2015 Blog

A New Scan – Another Lesson

bjgabrielsen : April 10, 2015 9:17 pm : 2015, Diagnostics, Genetics, Imaging, Encouragement

As I write this, I need to provide some background information. My own prostate cancer was initially treated in 1995, recurred in 2002, and has been kept in check since then although I may be getting resistant to conventional, sustaining hormone treatments.  I am totally asymptomatic but when my PSA starts rising uncontrollably, it doubles in just two months, hence my physicians consider my cancer to be aggressive.  God’s protection and excellent medical care have brought me to this point, but cancer is obviously located somewhere in my body.  State-of-the-art sodium fluoride bone scans and sit-down MRI’s have failed to detect it anywhere.  So next week, I am scheduled to undergo a carbon-11-labelled choline PET scan at the Mayo Clinic in Minnesota details of which can be seen in the linked video.  The goal is to find area(s) of metastasized prostate cancer and hopefully eliminate them.  Meanwhile, in 1991, I had my right hip replaced as a result of a near-fatal automobile accident.  In 2007, surgical modifications were performed but the original hip works well to this day.  Over the years, I had favored this right hip and in conjunction with spinal scoliosis, I was now experiencing a small degree of intermittent lower back pain which was accentuated by a recent fall which produced muscle strain in my buttocks and thigh areas.  I was being treated by an excellent local physical therapist.  All this brings you up to date.  The pelvic area is one of the areas to which prostate cancer metastasizes.  Yesterday, I was reviewing an e mail I had received from a trusted physician friend which stated that pain in the lower back, buttocks, and groin areas were indicative of metastatic prostate cancer.  Immediately the “black depression cloud” descended over my mind and I spent a sleepless night convinced I had serious pelvic metastases.  The next morning I fervently asked the Lord to specifically give me a word of assurance that He was in control of my condition.  One of my devotionals for that day cited Jesus’ statements concerning the Holy Spirit found in John 14:26 as follows, “but the Helper,the Holy Spirit, whom the Father will send in My name, He will teach you things and bring to your remembrance all that I said to you.”  Upon reading this verse, immediately my heart and mind were focused on all the previous times that God had taken amazing care of me, and specifically reminding me of the words He had spoken to me on several occasions, most recently February 16th and February 19th, that if I remained faithful to His mission for my life, He would take care of my body.  Then turning the page in my Bible, I unexpectedly came upon the next verse John 14:27, “peace I leave with you; My peace I give to you; not as the world gives do I give to you.  Let not your heart be troubled nor let it be fearful.”  This was the same message I had been given many times previously.  The bottom line is this.  In these two verses, Jesus says that the Holy Spirit will teach us all things and remind us of everything Jesus has said to us and done for us.  The Holy Spirit will therefore bring God’s word to my heart and mind, and apply it to any current conditions in my life.  As Isaiah 28:29 says, “all this comes from the Lord Almighty, wonderful in counsel and magnificent in wisdom.”  In this context, I proceed to the Mayo Clinic.


Bone Health, Osteoporosis and Prostate Cancer

bjgabrielsen : March 20, 2015 5:27 am : 2015, General Patient Information

Osteoporosis is a major side effect in the use of androgen deprivation therapy (ADT, hormone therapy) for prostate cancer.  Men are urged to discuss any potential risks of osteoporosis and bone health in general with their physician.  Primary risk factors include hormone therapy, lack of exercise, vitamin D deficiency, tobacco or alcohol use, thyroid problems, having a thin frame, previous fractures and bone metastases.  Bone density measurements (not to be confused with bone scans for metastatic cancer) are generally obtained by either dual-energy X-ray absorptiometry (DEXA) scans or quantitative computed tomography (QCT) scans usually of the lumbar spine and hip.  QCT is a technique that measures bone mineral density using a standard X-ray computed tomography scanner.  QCT enables spine bone mineral density (BMD) measurements on patients with scoliosis, which cannot usually be measured using DXA scans.  It is reported that for men, while the DEXA scan is the most commonly utilized, it seriously underestimates the degree of osteoporosis.  QCT can avoid the artificially high BMD measurements that can confuse the results from DEXA scans in arthritic patients and patients who suffer from disc space narrowing or spinal degenerative diseases.  Therefore, in the case of men with prostate cancer, some physicians recommend QCT over the more common DEXA scan.  To enhance both muscle and bone density, weight-bearing exercise is essential. Several treatments are available for prostate cancer (pc) patients who have osteoporosis or bone metastases.  These include: a) Zometa® (zolendronate), administered by i.v. drip monthly for pc patients with bone metastases; b) Xgeva® (denosumab), one injection monthly also for pc patients with bone metastases; c) Prolia® (denosumab), administered by injection every 6 months for men with osteoporosis  or pc patients on hormonal therapy at high risk of fracture; and, d) Reclast® (zolendronate), administered by i.v. drip annually in men with osteoporosis.  It is recommended that patients take calcium and vitamin D3 supplements and monitor them regularly by blood tests while taking any of the above-medications. Also a dental checkup is recommended before starting any of the above.  It should also be noted that the greatest benefit from these agents is observed in the first year or two and it is possible to be on them too long when their risks begin to outweigh their benefits.  As always, on-going thorough discussions with your oncologist or urologist regarding osteoporosis, bone health and prostate cancer is a necessity.  Major portions of this article were summarized from the February issue of the Prostate Cancer Research Institute (PCRI) Insights as well as the following linked Wikipedia site.


