Little bit about myself. I'm 49 years old. I work in marketing and advertising here in San Diego, California, and I was diagnosed with prostate cancer when I was 42 years old of age. The way I came to being diagnosed with prostate cancer. During my early 40s, up until when I was 42, I was having a lot of discomfort in my hip, at least for a year or so. I was trying to be healthy and exercise, run, because I was gaining a little bit of weight and it just became intolerable.

The hip pain was affecting the way I was sitting, the way I was standing, the way I was walking. So I went in to get checked up by my primary and she was great. She was very thorough with directing me to a specialist, but at the same time wanted to do some follow-ups with me and give me a prostate exam because she thought it might not hurt to start having a baseline. So she wanted to do a rectal exam. And at first I was hesitant, but luckily she was very, very... How do I say this?

She was very committed to having my prostate exam. And she was very helpful because the thing that convinced me was that she asked a lot of questions, everything about my urinary history to my health and activity. I think she saw some symptoms in me that I was not being realistic that were symptoms, like the fact that I was very overweight. My cholesterol levels were not healthy, at a healthy level. And sure enough, my prostate was enlarged and a little bit hard as she described it.

So she immediately suggested that I do a PSA blood test from that point. And that was back in September. I believe it was September 1st of 2016. And after that, that first initial PSA test came back with a high number of 16.6. So that's where my health journey started with prostate cancer. And it all happened thanks to my primary. From my primary suggesting that I do a PSA blood test, that kind of still kept me in kind of like a procedural state of mind, like, "Oh, it's just blood work, nothing to worry about."

I didn't know anything about prostate cancer. I was 42, I still felt like I was invincible and indestructible. So being a typical guy mentality, I was just going about my business. What I realized later is that once the blood work came back, we thought, "Okay, it could be an anomaly. It could be that I just have an enlarged prostate and I need medication, so we're going to do another one and let's determine it from there."

So once I got my second result, and it was still 16.1 or 16.6, then they handed me off to a urologist, a specialist. And within the course from September in October, I must have done two PSA tests at the end of October. I did a biopsy, and that was, let me see, October 30th in November. I'm sorry, September and October were the PSA tests that were static number of 16.6. And then in November, that's when I had my biopsy. And the results came in December 12th of 2016, and that's when I found out from my doctor the diagnosis was cancer.

So it was a scary time. Nobody should get that call from your doctor. I remember it clearly because my kids were doing their homework, my wife and I were cooking, and I stepped outside because I knew the doctor's number. And the first thing that he said immediately was, "Alex, I'm sorry to tell you, but it's cancer and it's the bad cancer." So that just changed the whole thing from me thinking that it was just procedural blood work to wow, the C word, which I never considered in my life. From me going to my primary in September to being biopsied in November, a lot of change.

I think those first two months, initially I was keeping things at bay, but once we got the results early December and the biopsy showed that it was cancer, it started a very fast barrage of meetings with my urologist. He handed me off to a specialist, a surgeon, and from that point on, we knew that it was serious. My doctors didn't give me that many options. The two options were surgery, radical prostatectomy or take my chances and see what happens with the cancer. So I think it was an obvious decision.

My wife and I felt comfortable. We wanted the prostate removed. My diagnosis... And let me step back, part of the reason that we were able to make a informed decision was because we trusted the doctors. We knew that they were experts. They had seen this and we wanted to follow their advice. So when the biopsy came back, I diagnosed with stage three cancer. It was a Gleason score of four plus five, and it was advanced.

So following the biopsy results, I had two weeks of intensive scans, everything from a bone scan, CT scan, blood work, MRIs, just to see what had occurred in my body. And luckily, the cancer was still contained to the prostate. So then the decision to remove the prostate became much easier having all that information because it really created a path with all the information that my doctors were collecting at the time to make sure that it was the right treatment and to make sure that we would proceed in the right direction.

