to having both knee joints replaced on 13-Feb.

I had the operation on 13 February. I spent a week in recovery wards, then 2 weeks in rehab ward at Calvary
Hospital in Canberra. If anyone is sick enough to have to stay a long time in hospital, then Calvary is The Best place
to be. Their ethics are excellent.
The first week was painful and I was allergic to Endone. I was changed to Targin based pain relief for a total of 5 weeks.
I gave up using crutches at 8 weeks after the op. I had my first bike ride of 6km on 22-4-17, and I felt I could have
ridden further. I modified one of my bicycles to have 160mm long cranks instead of 175mm cranks to allow pedalling
with much reduced maximum knee bend. The main problem after TKR is getting enough knee bend and getting knees
to straighten.
Being able to ride most road bikes depends on minimum angle between femur and tibia to be less than 80 degrees.
I can only just get this with R knee. L knee has more bend, and it is more comfortable pedalling than R knee.
I guess I will improve over time.

I lost over 3Kg in hospital because of the pain medications and hospital food, which is sufficient for survival, not
wonderful. The Targin plus other drugs are fairly toxic to bowel function and probably exterminate many of the gut
bacteria essential for good health.

From week 3 to week 8, I slept very poorly at home and was slow to regain weight. But 2 weeks after quitting Targin
and have put a Kg back on. I was sleeping better week 9, not being woken so often by pains. I went back to diet of
mainly vegetables with less than 100gm as of carbs or protein a day. It is The Only way for me to stay well fed, keep
weight constant and below 83Kg.
I just had to learn to walk ride a bike again. At week 9, I could walk 1km+ without crutches.
I am now at week 14, and have continued to improve walking and cycling. I walk about 1/2 km daily just getting
around to care for myself, and I've been riding 100km a week; a typical ride is now up to 22km, on mainly flat roads
with gentle hills. The bike I have been riding is a single speed bike with 44t chain ring and 18t freewheel cog on wheel
which gives me a 65 inch gear which I am pushing this with 160mm cranks so the gearing at low speed feels the
same as the 72 inch gear with the 170mm cranks I used previously. This gear is a bit high for me at age 69, but I just
slow down and try to concentrate on turning the pedals right around the circle. But after riding say 18km on 5
consecutive days, my knee-caps get sore, and I need to take 2 days off bike and I am then better when I return to
the bike.

I have also spent time restoring a second bike with a nice frame using Reynolds 531 tubing. It has old Shimano 3S 3
speed hub gears from a 1980s ladies bike which was not ridden very far, and in good condition. It will have about the
same top gear as I push now, but will have two lower gears which should allow me to ride anywhere in suburban
Canberra, with concentration on pedalling quickly with low stress. I should be able to turn the 170mm cranks OK.
I hope to be back on my 10 speed Cannondale with 175mm cranks within a month or two. The rate of increase of
knee bend is like watching a glacier move along a valley.
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Maybe my knees will get nicely better just in time for the cancer to pull me down again.
But I ain't no quitter, and I will seek whatever other forms of treatment are available. I see my GP in 2 weeks and
oncologist in 3 weeks and will ask them both to find out what is now possible in Canberra or in Australia.
Being positive for me means understanding all the negative possibilities while sensibly taking action to extend life
to the maximum. I cannot live forever.
----------------------------------------------------------------------------------------------------
Prior to 6 February 2017, I wrote.........
Weather has been succession of heat waves with over 35C, and some hot nights making it impossible to get to
sleep before 1:00am.

25 November 2016.
The spring weather has been delightful and my overall condition has improved. For newcomers to my blog here, I had
an additional 31Grey of external beam radiation therapy applied to my prostate gland from July 18 to August 9 this year.
This added to the initial 70Gy I received in 2010. Thus total RT to PG was about 101Gy. Severe radiation colitis
occurred from August 20 to about October 30.
Side Effects. But since October, the radiation colitis symptoms of enduring high flatulence and 8 daily toilet sessions at
least has eased off and bowel function has become closer to normal.

The result of RT has mutilated my sexual function. For those not used to the unpleasant facts about prostate cancer
treatment, let me explain :-
All men I know who had an RP have had complete ED. One man told me his wife could excite him to an orgasm
without a hard-on. Maybe she sucked patiently, or more likely used a vibrating vagina toy with suction. He could not
go into details with me. Too many male inhibitions about sex details. Toys are NOT like the real thing, and probably
most ppl over 50 would just give up wanting sex, and complete their partnered life without sex.

But I estimate more than in 50% of partnered relationships where there has been no disease of sexual organs, the
couple have ceased having sex. Nobody ever admits it though. A small % of women would seek real sex with a
whole man elsewhere and maybe get a divorce. For those who had an RP, and no ADT, desire remains because
testosterone remains. But of course most older women's desire and ability to have sex rapidly dies above age 50 or
earlier, so a man of 60 wanting to do things is irrelevant. He cannot even jerk off. All men I know who had an RP
found Pca returned and they needed a full 70Gy of PG radiation. I know a case where one guy had the EBRT a
year after the RP, and 18mths later his Psa began doubling each 2 months, and he is in SERIOUS TROUBLE,
and will probably need to start ADT and consider whatever else he can get.

I believe these sorts of Pca troubles are far more likely than doctors like to tell you, or more likely than publications
from Cancer Councils and other Govt advisory bodies.

I did not have RP, and had RT and ADT as primary treatment, and after 5 years at age 66, I suddenly got
fibroids in erectile tissue, and Roger shortened by 30%. This is said to be a direct result of prolonged time on ADT.
Erections are possible, but it just points down, is ugly, and is useless for sex. There is no sensation of pleasure, and
no ability for the build up and release of explosive orgasm.

So, after Pca treatment, a man has to farewell his sexuality. Suck it up Bro ! There are not many women enthusiastic
about a nice black strap on vibrating dildo.

Despite the chemical castration of ADT, desire for company of women remains strong, and I enjoy talking to
those willing to talk. But many of the women I see around are quite allergic to men after their menopause,
especially if they have been divorced. A really good relationship with a partner should not rely on sex.

Urinary incontinence has never been a problem for me and I am still OK now. It is due to fail at some time
due to RT damage to nerves. Fecal continence is OK, but when I feel I need to go, I need to move very quick,
I cannot just put it off for an hour or two.

The PSA graph shows the fall of Psa after RT last July to a nadir of 0.39 last November. I have not had such
a low Psa since beginning of 2015. I am continuing with monthly injections of Lucrin and daily Cosudex
and Flomaxtra tablets.

It is still too soon to say I got much benefit from IMRT at Epworth Hospital in Melbourne where I received the
Calypso EBRT during July. I would argue it is impossible to say IMRT did any good, while doctors there would
always disagree with me. I prefer evidence based medicine. I believe the Cosudex is the main agent acting to
blockade whatever tiny amount of testosterone is in my body which is not suppressed by Lucrin injections
once a month.

However, it is surely certain that RT at Epworth plus the RT I had at Canberra Hospital in 2010 has done my
stubborn cancer cells no favours.

It remains to be seen if my Pca survivor cells which remain after treatments so far will survive or whether they
become more difficult to treat in future, and begin to dominate remaining radiation affected tissues, and then
spread or become some other form of cancer which may not produce Psa and hence not be detectable by
Psa tests. There are a number of future possible outcomes which all are quite awful.
I recently read a frightening opinion by well informed medicos about Pca where one doc said the Pca can seed
itself in bones and then come alive some years later. More reading indicates that once bone metastasis has
begun, and is detectable, it means you have only 3% chance of being alive 5 years later.
I do not really know my cancer status; the more one reads, the more certain I am that I am uncertain.
But between now and when Psa could measure 50 may be 3 years.
 
But right now, I am well enough to have a big knee operation and put up with the battle it will be to recover
and learn to walk without pain and ride a bike a bit further - before I die, so I can get married to suitable woman,
finish projects, get affairs in order, and leave much less mess behind me than do so many other ppl when they
finally die.

I am booked in to attend a pre-admission clinic on 13 December in advance of having titanium and
plastic inserts to both knee joints some time after January 2017.
--------------------------------------------------------------------------------------------------------
Before 20 October 2016 :-
Nothing much has happened to my health in the last month, except I am still suffering effects of radiation
colitis, a side effect of having had radiation of PG in July. So bowel habits are very irregular because the rectum
now cannot do its store before dumping routine which everyone else takes for granted. The condition has very
slightly eased over last 3 weeks. I am now seeking a bone density scan, and an injected drug to slow down bone
loss due to ADT which is continuing with monthly Lucrin and Cosudex. Sleep is irregular, with 5 get ups a night,
and some nights I sleep less than 5 hours. There is no acute pain and continence is still intact.
 
Before 24 September 2016 :-
My Psa was 0.52 at 24 September, going down from 0.73 at 17 August, and down from a peak of 2.8
in mid July 2016.

Why did this happen?

In Early July I went to Epworth Hospital in Melbourne to have "salvation radiation therapy" using Calypso
IMRT applied to my PG and to two lymph nodes in upper thorax. 31Grey was applied to PG to raise
the 70Grey level applied in EBRT in Canberra in 2010 to a total accumulated level of 101Grey.
45Grey was applied to each lymph node. There were two hospital visits before IMRT on July 1, and
July 10, with IMRT applied twice a day from July 18 to August 9 to PG, and once a day to lymph 2 nodes.

July 1. I had a minor operation to install 3 x RF beacons to PG to guide the Calypso IMRT to PG.
A hydrogel pad of about 10mm thick and 50mm dia was inserted between my rectum and PG, to push
the PG away so that high intensity X-ray beams did not fry a section of rectum tube. In previous EBRT
in 2010, no hydrogel was used, and the amount of RT used on PG is limited by what the rectum can be
allowed to withstand, plus other areas.

The Calypso IMRT has multiple beam directions, not just the 4 of standard EBRT, and the path of
beams can be chosen to avoid areas previously radiated or those where little radiation could be tolerated.
The radiation beams are not fine beams with sharp boundaries but have diffused beams like a torch light
shining. But where all the beams intersect at the target, the accumulated radiation intensity may be 50 times
higher than somewhere only 20mm away.

July 10. I was "measured up" and a temporary body cast made with some sort of plastic-paper foam to
allow easy and accurate body alignment while on the radiation table before radiation. The body cast is
not an enclosing cast; it is only 75mm high to wrap around the underside of a body on a flat table, and
the cast allows easy body alignment by at least two staffers attending before RT sessions began.
Tiny tattoos were placed when information from previous CT scans was correlated so that for each session
of RT, my body could be positioned to within +/- 1mm of the correct positions with laser light beams.
It is important that the huge radiation gadget knows where to aim - guided by the tattoos and the three
"radiologically opaque" beacons which had been inserted to my PG on July 1.

I began taking 1 Cosudex pill daily, each 50mg. I was already under influence of previous Lucrin injections.
I also began to work on my bowel to ensure there was no gas or shit in rectum before 9AM. That meant
continuing my vegetarian diet, but using one Coloxyl tablet each evening to ensure a good shit by 8:30am.
It was important that I attend all radiation sessions shit&gas free and with a nearly full bladder to keep the
PG in the alignment position as accurately as possible.

July 18 to August 8. There were 2 sessions of RT per day, 6 hours apart, with PG and two upper lymph
nodes done at 10am, and PG again at 4pm. A Psa test was done on July 18, but I was never told what
the result was, but I estimate it was 2.8. 
My Psa rapidly reduced from estimated 2.8 at July 18 to 0.73 on August 16, about a week after finishing RT.
The RT doctor forecast that Psa would flare up before reducing, but that has not been observed.
By 24 September, Psa fell to 0.52.

I do not think the radiation has caused or assisted the Psa reduction, unless this is proven to be the case
in future months.

The RT could only be deemed to be effective if I stopped all ADT and the Psa continued to fall. I am not
going to stop ADT.

I do think the Cosudex has caused most of the Psa reduction, because whenever I was previously given a
month with daily Cosudex pills, 50mg, there was a rapid Psa reduction, as shown on graph.

