Cancer Non-Update

The Zytiga does not appear to be working very effectively. My PSA has continued to rise in spite of the new treatment:

2014-03-18      7.8
2014-04-14      9.4
2014-05-12      10.6
2014-06-01      begin Zytiga
2014-06-23      21.5

If you plot those on a graph, it looks a lot like an exponential growth curve. I can just imagine somebody in a bad SF movie saying “IT’S GROWING EXPONENTIALLY!!!”

Of course, all biological systems grow exponentially (subject to environmental limits), but we’re hoping the treatment either inhibits the growth (possibly even killing it off and making an exponential decay instead of exponential growth) or at least slows the growth, leading to a large time constant.

Unfortunately, doubling in that short a period is not a large time constant. It is growing fast.

The oncologist said he observed that sometimes people have a brief increase in PSA when they start Zytiga, but he’s never seen one this severe. He also says that patients respond more poorly to Xtandi after they’ve had Zytiga. So he recommended chemotherapy.

I’m not convinced by his argument. When the cancer cells become resistant to a treatment, it is because I have evolved resistance to the treatment. I killed everything that treatment could kill, so whatever is left has developed some resistance. But if the Zytiga never worked in the first place, I have not been putting evolutionary pressures on the cancer cells; maybe they have not needed to make adaptations to the Zytiga, and therefore those adaptations will not help them resist Xtandi.

I want more data before choosing the next treatment. So, I’m going to have another bone scan, a CT scan of the thorax, and another blood test. If the PSA has gone down, it might be that I have had a remarkably large PSA jump from starting the Zytiga. I don’t think that is it, though: when the oncologist prescribed it, he said that Zytiga doesn’t work at all for about 1/3 of patients.

The radiological tests are meant to try to find out what the tumor progression looks like. That is, are the tumors bigger or are there more of them? If I have mild tumor progression, that might indicate Xtandi is a reasonable treatment. If I have severe tumor progression, that indicates that chemotherapy should come next. In either case, we also have a new baseline for recognizing further progression.

But since I’m still in the middle of collecting data, I don’t know what the real condition of the cancer is, and I don’t know what I will be doing next. Therefore, I’m calling this a non-update.

None of this looks good, though. The median survival from beginning chemotherapy is about 18 months, but I have not reached
median duration in any stage of this disease. I’ve known since the diagnosis of the metastasis that this disease is going to kill me, but there was some probability that it might take more time to do it.

Now, it doesn’t look like it. Rather, it looks like I’m going to be one of those people who brings down the average and the median. I don’t like it, because it means I need to get ready to die, maybe in the next year.

Shit de Fuck de Shit de Merde de Tabarnac!

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3 Responses to Cancer Non-Update

  1. Rob Jenson says:

    What is Tabarnac and why is their shit so special?

  2. Tabarnac is a Quebecois swear word. They use religion-related words instead of sex & excretion related words when swearing. So, for example, you might go to your car and see a flat tire, and say “Calice!” or “Tabarnac!”, where in English we might say “Shit!” or “Fuck!”.

    Tabarnac is tabernacle, calice is chalice.

    I took that line from a movie called “Bon Cop, Bad Cop”. One of the cops is English Canadian and the other is Quebecois Canadian. The movie is half English and half Quebecois French, and it is really funny. There is a scene where they arrest a Quebecois guy and he keeps cursing at them. The English cop doesn’t understand, so the Quebecois cop gives him a translation and a lesson in Quebecois swearing. Later in the movie, the English cop says the line above.

    If you put on French subtitles on a US DVD, you usually get Quebecois French instead of Metropolitan French, and occasionally you get to see some examples. The movie Orgazmo (by the South Park guys) is about a Mormon missionary in Los Angeles; in the intro, this sweet old lady answers the door, and when the Mormons introduce themselves, she tells them “You can go fuck yourself”. The French subtitle said “You can go cross yourself”, referring to that head/abdomen/shoulder/shoulder motion that Catholics make. (Later, the missionary gets a job playing Orgazmo in a porn flick, though he doesn’t do any nude scenes because they call in the Stunt Cock.)

    I find the Quebecois swearing amusing, but my favorite swear phrase is from German: Er hat Mann in seinem Hirn gescheissen, und vergessen umzurufen. Somebody shit in his brain and forgot to flush. “mon calice!” or even “hosties de pourris de tabarnac!” (rotten/decayed Host in the tabernacle) just can’t match it.

  3. Carolyn Sienkiewicz says:

    Thank you for your straight-forward explanation of where you’re at. I think it’s very kind of you to share this with your circles so they can stay informed and can know how you are doing with it. Your ending with a nice tribute to “Bon Cop Bad Cop” puts a nice cap on it. ;>

    Indeed, shit de fuck de shit de fuck de tabarnac.

    Characters Martin Ward (Colm Feore) and Dave Bouchard (Patrick Huard) would compliment you on your usage. (As would the fabulous Pierre Lebeau [as Capt. Leboeuf] — he of the adorable “hop-hop-hopportunity.”)

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