So once I was diagnosed and the results from all the scans came back, we had two initial meetings with our urologist. My wife and I met with her, and she provided all the information on whether radiation was a viable option or whether we should go with the surgery. And the sense that we got was, "Why try to contain it with radiation?" The prognosis was that my cancer was very advanced, very aggressive, and removal was the best step. After that, we can revisit the radiation as a follow-up treatment.

But one thing that my wife and I decided not to do was not let anyone know. It was around the holidays at this time. We wanted to focus on making sure that everybody was okay. And at the end of the day, I remember feeling optimistic. Even though it was a bad diagnosis for me, I still felt like I needed to keep it together. And telling my family, telling my kids was not going to be an option.

So what we did is we went through the Christmas holiday. I had my surgery on the 27th of December, and then after I felt a little bit better in the new year, that's when we had meetings and got together with family to tell them that I was going through this cancer journey. And it was a lot easier for me that way because a lot of people were concerned, but because they saw me already feeling better, it was a lot less of a blow to their fear.

I think I mentioned that my whole cancer journey from my diagnosis to my surgery was really quick. Over the course, I feel like of a month or 20 days, you could say, I got diagnosed with prostate cancer and I was in a surgery with a radical prostatectomy, so I didn't have a lot of time to process and prepare. I think my doctors were really helpful in making sure that everything was lined up. But after the surgery, that's where things hit me.

And I think I've never been a big fan of medication, but I took medication because the discomfort and the pain afterwards was a little bit intense, but I think it lasted about a day or two. After that, I was able to go off the meds and really start the healing process. The recovery was very smooth and I feel like only just a couple of weeks of incontinence, they gave me exercises with the regimen ball, and I was able to do those exercises fairly quickly. And I felt like I was back to normal almost within a month.

I was still wearing the pads just for purpose of the accidents because certain movements or if I had too much to drink or if I didn't go to the bathroom quickly enough, I would have incontinence issues. But other than that, the discomfort was subsiding. I ended up having disability from my work for four months, but I ended up going back after two months, and that was a huge mental boost for me to get back to normality.

It was also a way for me to get into something to distract me instead of being at home trying to recover, I was back in my office, I was back interacting with people. And it took a little bit of juggling, making sure that I would go to the restroom regularly and take care of this and making sure that I didn't have any accidents. But over the course of three months, I think I was almost to 90%. And that first year was just a lot of healing, both physically and mentally.

Post-surgery, I think one of the biggest symptoms is the erectile dysfunction. I think it's something that was discussed as a possibility, but being that I was younger, they expected my health to be able to bounce back. My doctor actually was, as she stated, a little bit more aggressive in the surgery and took a little bit more of the tissues to make sure that there was no remnants of anything outside of the prostate. So it did leave a little bit of damage and some ED, issues with ED.

But if there's one thing that men dealing with prostate cancer should know, that there's hope and there's medication to deal with it from everything from Cialis and Viagra to the [inaudible 00:11:38] shot and injection to other things that I haven't ventured into. But with proper consultation with your doctor and neurologist, I think you can get treatment to address those needs. And so far, it has affected my personal life with the sexual dysfunction, but not to the point where I can't partake or not enjoy intimacy.

Every person and every man's prostate cancer journey is different. So I would go online to try to read up on similar cases, but I was the, as my urologist would call mem her unicorn. She didn't have patients that were my age or my background and my health status. So it was really difficult to get some perspective. What she did really well was create a plan for me to get followed up and continue my PSA testing. So for the first year, I was getting PSA blood work every month on a monthly basis.

So from the recovery to checking in, to my PSA blood work, it was all part of this regimen that first year to see where we were and almost create a new baseline post-surgery. And for the most part, it was very good. I think one thing that I would've appreciated more support in would've been to get more guidance on the health or healthier lifestyle aspects, but I ended up learning that on my own. I think as far as the PSA blood work and the monitoring, it was key.

It was key to helping me stay mentally healthy and also physically healthy. And then from there, after that first year of having no detectable prostate or PSA, it was just every quarter and then it moved to every six months and then once a year. At this point, I felt like my relationship with my cancer journey with my urologist was more focused. We were on the same page on everything, so I kind of just used my primary as a backup if for some reason I couldn't see my urologist. And my primary supported that decision as well.