I cannot say yet if the large expense and trouble of attending Epworth has resulted in any worthwhile
benefit. Medical outcomes after procedures are often very uncertain, and radiation effectiveness is still
quite low. 

The full answer of what my Pca status is cannot be known yet. But I have had Pca since about 2005,
with diagnosis in late 2009, with Gleason 9, aggressive cells. The treatments and dealings with doctors
has made me very cynical, and I doubt many things doctors say.
After seeing that so many things doctors said were just "Blatherations of Bullshit", I am sure many of
you now know why I am so doubtful about doctoral forecasts and predictions. No doctor can be assumed
to be honest until time proves him/her to be have been truthful. (( There is a huge disparity between what
many well trained, well educated, and obscenely paid professionals say and what happens later after
prognosies have been given. But this is REAL LIFE, and what else is there? honest  fools? people who
had no idea? at least doctors do know more than one who'd trained in 1716. ))

I was told in 2009 an RP operation would be fine, but that idea was abandoned during attempted surgery
in April 2010. I was put on ADT, and had EBRT in late 2010, and told "this will fix you!", but in 2012
I found the RT had been quite useless, and could have been predicted because the REAL rate of RT
success with Gleason 9 is only a lousy 10%. ( Report from St Vincent's Hospital Sydney )

After 2 years of ADT, I paused ADT in April 2012, with Psa < 0.08. But by May 2013 Psa went to 8.0,
and I was forced to re-start ADT. Doctors were WRONG about what they said would happen. It seemed
EBRT had done nothing to halt my Pca. Psa went down to 0.2 after ADT was recommenced, not as low as
before I paused. I has another ADT pause during 2015, this time the doctors didn't forecast anything;
I thought, maybe good, maybe not good, and sure enough, Psa shot up, and I re-started ADT. But the Psa
didn't go as low again and it began to rise while on ADT at beginning of 2016. This seemed to indicate
typical ADT failure where Pca refuses to stop progressing even with testosterone suppression.
But testosterone was 0.9 last February, and higher than the recommended maximum level of < 0.5 to
starve a Pca tumor of testosterone on which it depends to grow.

Was the Lucrin having difficulty closing down testicular function? It seems like it was. The addition of Cosudex
( bicalutamide ) to ADT with Lucrin starting at July 10 may be doing the main part of good.

The monthly inject of 7.5mg Lucrin is easier to take than the 22.5mg for 3 months. Costs are the same.

By April 2016, the doubling time for Psa rise became alarming. My good local oncologist said I could go
Epworth Hospital in Melbourne to have a new type of scan, the MPsa PET gallium68 scan which has become
available in last 18 months. I qualified to attend Epworth because my Psa was between 1 and 4. Epworth
had recently imported the Calypso IMRT method from USA.

On May 2, I had the Mpsa PET with gallium 68 at Bridge Road Imaging and results were viewed on May 3
with the director of Radiation Oncology at Epworth Hospital. I had an enlarged PG, and scan results showed
two distant spread spots in two upper thorax lymph nodes "associated with the prostate gland." The doctor
said the spread spots were not in lungs or other organ. He said these small level spots would not kill me
because I would have much bigger problems with the main primary tumour within 2 to 5 years. Ah, so without
his RT, I'd last only 5 more years max. My PG tumor is ageing, and probably began in 2005, but didn't make
a big Psa, so it was 2009 when Psa rose above 5. Old PG tumours can end up being deadly. I have no idea
when the spread to the two lymph nodes occurred, but the doc said the lymph node spread was a tiny amount
of Pca. Hmm, and I just thought, "from little things, big things grow!"

The doc said he could offer more "salvation" radiation via Calypso IMRT to increase accumulated level in
PG to a threshold more likely to cause Pca cell death. He was not sure if it was possible to radiate the
lymph nodes at the same time.
 
I returned to ACT, booked appointments for second opinions for which I had to wait a month. This gave me
time to search online for anything I could find about trials of salvation RT for patients like me who had RT as
the primary treatment. I found very few cases where the PG was radiated a second time after Pca began to
progress.

I was in a tiny minority category of patients.

I considered having a surgeon remove my bladder, PG, and seal off penile urethra well away from outlet from
PG, having both ureters brought to a stoma, then facing life with an external piss bag. The urology surgeon
who first saw me in 2009 was not interested in this surgery for me at any time in future despite having done the
same thing for a friend of mine, and who has no Psa, and probably no Pca cells in his body, and he is doing well.
But my friend accepted his op because he didn't want RT or chemo etc, and the usual long drawn out and losing
battle. I'd been radiated, and the bigger op was now not possible - too much danger of bleeding to death.

The most common op is to remove PG and join penile urethra to bottom of bladder. It is the Radical Prostatectomy,
RP. It might be OK where Gleason score <6, but distance from surgery to Pca is less than 20mm, and in many
cases the surgery area develops Pca. Therefore many who have an RP will need to have RT and then have a long
battle to keep the demon of Pca under control, they may need the years of ADT and chemo therapy; the fight is
never over until the cancer wins.
The surgeon said he might install a supra-pubetic catheter if my prostatic urethra became constricted. It involves
a plastic pipe with balloon at end inserted below belly button, and direct to front of bladder. The balloon is expanded,
has holes in it, and piss flows to a collection bag. But insertion point is just above the vertical pathway for radiation
to PG which was done in EBRT. The holes for catheter insertion heal up rather like the cells around a thick ring or a
bone which some ppl may insert through their nose or an ear lobe. There is always a risk if infections.
My GP has a patient who has had an S-P-catheter for years, but for other reasons than mine. It is the cheap easy
alternative to the stoma and bag to side, but the PG remains with its Pca liable to grow and kill.

He did say I could try the Melbourne IMRT Solution, and getting upper upper lymph nodes radiated in the same
sessions as for PG. I knew that he knew he could not help me much in future, and I felt he didn't have much hope
for my long term survival because of what he found in 2010 when he found he could not remove my PG - too
 much cancer. He didn't ever tell me that. But what other reason was there? I also I sought opinions from my
oncologist, and from the radiologist who did my EBRT in 2010.

None of the these three doctors in Canberra had the specialty training or the software which could allow them to
view the 3D MPsa scans I saw at Epworth with the top radiology doctor. The Bridge Road Imaging service
supplied a DVD with scan info, but it didn't include the IntelliViewer software so nobody at Canberra Hospital
could view my scans any better than I could on a PC with Windows XP, 7, or 10. 

The latest gallium-68 scans give Pca patients and doctors with a much better idea of the cancer status. Without
the gallium-68, (or choline-II in USA), it is difficult to choose the best battle strategy. My scans showed metastasis
(spread) some years before any CT scan could show. And by the time Pca shows up in a CT scan, its usually way
too late for treatment to be effective. If there were too many spread spots then the use of any IMRT or EBRT
may be ineffective because so many beam pathways would be needed that total amount of radiation applied will
cause intolerable side effects and damage to healthy tissues. Many small tumors mean indicate systemic nuclear
 radiation or chemo therapy et all may be better. Trials of systemic radiation with Lutetium 221 are underway at
the new Peter McCallum Center in Melbourne.

Trails of Actinium 225 have been done in USA. The radioactive element is in a solution, like salt in water.
There is also a secret binding agent that is specific for a type of cancer in solution. This clear solution is pumped
into a vein or artery and during the next hour or more the solution reaches all parts of the body. The binding agent
binds to tumor locations and brings the radioactive gallium ions with it, and and magic happens; the tumor gets
a lethal dose of RT. While the radioactive ions circulate in the blood circulation network, they don't linger so their
radiation dose to healthy tissue is negligible. This all gives a theoretically positive outcome, but is somewhat subject
to many variables and laws of chance, but a success is deemed where more than 50% of patients gain many years
of life afterwards.

But the most sensitive scans cannot show what will happen in my future if I am already riddled with small amounts
of cancer spread which are too small for today's Mpsa scanning methods to detect.

If I had the same MPsa scan in 2018, it is highly possible other metastasis sites would be found, even if all the
metastases and the PG itself had gone into remission. There can be a point where one chases an increasing number
of targets all over the body again and again with increasing sense of futility and increasing expense.

Epworth Hospital must have invested heavily in bringing Calypso IMRT and Mpsa tests to Australia within
last 18 months. Epworth is a "private hospital" which means they charge exactly like wounded bulls, to ensure their
income from patients pays for the investments and returns a healthy profit to those entitled to such profit from
business. The Australian public hospitals are often starved of funds for the latest equipment available.

Following the month long pause to think, I returned to Melbourne at beginning of July to proceed with the
Calypso IMRT for both PG and 2 lymph nodes. I signed what had to be signed, giving verbal uninformed
consent because the doctors could not answer all my questions.

The proposed PG salvation radiation was to be done exactly the same way as in vented by one Dr Gary
Shultz in USA. in 2011, The American Journal of Clinical Medicine published an article about Gary's and its
easy to Google, but there are no records of any trials or patient records to support Gary Shultz's claim in
AJCM that remission occurred in all 45 patients he claimed to have treated. 

These patients had previous EBRT which had failed stop the Pca. Gary's technique is to apply an extra
31Grey to PG with continuing ADT and blockade ( Lucrin + Cosudex ). Calypso IMRT was less damaging to
surrounding body than the standard EBRT so the target radiation level could be increased by about +50%.

Only brachytherapy with many radiated inserts could deliver more radiation to a PG than any external beams.
So, Gary's treatment seemed TOO GOOD TO BE TRUE. I have no idea if Gary treated 345 patients and had
45 successes, while not mentioning the other 300 who may have died since 2011, suffering numerous tragic
side effects and recourse to other futile treatments.

It was not unreasonable for me to ask a professional radiologist that he provide evidence for the likelihood
that what he proposed might work. I was forced to swallow the idea that there was no real evidence that the
Gary Shultz method worked at all, and maybe it was no better than the EBRT treatment I'd already had in 2010
- which did not work.

There was more blind hope than skepticism in my mind. Even if later I find that over time it was a failure,
was it not worth a try?

The alternatives available earlier this year included juggling of castration methods and chemical blockade of
testosterone, and then inevitable metastasis and a slow death with one chemical after another. The Internet is
riddled with postings by men who are diagnosed with Pca, then get treated, and a few find they really do get r
emission but many then go for years living with Pca and suffering the sexual mutilation and premature ageing
of the treatments. They stop posting about about it. The ones who continue posting are those battling on, with
some having their wives or children posting when the man has become quite sick, and facing the inevitable.
Was I not going to go down over time?

I have been sitting on Puff The Magic Prostate Grenade since diagnosis in 2009, and it is likely to explode
any time soon. The Medical System failed to protect me by ensuring early diagnosis because the Australian
Psa threshold level for treatment is 5.0. It is 3.0 in UK, and had it been 3.0 here in Oz, I would have been
diagnosed in 2005. 

Despite the lack of evidence held by the top Epworth professionals, I gave my uninformed consent to proceed.
There was a diligent team of young bright radiation operators at the Epworth Centre. There was more than one
team, and all were busy, but reliably punctual and friendly.
 
The estimate of costs was presented to me at $22,000 at July 2. I had to pay large invoices each week,
without having any clear indication of what the items were or what the Medicare refund would be. The costs
at end of treatment ballooned to about $26,000, with some outstanding bills still to be paid when I get some
 explanation of what was done when I discuss all the invoices with a Medicare staff member. So far, Medicare
has paid me about $11,000. The Epworth staff said a private health insurance fund would not have covered
my costs to any greater extent.

Not all the item numbers listed in invoices at a Private hospitals will attract a large payment from Medicare.
So when you go to Epworth, make sure you are flush with cash before you turn up. The sobering thought is
that this treatment in the USA would have cost $50,000, and there would be no Medicare funding, and the
cost of a 6 week stay in USA would be very high.

I returned to ACT on August 9, and waited a week, then had a Psa test which measured 0.73, so Psa had
fallen to 1/4 of the level it had been before IMRT.

The doctor said I might see a Psa "flare", ie, a rise of Psa immediately after IMRT. and then he said Psa
should fall. The Psa did not flare, it just dropped, and then has continued to drop over last 6 weeks to 0.51
at 21 September.