Psychological Side Effects of Hormone Therapy

bjgabrielsen : March 19, 2015 5:57 am : 2015, Treatment Information

About half of all men treated for prostate cancer will be prescribed hormone therapy, otherwise known as Androgen Deprivation Therapy (ADT) wherein testosterone levels are significantly reduced.  Although ADT is not usually considered curative, it can keep prostate cancer in check for years and even decades.  ADT is often initiated prior to radiation therapy to improve its efficacy.  This use of ADT is called neo-adjuvant therapy.  ADT is also used in the event of residual  cancer after initial surgery or radiation therapy.  Such use is referred to as adjuvant therapy.  Systemic therapy is when ADT is used to treat cancer that has spread beyond the prostate gland.  While ADT has obvious benefits, it also causes an array of side effects in addition to the well-known hot flushes.  For example, the risks of osteoporosis, bone fracture, anemia, cardiovascular and kidney disease as well as diabetes and fatigue are increased. Also, weight is gained at the expense of muscle mass (sarcopenic obesity).  There are also psychological effects of ADT as well.  Recent controlled studies have indicated that ADT is notably associated with an increased risk of depression.  There have also been several studies which suggest that ADT may impact mental cognitive functions involved in how one perceives, reasons, thinks and remembers.  In addition, ADT can negatively affect a man’s interactions with the person he is normally closest to, such as a spouse or partner.  This can also have repercussions on the latter’s health.  In general, the psychological distress associated with cancer is greater on females than on males whether they are the patient or the partner.  On a positive note, when it comes to dealing with physical or psychological side effects of ADT, physical exercise helps uniformly.  It not only protects the heart, muscles and bones but it can improve mood and memory, reduce depression and fatigue and even improve sexual function.  In fact, exercising together with a spouse or partner can help maintain intimacy and strengthen their spousal bond.  Finally, one recent study noted that the survival benefit for prostate cancer patients in having a supportive spouse beats the benefits of chemotherapy.  This entire article linked herein recently appeared in the February 2015 issue of the Prostate Cancer Research Institute (PCRI) Insights.  The reader is highly encouraged to read and subscribe to the entire article, issue and periodical.


Latest Information on Molecular Imaging for Prostate Cancer

bjgabrielsen : March 9, 2015 1:56 am : 2015, Diagnostics, Genetics, Imaging

The Prostate Cancer Research Institute (PCRI) publishes a periodical entitled Insights which is available by e mail or regular mail.  I strongly advise readers to subscribe electronically.  The February issue discussed several very important topics including molecular imaging.  After initial surgery or radiation prostate cancer treatment, 40% of patients will experience a PSA relapse.  Knowing the location of the recurrence is important since recurrence at or near pelvic lymph nodes may be amenable to additional curative focal therapy.  Standard imaging techniques such as technetium bone scan, CT scans and MRI are usually unable to see tiny recurrent tumors.  However, PET scans which work by exploiting various aspects of cancer metabolism can often visualize and locate these small tumors.  Acetate and choline represent two building blocks of cancer cell membrane synthesis.  Therefore, if these areas of the cancer cell are made radioactive with carbon-11 (C-11) acetate or C-11 choline or fluorine-18 (F-18) radioactive isotopes, these areas can be observed on a body scan.  The article’s author, Dr. Fabio Almeida, Director of the Arizona Molecular Imaging Center, provides data on 373 patients with PSA recurrence who were scanned with C-11 acetate PET scan.  Cancer detection rates correlated with the patient’s PSA level.  PSA levels of 0.2 – 0.4 ng/mL, led to 50% cancer detection rate; a PSA of 0.41-1.0 ng/mL led to a 77% detection rate; while a PSA level greater than 1.1 produced a detection rate of over 90%.