But yeah, my journey, they say the survival rates are really significantly higher if you don't have a recurrence the first five years. Well, I was at the cusp of my fifth year and I had a little bit of a recurrence. My number on my PSA started creeping up from undetectable to a 0.1. And it was a little bit of a surprise to all of us. I think we're all expecting that unicorn mentality that everything was going to be great. And I think for me, I was still in this phase of like, "Oh, I had my surgery, I'm cured. It's over."

And I think the reality of prostate cancer or any cancer is that you have to be vigilant. You have to constantly be keeping an eye out and being healthy, monitoring. So what ended up happening for us, we went back to that three-month cycle of checking the PSA. As soon as we start hitting that number of 0.1. And it took about a year for it to increase to a 0.2, and then another year it increased to a 0.3. So it was increasing at a very slow rate.

But by the time it got to a 0.4, we were both, my urologist and I were both determined to figure out different plans because now it was leading into a full recurrence. So we wanted to have a plan in action, or we wanted to have a plan set in motion. During the course of two years, my PSA started incrementally to rise, and we were at the point of seven years into my cancer journey, and at this point, my urologist suggested that we take some further steps.

So she handed me off to her radiation oncologist, and in her practice she had a support team that met with me to discuss ADT treatment and radiation. At this point, we were all discussing the possibilities of different types of treatments, different options. Again, very similar to when I was first diagnosed with prostate cancer. I didn't know anything about this. I didn't know about testosterone being such a factor with prostate cancer.

I didn't know about ADT. And I think it was a bliss, right? Out of mind, out of sight. But I got shoved and pushed into this direction to really educate myself. So I started looking online and I reached out to other doctors, naturopaths, MDs, everything, just to get a second and third opinion. And lo and behold, that's how I came about meeting Dr. Rana McKay at UCSD, and we had a great interaction.

She reviewed my case, shared it with her colleagues. And we hit it off because she had such a great background of information and research, but also the application of the medical side. So from that point on, I switched from my urologist and my primary to UCSD. And that's what led me to this new treatment plan. One of the things that I really focus on, especially nowadays when I talk to other men, both that are dealing with prostate cancer and just want to learn more about prostate cancer, is the importance of having doctors that you can relate with and they can support you.

When I first started this journey and I was diagnosed, it was very fast and I had no point of reference to get a second or third opinion. Luckily, the people that were involved in those decisions were top-notch, and they did an excellent job to help me stay healthy. But the difference in this journey is that I had time when my recurrence started to happen. I had a decent amount of time to research and meet with different doctors in different clinics.

And when I saw the work that they were doing at UCSD and how Dr. McKay handled cases with other patients, I felt that she balanced both the research and the knowledge with a very caring perspective and approach. Hearing from her patients directly, it was just such a fresh, I don't know, perspective. So from talking to her, she was really helpful at laying out three different plans.

And she gave me her feedback and suggestions on what she thought would be the most beneficial for me in my future, my health, but also taking into account different effects from radiation to no radiation, to medication to no medication, even so much so that she suggested being part of a trial. So along that path, she put me in contact with her radiation oncologist and her team, and I went from having one doctor, one urologist, to having a team of six and seven specialists and experts at UCSD.

So talk about that support group that I think is important to keep you healthy. It wasn't like anything I've ever experienced before, and I felt a huge load off my shoulders because now I really wasn't alone. Now I had people that I can balance ideas and questions and get answers that were from different perspectives. So the journey was definitely different, and it helped me make a solid decision that felt right for my health, for my family. And with the team, we were all on the same page.

When I was at my previous urologist, we did a PSMA scan, and that's how they determined where the location of the recurrence was, partially on a hip bone and partially on some lymph nodes around their growing area. So with that, I was able to further have more detailed conversations and follow-ups with other doctors. Dr. McKay was really helpful because from that point, she just took it and ran with it, and she had her colleagues review it.

