Natalia

This true story is being shared at the request of the deceased.

Tom Lucas retired as a captain with the Edmonton Fire Department after 30 years of service at the age of 54. He and his wife decided to retire to a midsize Okanagan Valley city. Tom enjoyed an active lifestyle including winters in Arizona and Mexico. While a firefighter, he meticulously followed required medical protocol, which included a PSA (Prostate Specific Antigen) test. This blood test is used primarily to screen for prostate cancer. While enjoying his retirement, Tom continued to have annual medical reviews but without PSA testing as his medical doctor did not order them.

Approximately 8 years after arriving in the Okanagan, Tom’s wife queried the lack of PSA testing while reminding Tom that his brother had been diagnosed with prostate cancer. Tom agreed that he was remiss to not have requested PSA testing. On his next medical review, he stated his desire for a PSA test. The medical doctor informed Tom that he did not order them for his patients as the results were “inconclusive”. Tom pressed for testing which showed a PSA score of 38. A normal score for a person of Tom’s age is 3.

When abnormal results are derived from a PSA screening test, a biopsy may be recommended. A biopsy was undertaken in which 8 probes were inserted. Each of the 8 probes showed positive cancer. Tom’s results were rated as a Gleason Score 8. The maximum is 10. A Gleason Score biopsy result greater than 7 can be an indication of intermediate or high risk of prostate cancer. 1.

After reviewing Tom’s results, the urologist informed Tom that he had a very aggressive form of prostate cancer. He estimated Tom’s life expectancy at 3-5 years. Tom contacted the Interior Cancer Centre in Kelowna and began a prolonged involvement including treatment, clinical trials and oncological supervision.

Tom became a meticulous researcher of prostate cancer, treatment and results. His newly found disease did not lesson his adventurous lifestyle, but it now included becoming a disciple of spreading the “word” about prostate cancer and the importance of continuous PSA testing. Tom became an active member of his local Prostate Cancer Support Group and engaged in considerable outreach presentations.

Tom became the guru of his support group regarding current information relating to prostate cancer. He continued to live as active a lifestyle as his declining health permitted. His tenacity and “joie de vie” resulted in him experiencing life for 8 years from the time of initial diagnosis of the prostate cancer.

Tom made a request to this writer that his story be shared so that men will see the need to take responsibility of looking after their own health needs and recognize that a PSA test is an accurate indicator that may require further investigation and consultation by patient with medical personnel.

Acknowledgment: This story is shared with permission from PROSTAID.

Brad:

“I had been getting my PSA (Prostate Specific Antigen) tested for a few years along with a DRE (digital rectal examine). In 2008 my family doctor noticed a rise in the PSA along with hardness to my prostate gland and at 53 years old I was referred to a Urologist who recommended that a biopsy be done.

The biopsy confirmed I had Pca (Prostate Cancer). My Gleason score was 7 (3+4) and within 3 months my PSA had risen from 4.47 to 5.7. Because of the velocity and my age I was not considered a good candidate for external beam radiation or brachytherapy, so I had a radical prostatectomy. The surgery went well, and pathology indicated my margins were clear. It was felt my cancer was contained in the gland which had been removed. But unfortunately, within in 6 months my PSA had started to rise. Less than a year after surgery I was referred to a radio-oncologist and my PSA had risen back up to 2.0.

Radiation of the pelvic area was not available to me because of my age and my recurrence was felt to be microscopic, meaning they would have to radiate my entire pelvic region with no assurance they would be radiating the cancer. I was referred to a medical oncologist who enrolled me into a clinical trial involving a relatively new chemotherapy, at the time, (Taxotere / Docetaxel) combined with ADT (Androgen Depravation Therapy). 6 months of chemotherapy along with 18 months of ADT. My PSA dropped immediately but within 6 months of finishing the ADT the PSA began a slow rise. When I say slow rise, I mean slow. It took less than 4 years to go from 0.2 to 13.8.

Until then regular bone and CT scans did not reveal any metastasis but a scan in November 2016 revealed a 2 cm tumor in the prostate bed. After a referral to the tumor board, it was decided that I would immediately restart ADT in an attempt to shrink the tumor to allow for radiation and minimize potential damage to vital organs. The plan worked and in June 2017 I completed 20 rounds of radiation. My PSA was again undetectable, and scans showed no evidence of the tumor.

In January 2018 my PSA was still undetectable and we decided I could take a treatment holiday. Unfortunately, within 6 months, my PSA was rising again and within the year I was back on ADT. This time my PSA did not drop to undetectable but hovered around 2 until March 2020 when it rose to 3. By September my PSA doubling time had gone from over 14 months to 6 months.

Fortunately, I again was able to enroll in a study involving a new drug which had just been approved by Health Canada in February that year. Since starting Darolutamide in October 2020 my PSA has remained undetectable.

I am one of the luckier men who has minimal side effects. My spouse attends all my doctor appointments and keeps me on track. I have a supportive family and a well-informed support network of friends whom I met in PROSTAID Calgary.

3 Key Take Aways?

1. Be your own best advocate. Do your research. Be prepared to have informed discussions with your medical team.
2. Do not discount the importance and value of clinical trials and studies. They can change the course of standards of care for those who might be on a similar journey.
3. Rely on the support of family, friends, and support groups. They are invaluable. This is a marathon, and you cannot do it alone. Also, you won’t believe, the huge benefit to you when you help others.”

Acknowledgment: This story is shared with permission from PROSTAID.