14-Jan-08: PSA = 1.90
26-Feb-08: Start Crestor again with Dr Tannock's blessing.
25-Jan-08:Dr Bailie - Car broke down on way to appointment, once again could not attend.
1-Feb-08: Dr Bailie - Could snow storm - unable to drive to Toronto.
11-Feb-08: Dr Bailie treated right ear, referred me back to Dr Riddell. No chance of regaining hearing in right ear. Skin has grown across membrane limiting movement. Surgery not an option. In his report to Dr Seward, he states: "Dr Rutka feels that his condition is likely to be persistant, but hopes that it can be kept under control with regular applications of Gentian Violet and Lotiderm.
12-Feb-08: Dr Fiala, Dermatologist-Sprayed the skin on my nose. Said basil cells growing there.
26-Feb-08:Sofi Quadri, Audiologist. Hearing retested. Results- same as last test.
10-Mar-08: PSA = 2.12 - elevated again.
11-Mar-08:Dr Riddell - Treated right ear with Gentian Violet, did not have the cortisone to apply. To continue with drops.
12-Mar-08:Dr Tannock - says I am maintaining well. Has arranged for another bone scan.
07-Apr-08: PSA = 2.35
08-Apr-08: 25 Hydroxy Vitamin D = 55 nmol (Normal Range 75 - 250); LDL = 2.2
09-Apr-08: Lupron Depot 7.5mg I.M. (continuing q28days)
05-May-08: PSA= 2.6;
06-May-08: 25 Hydroxy Vitamin D = 61 nmol
13-May-08: Dr Ridell; Office moved upstairs at SMH - did not have Gentian Violet OR Cortisone to apply.
02-Jun-08: PSA = 2.70 NG/ML; Free PSA 0.22NG/ML; PSA Ratio = 8 %
03-Jun-08:
25 Hydroxy Vit D = 51 (LO); Creatinine = 105 UMOL/L (60 - 125);
eGFR = 67mL/min/1.73 m2 (60 - 89); Sodium = 142 mmol/L (135 - 147);
Potassium = 4.5 mmol/L (3.5 - 5.2); ALT = 26 U/L (5 - 68).
11-Jun-08: Increased VitD3 intake from 4,000 to 6,000 I.U.
18-Jun-08: Dr Ian Tannock, PMH.
Agreed it was time for a change. Directed to stop Ketoconazole and gradually wean off the Hydrocortisone. Agreed to a return to Casodex; does not favour nilutamide due to increased possible side-effects. Does not want Gord to start Casodex now, but wait until next appointment in 3 months.
18-Jun-08:
Princess Margaret Labs: PSA: 2.93; T= .5;
Hb: 137 g/L; Lkc: 5.7 bil/L; Plt: 182 bil/L;
MCV: 99.3 fL; RDW: 12.4 %CV; Erc: 4.32 tril/L;
PCV: 0.403 L/L; MPV: 7.9 fL; MCH: 31.6 pg;
MCHC: 339 g/L; NeutroA: 4.4 bil/L; Lymphs: 0.4bil/L;
Manos: 0.9 bil/L; Basos: 0.0 bil/L; LD: 223*;
Na: 139; K: 4.2; Cl: 103; Creat: 95; AST:33; ALP: 51;
Bicarb: 30*;TBili: 11.
19-Jun-08: STOP HDK (High Dose Ketoconazole); continue HC 10mg in AM, 5mg in PM.
02-Jul-08: PSA = 5.59 [No Keto withdrawal response]; Free PSA = 0.42; PSA Ratio = 7.0%
03-Jul-08: Reduce HC to 5mg AM & PM
08-Jul-08: Increased Vit D3 to 8,000 I.U.
10-Jul-08: Dr Seward; visit prompted by elevated PSA on July 2nd; concerned about Vit D levels but does not advise increasing beyond the 8,000 I.U. - suggests repeat PSA in 2 weeks from last.
14-Jul-08: PSA = 5.92; Free PSA = 39; PSA Ratio = 6.0 %
14-Jul-08: Calcium=2..41 mmol/L (2..1 - 2..55); Albumin=42 g/L (35 - 50)
17-Jul-08: Reduce HC to 5mg AM, 0 mg PM. Saw Dr Amarnath; and have Rx for new glasses.
17-Jul-08: Dr. Bailey, ENT at T.G.H. Toronto. Right ear definitely worsened; treated with Gentian violet and cortisone. Rx for new drops with strong cortisone content. 4 drops every other day.
21-Jul-08: Fax received with latest PSA results (July 14th)
22-Jul-08: Attempt to reach Dr. Tannock with PSA results and request Casodex start now.