HOWEVER, I am very skeptical about whether the IMRT achieved any Pca reduction.

The EBRT in 2010 did little to halt my Pca. ACT doctors told me the EBRT could work a miracle.
But St Vincent's Hospital In Sydney have a document on their website which says Gleason 9 tumours like mine
have only 10% chance of being stopped with EBRT. Basically, the surgeon in ACT who attempted the RP in
2010 found too much cancer to proceed, then palmed me off to the next best treatment, radiotherapy,
and those guys seemed stupidly optimistic, and offered me nothing else, which at the time could have been
brachytherapy........

The ADT has been main agent to keep my Psa low.

Before I began the IMRT in mid July, I also began to take 50mg Cosudex pills each day. Gary Shultz
recommended that the daily dose should be 150mg, but the Epworth doctor said 50mg was plenty.

So why did they allow me to have a lesser dose than recommended by Gary Shultz in USA?

I was told by an old lady radiation nurse that 150mg pills were not available in Australia. I asked if I should
take 3 x 50mg pills a day. There was never a clear answer. More BULLSHIT. Cosudex acts to block
testosterone getting into receptor cells at the PG tumor. So with Lucrin to reduce the level of testosterone,
50mg / day may be enough to give enough blockading. How was I to really know? The idea behind RT is to
damage Pca DNA, and then the lack of available testosterone prevents cell division and re-growth so Pca cells
are more likely to die instead. Its a good common sense theory, but the reality of cancer chemistry is far more
complex, and not all known.

But older Pca tumors can grow more testosterone receptor cells in response to lower amounts of testosterone
due to ADT. Continuing Cosudex just further stimulates receptor cell production so that no amount of Cosudex
will block all testosterone to cause Pca cell death.

In 2010, I began with a month of Cosudex before injections of Eligard began. This was said to give less side
effects than starting with Eligard without Cosudex. Probably, Eligard ( or Lucrin etc ) takes a long time to begin
reducing testosterone, so docs go for the thing that gives a quickest drop in Psa. They may not have liked to
keep me on Cosudex after starting Eligard because it may have provoked the tumor to become ADT resistant
earlier than it would otherwise.
I did think continuous Eligard plus Cosudex may have been better after April 2010, but now think the ADT
failure now seen would have occurred sooner.

ADT does not ever cure Pca, it merely slows it all down for awhile, in my case, by about 6 years.

Before 2016, the only time I was given Cosudex was at the beginning of ADT ( Eligard or Lucrin) to
"lessen side effects" of ADT for a month before commencing ADT. Not a word was said about what
Cosudex actually did. But it has always caused a rapid initial fall of my Psa, and most of what I am seeing
now is probably due to this chemical.

I missed the monthly shot of Lucrin for July. However these monthly shots have at least a month of overlap if
you miss an injection.

Whether the IMRT has worked at all will become obvious in years ahead if Psa continues to fall, and especially
if I have stop the ADT with Lucrin and blockade with Cosudex.

The latest Psa graph update shows a rapid decline of Psa level between 18 July and 16 August. Between 16
August and 22 September, about 5 weeks, Psa fell from 0.73 to 0.51 in 37days.

Therefore the "Psa halving rate" is now 64 days, about 2 months. If that trend continues then in 6 months
after 16 August the Psa may be 0.1, in February 2017. If Psa rate of fall was linear, Psa would be zero
by some time in January 2017. Cancer is a disease that can rise logarithmically 2,4,8,16,32 because cell
numbers double after a time period. But I doubt the rate of decline of cancer cells cannot even be predicted,
although some cancers cease their existence abruptly when surgery succeeds to remove all of it.

I gave up all alcohol in July 2014 and I see NO REASON to break out champagne to celebrate a win.

So, forecasting future Psa level can be an irrational form of stupidity. Nobody could ever make any reliable
forecast. In another month my Psa may well begin to rise again without me having much way to stop it, apart
from chemo therapy, and while taking measures to better manage the suppression and blockading of
testosterone.

For the first two weeks after my return to ACT after the 5 week "Medical Holiday", I thought I had escaped
sustaining radiation side effects. But then 2 weeks after treatment, WHAMMO, I am hit suddenly with severe
diarrhea and my bowel producing large gas and mucus flows and uncontrollable bowel irregularity.
I've had 2 weeks of fecal incontinence and "explosive shitting events" where I filled underwear with poo
while rushing to a toilet. The usually good rhythm of bowel has gone, and my rectum seems badly affected
by radiation.

There are warnings in literature about EBRT. There are side effects, and I had them all, but not as badly
as some other fellows. Epworth offered protection against side effects to rectum by the installation of a
hydrogel pad between rectum and PG. I am having much worse bowel troubles now than I had after the
radiation in 2010 after the EBRT. So was the hydrogel inserted properly? Methinks the doctor who
 inserted 3 RF beacons to my PG and the hydrogel needs to much improve his methods. I will not say
 the word incompetent. It remains to be seen how well I recover in coming weeks and months.

My condition is now being monitored by my GP and whoever else may help, and it seems I am suffering
severe acute colitis after radiation. Google is full of information with videos about this terrible condition
which could go on indefinitely. Just what may possibly be done to alleviate the effects quite unclear so far,
but I probably will have to be seen by a gastro doc. I am not bleeding much, but continue with little regularity
 some pain, and discharge of gas and mucus.

Stop rolling your eyes, all this may happen to YOU.

The literature supporting Calypso and the use of hydrogel may be misleading. However, probably the
hydrogel does lessen the side effects to rectum.

If you seek similar treatment to what I just had, assume you will sustain WORSE side effects than the
doctors indicate may occur. Usually they fob off everything you say, avoid all difficult questions.
They just want you to accept treatment to keep their income coming in.

I do not know if the bowel damage sustained at Epworth will be permanent. There have been cases at
other hospitals around the world where much worse damage to bowel/rectum has been sustained despite
evidence suggesting that damage would occur.

I read of a classic case in Sweden in 2003 described by caption "how not to do radiation". They just
repeated normal EBRT like I had in 2010, and over half the patients endured the problems with fistulas
forming where a rectum wall ruptures and shit exits into perineal cavity and with bleeding and infection
and pain. Such bowel/rectum damage can only be fixed by removal of large section of bowel, formation
of a stoma so an external shit bag can be worn. Radiated tissues in this operation have to be avoided
because once cut, they do not heal and may bleed for days or weeks. And the article said there was
not much remission of Pca. 

Before going to Epworth, I was still having occasional bleeds from rectum as a result of EBRT in 2010.
These bleeds were bright red arterial blood which occurred if the shit was lumpy. There was never more
 than half a spoonful. The bleed lasted only seconds. In 2013, a specialist  gastro doc could not find
where the bleeds were coming from during a colonoscopy in 2013 to check for bowel cancer.

He had thought I had piles, but none were found. I met a bloke at Pca support group who went on a
world cruise after EBRT, and he bled cup-fulls of blood. So he surely had a "bloody holiday", and I guess
it was a voyage of worry for him and his nice supportive missus.
 
A week after I began IMRT on July 18, I needed to get up at night to piss up to 7 times. I began to
need to take a nightly Tamsulosin pill aka Flomaxtra to reduce PG swelling and resulting constriction
of the prostatic urethra, making pissing slow, and laboured.

I continue taking a Flomax pill each night since I began treatment to get a better sleep. The bladder
seems to have survived. I still can stop or start flow at will. But experts say that the control I have now
will reduce to complete urine continence because of long term radiation damage. The radiation doc told
me the May scan indicated my bladder wall muscle has much thickened because of its extra work over
last 7 years to squeeze the piss through a reduced size of prostatic urethra. Once my bladder decides to
squeeze, I need to get to a loo fast or the sphincter control is insufficient while trying to stop the pissing
with pelvic floor muscles. Keeping a piss bottle handy when not close to a toilet is completely sensible !!
I spend 95% of my time alone, and there is nobody such as a fussy wife to become upset by seeing an
old man easing a problem in a practical manner. 

I have a date with a continence nurse soon to discuss better ways to manage degradation of my bladder
 and bowel function by radiation.

On July 1 I had the gel inserted and 3 RF beacons inserted to PG tissue using some kind of applicator tool
and guided by ultrasound. The beacon position in the PG is somewhat critical to ensure the beacons can give
the right information to guide the IMRT Varian machine using Calypso software. If the PG position moves
during IMRT, the beams follow the moving target - in theory - and just how successful this is anyone's guess.
The beacon applicator tool was never described to me, but it was a "transient" procedure, and doc cited
difficulty with the tissue hardness of my PG. I felt I was among fools who blamed me or their tools for their difficulties.

The beacon implants and gel insert was done between 12noon and 1pm, Friday 1July. Because I was
unaccompanied by a partner or carer, I was compelled to stay a night at Epworth ( at a cost of $860 I later found ).
 I was not permitted to just go back to a hotel room, which was normal for other Calypso IMRT patients who
were having IMRT following an RP. But it turned out to be necessary for the night's
stay.

Blockage and inconveniences.
At 8pm, 7 hours after beacon implanting, I could not piss. I dosed off, and at 2:30AM I remained blocked.
I asked the ward nurse to phone the doctor about what next. The male nurse spoke poor English and seemed
incompetent and un-communicative, inspiring no confidence in me. But the phone call occurred, and it worried
the doc who had done the beacon insert.

An intern arrived at bedside with a catheter, another poor English speaker, and he was very nervous about
what he had to do. I had to calm him down, and prevent over eagerness to push catheter lest it rupture my
urethra somewhere. We got it done OK, and I have NO APOLOGIES to anyone for being quite SURLY
about it all when I wasn't trying to calm upset middle aged male nurses easily offended, and from Philippines
or south America, it seemed. No pretty girl nurses in wards at 3AM, no specialist doctors either.

The catheter was pushed through a soft blood clot which blocked the prostatic urethra. The bleeding
continued for some hours with blood seeping
backwards up into bladder. I spent a second day at Epworth ( another $860 ) until they were happy for
catheter to be removed and bleeding had subsided enough for me to be "sent home", ie, to my lodging at
Ryder Cheshire, a place run by a charity entity.

The cause of bleeding was never fully understood by docs. They admitted nothing. I figured blood from
within cut prostate tissue with beacons had found an exit pathway via sperm ducts to the prostatic urethra,
where it was able to pool and form a clot and urethra blockage to stop urine flow from bladder to penile urethra. 
The catheter must have pushed through the blood clot, and urine mixed with blood flowed out immediately.
More blood may have flowed backwards to bladder from bleeding prostate to bladder and around the
outside of catheter. I did not bleed from penis while catheter was inserted. These details were not understood
by the doctors.

I did get a visit from the insert doc on morning after blockage who said he did have difficulties, and that I was
THE FIRST patient to be having salvation radiation after having had only EBRT as primary treatment.

The removal of catheter was without pain, and I was allowed to leave to go back to my lodgings at
Cheshire-Ryder Homes on the Sunday after the Friday operation. During the next 10 days up to July 10 when
I was due to begin RT, I was able to email doctors to question their methods. During the first week my emails
with doctors indicated they did not know whether they had punctured my bladder or punctured my prostatic
urethra or both while trying to insert the 3 RF beacons. Without spelling it out, the doc inserting beacons could
not see what he was doing. The Ultrasound image maker used to monitor such things was not letting him see
clearly. So he was stabbing in the dark.

On the second morning of my hospital stay, another doc arrived to chat. He said he had done
,500 brachy-therapies, and he said less than 1 in 60 patients had bleeding problems and that most of those were
like me, from interstate, and he didn't know why. Nor did I because such info was just irrelevant bullshit; why was
he there? why talk to me? what magic thing was he going to do to alleviate my problems? - nothing he could think of.

But, brachy-therapy patients can have up to a hundred radioactive needle size inserts injected into PG with a
special tool, less than 2mm dia, and all the little needle stick injuries all heal within a day because they are still
mainly healthy, and heal up before the radiation from inserts affects them. Brachytherapy can deliver 150Gy to PG,
and with fewer side effects to bowels or rectum, so it has been the best RT available. But once PG has been given
70Gy from EBRT, or more from BT, then later the PG blood vessels will not heal quickly if they are cut by any
surgical procedure.
 
