We had our consultation with Jeremy this morning. As discussed, the focus was initially on the PSA test I had done on the 12th (this being about 6 weeks after the operation). The level was 0.9, whereas the previous test (prior to the surgery) had been 9.9. Obviously the former seems a lot better than the latter. Following a prostatectomy, however, the desirable level is 0.0. So anything higher than 0.5 confirms some residual disease. The question is, where? Another scan is required to locate and determine what is going on. I am therefore going to have another whole body PSMA/PET procedure at the Alfred – they are going to ring me to set this up. This will probably be in January.

While it is slightly disappointing not to be home free, I didn’t actually expect the test result to come back zero. So as far as I am concerned, it is not as bad as it could have been. If the disease is within the pelvic area, radio therapy can be used (see no. 3 below). Jeremy is always keen to point out the positives:

1. I have had the optimal first treatment, i.e. the prostatectomy. (Jeremy said last time this would have removed 99% of the cancers.) Therefore we are not in a rush to determine the next treatment.
2. The disease is PSMA-avid. This makes it easier to see it because it shows up on a PSMA-PET scan. Easier to see means that
3. Stereotactic radio therapy can be used. This is a specific kind of RT with much lower side effects. A 2016 study of stereotactic body radio therapy found “a 98.6 percent cure rate with SBRT, a noninvasive form of radiation treatment that involves high-dose radiation beams entering the body through various angles and intersecting at the desired target. It is a state-of-the-art technology that allows for a concentrated dose to reach the tumor while limiting the radiation dose to surrounding healthy tissue.”

I also saw Susannah the physio this afternoon. She is encouraging me to become less reliant on pads. (The urinary continence has certainly improved since I saw her last.) She said that going pad-free speeds up recovery of more normal levels of continence, and is better for the perineal region. Obviously I will be selective about when I do this, e.g. not while engaged in activities that cause leaking, while I have people over, etc.

I have a new exercise to do, which involves bending over to pick up a 2 kilo weight. I am to do this 15 times. (Needless to say I will be engaging the pelvic floor the while.) The aim of this exercise is to teach the muscles greater endurance. I will check in with her again when I know the date of the PSMA/PET scan.

It has been very hot here, about 37 at one point. The change has come through and dropped the temperature to 23, with some rain.