I had my first consultation with Dr Kasherman on 22 August.
It was an almost three-hour journey to Dr Kasherman’s consultation rooms in Woollongong. Dr Nicholson had wanted me to see one of her colleagues, Dr Gary Tincknell, with whom she worked very closely, but he was away on holiday for 4 weeks, waiting any longer to start the treatment process was an ill-advised option.
I had seen the reports of both the biopsy tests and PET-CT scans online. There is a scale of “aggressiveness” for prostate cancer cells. It’s called the Gleason score and mine was 9/10, very aggressive, which helps explain why the cancer had spread as much as it had. The PET-CT scan showed, in glorious technicolour, the extent of the bone cancer. Dr Kasherman described my PET-CT scan results as me looking like the fairy lights on a Christmas tree. Fair, but not really what I had hoped for. The bone cancer was more widespread than I had feared.
It was Dr Kasherman’s job to identify the best course of treatment for me. He was very “matter of fact”. If I was to give him a little feedback, I’d no doubt suggest a slightly less “intense” style. Kim could do much to help him in that regard!
The first drug would be by way of an injection. It’s called Degaralix and is designed to treat prostate cancer that is locally advanced or metastatic. Degarelix is a treatment for hormone dependent prostate cancer. Hormone dependent means that the cancer cells need a hormone in order to grow. It is given by injection under the skin (subcutaneously), normally the stomach. Dr Kasherman gave me a script for the drug, and I ordered it from my local pharmacist.
I made an appointment with the nurse at our local medical centre for the Friday of that week, 25 August.
When I arrived with my prescription I was advised that the nurse was running very late and asked if I would be OK if one of the doctors administered it. I figured that the doctor is at least as competent as the nurse.
I saw Dr Emma Thompson, a very friendly senior member of the practice team. I had been told that I would have 200ml of the drug. The syringes come in 120ml and 80ml doses. Dr Thompson read through all the instructions and started with the first injection, which I hardly felt. She then used the second syringe to inject a second dose. I didn’t give it much thought, but she then gave me a third injection – who am I to challenge the professionals!
Big mistake! I left the surgery feeling quite positive, it had gone well, very little discomfort.
I just got to the car and opened the door when the phone rang. It identified the caller as Milton Family Medical Practice, our local medical centre. It was Dr Thompson, in somewhat of a fluster, and she asked me to immediately return to the surgery to see her. Somewhat embarrassed, Dr Thompson admitted she had “overdosed” me! The pharmacist had provided two syringes of the120ml and one of 80ml. She had not noticed this and had proceeded to give me all three doses, a total of 320ml instead of the prescribed 200ml.
She had immediately called Dr Kasherman, the prescribing oncologist, to admit the error and seek his guidance on what she should do. Apparently, he said the only effect would be that the side effects of the drug may be more pronounced as a result. I assured Dr Thompson that I felt fine – I was still alive! She said she wouldn’t sleep over the weekend and would call me first thing on Monday to make sure I was OK and to immediately go to our local A&E in the event of any problems.
To be honest, I had no side effects and would never have known I had the drug apart from the slight lumps under the skin of my stomach! Dr Thompson duly called, and I reassured her that all was well. Indeed, the pains in my joints and some bones had gone so the extra seemed to have done a good job.
The second drug is Darolutamide and is taken in tablet form, which would no doubt be of great relief to Dr Thompson!
It is a type of chemotherapy and an antineoplastic (anticancer) drug that belongs to a class called antiandrogens. It works by counteracting the effects of testosterone, the primary sex hormone produced by males and used by the prostate. It is important to understand that darolutamide is not a traditional chemotherapy drug and has a different way of working. It works by blocking hormones which stops the cancer cells growing and spreading.
I started taking darolutamide, which supports the Degarelix injections, two weeks after the injections, on Friday 8 September. I take two tablets in morning and evening, and I think I will be on these throughout my remaining life.
The third treatment, at this stage, at least, is Docetaxel, which is definitely a type of chemotherapy. This treatment is repeated in three-week cycles and, in my case, for a total of six sessions. I had the first “dose” on 21 September.
At the end of my consultation with Dr Kasherman he asked for a further CT scan, to look at my spine in closer detail. The scan was done on 24 August. I had a review meeting with Dr Nicholson on 25 August, the morning before the “injections” with Dr Thompson. Basically, Dr Nicholson had seen Dr Kasherman’s report of our consultation and agreed with the “Christmas tree” analogy. She seemed to agree with the drug regime, but I detected some disquiet, which neither Kim or I could define. Let’s put it like this – Dr Nicholson was keen for me to see Dr Tincknell for review – you will recall he was a close colleague of Dr Nicholson but was on holiday.