Other scanning methods discussed in the article include PET scanning using a radioactive gallium-68 labelled prostate specific membrane antigen (PSMA) agent.  PSMA is a cell surface transmembrane glycoprotein that is over-expressed in prostate cancer cells.  Another method uses a synthetic, non-metabolized amino acid analog labelled with radioactive fluorine-18 (anti-18F-FACBC) which accumulates in prostate cancer cells due to over-expression of multiple amino acid transport systems.  PET scan results using this label appear to be comparable to C-11 acetate or C-11 choline scans especially when the PSA level is greater than 1.0 ng/mL.  Very small bony lesions can be best detected by PET/CT scanning using sodium fluoride radiolabelled with fluorine-18 (F18-NaF) which is readily absorbed into the matrix of bone and has very high affinity for bone metastatses.  F18-NaF provides higher sensitivity and specificity than bone scans based on technetium-bone imaging.  In conclusion, while multi-parametric MRI is becoming the imaging study of choice for initial prostate cancer diagnosis and targeted biopsy,  PET scans such as those discussed above may be complimentary especially in higher-risk patients to rule out the presence of local and distant sites of metastatic disease.  The PCRI article concludes with a comparison of the above radiolabels pertaining to their production in a cyclotron, their urinary excretion, their half-lives and specificities.  The author states that while C-11 acetate and C-11 choline offer several positive characteristics, their short half-life requires more dedicated equipment.  Of the probes, F18-FACBC seems to come closest to having the optimal characteristics.


A Divine Encounter to Remember

bjgabrielsen : February 19, 2015 3:28 am : 2015, Encouragement

When it comes to spiritual issues, my rational and scientific background often predominates and I am not usually an emotional man though I have experienced God’s presence (through the Holy Spirit) many times since becoming a Christian.  However, on Tuesday, February 17th, 2015, I experienced Jesus’ specific presence and message to me as I had on only 2-3 previous occasions.  Yesterday, I was feeling mentally and physically overwhelmed dealing with prostate issues, an infected leg, bursitis and muscle pains. I was hurrying preparing for a 2 PM appointment with a physician and realized that I had not spent any time that morning reading God’s Word in short devotionals which was my regular habit.  As I finished brushing my teeth, I strongly sensed the need to simply bow down and ask the Lord’s guidance in the upcoming medical appointments.  I had only five minutes or so before I had to leave so I bowed down exactly where I was.  As I started to verbalize my situation to the Lord, His presence intensely enveloped that little room.  Immediately a picture appeared to me of several men lowering a paralyzed man through the tiles of a roof in order to lay him at the feet of Jesus since the room itself was too crowded. This scene is described in Mark 2:1-12 where Jesus manifested His divinity by forgiving the man’s sins and then healing him.  This was especially relevant because several friends and family were praying for me.  As I was on my knees, Jesus specifically reminded me of previous “instructions” I had received from Him, namely that I was to minister to medical personnel whom I would encounter and in turn, He would take care of my body as I yielded myself to Him (see Romans 12:1).  All this was accompanied by such a feeling of intense joy, peace, and especially thanksgiving and praise to the Lord that I had rarely experienced.  I began to weep with joy, lifting my face and hands upward.  I continuously uttered thanks and praise for several minutes.  Words were insufficient to thank and praise Jesus for his specific message of encouragement to me.  When I read in the Old Testament how God delivered His people Israel again and again, He told them always to remember the specific times of their deliverances as the details would be easily forgotten with time.  I write this for my own remembrance as well as an encouragement to any of you who may be in a similar situation. I had experienced similar direct messages from the Lord on few occasions.  For specifics, see the My Story section of this website, 2004-2005, specific entries dated Sunday, January 11, 2004 and March, 2005.  If any of you are not sure of your own personal relationship with God, please see this linked website section.  I offer my sincere thanks to you all for allowing me to share this encouragement.


MRI-Ultrasound-Guided Biopsies Diagnose More High-Risk Prostate Cancers.