She followed up once I became her patient, she followed up with additional scans and MRIs to make sure that everything was still according to what the research and the results from that PSMA scan were. From that database or from all those results, she was able to create a plan for us to do radiation, but also start treatment with ADT. So she created a very clear path for me to follow using medication and the treatment.

I was still in my little imaginary bubble of health when my recurrence started because it started with such a small number, didn't just jump to a solid full number. I think my urologist at the time would say, "Oh, it's just dust, cancer dust floating around and your body's going to clear it out." But once it became clear and we had proof from the PSMA scan that there was an actual recurrence and we had factual locations of what to do, I think emotionally it's disheartening to know that you have to deal with this again, here's the cancer back.

But one of the things that I really appreciate Dr. McKay doing was settling me down and saying, "Listen, we're ahead of it because we know what to do. You're in good hands, and here's the plan." The plan that Dr. McKay suggested included ADT, androgen deprivation therapy, which once again, I had no clue what that meant, what it was, and being in my late 40s at this point, wondering what's going to be my future and how is this going to affect my life.

I've never been one to depend on medications so I felt like taking medication that was very intense was going to have some severe side effects. I read and researched the medication involved, Lupron, which I thought was really concerning. So I try to finagle away to try to avoid doing the ADT and try to avoid doing the radiation. And then at the end of the day, I said, "Wait a minute. I've been trying this approach already and it hasn't gotten me anywhere, so let's go in." And it took a bit of commitment from me. If Dr. McKay was going to be my guide, I had to have trust in what she was offering.

So Dr. McKay's plan for me was to start a regimen of ADT with two medications, one of which was in a medical trial, to see how these two medications work in conjunction with radiation treatment. We started that process in March of 2023, and by April I had my first dose of Lupron, the injectable. And we do that every three months. And at the onset of the first injection, I think my body responded with some side effects true to what they disclose, a little bit of the rashes, dryness, fatigue.

I had some night sweats. And I think all in all, I experienced them around the first month post the injection, and only for about a few days. After that, that was the last I've ever felt. I'm about to go a year into the Lupron medication and no side effects that I can think of. So it's been a really great process to be able to have trusted my doctor with this recommendation, but also to not have to worry about the side effects. And I hope that it continues.

Along with that, we also did the regimen or the treatment of radiation, which started at the end of July in 2023. And that lasted about seven weeks. So it was a localized radiation treatment on the two areas with a little bit of a general radiation around the pelvic region. And that was surprising. I think a lot of people talk about radiation, and it's okay. Again, I did not want to do any of these treatments, but I'm glad that I did because now I have peace of mind.

I feel a lot better having done it, and I feel that my doctors were really competent to do it the right way. It was not a just general blast around my whole body. It was very focalized or focused, and they did a really great job of walking me through the process. They had a great team at UCSD. I would come in every day at 12.

It was my lunchtime meeting with them, and then I would leave 15 minutes later and I'd go back to work or I'd come home if I needed to rest. Because some of the side effects with radiation are fatigue, and for the most part, the fatigue and mental fogginess that you experienced with radiation wasn't that present until I think the last week or maybe the second to the last week when the accumulation of all the treatments was really hitting a high point.

But overall, I think within a month after my radiation treatment, I started to feel like myself again in terms of the energy and the mental focus that I felt. I lost a little bit on that edge. I think to answer that question, I need to go back. When I was first diagnosed, when I first got that call from my doctor after the biopsy, you feel like the world is crumbling around you. My kids were young. I was looking at my wife as I was talking to the doctor, and it was a scary thing to think about cancer. I have cancer. It's still, to this day, it sounds unrealistic. I can't believe it.

But early on, I felt like all I had was my positivity. If I didn't stay focused on my positivity, I feel like it could have gone a different way in a different direction. So even though I felt concerned about the surgery, even though I felt concerned about doing ADT or radiation treatment, I still had faith in my doctors and my team, and I had faith that if I did the right things, health-wise, exercise, mental to complement what they were providing, I think I was going to be in a good place.