The BT radiation is known as the best type to have. But it is more expensive, and in 2009, was not available for
me as far as I knew. No doctor mentioned I should get it. Besides, its only radiation, and with a Gleason 9 tumour,
the chance of it working was only 50% - maybe. I was told to have EBRT, it was supposed to be as good, but it
just ain't, and later I found St Vincents's Hospital in Sydney has literature at their website which says the probability
of Pca recurrence after EBRT for a Gleason 9 tumour was 90%. Brachy therapy BT may have been marginally
more effective than EBRT for my high grade tumour.

I explained to both these visiting docs that success of interplanetary space missions depended on rocket scientists
having to investigate every possible way shit can happen. I'd been previously well radiated, and both docs didn't
see that I was probably 100% likely to bleed, and I was not in the category of the 1.66% of BT patients who
bleed after BT insertions. I suspect the hospital charged me for the unwarranted unwanted chat on Sunday
morning.

Most docs are not driven by charity, and the Sunday doc must have been curious, maybe informed by other
doc. And my payments to Epworth paid for his curiosity. The 2 days in hospital because of bleeding cost
$1,700, with none reimbursed by Medicare.

After being told I was the first patient for re-radiation and this made me realize I was nothing more than a
laboratory rat for docs to experiment upon without ANY useful info from the USA doc who recommends
this process. If the docs want my respect, they must earn it. 

I left the Epworth Free Masons ward on Sunday afternoon July 3 and settled in at lodgings run by Ryder Cheshire
which is an independent entity which has volunteer workers only, except for one lady who does the books for a
total of about 50 one bedroom apartments with two beds for the many ppl from faraway regions of Victoria and
NSW. Maybe there were 40 ppl staying, with many cases of breast and prostate cancers. This WONDERFUL
place allows allows patients and partners or guardians / carers to have cheap lodgings for a typical stay of 6
weeks. One woman had had 29 courses of radiation, others had lost a lung, or were in a much worse position
than myself.
THAT was humbling.

I walked a kilometer to shops for basic groceries, and knees felt very sore, and I was still bleeding from dick
a bit from minor op 2 days before. I had another week to wait before being "measured up" before another week
of radiation planning. Those first 2 weeks of my stay at Cheshire was very pleasant, and there was a mobility
scooter available which I used to go to shops, and to a fine Lebanese restaurant, the Gorgia Cafe in Ivanhoe
which became my daily eatery for the 2 weeks where there was no daily radiation.

They had Wi-Fi, so I could email the doc to ask so many questions about why I had bled. I asked what evidence
supported the claims by Dr Gary Shultz in USA. The bleeding kept going for a week, and I do not know if I bled
from incision entry point for beacons into the perineal area.

During the 2 weeks with no radiation, I asked more questions and ended up asking the radiation doc to email
Dr Shultz to find out more. He sure was not going to do that. I said better methods are needed for placing RF
beacons to avoid damaging or cutting things like bladder or prostatic urethra during injections. I said he will have
other patients like me so he needed to be ready with improved methods. It is possible he totally ignored all I typed.

He ended up admitting there was no information available about Dr Shultz's patients and that I had now been
fully informed and that was that. In other words, there was no supporting evidence that the RT he offered was
much good at all. Hence I had given my uninformed consent. We both knew it may not work as planned.

10 days after the minor surgery, I did try to visit an aquatic center near my lodgings to swim a bit, 400M, and
I bled again, so I gave up all silly notions of doing any exercise while in Melbourne.

The radiation treatments began on 18 July and were completed on August 9. At 10AM each day I had IMRT
to PG and to upper chest targets. At 4PM I had a second round of IMRT to PG only. I filled in time by doing
web-page work with my laptop. There were 4 radiation staff and 2 nurses in an office who had little to do
with me except to lecture me about having a gas free and shit free rectum. They managed to give me enough
potty training to always arrive gas&shit free for RT, and with 500ml of water in bladder. After return to ACT,
I have had 3 brief emails from the head radiation doc asking about my bladder and bowels. All was cordial
without me bashing the man with questions was never going to answer. He must have winced when he tried to
read the screen fulls of history and suggestions and about my terrible fecal incontinence. I doubt he read much
at all. I am not officially in his care any longer, and there's little need to contact him. He may read this here.

A week after I returned to ACT, I climbed back onto bicycle. No more bleeding. The entry point for surgical
gadgets under crutch had healed OK - not radiated. I was able to increase distance and speed, and I regained
my fitness levels close to what I had in mid July before the Melbourne trip. But I did notice that I breathed more
heavily riding uphill, and there has been some damage to lung tissue. The doc did say I might have some difficulty
swallowing and a sore esophagus, but I had neither. I seemed to burp more and suffer some slight indigestion.
Appetite has remained good but since August 9, and increased bowel irregularity has not stopped me eating the
same vegetarian diet. However, I like to make my salads with green fresh green vegetables which i can heat in
microwave to make them more easily digested. There is no need for so much raw food.

Weight has bounced down a Kg while in Melbourne, then up 2Kg, then down again, as irregularity manifests itself
with erratic disposal of bowel biomass. Once past the acute irregular shit-in-pants events, I now have a regular
form of irregularity, with rectum not happy with handling shit, and wanting to spurt mucus and gas at least 10 times
a day.

My resting heart rate in mornings is 50, up slightly from the 48 last July. it takes more time for HR to go lower
even after short rides. I have a pain in the lung on right side, similar to having  cracked rib some years ago, so
I assume I have poorer lung function, so heart beats faster to get more blood around to be oxygenated at the
lower rate. So the Melbourne treatment had a slight worsening effect on my cardio vascular health. I was told the
two distant Pca spots were in 2 lymph nodes. Their position looked like they were in my lungs. I have ZERO idea
of exactly what was radiated in upper thorax; the machine is able to gain enough info from scans to aim at whatever
volumes are on scan without any other tests able to proove that indeed the spots were at lymph nodes, and not
within my lungs. So I can only cross my fingers. I am just a dumb ( and irritating patient ) who just cannot trust
the education and experience of doctors unless they proove they know what they are doing. The world is full of
well educated fools on good wages, and beyond anyone's ability to scrutinize their efforts. Shakespeare wrote
many plays about powerful blokes and sheilas who were were so flawed......

Last February, I joined the the waiting list for two new knee joints at Calvary Hospital in Canberra.
Walking further than 100M has become painful, and scans in 2014 proved I need two new joints, all propelled
by the crummy genetics I inherited from my dearest mother's genes. She hated all vigorous exercise, and I never
ever saw her raise a sweat. She did like to swim, and I watched her extremely slow motion in a pool where I
took her when she was 73. She got through to 98 years of life as a mindful plodder, an attribute we both had.
She had few athletic attributes which allowed others to do twice what she did. I am much the same, but I
inherited my father's zest for exercise; he set a schoolboy record for The Mile in about 1924, and rowed
well for the posh school. He was always ready for real stinky sweaty work for real men and I often helped
him eagerly with the work around the house and at his vet practice. But he neglected a melanoma on his leg,
and he died at 60.

If my cancer continues to outwit the doctors and I need chemo therapy, I won't get those new knees.
The waiting list was 12 months, but Calvary contacted me for pre-admission in mid August. I told them I
needed more time to allow doctors to decide if I was likely to have a long remission time and hence allow the
knee surgery. It would be extremely pleasant to be able to walk 800meters to the local shop and, and that would
greatly help my health and help reduce bone density loss due not using legs walking. I could also ride a lot further,
and I can say I would be most eager to do all the rehabilitation needed after knee surgery.

During time in Melbourne, for weekdays with radiation there were cars provided to get patients from Ryder
Cheshire to several hospitals, all driven by eager volunteers between 55 and 70. Ryder Cheshire is about
10km away from hospitals in Richmond. The private hospitals' policies give local transport to the sick coming
from all around Victoria and NSW. It helps make the big services of big hospitals available to those in remote
 regions without the stress of getting around in a big city. There were some spirited discussions every other day
on the 1/2 hour drives from "home" to the hospitals. Most patients had only one radiation session per day, so they
were driven home by the volunteers before lunch. I was the only one getting two radiations per day, at least 6 hours
apart, and Epworth Centre staff gave me taxi vouchers for a free ride home in slow peak hour traffic which cost
an average of $33. It meant I did not have to walk in pain on bad knees. For those who can walk, there is also a
good train service from Ivanhoe to West Richmond station, 300 meters from the Epworth center. From a station
at Ivanhoe, bus 548, which reduces 1.4km walk from station to Ryder Cheshire to 300M. There are also taxis
from station to Ryder. I may have had to stand while using public at peak hour times. Epworth did not charge
me for vouches worth a total of about $660. They still probably made a healthy profit from the total of
$26,000 they charged me. I would not be surprised.

Ryder Cheshire refused to take a cent from me for the accommodation. They didn't seem to know what rate to
charge me, which depended on whether Epworth would pay them, at a higher rate than they felt they could charge
me if I paid direct, ie, $20 per night for 31 nights. I suspect Epworth did pay them, and paid $38 per night, and
the Epworth accounts had no item for accommodations. I have no idea who paid who, but probably the
accommodation costs are buried in the invoices from Epworth. I filled out forms to claim for ACT Government
assisted travel expenses. I never heard a word from ACT Govt, for this little used service. The accounting of
costs at Epworth seemed unclear, but Medicare staff in Canberra said all was well with their charges.

I gave the Ryder Cheshire a donation of $1,000 before I left. If I'd had to pay for a Hotel at $100 per night,
If have paid $3,100, and not had access to the daily transport to hospitals, and not had a tiny bedsitter flat to
cook in, my costs would have been far higher. If I ever need to get medical treatment in Melbourne again, I'd
want to stay at Cheshire Ryder. It is a lovely simple old fashioned place to stay with ppl about who have troubles
like me.
-------------------------------------------------------------------------------------------------------------------
Before my Melbourne treatments a gentleman emailed me to to describe his IMRT which followed his RP
some months before at Epworth Hospital to which I went. I'd met Paul online in 2004 I gave him details for a
component he wanted to make for an audio amp he was making. We still share an interest in DIY Hi-Fi
technologies. His descriptions of what happened to him gave me confidence that side effects for IMRT
might be minimal, and that radiation treatment itself was quite tolerable, and that the hospital staff were very
nice. Most of this turned out to be quite true.

After his RP, his Psa went very low, then began to rise. He then had the surgery site radiated using Calypso
IMRT, and Psa went down again. I met him in Melbourne and had dinner with him twice.
But some months later, his Psa is rising again, showing that Pca is progressing despite all the surgery and RT.
Because his Psa went so low after the treatments, it was unlikely there were metastases somewhere.
When Psa does not decrease much, it could mean there is Psa coming from a metastasis.

I'd say he will have to go to ADT, and probably he may suppress his Pca for some years like me, until the
Pca becomes castration resistant which is usually inevitable.
I began with PG that was NOT removed because the doctor said I had an inoperable Gleason 9 tumour
which had slightly escaped the PG capsule- a monster. Paul will live many years yet, and probably more
years than I will, and I'm 10 years older, and much more likely to go down in 5 years, before any magic
cure arrives.

Good links...
Subscribe to this site for continual emails of latest progress in research and drug trials :-
https://prostatecancerinfolink.net
Psa level between age 40 and 60 indicate lethal Pca in later years :-
https://prostatecancerinfolink.net/2016/06/14/another-step-toward-a-rational-risk-stratified-psa-testing-methodology/

If Psa is above 1.0 at age 59 there is good reason to worry.......
Reading:-
http://www.prostateoncology.com/education/glossary/a:hormonal_therapy
http://prostatecanceruk.org/for-health-professionals/latest-research
------------------------------------------------------------------------------------------------------------------
Before 29 May 2016.
My prostate cancer progress presents a bigger battle in coming months. All those people who said I would
get better and that I didn't have anything to worry about and that alternative therapies would work WERE
ALL WRONG. Today I cycled 45km to give a total of 136km for the last week.

