It was that time again—time to recheck my PSA. It had been three months since my last PSA after proton therapy ended in February. That PSA had disappointedly shown a slight rise from 57.64 to 63.21 despite undergoing proton therapy and having a subsequent normal prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scan in May.
Despite a normal PET scan, that rise indicated the prostate cancer was still growing. Sometimes, focusing on the positive is easier in the advanced cancer journey, even when the negative is staring right at you.
That asynchrony between a rising PSA and a normal PSMA PET scan meant that not all of the cancer cells in my body were producing the prostate-specific membrane antigen on their cell surfaces. That PET scan lights up when that specific protein is on the cancer cell surfaces.
As I explained in the last newsletter, PET scans for prostate cancer have unique properties to detect specific parts of the cancer cell's metabolism. So, while it was disappointing that my PSA continued to rise, I focused on the normal PET scan and the still relatively low PSA doubling time.
PSA and anxiety
It's easier for me to order my PSA level instead of going to the radiation oncologist's office to have it drawn. In addition, I'm a member of a company that provides low-cost labs. Lab work is another way companies play the health insurance game.
Lab work is marked up the way wholesale jewelry is marked up before selling to the consumer. I'd rather pay cash for an eleven-dollar PSA level than have a lab associated with my radiation oncologist milk my insurance company one hundred dollars for the same test.
As I was sitting at my computer ordering my PSA, sweat began pouring from my armpits. I had been waking each morning the past week with a slight unease as I started thinking about when to order the PSA. But as I sat at the computer typing in my order, my sympathetic nervous system kicked into high gear.
You'd think I'd be used to it by now, but I'm not. I had the blood drawn on a Monday, and I woke up wide awake at four a.m. the next morning thinking about getting the results that day. Isn't it unbelievable how your body-mind carries worries into your sleep time and then sends a surge of adrenaline to wake you?
In the last newsletter, I spoke about how maybe it was a simple "PSA bump" due to radiation when I knew the odds of that were extremely low. I wasn't expecting a great number this time, but what I saw when I opened my lab account was shocking.
My PSA had almost doubled in three months, from 63 to 117! My PSA hadn't doubled that fast since the summer of 2019.
Immune system problems
I wondered if something was wrong with my immune system in March when I was diagnosed with an aggressive squamous cell skin cancer on my chest. Thankfully, my dermatologist was able to excise it entirely with negative margins. But she told me something strange when I went in for the results.
She said, "I only see aggressive skin cancers like that in my transplant patients."
I didn't know exactly what to think because I didn't consider myself immune compromised. Then, more evidence arose. I had a bout of COVID-19 the week I was supposed to start proton therapy despite being vaccinated, boosted, and having had a prior bout of COVID-19.
Then, at the beginning of June, I developed a sore throat that lasted a month. It was so painful I saw an otolaryngologist (ENT) physician and had a fiberoptic laryngoscopy. He placed a scope through my nose and into my throat and larynx.
Despite not seeing an abnormality, he told me my sore throat was due to acid reflux. I know what acid reflux feels like, and I hadn't felt anything like that. Something else was going on.
Shortly after I saw him, my sore throat went away completely. But something I'd been having for several months never went away - severe fatigue. I honestly can't remember when the fatigue started. I attributed it to waking up at four thirty a.m. to go to work.
But then the fatigue ramped up after my bout with COVID and the subsequent seven weeks of proton therapy. I told my radiation oncologist about it, and he attributed it to COVID-19 combined with proton therapy.
Tests and answers
It was sometime in July when I told my buddy Daniel Kessler about everything I was experiencing. Daniel is a good friend I met while he was moonlighting in my primary care practice in 2007.
Daniel has dual citizenship with Germany and the United States and is one of the most brilliant physicians I've ever met. He graduated from Mayo Clinic's Family Medicine residency and is board certified in Family Medicine, American Functional Medicine, Integrative Holistic Medicine, and Swiss Biologic Functional Medicine.
Daniel suggested some lab work, including blood, stool, and urine tests. We did multiple tests, some traditional and some functional medicine tests.
And boy, did we find the answers for why my immune system is compromised. The results explain the fatigue, my aggressive skin cancer, my second bout of COVID-19, the severe fatigue, and why my immune system lost control of the cancer.
Thankfully, it's all something we can address and hopefully eventually resolve. But it's going to take a lot of work. I'm getting used to that. And precisely what we found will be in the next newsletter.
Until then, lots of love.
Keith