23-Jul-08: Found message from Dr T. on phone late tonight. Agrees Gord start 50 mg daily of Casodex. Suggests, Dr Seward can write the script.
24-Jul-08: Reach Dr Seward - suggests Pharmacy make up the Rx and fax it to him for his signature. Gord goes to Pharmacy late afternoon - Script obtained, but the Drug would be over $100, so Gord asked them to order in the generic bicalutimide which is covered by OHIP. In the meantime, he found some unopened and still within the "best before" date. So START: Casodex 50mg daily.
29-Jul-08: PSA=6.93 NG/ML; free PSA=0.47 NG/ML; PSA Ratio=6.0%
31-Jul-08:
LifeLabs: 25 Hydroxy vitamin D= 134 nmol/L (75 - 250);
Creatinine=97 umol/L (60 - 125); eGFR=73 mL/min/1.73 m2 (60 - 89);
Sodium= 141 mmol/L (135 - 147); K=4.1 mmol/L (3.5 - 5.2);
ALT=28 U/L (5 - 68).
22-Aug-08: Dr Bailie at TGH for the ear again. If not improved, he had threatened a cortisone injection into the middle ear - OUCH! However, there is some improvement, so we carry on with drops another month.
25-Aug-08: PSA=6.79; Free PSA=0.01 NG/ML; PSA Ratio=8.0%
26-Aug-08:
LifeLabs: 25 HYDROXY VITAMIN D = 102 nmol/L (75 - 250);31-Aug-08: STOP Avodart: "Forgot" to re-order!!!
Creatinine = 87 umol/L (62 - 115); eGFR = 68 ml/min/1.73 m2 (60 - 89);
Sodium= 142 mmol/L (135 - 147); K=3.8 mmol/L (3.5 - 5.5);
ALT=23 U/L (12-49)
10-Sep-08: Princess Margaret Labs: PSA: 7.74; Free PSA: 0.63; Ratio: 0.08
Saw Dr. Anastasios Stathis instead of Dr Tannock: Gord refers to "some motor problems; difficulties on walking because of some hip pains, but this is stable with regards to last visit. Recent bone scan (July) negative for metasteses. Appetite good, weight stable and physical activity stable in past month.22-Sep-08: PSA=7.56; Free PSA=.62; PSA Ratio=8.0%
On physical examination heart & lungs not remarkable. Abdomen soft without organomegaly. He has no pain. Presents some peripheral leg edema mostly in right leg, but this is stable since major cardiac surgery.
Clinically, Mr Burgess is stable and his last PSA once he started with CASODEX was in reduction with respect to the one before. He will continue on Lupron plus Casodex.
20-Oct-08: PSA=9.29; Free PSA=.71; PSA Ratio=7.0%
21-Oct-08:
Life Labs: Hb=138 g/L (135 - 175);
Hematocrit=0.41 L/L (0.40 - 0.50);
White Cell Count=4.5 xE9/L (4.0 - 11.0);
Red Cell Count=4.49 xE12/L; (4.50 - 6.00) * Lo;
MCV=91.8 f/L (80 - 100);
MCH=30.7 pg (27.5 - 33.0); MCHC=335 g/L (305 - 360);
RDW=13.6 % (11.5 - 14.5);
Platelet Count=184 x E9/L (150 - 400);
Absolute:neuts=3.2 x E9/L (2.0 - 7.5);
Lymphs=0.4 x E9/L (1.0 - 3.5) -* Lo
Mono=0.8 x E9/L (0.2 - 1.0); EOS=0.2 x E9/L (0.0 - 0.5);
Baso=0.0 x E9/L (0.0 - 0.2); Iron=19 umpl/L (14 - 29);
TIBC=66 umpl/L (45 - 72); Saturation=0.29 (0.20 - 0.50);
VIT B12=826 pmol/L (198 -615) * Hi;
GLUCOSE: Fasting=6.0 mmol/L (3.6 - 6.0);
Creatinine=90 umol/L ( 62 -115);
eGFR=66 ml/min/1.73 m2 (60 - 89);
Sodium=143 mmol/L (135 - 147); Cholesterol=4.23mmol/L;
Triglycerides=1.19 mmol/L;
Total Bilirubin=11 umol/L (0.0 - 22);
ALT=23 U/L (12 - 49); ALP=60 U/L (45 - 129);
CK=158 U/L (40 - 280);
Sensitive TSH=1.0 MIU/L (0.35 - 5.0).