Weight is 84.2Kg, resting heart rate = 52 bpm at 1 hour after the ride, 48 bpm this AM, and nice steady
beats with no double beats or missed beats. My vegans diet is continuing, and I have to be honest, its 95%
vegans because I do allow low fat milk for my tea, and 150 grams of salmon from fish farms in Tasmania.
I quit all coffee 2 months ago after realizing it contributed to feeling too hyper after 3 coffees, and probably
caused a bout of uneven fast and slow HR just after last X-mas. I've been on ADT aka HT to block my
testosterone production since 2010, so 6 years now, and I had an eight month pause in 2012-2013, and a
gain last year 2015 for 5 months. After both pauses the Psa shot back up. Since the last pause and after
recommencing HT last August 2015, Psa went to a low of 1.0, and then began to rise to 1.5 by April 2016.
Its now 2.3 so it is doubling each 4 months, fast, and HT with Lucrin injections is not able to keep testosterone
below 0.5 for adequate suppression of testosterone, hence Psa is rising, and Psa would be 128 in 2 years if
nothing is done about the situation.Before 4 May 2016 I could not find any available trials of new treatments
in Australia.
But when I last spoke with my good oncologist he suggested I go to a Melbourne imaging clinic and consult
with a Melbourne radiologist at Epworth Hospital. These together offered the new benefit of an MPSA +PET
scan which shows my cancer status and is a guide to choice of further beam radiation using the Calypso IMRT
method :-
http://www.wesleymedicalimaging.com.au/uploads/file/New%20PET%20Studies/PSMA.pdf

Calypso seems to be the best way to deliver RT to prostate tumors with much less damage to surrounding
organs or bones. I had previous EBRT in 2010 with probable radiation levels of 65Gy, with some side effects
on bowels. The proposed Calypso IMRT uses computer program and implanted RF beacons and hydrogel to
much reduce side effects to bladder and bowel.
There are online articles on Calypso such as.
... http://www.sciencedirect.com/science/article/pii/S0360301606032767
There are plenty more, and these may confuse patients and make them anxious unless you are a naturally
scientifically minded person like myself.
I also found a video suggesting IMRT was no better than older EBRT,
https://www.youtube.com/watch?v=XWobSwAnP68

But I think the IMRT is a much better way to deliver RT for me. Doctors like to tell us to stay away from
Internet which makes us anxious and confused, and just rely on their learning and experience. But much of
what many doctors told me made me anxious and confused.

The anxiety and confusion did not last long in my mind because usually what the doctor says agrees with
what I find on the Internet, and I have a rational mind. Many modern clinical treatments have been
developed over many years of trials which have been regulated by government organizations.

But regulated systems don't always keep patients safe. For example, I should have had a biopsy when
Psa reached 3.0, some years before my Psa climbed to 5.0 when the Gleason score had increased to
dangerous 9 and Pca tumour was inoperable ! 

But the fact remains that modern medicine does more good than harm, and I would be dead now without
the treatment I have had.But despite all the modern wonders of treatment, prostate cancer manages to kill
33% of men diagnosed. It is highly likely to kill me because I was diagnosed too late, even after having
regular Psa tests, and then finding I had a Gleason 9 tumour with aggressive cell type.

The doctor at Epworth Hospital is the first doctor who was happy to email me with with considerable
information. The IMRT he proposes does seem safe to me, it means 31.2Gy are to be applied in 26
sessions over 3 weeks, which in theory raises total radiation for my PG to 96.2Grey. The doctor
supplied a paper published in American Journal of Clinical Medicine, Fall, 2011, Page 170, where
one Dr Gary Shultz claims he gave repeated RT to 45 men who ALL had a positive outcome, ie,
Psa began to fall.

http://www.aapsus.org/wp-content/uploads/ajcmeleven.pdf

I am seeing my good oncologist on 31 May, and my urologist on 8 June, and I will also see the
radiologist who did my EBRT in 2010, on maybe 14 June,
to discuss the following :-

1. Details of small amount of Pca spread to 2 lymph nodes in upper thorax.
2. Permissible maximum amount of accumulated radiation to PG.
3. Case histories of patients with similar Pca progress who have had two repeated courses of RT.
4. Possible side effects of bleeding from blood vessels of PG,
5. Possible dysfunction of prostatic urethra, including disintegration, or stricture, interfering with urination.
6. Possible alternative surgery involving removal of bladder, PG and formation of stoma to allow ureters
from kidneys to drain urine to external plastic bag. ( 40,000 ppl in Oz wear bags for body waste due to
cancer or road crashes et all, and they have a good life. )
7. Whatever else they tell me, or what I forgot to include here.
I learnt much from Internet from research hospital publications online, Sloan Kettering et all.
Doctors have yet to get rid of my prostate cancer, and quite a number of treatment plans did not
work despite their best intentions and predictions, and to me, not reading the Internet would be
like poking my head in the sand. Am I not entitled to get my info from the Internet just like doctors?
The new PsMa scans have become available in last 12 months, and are on trial in Oz.

It seems the supply of patients for a trial are supplied by a referring doctor, so I probably had no
chance of getting into any trial without a doctor's referral.

My local Canberra oncologist and radiologist both said they had referred patients like me to hospitals
in bigger cities such as Sydney of Melbourne where a bigger range of specialist services and treatments
are slowly becoming available. My local oncologist said patients he sent away to Melbourne were
helped, but not exactly how many or how their life improved, so I am yet again left to assume there
may be some increased lifetime and there was no talk of a cure or remission.

I am sitting on my Prostate Grenade, and while its growth activities have been slowed by HT, it does
not mean it will just die and fade away. It will slowly swell up and try to choke my prostatic urethra
which will slow my flow to a dribble and affect my kidneys. If left alone, it will evolve to become a
worse form of cancer which is more likely to spread in a rush - the grenade pin falls out, and floods
 my blood stream with Pca, and overwhelms my immune system. The proposed IMRT is the Last Chance
I have to intervene with available treatment in Australia afaik. If this treatment fails, then I will have to
begin chemotherapy, not something anyone can look forward to.

The expense is minimal for the PET scans and course of radiation, and there are costs for travel
and accommodation. Not much of all this is funded by Medicare.

For 2 days in Melbourne to undergo scans and re-diagnosis, return air fare was $432 aud with
Virgin, a small room at a Quest hotel was at $150 a night. On return, I found cheaper accommodation
for $80, which I may use in future. Some of the costs of travelling outside ACT for medical treatments
may be paid by ACT Govt. There is a special claim form, not much publicized, and without mention
of funds for air fares.

On Monday 2 May, I had a CT scan with radioactive iodine.
Then I was injected with special solution which is able to bind Gallium 68 isotope to places where
any Psa is being produced. A PET scanner used to produce the PsMa scan which tells doctors and
myself just where Psa is being produced now, something nobody has known since 2010. The scan
is said to be far more sensitive than a CT scan and very low amounts of Pca are seen. The main
source of Psa is the primary tumour at PG.

On Tuesday 3 May, the radiologist said the PET showed no Pca in bones, bladder or bowel, rectum,
but there were two small amounts in two upper thorax lymph nodes. He said these would not be a
major problem and would be fixed after the main primary tumour has been radiated. I will need to
examine the follow up carefully. Before being sent to Melbourne I didn't think any more radiation
could be used, but it seems I was incorrect. The Melbourne doc said it could be at a higher dose than
the original in 2010. Just what that means wasn't clear, was the total accumulated radiation to be higher?
By how much? My research on Calypso tells me IMRT with 81Gray levels are possible, above the
probable 65Gy levels of 2010. So was the total radiation level to be increased to 146Gy? I searched
all over the net to find what was the maximum safe level of radiation by X-rays for the prostate
gland. Many other parts of body were given nominal maximums, but not the PG. I assumed 81Gy.
The doc sent me the .pdf showing recommended treatment by Dr Gary Shultz.
It tells us the IMRT applies 31.2Gray to PG, and when added to say 65Gy with the normal EBRT
the total = 96.2Gy. The EBRT in 2010 wasn't a high enough level to halt the tumor growth, but must
 have caused some damage, and there has been some recovery, or healing, so the 31.2Gy now
proposed may be well tolerated by healthy tissue, but maybe not tolerated by Pca.

It is assumed healthy tissue will always survive radiation better than cancer cells. The cancer growth
depends on a good blood supply which it extends for itself to do well. Methinks some cancer is could
be much more robust than healthy tissue, and unless all blood vessels are destroyed by radiation, and
surrounding healthy tissue as well, maybe then the cancer might just give up. 

Any simplistic explanation of how radiation or chemo actually works is likely to be BULLSHIT.

The original EBRT I had in 2010 used old machines with beams at only 4 directions, each session
gave 1 shot vertically up, 1 shot vertically down, and 1 shot horizontal left, 1 shot horizontally right,
with no regard for where the entry and exist beams went, and with poor dynamic control of beam direction
relative to prostate, and unknown beam shaping to conform with shape of PG seen in accompanying CT
scanning. PG can vary up to +/- 6mm due to breathing, and bowel content movements. Therefore beams
are allowed a 10mm margin exceeding the shape of PG, and this means the rectum walls cop a large
dose of RT. I was expected to drink plenty water before each session to stretch bladder to keep more
of it away from PG.
The Calypso method allows calculation of the best beam directions at many angles all worked out on
a computer prior to the radiation. The intensity of radiation is variable and beam direction is locked on to
tracking information from implanted RF beacons within the PG. Hydrogel is inserted between PG and
rectum and I assume bladder as well to nudge these adjacent organs 12mm away from PG, So the beam
control uses a much more sophisticated computer control program, a benefit of progress over last 20 years,
and thus offers less side effects, and raises the amount of RT allowed to be given to PG. The hydrogel
hardens to being like rubber immediately after insertion, but dissolves away during 4 following months.
Its is said to be entirely inert, and safe to use.

I don't expect very much additional radiation damage to what I have had already, except to prostatic
urethra, all nerves, and thus may bring incontinence.
 
The doc said the IMRT can be over a week, or 3 weeks. The week of RT suits those wanting the
cheaper cost, and shorter accommodation, and less time off work. Being retired, the longer 3 week
time suits me, and doc said the longer time gave slightly better results. He said there is a chance
the Tumor Cells Will Be Exterminated. A bit like a Darlek in a Dr Who episode.

Well OK, sure, but all exterminated? will some just modify themselves into something worse?
It is cancer we face, and it is real good at making a fool out of many doctors.

A Psa test 6 weeks later would tell me and my doctors who are all interested if the IMRT has done
anything. Psa is supposed to decline. The worst outcome would be a rapid rise in Psa. I'll remain on HT,
maybe monthly Lucrin shots, and Cosadex.

I have provisionally agreed to go ahead. The doc in Melbourne is happy to do the  RT if my other
doctors have faith in what is to be done, and of course to get to see all the doctors I had to book
appointments and get around the waiting times of up to a month before my turn was available.
There are hundreds of other patients, some in greater need than me. And I have to wait for one doc
to return from time off, and oncologist takes a break a week after I see him. So unless you get busy
to talk to these docs, then expect almost no co-ordination or concern about yourself.
Just make sure you are polite, not ever surly, doctors and specialists are not God, they are just men
or women, and you must make do with whoever is around and I believe this approach leads to the best
evidence based treatment you could have. The oncologist didn't know what Calypso IMRT was about
when I mentioned it. After dealings with me he will learn just what is on offer; I very much like talking
to my doctors, and I try to bring then a concise list of my concerns.

Because there is some Pca spread to lymph glands I will have chemotherapy at a later date, maybe
in 2 months time. Nobody knows what might work, or what combination of chemicals might work.
Many chemicals merely delay the the end game a few months, but in some cases it gives years of life.
There are chemo drugs such as abiraterone, enzalutimide, taxotere, cabazitaxel, etc.One solution might
be the to removal of bladder, PG, and sealing off penile urethra. Then the two ureters from each kidney
are brought together to make a join to a hole at side of lower abdomen for external urine bag.
But because my Pca has some slight systemic spread the surgeon may feel it is a pointless exercise.
I know a guy who has been through this, he's lived happily onwards after this op and gets jobs done
around the house and his wife still loves him.

