We saw Dr Parente on Wednesday. The PSA is continuing its gentle rise: 2.9 at the last test a week before the consult, up from 2.5 previously. Dr P continued to emphasise the trajectory of the increase over the quantum of the score; the former remains low. This time he also made the following points:

• If I were not taking Enzalutamide, the increases would be much steeper. Therefore (my words not his) it’s doing its job in damping things down.
• I asked if I needed another scan, but he doesn’t think I need one.
• At this rate, my doubling rate (i.e. the period of time in which the PSA score would double) is about four months. He said he would only start worrying if the doubling rate got to about four weeks.

I understand Dr P’s reasons (which he has previously explained) for wanting to get the most out of this treatment regimen before switching to another one, giving me another line of chemo, etc. Everything else is still the same, i.e. I’m feeling fine, keeping up the exercise, staying busy, and am not too worried about developments. I continue to see Dr P every four weeks. I start to get a bit anxious around the three week mark, peaking when I have the blood test about a week before the consult. After this, however, I tend to relax and think, well, I’ve done everything I can, we’ll see what he says. The effect of the anti-depressant and CBT combo helps to keep this anxiety manageable, as do the two exercise classes a week.

This week I also had my biennial consultation with my psychiatrist, Dr T. I need to touch base with him periodically so that he can renew the authority for my dexamphetamine prescription. (This last is very helpful for my ADHD.) Dr T said he had a friend with prostate cancer, who was controlling it entirely with diet and exercise. I just said “Good for him”. It’s interesting how many people know PC patients who are using complementary treatments, and who implicitly recommend these treatments to me. (Apart from medical professionals, no-one has ever recommended surgery, chemo or radiation.) I have had the odd comment here and there about the importance of maintaining a positive attitude, and so on.

I think these comments all come from a good place. People want to pass something onto me that they think could be helpful. I’ve no doubt that complementary therapies can be efficacious with less aggressive cancers. (Of course spontaneous remission can occur at any time.) No-one has explicitly recommended complementary therapies to me, but if they were to, I would ask them for a citation to a gold standard, double blind study, published in a high impact, peer reviewed journal. Evidence for these treatments, however, tends to be anecdotal, and involves only a single subject. The cases mentioned also seem unrepresentative, in that only the success stories are reported. No-one would boast about having abandoned their conventional treatment for complementary therapies, only to find their symptoms recurring; returning to their oncologist, they find that their cancer has become too advanced for any further medical intervention. Statistically, of course, such outcomes must occur. Complementary medicine researchers are attempting to build up a research base of properly conducted studies of these therapies. Meanwhile, I will stick to the treatment I am receiving, unless and until I have a reason to change it.

In more cheerful news, we got our new vehicle a fortnight or so ago, a Toyota RAV 4 hybrid Edge. It glides along in a beguiling way. I have clocked up about 270 kilometres in it, mostly just doing trips to the shops and exercise class. The needle in the fuel gauge is still showing 3/4 full. I gave it its first wash this morning; it was pretty clean, just rather dusty. It is noticeably higher than the Camry: I had to stand on a little step to wash the roof. Of course it towers over the GT (which has become my beloved’s car). I drove behind a GT the other day, and could see right over its roof. The extra ride height on the RAV is handy for getting in and out, although I think the GT kept me somewhat flexible. The former is the sixth Toyota that we have owned, jointly and severally.