Urinalysis: Colour - yellow; Appearance - Clear;
Specific Gravity- 1.024 (1.001 - 1.030); PH- 6.0 (5.0 - 8.0);
Negative for protein, glucose, ketone, blood, nitrate, glucocyte.
25-Oct-08: START Avodart again
27-Oct-08: Dr Seward; Received above results; Flu Shot!
28-Oct-08: Inform Dr. Tannock by Fax re: stopping Casodex; setting up sooner appointment; possibility of abiraterone acetate trial; nilutamide; etc......
29-Oct-08: Dr. Tannock by telephone: Yes stop Casodex; no sooner appointment; abiraterone trial for Keto naive patients only; willing to prescribe nilutamide with much hesitation and warnings re lung side effect; there are also possible issues with visual disturbances and night driving. His preferred course of action - do nothing until there are symptoms (i.e. pain or evidence of bone metasteses or urinary retention etc....) Age factor mentioned frequently. We requested the nilutamide.
29-Oct-08: Fax Dr Seward requesting his partnership with us in surveillance for the possible side effects.
9-Nov-08:Started Nilutamide (Generic “Anandron”) 100mg 3x daily.
10-Nov-08: RVH – Bone Scan – Negative.
17-Nov-08:
Life Labs: Creatinine=92 umol/L (62 - 115);18-Nov-08: PSA=9.32; Free Psa=0.76; Ratio=8
eGFR=64 mL/min/1.73 m2 (60 - 89)
Sodium=140 mmol/L (135 - 147); K=3.8 mmol/L (3.5 - 5.5);
ALT=19 U/L (12 -49)
25 Hydroxy Vitamin D=145 nmol/L (75 - 250)
21-Nov-08: TGH - Dr, Bailie for ear treatment
24-Nov-08: Dr Seward for blood results and set up testing as base for possible lung side effects of nilutamide
25-Nov-08: Chest xray at Stevenson Memorial re Nilutamide possible side effect
03-Dec-08: Visit with Dr. Tannock – after learning of some nausea and hiccupping agreed to back off nilutamide to ½ dose – 50mg three times daily.
03-Dec-08: Princess Margaret Labs: PSA= 10.48
Hb: 140 g/L; MCV: 90.8 fL; Lkc: 5.7 bil/L;03-Dec-08:
Lymphs: 0.3bil/L;* Plt: 191 bil/L; NeutraA: 4.5 bil/L;
LD: 205; Na: 140; K: 3.9;
Cl: 105; Creat: 100; Ca: 2..37;
TBili: 10; AST: 20; ALP: 45;
Dictated by Dr. Vincent Tam, Resident Princess Margaret Hospital:
"Mr Burgess is an 82-year-old gentleman with prostate cancer that is currently being treated with Lupron, Nilutamide and Avodart. The patient has been previously on Ketoconazole and Hydrocortisone as well as Casodex on numerous occasions.
The patient was recently prescribed Nilutamide in early November of 2008 by dr. Tannock. The patient reports that he is feeling relatively well. He does not have any pain and in particular denies any bony pain. He did have approximately 1 week of intermittent nausea after starting the Nilutamide, however this has subsequently resolved. He is eating well and his weight is stable. His EOG performance is 1.
On examination, the patient does not appear to be in any distress. There is no palable lymphadenopathy in the head & neck. Respiratory and cardiovascular examinations are unremarkable. The abdomen is large, soft, there are no palpable masses, no palpable hepatosplenomegaly. There was no pain on papation of his spinous processes down his back.
Recent PSA's: September 2008 - 7.74; October 2008 - 9.29; November 2008 - 9.32 appear to show stability.
In summary, we will continue with the patient's current regime of Lupron, Nilutamide and Avodart.
We will see the patient back for repeat PSA an blood work in 3 months time. Should the patient require to be seen sooner he will contact Dr. Tannock."
08-Dec-08: Gord fell on sidewalk in Toronto “didn’t see the curb down. Weak quads just gave way”
15-Dec-08: PSA=11.41; Free Psa=0.85; Ratio=7
15-Dec-08: Visit with Dr. Josse re Osteoporosis checkup: .- maintaining well.
17-Dec-08: RVH for Lung Function test
17-Dec-08:
LifeLabs:19-Dec-08: TGH - Dr Bailie for right ear treatment: - maintaining
Creatinine=97 umol/L ( 62 - 115);
eGFR=64 mL/min/1.73 m2 (60 - 89);
Sodium=145 mmol/L (135 - 147);
K=3.9 mmol/L (3.5 - 5.5); ALT=14 U/L (12 - 49)
22-Dec-08: Dr Seward for blood test results of Dec 17