Many websites are a cause of confusion and anxiety, but I found this from the UK...
 http://www.cuh.org.uk/bladder-cancer/your-stories/alan-hoensch
The PET scan showed my bladder is not happy. The bladder is muscular bag with walls normally
3mm thick to expel urine with an easy squeeze to get urine out along well sized tubing with few  restrictions.
But in my case, the urethra in PG is being strangled making it harder to expel, so the bladder has built up its
muscle thickness to 10mm. I don't realize the effort it makes and nothing is painful, unless I delay getting to a
loo.

I told the Melbourne doctor that men should be able to have their PG removed before cancer spoils their
fun, and before cancer makes it impossible to spare nerves. But he said no 25yo would want this, but I
said many over 55 would much like it, and they are usually able to afford it. It is rich old men who fund old
men's cancer research and treatments.

But prostate surgery often leaves a small number of Pca cells behind, or healthy PG cells which will develop
Pca later if the DNA allows it. I know about 5 men my age well enough to know their Pg condition; all had
surgery, and all had Pca return, and all had "salvation treatment" with RT. Some had HT, while others didn't,
so the HT was a spare weapon up their sleeve if the Pca progressed.

One friend had surgery over 6 yrs ago, Psa went down to < 0.02 after a year, then hovered for a year or two,
then began to rise to 0.7 before last December. He then had 35 sessions of EBRT over a month to the area
where bladder was joined to urethra. His Psa is now 0.1, and apparently falling. But his tumour was Gleason 6,
and the target for RT was small, so "salvation" RT is more likely to work. I had Gleason 9, aggressive cells,
operation was impossible and I'm in a much worse situation.

There are idiots who suggest Psa testing is all BS, and treatment does not extend life very much.
But I would now be dead if Psa tests and treatments had not been available.

While surfing the Internet I just found a .pdf document prepared by St Vincents Clinic in Sydney about
the range of things done at this clinic.

https://stvincentsclinic.com.au/wps/wcm/connect/d4f26437-5af8-46b6-bbed-981b66d7616e/2014+Proceedings.pdf?MOD=AJPERES&amp;CONVERT_TO=url&amp;CACHEID=d4f26437-5af8-46b6-bbed-981b66d7616e

On page 11, there is a table giving Psa levels at which referral to a urologist should occur.
For men of 60-69, the Psa level is 3.0. My Psa would have exceeded 3.0 well before 60, and my
GP did not send me to a urologist until Psa went close to 5.0 in 2009, when the tumour had grown to be
inoperable and with aggressive cells.

So I cannot stress how important it is to be diagnosed early, which means a biopsy at Psa = 3.0, regardless
of other public health guidelines based on Psa of 5.0.

Other good reading about radiotherapy, UK
http://www.cancerresearchuk.org/about-cancer/type/prostate-cancer/treatment/radiotherapy/external-radiotherapy-for-prostate-cancer

General info about survival rates, USA
http://www.harvardprostateknowledge.org/how-to-handle-a-relapse-after-treatment-for-prostate-cancer

From what the Harvard site says, I had a 90% chance of recurrence of Pca after the "normal" level of EBRT
used at Canberra Hospital. The recurrence of Pca was masked by action of HT, so the recurrence was seen
in three rises of Psa when I ceased HT 18 months after initial RT. The maximum rate of Psa rise was much faster
than 2ng/L per year.
-------------------------------------------------------------------------------------------
My vegans diet includes large amounts of raw vegetables and herbs in salads, and regular quinoa plus
almonds boiled together, tiny amounts of low fat milk, sugar, salt. I use virgin olive oil in many things, but it
amounts to less than everyone else's fat intake. I don't eat any junk food, ever, no chips, deep fried anything,
no alcohol, no coffee, no cheese, and I really don't know anyone else who eats like I do. The ONLY way
ppl get fat is because they eat too much. Regardless of all other considerations or invented feel-good
justifications or theories anyone anywhere says about food and weight, if you stack on more weight beyond
what is ideal for you at 35, ie, when your BMI should have been less than 25, then you have eaten too much.

I was at my fittest at 42, and weighed 82Kg. I could ride a bicycle 300km in a day at 28kph average. And I
have quite poor athletic genes. I'm now 84Kg, and bike speed is now down to 20kph because muscles have
weakened at 69, and I've been chemically castrated for 6 years now. The weight change is about -5Kg muscle,
+7Kg fat, but I still have BMI about 25.0. Despite the terrible condition of my knees which need titanium joints,
I still manage to ride over 100km a week.

I weigh myself naked each morning on electronic scales, and plot each day's starting weight on a graph in my
hand-written journal I've been doing for last 55 years. Only one person controls food flow down your neck,
HE IS YOU.

What you eat should be full of vitamins and micro-nutrients. As we age, we need less food calories, but we
need good nutrition. We have less muscle weight and we do not need extra protein or extra carbohydrates;
you need less of all things which are calorific.

Breakfast for me is a bowl of chopped raw kale, one raw tomato, one spoon of olive oil, a sprinkle of turmeric
and salt with iodine, and a pot of green tea. I don't need to eat between 8am and midday. Lunch is one
vegetable only sandwich and a pot of tea. I found it very easy to accept the more frugal existence despite
my improved finances and the booming roar of advertising shouting at me to eat and drink garbage, and
spend my way to being happy.
Over eating is poisonous, over spending makes you sad. Dinner is a salad with many green things and red
capsicums etc, and staple food is boiled quinoa with some almonds, which need to be cooked to allow their
goodies to be absorbed. I eat maybe 5 small green apples after dinner to midnight. Being chemically
castrated means I have almost no testosterone which slows down my metabolism which has me feeling the
cold more. I am unable to burn excess calories and any slight excess calories become fat shortly after eating.
-------------------------------------------------------------------------------------
For the first 4 years of ADT, erections rarely ever occurred spontaneously, but any seductive images if females
brought Roger to life and then this all changed to less often, and signals to Roger became muddled and only
due to a full bladder unlike previous years where this rarely happened before treatments.The ADT ruined all
my sexual abilities by end of 2014. Whatever pleasurable sensations I could have become so dulled that any
possible
sexual excitement became not worth pursuing, and absence of testosterone has caused penile atrophy, with
fibroids forming in tissues resulting in erectile deformity, ie, a dick with bend, and very fragile skin. I have the
kind of dick no female would ever want have anything to do with. Medical treatment for prostate cancer always
kills Roger.
Most men would not prefer to know the results of long term ADT. I was highly hetero sexual and capable
of pleasing myself or any female until about 2013, 66yo. I have now accepted that between now and my death
it is highly unlikely any female would ever want to have anything to do with me at all. Sex with any F after a
certain age becomes a liability - not enjoyable if the F is likely to be irrationally angry in your face after a few
months, or a few hours. Although I keep thinking about sex, and having some female company in my life, it is
just my silly dreaming.

Some men would have a penile prosthesis installed, maybe for $25,000, but in my case I've been radiated and
surgery anywhere in pelvic region is extremely risky because I could bleed to death due to damaged blood
vessels.

I have not heard of any man able to describe sex favourably in terms of how he feels during use of a prosthesis.
He would probably be OK if he had RP surgery only and had full testosterone, and then it should work well.
But if a man has had ADT for over 4 years, his WHOLE sexuality is buggered. It is normal that with prolonged
testosterone starvation the Roger gets fibroids in the erection tissues, maximum erect length will decrease from
140mm to 100mm, and it is very likely to have a bend in one direction, often downwards, so Roger resembles
a brass garden tap. it looks ugly, and penetration would be difficult to maintain, and the feelings of pleasure all
vanish. The skin around the head of Roger become thin and fragile where it joins the shaft, and a gentle rub
during a jerk off will easily tear the skin which then takes days to heal. Erections occur with a full bladder
while asleep, and then a man wakes up, and the erection vanishes after a pee. Even with an erection brought
on by a Little Blue Pill, and In the presence of a young fully functional female, a man is not going to do much
good, and the female is likely to flee to a man 30 years younger. Who could blame her?

The intensity of orgasm declines to zero, and no matter how well the female performs fellatio, it just becomes
a boring waste of time. So use of a vibrator may do a better job on the female, but psychologically, it is bullshit,
 the young female can only be satisfied by a real man. There would of course where the female has huge medical
 limitations, and is happy that ANY man is able to be vibrantly intimate with her; but this is actually very rare.
Usually man of 60 has not got to worry about sex with a wife if she's close to his age. The decline in a woman's
sexuality is dramatic after about 45, and women become frail, they cannot and will not try to stay fit, and
sometimes they become emotionally erratic and difficult to love, let alone make love to.
Welcome to the land of Old Age.

Between 2009 when I was diagnosed and 2016, I rode about 90,000 on a bicycle, and I think I scared away
any possible partners I may have seen. Few women near my age rode bicycles, and were seriously dismayed
I was in much better health than they were. But then, I had a wife who left me at age 22, and she
was similarly afflicted by my vibrancy and indestructability. I was a man they could not root, shoot, or electrocute.
Good, afaiac. Why would I ever let myself be so physically mediocre and so many others????

I have often thought of marrying my bicycle. It may become possible in these days of liberation where even
gays can marry. A man could marry his dog maybe. But marrying a bicycle looks good to me, and why?

Because the man can go for a fukken ride any old time he fukken wants to!!!.

No back chat, low costs, feels good, and its freedom, and I am sure the bike loves it too.

Unfortunately, my preaching is to a mass of men who insist that they destroy themselves by 50 with
becoming unfit and overweight, usually from eating
too much junk food laced with fructose and sucrose, sugar, and too much alcohol. Their whole life is
one of TOO MUCH.

I found all young women soon vamoosed when the reality of the required co-operation together caused
a Female Allergic Reaction. Love is such a dreadful threat to so many ppl. I doubt any doctor has any
answer to the not so uncommon malady of where people look me in the eye to tell me "I Hate Love".
I once read this written in large painted letters on one of Canberra's cycle paths. I had a female boarder
in my house for 10 years who one day blurted out "I hate love". She was a fine responsible tenant to have,
but had zero ability to relate to anyone beyond the non personal.

The fact remains that many ppl hate love. I am often lonely, but then relieved I am not married to a
Female Dragon who finds fault in all I do, and is like a millstone around my neck.  I gave all women
only ONE CHOICE, to love, and sure, they did for awhile, but then that stops, and they could not stay,
and they repeated the bullshit on the next male victim. I was always gentle and understanding when
they departed, while wishing to leave a boot-mark on their arse on the way out the door. I was far to
polite to all I met.
--------------------------------------------------------------------------------------------------------
17 February 2016
Not much to report since last January. I ceased riding my bike late last October, and now I am trying
to lose the Kg I put on. Becoming Totally Vegans might do it, and help prevent the severe effects of
inflammation in my knees. There is theory lurking in minds of "healthologists" that eating or any other
animal product, eggs, all dairy junk, and cheese junk triggers the immune response to attack cartilage
because of molecular similarity.
While young, most of us can eat anything without any worry, except for fact most ppl eat way too much
of everything, and including excess sugar, fats and processed carbohydrates. But as age embraces us, it
makes us ache in our joints, and the less we do to encourage this, the better. I find this true for myself and
without knowing if any of a myriad number of theories about diet and health are in any way true, or proven.

Anyway, for me, a fairly strict vegetarian diet is better than taking any pain killers, and it is natural to me
to NEVER EVER buy ANY JUNK FOOD, including all meat. Not even Lindt chocolate bars or a
monthly bottle of red wine. Sure they taste nice, but the health benefits are extremely low, and whatever
chocolate you eat, you can't avoid the huge fat/sugar content even though the packaging claims "85% pure
cocoa. With wine at 12.5% alcohol, its much more calorie riddled than green tea. Anyway, I have slowly
gained a Kg over 3 months, and I thought 150grams of skinless chicken 3 times a week was OK, but no,
it ain't.