bjgabrielsen : February 17, 2015 5:01 am : 2015, Diagnostics, Genetics, Imaging

Prostate biopsies that combine MRI technology with ultrasound appear to give men better information regarding the seriousness of their cancer, a new study suggests.  The new technology, which uses MRI scans to help doctors biopsy very specific portions of the prostate, diagnosed 30 percent more high-risk cancers than standard prostate biopsies in men suspected of prostate cancer, as reported by the senior author, Dr. Peter Pinto, head of the prostate cancer section at the U.S. National Cancer Institute’s Center for Cancer Research in Bethesda, MD.  These MRI-targeted biopsies also were better at weeding out low-risk prostate cancers that would not lead to a man’s death, diagnosing 17 percent fewer low-grade tumors than standard biopsy. In a targeted biopsy, MRIs of the suspected cancer are fused with real-time ultrasound images, creating a map of the prostate that enables doctors to pinpoint and test suspicious areas.  To test the effectiveness of MRI-targeted biopsy, researchers examined just over 1,000 men who were suspected of prostate cancer because of an abnormal blood screening or rectal exam.  The researchers performed both an MRI-targeted and a standard biopsy on all of the men, and then compared results.  Both targeted and standard biopsy diagnosed a similar number of cancer cases, and 69 percent of the time both types of biopsy came to exact agreement regarding a patient’s risk of death due to prostate cancer.  However, the two approaches differed in that targeted biopsy found 30 percent more high-risk cancers, and 17 percent fewer low-risk cancers, the type of cancer where this person certainly would have lived their whole life and died of something else.  An MRI is great for guiding doctors to serious cancers, but is not able to detect lesions smaller than 5 millimeters.  While this MRI – ultrasound technique is being widely publicized in medical circles, questions remain.  For example, would the new technology, which requires an MRI for each suspected case of prostate cancer and new equipment to fuse the MRI with an ultrasound scan, be worth the extra expense?  Dr. Pinto believes the new technology might actually save money in the long run, by reducing over-treatment.  See the following link for additional details.


The Peace That Passes All Understanding.

bjgabrielsen : February 16, 2015 3:30 am : 2015, Encouragement

Sunset over the Gulf of Mexico, Boca Grande, Florida; BJ Gabrielsen photo.
Sunset over the Gulf of Mexico, Boca Grande, Florida; BJ Gabrielsen photo.

I recently learned that I may be becoming resistant to the treatments that have kept my cancer under control for nearly nine years.  I was also informed that in such a condition, I could possibly expect 3-5 “good” years of life remaining even with newly approved, available prostate cancer treatments.  My initial feelings of despair and disappointment lasted a few days during which I candidly poured out my broken expectations and concerns to God much as David did in many of the Psalms.  As a result, I have learned some valuable lessons some of which I share below.

Time is a precious gift. As Moses reminds us in Psalm 90:12, it is a matter of eternal significance how we spend the time apportioned to us in this world. “Teach us to number our days aright that we may gain a heart of wisdom.”

John 14:27 has become a promise from Jesus to which I tenaciously cling. “Peace I leave with you, my peace I give unto you, not as the world gives do I give unto you. Let not your heart be troubled nor let it be afraid.”  To see us through rough times of life, God provides His protection and peace.  But protection does not mean that troubles won’t occur.  Jesus allowed the disciples to experience the fear and anxiety of being in a boat on a turbulent sea.  He permitted them to suffer because He had something far more important in mind. He wanted to teach them to recognize their own helplessness, His sufficiency and their need of Him.  The peace that God provides is not dependent upon the quieting of our circumstances or the removal of external pressures e.g. physical conditions.  The promised peace comes in two ways.  First, Jesus Himself becomes our peace. Through His death, He has reconciled us to God the Father and we are no longer estranged from Him. “Therefore being justified” (declared innocent) “by faith, we have peace with God through our Lord Jesus Christ”, Romans 5:1.  In addition, having a right relationship with God is accompanied by the inward presence of the Holy Spirit who enables us to experience an increasing sense of inner tranquility.  If we are experiencing prostate cancer at its various stages and impacts, are we using all that God has provided?  Following God in a right relationship leads to a deepening relationship with Him. He chooses to reveal Himself to those who seek Him and obey His instructions.  And when we see that God always keeps His promises, our confidence in His faithfulness will soar.  Hebrews 10:23 states ” let us hold fast the confession of our hope without wavering for He who promised is faithful.” Whatever our situation, we know we can trust Him. Then He will transform our worries into joyful anticipation about what He is going to do next in our life. Even if hard times await, we’ll be convinced that God will work them out for good (Romans 8:28).

To ensure you have a relationship with God, see the website link.  Some of the above was cited from the Feb.6th, 2015 In Touch Devotional by Dr. Charles Stanley.


Unsolicited Advice from Survivors for the Newly Diagnosed Men with Prostate Cancer

bjgabrielsen : January 23, 2015 5:54 pm : 2015, Encouragement, General Patient Information

The following post comes from a site called Prostate Snatchers written by Ralph Blum and Dr. Mark Scholz.  You are urged to subscribe to their periodic e mails by logging into prostatesnatchers.blogspot.com.