And overall, having a recurrence wasn't the best experience because it's a hit to your positivity, it's a hit to your experience of feeling cancer-free. But it is also now that I learned part of that journey. And I think surrounding yourself with the right people, the right doctors, makes a big difference. And now I feel all the better. I feel like a completely different person you can say, because now it's opened up these avenues to understanding more about how my cancer affects my body.

And I have these conversations with my medical team that really are good foundations for improving my health, not just getting treatment. So it's been an interesting journey, but without a doubt, I think the doctors really complemented my perspective to stay positive, because even when I didn't feel like doing a treatment like radiation, it was the right medicine, it was the right approach. And I think other men need to understand that there is something good that comes out of these treatments.

I think it's important to share the cancer journey with all men. I mean, at this point, even women need to know for their health the things that you can do to stay healthy. But I think in terms of prostate cancer, as a young man being diagnosed or as an older gentleman, I think it's important to know that there is hope. There is a way to live comfortably, to have a substantial long life, both with medication standard practice of care, and with alternative healthy practices of exercise and diet.

I think having a recurrence, I used to see it as a horrible thing, like, "Oh my gosh, that means that I'm about to die, or worst case scenario. But again, the vigilant team and the options that they laid out made it such an experience that it was actually manageable. It was a positive experience. And I know that if something else were to happen in the near future or in the future, my team would be able to address it. So I think it's important to be able to focus on the positives and to understand that you can live, you can thrive, and there is hope.

I'm happy to say now my PSA is undetectable, my cancer-free, as my oncologist, radiation oncologist pointed out, and his recommendation was to go enjoy life cancer-free. So I feel like I'm thriving. I feel excited to share my story with other people. And yeah, it's weird sometimes when I talk to people and I tell them, "Thank God for cancer, because it saved my life." And that's a very mixed message. But I think the way I was going when I was 42, I was not healthy.

I was not paying attention to the red flags that were popping up. Now with my team and with my health focus because of the cancer, I feel like I'm healthier and better than ever. I want to give you some background because I think when it comes to ADT, and the more I learned about ADT treatment, one of the biggest concerns was my sexual activity, being that I was still young, fairly young. I won't say too young, but I've always been very sexually active, very much a cornerstone in my relationship, my intimacy with my wife.

So it was a huge concern, having to consider taking treatment that was going to affect my performance. And being that ADT in terms of the medication that I needed to take, was to drop the testosterone levels significantly, it was going to have a huge effect. And in the time when we're still discussing, and I had two opinions from two different doctors to see if that was the case, they both agreed. Dr. McKay put it perfectly. I could still have intimacy, but it's not going to be the same type of intimacy. And it's true.

It takes a little bit of adjustment mentally to get around it because it's not the same bodily functions that you once had, but you still feel very attracted to your spouse, or I still feel very attracted to my partner, and there is that love and intimacy, but it's not in the same physical way that it used to be. And the good thing is that after my two years of ADT treatment, we're going to reevaluate and see how I recover and how the testosterone will play, and again, regain some intimacy.

I think when you have a spouse or a partner that's on this journey with you because you're not alone, it's important to have these conversations, not just about the treatments, not just about the stressful decisions that you have to make, but also about the love and the interaction and the support that you have for each other. Because the treatments will take care of themselves once they get put in place, the more important aspects of the support group or your spouse is really keeping that intimacy.

And I remember my doctors telling me, "Listen, go on more walks, hold hands, snuggle." And I was like, "What is this? What type of advice is this?" But now these moments where we have time to talk, snuggle in bed, watch a movie, it just really amplifies the importance of the intimacy that's beyond sexual need.

We all love the sexual activity, intimate activity, but there's more to it now. And I feel like my wife and I, because we were together in the decision-making process from my treatments to my surgery, to the follow-up treatment with my remission, it's all been a bonding experience, which we both had to be very mindful and discuss openly to make sure that we were able to connect in a different level.