I used to ride for 10 hours a week, and had a need for protein, but with being sedentary, there's just no
need for so much, and I figured I was getting enough protein for reduced activity. With chemical castration
with Lucrin, to combat Pca, my body has become unable to burn of any excess calories. Right now, height
= 1.845M, weight 85Kg, BMI = 24.9 I should be less. Waist is 100cm.
I was 1.865M, and weighed 83Kg, BMI 23.8 when I was very fit and raced on bicycles in 1980s-90s.
My waist now measures 100cm, and in 1990 it was 90cm or less, and I had maybe 4Kg less fat and 4Kg
more muscle. Even though my BMI was 24 at 42 , I still had a much higher fat % than the quickest people
I raced against. I was always at a big disadvantage on hills, and in time trials the slim guys have less volume
so they cut through the air faster than I could. Naturally, athletic clubs attract people who are naturally
good at sports, and they beat all the slow coaches like me. Their ego gets the big lift with wins over those
less endowed with great genes. It was sickening to witness the constant focus on a win. But occasionally
I did very well in handicap races.

The idea of BMI and waist measurement does not tell us all about a person. A short weightlifter may have
waist above 100cm, and BMI 30. Weightlifting may be all he can do, but he can find a happy path in life
like everyone else. We are not all the same. Now as we age, we reduce muscle weight even if we keep
exercising. About 80% of us get heavier, and lost muscle is replaced by fat, and BMI can remain the same.
So the weight of muscles I had are replaced by fat, especially around the gut. There's much more to grab
hold of compared to being 40. We should get LIGHTER as we age, we all like to live well, and enjoy activity,
like cycling, even though av speed goes down. I have found it is impossible to get lighter, and I'm 3Kg heavier
than I was when fittest at age 40, so my fat % has probably doubled.

But at least I don't weigh 100Kg like so many other guys my age.

My limiting factor is now my joints, with knees leading Nature's charge to reduce my lifestyle. And while
my knees ache, so do hands and wrists and back; whatever my body is doing, it is having challenges at more
than one place. But after doing anything physical, despite the aches and pains, I am glad I did it, and my
mind and body both feel better.
 
Just after last update, about a month ago, I had a bout of heart fibrillation where HR suddenly went to 120,
and irregular, so I drove to Calvary Hospital where they kept me there till 1AM. The docs put me on Sotacor,
to slow HR. Within 6 weeks HR went back to normal, and I've now stopped taking the drug. But I am taking
100mg of Cartia, (aspirin ) daily, if I remember, which may be thinning blood slightly to lessen the hypo-tension I
suffer. Hypo-tension is not to be confused with hypertension. Subsequent heart clinic on 16th Feb looked at
heart with Ultrasound, and doc said my heart looked just great. I said "Hmm, shame about the Pca, I'll be a
good lookin' corpse on the slab after it kills me".
 
Two weeks ago I had a mechanic fix the brakes on my 1986 Ford Laser. He had it for 5 days, because
suitable parts were not immediately available. This forced me back onto bicycle, and I rode 100km last week,
with 15km ride up the hill to the heart clinic. I figured I'd make it, and all went fine, if I died on the way, so be it.
Doc was not alarmed, but more confident I'd be OK. A bloke of 30 overtook me up steepest hill and maybe he
was trying, but then I caught and passed him just before the crest. Heck, I'd given the yung turk a 38year
advantage, so I realized I wasn't near death just yet. Don't ask me what caused the bout of HR bothers, but I
suspect it was eating a few dark red carrots; I'd heard dark red vegies are very high in a very good anti oxidant.
Maybe too good. I can't be sure. I've only ever had it once before in 2004, after coming off VIOXX which later
got banned because it killed ppl with heart problems.

Knees didn't ache later as a result of the rides, like they did back in October. Not as bad as in 2004.
We need to keep exercising.

January 7, 2016. Prostate cancer report.
My last Psa test was 18 Dec 2015, and I visit my oncologist later today, 7 January 2016. ADT hormone
therapy continues with Psa is not going down as far or as fast as it has during past applications of Eligard and
Lucrin.

The graph gives my Psa history which explains how my treatment for prostate cancer has proceeded with
ADT and Radiation. My conclusion at present is that Psa is not being held down to the initial levels achieved
when ADT began in April 2010. Since then, I've had two pauses from ADT, and during both the Psa rapidly
rose indicating that radiation did not have much effect on cancer cells. The underlying value of Psa from 2011
to present 2016 shows that it is slowly rising, and testosterone is not being fully suppressed by Lucrin injections.

I can see that if the slow rate of increase of my Psa continues, it probably will indicate Pca is going to spread
and kill. Its what cancer does. Use of alternative therapy such as apricot kernels, about 24mg per day of amygdalin
seemed to have zero effect on Psa over a long time of intake. Cannabis oil with low THC, high CBD seems to
have done nothing between Feb 2015 and October 2015. My daily dose began at 0.2mg, a very tiny amount,
but it was enough to get a strong high. Sensitivity slowly reduced and at end of period I could take 5mg.
I stopped taking it Oct 2015, and experienced no withdrawal effects. It has been totally non addictive, and
gave me good inner calm feeling about life.

Websites promoting cannabis for cancer cures should be considered snake oil treatments until proven otherwise.

There have been NO studies of social groups of ppl who regularly smoke or ingest cannabis products, such as
those living in Jamaica et all. I might guess that any studies might show there are no reductions in cancer rates
where it is widely consumed and in tropical regions where it grows so easily it is hard for authorities to eliminate.
I might add that prostate cancer rates are worst for those with dark african genes, and there is considerable
variation in rates for different races or genetic blocks of men.

There is no way yet for a man to alter his genetic make up to not endure prostate cancer. Some websites
promoting cannabis oil say you need to take a GRAM a day but this seems utterly wrong. One gram = 1,000 mg,
and has volume = 800 cubic millimetres. I doubt I ever took more than 6 cubic millimetres a day, a small drop
on the end of a little metal spatula I made. So, assuming I averaged 5 mg a day for 270 days in 9 months,
the maximum I would have used was is 1,350 mg, or just over 1.35grams, or less than 2 cubic centimetres, 2cc,
and not much from initial supply of about 20cc, or 16 grams, which was obtained by my friend from about 300
grams of harvested Sativa heads.

The oil yield rate is extremely low compared to rate for the Indica variety that has been subject to genetic
selection since 1970s when Indica began to be grown commercially by hard nosed arsolic criminals who want
the product to give a huge high for a small amount which is cheaper to grow. The Indica sold in most underground
sales is "skunk" and very high in THC which has psychotic large effects so beloved by those subject to becoming
hooked to drugs. There is a very low % of CBD oils in skunk, and its these oils which give the calming effect, and
boost to immune system, if there is any to be had. It turns out that our bodies produce CBD chemicals naturally for
immune system and calming function. Therefore skunk sold on the streets is having a very bad effect on the hoards
of stupid young people who foolishly believe they can ease the pain of their existence by getting high, and the then
so many suffer schizophrenia or other disorders which make then useless for anything, unemployable, and
dependent on welfare. I should know, because I have a nephew who succumbed to mental illness while trying to
keep up with his 2 older brothers, one of whom sold pot to classmates at age 12, and who went on to become a
bankrupt at 23, after dabbling with heroine given to him by a girl friend. The other brother dabbled in cocaine.
These three young ppl had Shit For Brains in the formative years; nothing could be done to get them on the straight
and narrow. They were always allergic to hard work. 

So I really do know about cannabis and its effects. My friend who prepared my oil for me did not dilute the oil at all,
and in fact it was a dark brown grease, unable to flow.

Had I had tried to take 1 gram of the oil I had daily, I would probably have become extremely ill. It may have had
such a huge psychic effect that I could have a fall or other accident in the house and done myself an injury. It may have
been fatal. Websites promoting cannabis oil for health say the high from THC need not be strong, just be present,
and still allow you to live independently without risk of accidents, despite the feeling of "being remote" while cooking,
or watching TV. The guys promoting "Medical Cannabis" will insist on telling ppl they need 1 gram a day. The density
of oil = 0.8 grams per cubic centimeter.Therefore 1 gram of oil = 1 / 0.8 = 1.25cubic centimeters = 1,250 cubic millimeters
= 1,250ml.

The guys selling oil know that ppl only need 2.5ml per day of oil to get a high especially with skunk or a new user taking
it for medical reasons. I have seen websites saying you need 60 grams or 1 gram a day for 2 months for a cancer cure.
The active ingredient of raw oil might be 60 x 2.5ml = 150ml = 0.15cc. To this they add 75cc of canola or olive oil,
so the bottle contains 75.15cc of diluted oil.

They have diluted the product by a factor of 1/500. The price is only $10,000 - to save your life. The price they get for
the raw THD ingredient in medical cannabis paid by gullible non-street wize ppl is far better than the price ppl pay for
the same amount of THC to ppl who need to smoke 2 bongs a day. There is no evidence cannabis oil cures cancer.
With the oil my friend provided, I certainly got a high always with less than 5mg. It seemed so "strong" at times that it i
s strictly a stay-at-home substance, you MUST NOT tempt fate by driving a car, or doing anything in a workshop.
So this "therapy" is a "mind zonker", even with this variety of Sativa which is just a natural wild variety which has not
been genetically selected to make the THC much higher and CBD lower. The Sativa oil had me "good for nothing a
hour after taking it." I found I never ever had feelings of paranoia which are the hallmarks of psychologically damaging
varieties of Indica cannabis which are very high in THC and with hardly any CBD should be avoided at all costs,
especially by teenagers who can succumb to schizophrenia and other mental illnesses. Natural Sativa variety is low
yield, low THC. And anyone 16 who reads this will not have the slightest idea about what he is buying, and what I
say here is all bullshit.

There are ppl very prone to addiction to many things; 80% of alcohol is purchased by 15% of the population,
80% of gambling is by 10% of population who are problem gamblers. Studies would show 80% of recreational
use of drugs is by 15% of population, with a good number becoming addicted. Tobacco was once smoked by
50% of everyone I knew, with probably 25% smoking twice as much as the other 25%. I once smoked up to 15
cigarettes a day, then said I'd give up, cold turkey, at age 34, when a GF at that time said I stunk like a chimney.

I did give up, cold turkey, but GF went through usual cycle of Love, fading to co-existance, then Hate, and off
she went to roam and slut around
world - again - like the year before, in between the years of being employed as a primary school teacher where
she could not last longer than a year without getting fed up, and needing to piss off. This was typical of the many
useless dreadful young women I met who could not settle down with anyone. Their efforts to relate to me were
120% un-respectable. Sex wasn't especially wonderful, just sex. I don't have an addictive personality, and cannot
be addicted to fraudulent lovers, grog, cannabis or anything else at all. The cannabis oil had me sleeping better,
calmer, less worried, less anxious, and being more able to accept my dismal future. I didn't like being forced off
the bicycle with knee pains. There is nothing nice about declining with age and slowly losing every ability all
ppl under 50 take for granted. Aging means everything known and practiced as "human life" becomes very
limited, and denied to ppl when they get older.
-----------------------------------------------------------------------------------------------------------------
12 October 2015.
HT was restarted 1 August 2015 following Psa 3.3 level 10 July. Psa is going down again.

13 July 2015. Since February  2015 little has changed with my health, except that my knees are beginning
to wear out and I cannot ride a bicycle as fast. But I have finally given up any desire to go fast as I could all
the time. My Psa has risen from about 0.4 in Feb to 3.3 at 10th July 2015, so you can see that there is a very
fast doubling time. An acceptable doubling time is say 10 years, so from 50 it goes from 1.0 to 2.0 at 60, then
4.0 at 70, and 8.0 at 80, and maybe you last until 90.
I have a cousin of 70 who has Psa = 0.3. There is a good chance he had a lower testosterone level than I did.
In my case, I have paused from hormone therapy after February and its effect has down over 3 months and
my body has resumed testosterone production. Prostate glands normally generate a high Psa marker chemical
in blood due to testosterone presence, and it does this even when no cancer is present. Normal range
of Psa on pathology results is cited to be from 0.3 to 5.5ug/mL but this is misleading because what is
normal when you have been previously diagnosed with Pca?
I've known men whose Psa was 18 but there was no Pca. Well, not yet.