In 2014, approximately 233,000 men in the U.S. were told they had prostate cancer and to many of them it sounded at best, like the end of their sex life, and at worst like a death threat.  In reality, the majority of them turned out to have an indolent form of the disease that was not life threatening and could safely be monitored without any immediate treatment. Having said that, a diagnosis of prostate cancer is not a walk in the park.  Just when you are most vulnerable you are obliged to confront so much complex and conflicting information that to say it leaves you reeling would be an understatement.  So your first and most important decision is not to make a pressured decision, not to rush the treatment selection process or allow anyone else—including any doctors you consult—to rush you into undergoing an irreversible treatment until the shock has worn off and you have had time to carefully analyze all the data that applies to your particular case. The first step after being diagnosed is to understand the concepts of staging and grading. The grade of your cancer will tell you how aggressive the cancer cells are. The stage tells you how extensive or advanced the cancer is. This information, together with your PSA level, will help determine your prostate cancer’s risk factor—whether you are in the low-risk, intermediate-risk, or high-risk category. If your cancer is low-risk it can be safely monitored with “active surveillance” and does not require any immediate treatment.  If you are in the intermediate-risk category, you have many treatment choices, and in order to make the best decision you will need to get opinions from specialists with state-of-the-art knowledge. You will already have seen a urologist who, if you are a candidate for surgery, is likely to have recommended a prostatectomy. If this is the case, it is essential to ask him the tough questions: What are the risks? How many prostatectomies has he performed overall and how many has he done in the past twelve months? Does he perform nerve-sparing surgery, and if so what is his success rate with preservation of potency and continence? And if you are over seventy, please consider prioritizing  almost any other treatment option ahead of  going through a major surgical procedure. Before making a treatment decision you should consult a radiation oncologist about brachytherapy (radioactive seed implantation), and IMRT (Intensity Modulated Radiation Therapy), a precisely targeted type of radiation that delivers high doses to the prostate without damaging surrounding organs. In my opinion both these options are at least as effective as surgery at curing the disease and both are associated with significantly lower risk of long-term toxicity.  You should also consult a medical oncologist about hormone therapy, a treatment that blocks the male hormone testosterone and significantly slows the spread of the cancer, often for years. Hormone therapy does not promise a cure, but it is a viable, non-invasive alternative to surgery, an effective delaying action. A medical oncologist is a good doctor to consult with as they have no vested interest in either surgery or radiation and can often be helpful in sorting out the conflicting opinions you likely have heard.  If your cancer is in the high-risk category you will usually need two or more different kinds of treatment—probably hormone therapy plus radiation.  Some centers even may mention chemotherapy such as commonly done for patients with colon cancer or for women with breast cancer.  And there are many new treatment methods in the pipeline, so even if your cancer is aggressive, you are not looking at an imminent death threat. So do your research and take your choice. And always remember: Prostate cancer is about the best possible cancer to deal with.




Prostate MRI/Ultrasound Fusion Guided Biopsies for Prostate Cancer Detection

bjgabrielsen : January 23, 2015 4:37 am : 2015, Diagnostics, Genetics, Imaging

I recently came across a video presentation from the University of Alabama-Birmingham describing in detail the technique of using prostate magnetic resonance imaging (MRI) coupled with ultrasound techniques to guide urologists to specific prostate biopsy targets.  While the video is geared to scientific and medical personnel, it can provide general knowledge of the potential utility of this technique for the patient.  Currently such instrumentation and software are available only in the vicinity of medical and academic research centers but these are becoming more accessible.  This MRI/ultrasound fusion technique could conceivably become cost-effective since it would significantly reduce the need for multiple biopsies for active surveillance patients among others.


Vitamin D May Prevent Prostate Tumor Growth

bjgabrielsen : January 21, 2015 6:02 am : 2015, General Patient Information

This website usually posts articles from the medical and scientific literature, however with so much discussion about the diverse role of vitamin D in many diseases, a recent video and article from Fox News is very pertinent.  A University of Colorado Cancer Center study recently published in the journal Prostate presented new evidence that vitamin D may help reduce cancer-causing inflammation.  Scientists found that a gene GDF-15 – known to be up-regulated (stimulated) by vitamin D – can help block a protein called NFkB, which drives inflammation and stimulates tumor growth.  The accompanying video and article speak for themselves.  It is suggested that men have their vitamin D3 blood levels checked routinely.  Vitamin D3 blood levels of 30-80 ng/mL are optimum.  The appropriate blood test for vitamin D3 is the 25-hydroxyvitamin D assay as opposed to the 1,25-dihydroxy assay.




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