So "Normal" is a silly word, and 0.7 at 40 and 1.0 at 60 should be the standard.

THE DOUBLING TIME of the Psa level is much more important that the actual level if the level is "normal."
I had no surgery. I was radiated, so the prostate gland is just sitting there like an internal crouching demon
ready to mutate and grow uncontrollably. So whatever Psa chemical is produced, it could be from cancer
cells, or from normal cells. But not one doctor knows the exact state of my prostate gland or if there is any
metastasis. They are only guided by Psa level and its change and the statistics.

Having low testosterone < 0.5 ( normal range 8 to 38units ) in most males will reduce Psa to less than 0.5.
The pause in HT is supposed to do my body good to allow some return to having testosterone and to see if
the EBRT in 2010 has worked over time.

This is the second pause in HT I've had, and this time the mental change has been negligible. My bike speed
has reduced and general daily desire for sex and ability to "fix the itch" has not returned. Well, maybe it is
mental, because at 68, there is not a woman alive who'd ever want to be with me in any way. I have moved
to the age where I am naturally repulsive to 99% of sheilas. Most are far too polite to mention this fact, because
politeness is something many of them discover is the key to a peaceful sexless life without arguments with men,
usually over money, and getting their own way.

It is maybe 20 years since anyone actually touched me with care, except for medical professionals paid over
$100,000 pa. Its OK, I just handle it, rather like my mum of 98, who hasn't had a man touch her since she was 55.
I have become polite enough to enjoy women's company without ever having them feel frightened, angry, or
sexually aroused when it is not wanted. 

The Psa rise during 2015 is just like what occurred in early 2012, indicating cancer tumour is alive and well, and
intent on killing me. See the graph above for Psa after January 2008.
Psa rode from 4.3 to 6.3. I was diagnosed after biopsy in late Dec 2009 with Gleason 9, aggressive cell type,
young man's type of cancer, prostate gland was 3 times normal volume. Biopsy gave 9 live samples of 9 taken
through rectum wall, a very painful experience with no anaesthetic. Open surgery was attempted April 2010,
but abandoned after cutting me open. Cancer had just advanced beyond capsule but had not spread.

ADT with Casudex followed by Eligard was commenced, and In Dec 2010 I had 35 RT sessions when Pg had
been shrunk to smaller size due to ADT. Eligard was injected once every 3 months causing temporary chemical
castration. I am presently (12 October 2015 ) back under effects of re-started ADT 
with Lucrin injections. Psa has fallen, but probably I will never lower it to the 0.08 back in April 2012.
The effect of ceasing and re-starting ADT shows Psa rise and fall similar to between 2012 to 2013.

The latest peaking rise in Psa indicates it is likely the radiation treatment has done little if anything to prevent
prostate cancer from finally killing me even if I remain on HT for however many years Unkel Nature has
allotted to me. The graph shows an underlying rise in Psa at nadirs during ADT, and doubling time from August
2013 to April 2015 = 16 months. From this I could say that Psa in 6.6 years time might be 32, aged about 75,
and I may not be very well. The idea of living to my 90s would depend on a miracle cure.

There are some miracle cures one hears about, most one hears or reads cannot be taken seriously.
There's a drug called Keytruda which works for melanoma well, its now available on PBS scheme in Oz.
It is said to work on other cancer types including Pca, but then it is new, and trial results are yet to be finished,
so I doubt my oncologist is going to prescribe it for me in 5 weeks when he gets back from his winter holiday.
So knowing what the latest cure or treatment may be is fine, but so often we hear BS about something that won't
help us in time.
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Last July 10 2015, 3.3.Previous Psa June 2 2015, 1.4.
The 2015 Psa rise is similar to rise in 2012 when I paused for 6 months from HT injections.

I will start again with HT next week with Casodex tablets followed by Lucrin injections to reduce testosterone
to low levels.

I have no cause for optimism, and alternative remedies such as apricot kernels and daily cannabis oil for last
5 months have done absolutely nothing to change the shape of the curve for Psa rise. Had my Psa risen to only
1.5 with a then begun to fall, the HT + RT could have been said to work, but as I see it, its only a matter of time
and I would bet that when I re-start HT the Psa will not drop drop to levels on early 2014, 0.26.
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6 February, 2015.After an aborted attempt to remove my PG surgically in 2010, I was given HT for 2 years
with a full course of 35 RT in Dec 2010. After 2 years of ADT Psa went to a low 0.08. I stopped ADT, but by
May 2013 Psa climbed to 8.0 and free Psa indicated Pca was progressing. I started a second round of HT in
early June 2013. By the time the effects of the last injection of Lucrin ceased by about April 2015, I will have
had ADT for 22 months.
The Psa nadir during the second round of ADT has been 0.2 in April 2014. Psa has risen slightly to 0.36
last month, indicating a doubling time of 1 year. This does not mean the HT has become ineffective.
The PG cells I have are radiation affected and some may be healthy, and these produce a Psa reading along
with any cancer cells, and it is difficult to determine where the source of Psa really is, because the HT reduces
 Psa produced by both healthy and cancer cells - while the HT it remains effective.

During my last visit to my oncologist at CH, he and I decided to quit the ADT and watch the total Psa to see if
it rises rapidly and determine free Psa which will indicate if the cancer is progressing. The oncologist says a pause
in HT to allow a return of testosterone production will be good for me. If total Psa remains below 1.0 then it may
be considered the Pca is in remission but that if it rises above 1.0 - and rapidly - then I will have to return to HT.
I will not have a Lucrin injection at end of this month when the next injection was due. I might assume my
testosterone will begin to rise in about April, and I will have a Psa test in late May, just before I see my
oncologist in early June.

I may need to remain chemically castrated for the rest of my life.

Castration affects men in a variety of ways, and there are many myths. There is no feminizing apart from some
body hair reduction. Drugs like Lucrin or Eligard which suppress testosterone production do not cause feminizing
effect like female estrogen, sometimes given as ADT. So I shall not grow breasts any time soon, or hear rise in pitch
of voice etc. I doubt I suffer depression, and I can keep my weight under control, now 83Kg, with BMI = 24.8.
But of course I am ageing, and although I am same weight as I was when at my fittest when 41, some muscle has
been replaced by fat and there's nothing I can do to stop this while on HT and and under effects of zelodronic acid
to prevent bone thinning.

Unfortunately, many men find themselves depressed by ageing, and so many cannot ever control eating, drinking,
laziness, and social habits which are all bad. I'm the exception. Many men blame weight gain and the and drift to
other illnesses on medication, and by 60 they become ugly caricatures of what they once were, and they give up
on themselves. Their wives also to the same thing, and its no wonder depression is so common, and desire for
vibrant intimacy has become a thing of the past.

It's been 37 years since I was married, and I'm still looking for a partner and I definitely can function sexually.
So while single, I have nobody to displease by getting old and getting a few health problems. I find most ppl
avoid relationships like the plague after age 45, but I'd welcome one. The difficulty is in "chemistry", and most
women have zero desire for a man after their menopause, ie, they have "paused from men", and no amount of
chemistry, charisma, or money, care or anything else will make any relationship possible. There are thousands
of females over 30 advertising on dating sites wanting men. Let us suppose 50% are bogus creations by website
"managers", ie, arsole scamsters. The remaining 50% run a mile if a man does suggest a meeting; they say they
want a man, but most are quite incapable of following through with active pursuit accompanied by watchful eye
to sort out who is or is not a member of the army of men from Arsolia or Bastardia where all manner of fellows
really want to be euthanized tomorrow.

I continue to cycle a constant average of at least 200km per week to keep fit. Very few fellows overtake me
during my rides. There seem to be virtually no men my age still cycling. I rarely EVER see any woman over
40 on a bike, and 95% of all the females on bikes don't want anything to do with me; I am an old fart, and they
cannot keep up to my speed, despite them being perhaps 40 years younger, and me having bad knees and lack
of speed due to muscle weakness aided by chemical castration.

I probably have high willpower levels, so after July 2014 I gave up wine and chocolate and last Xmas gave
up having a cookie during each cafe stop while out on the bike. The ONLY way a man or woman can prevent
fatness by eating less calories than consumed by exercize, ALL THE TIME, until they die. Between 1993
and 2006 I stopped cycling and doing building work due to knee pain - I have bad knees. So during 13 years
I put on 19Kg, which works out to 2.7 grams per day. This seems like such a tiny weight gain, and ppl hate to
think something so small matters so much, but while living a sedentary life you just have to reduce calories far
more than one might think is sensible.

I have GFE genes - Get Fat Easy. The only way for me to control weight is to weigh myself EVERY morning
using electronic scales able to resolve to nearest 0.1Kg at least. Then I plot the graph of weight in my daily
diary, and if any jump in weight occurs, I fast, and ride a a bit. Over 2 months you will see variations in weight
of +/- 0.1Kg, but you can SEE the TREND of your weight, and read the average weight for each month.

I allow a Supreme Salad Sandwich every day at my favorite restaurant, the "Siam Twist" at Hackett in
Canberra.

Do not believe the poor reviews about the Siam Twist; it is luxuriously pleasant.

http://www.tripadvisor.com.au/Restaurant_Review-g255057-d7110784-Reviews-Siam
_Twist-Canberra_Greater_Canberra_Australian_Capital_Territory.html

With two large cappuccinos, its under $16, which I can afford. Once a week I have a Thai dish, Duck Salad
or a Laksa with noodles and tofu in winter. I enjoy occasional male company and newspapers to read, very
pleasant staff, and so I enjoy being away from home.

My knee osteo arthritis is beginning to limit what I do on my bicycle, so as long as I don't ride more than
300km within a week I am OK. I am not yet begging an orthopaedic surgeon to install titanium knee prosthesis
to both knees. It may happen, but I'd have to wait a year before getting the operation and my cancer progress
may prevent the operation if the docs think I will die sooner rather than later. Right now, the oncologist does not
think my prostate cancer is spreading. I don't need to ever walk further than 200M ( carpark to movie theatre ).
I doubt I'll ever need to walk further, say, along a beach at sunset with a beloved. If I try walking on sand my
ankle injury from a motorcycle prang at age 19 has me completely disabled.

Women dream of romance and expensive resorts, but they need to be able to be happy right here and right now,
and then all days following the day you meet them. They should never need to travel anywhere, but I make an
exception for coming out with me on a ride. Like many with leg injuries from a past life, I can cycle OK.
A bicycle is just a wheel chair with one wheel in front of the other.

For last few months I ate an average of 40 apricot kernels a day as alternative therapy which is claimed to
stop cancer spread. I doubt its having the slightest effect but then it seems a benign dietary supplement,
although they do cause some bowel irritation. I have have a friend with a HERB which I will begin to take
soon; I cannot say more about it, but if it appears to lower Psa after going off ADT, I'll let you all know a
bout it.
I now know of 3 local men who had what seemed to be successful surgery giving extremely low Psa.
All have complete ED, and most have enough continence. After a few years of having Psa < 0.02,
Psa rose, so one had additional surgery to remove his bladder and have an external bag fitted, another had
all the RT that I had, and another has Psa of 0.05 after 4 years and he probably will try HT and or RT, and he
much fears the Psa rise at age 75. So even if the cancer is removed surgically, some small amount of prostate
gland cells may be left behind, and they too may eventually become cancerous, if they were not already at
time of surgery.

In my case surgery was not possible despite a fairly low Psa at diagnosis in 2009. I still have a prostate gland
which is probably much  affected by RT, but exact status of cancer cells is quite unknowable. Therefore it seems
pointless to worry too much about a Psa which is 10 times the level which alarms other men so much after they
have had surgery. I expect my Pca to kill me; the doctors said they just don't have a cure.

Life expectancy for a man in Oz is now 84 years, but that just means very many die well before they turn 84.....
Sure, a few live to 104, but I don't expect to one of them.
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For anything before 6 February 2015 :- Past history.
My variable interest in road cycling :- Velosophy
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