George Happ

d.o.b.: May 18, 1936
Height  5"10",  weight 165, no previous serious medical problems in 1997.
Height  5"10",  weight 155 in 2008.

Dx:  PCa firmly diagnosed on 7/10/97

• DRE
8/94 by Dr. Mark Pitcher, University of Vermont: "normal prostate exam"
6/16/97 by Dr. George Jelinek, Fairbanks, AK: "The prostate itself is 2+, enlarged, on the right side, certainly not impressive for significantly elevated PSA".
7/10/97 Dr. Michael Albo, UCSD: "very small, 20-gram prostate slightly asymmetrically more indurated on the left than the right"
8/6/97 Dr. Michael Carroll, Fairbanks, AK: "Prostate is absolutely normal in size, slightly firmer to palpation and more prominent on the right."
9/10/97 Dr. Thomas Stamey, Stanford : unremarkable, "we measured your prostate to be about 21 gm."
• PSA
8/94 full physical but no PSA test was included.
4/25/97 PSA 61(blood taken at April Health Fair, results received 6/5/97);
6/09/97 PSA 66.4 (Hybritech)
7/1/97  Total PSA 74.8 (Hybritech), Free PSA 3.16 (Hybritech), 4 % free.
• PAP
 6/27/97 PAP=18 (Quest).
• Bone scan
6/27/97 at Fairbanks Memorial Hospital: "No evidence of metastastic disease".
• CT scan
6/27/97 at Fairbanks Memorial Hospital:  "Unremarkable CT scan of the abdomen and pelvis".
• TRUS-guided needle biopsy (7/2/07)
7/3/97 evaluated by Dr. Schaffner (Fairbanks Memorial Hospital): "Atypical glands, suspicious but not diagnostic for well-differentiated adenocarcinoma".
7/9/97 evaluated by Dr. Lester Wold, Mayo Medical Laboratories: "1) left lobe - a microscopic focus of prostatic adenocarcinoma (Gleason grade 2+2) is identified occupying approximately five percent of the needle biopsy. 2) right  lobe - atypical small glands suspicious but not diagnostic for
adenocarcinoma. "
8/97 evaluation by Dr. Jonathan Oppenheimer (Oklahoma) of one of the biosy cores (taken 7/2/97 and shown to the right) indicated Gleason grade 2+2 or 2+3 and was consistent with a transition zone tumor.
9/10/97 evaluated by Drs. Thomas Stamey and John McNeal, Stanford: "one of the three biopsies (15, 9, and 11 mm) from the right side had 2 mm of clear cell cancer Gleason grade 3+3".
• Laproscopic lymph node sampling (7/17/97).
7/17/97 Lymph node sampling by Drs. Michael Albo and M. Bidair, UCSD. Iintraoperative consultation, frozen section evaluation by Dr. A. Shabaik, UCSD revealed no evidence of malignancy in two lymph nodes .  Histopath report (7/22/97) showed no evidence of malignancy in two left nodes and four right nodes.
• Certified anterior transition zone biopsy by Drs. Stamey and Rodriguez at Stanford.
(Note: biopsied 6 weeks after the start of goserelin + flutamide). "We obtained today six biopsies from the left side of your prostate and six from the right dividing them into apex, mid, and bladder base."
9/23/97 evaluated by Dr. Stamey. "Left mid-TZ showed a suspicious focus 7 mm from the anterior tip of the bx, measuring <1mm, probably Gleason grade 3. Left base has an even smaller focus of similar appearing cells."

Tx rationale

The rationale for my choice of treatments is summarized in a draft letter that I prepared in 1997 for my health insurance company. The letter (found at Rationale.pdf) was not sent to the insurance company since it agreed to cover the treatment.

Tx CHB starting 7/25/97 - 11/25/97

• 7/25, 8/22, 9/18, 10/23 Goserelin implant.
• 7/25-9/18 Flutamide three times each day. Blasting diarrhea.
• 9/18-11/25 Calutamide one time per day. No diarrhea.
• Blood chemistry:  PSA=5.6 on 8/26/97; PAP=1.3 on 8/19/97.
• Blood chemistry:  PSA= <0.1 on 11/21/97.  Elevated AST and ALT which returned to normal by January 20, 1998 after seed implants (below).

Tx EBRT 10/1/97 - 10/31/97

• 4500 cGy EBRT in 180 cGy fractions, 5/week for 5 weeks at Anchorage Radiation Therapy Center, supervised by Dr. Richard Chung.

Tx Brachytherapy - 11/25/97

• 87 Iodine-125 seeds (0.28 mCi/seed) as rapid strands, implanted  by Drs. Peter Grimm and James Downey at The Prostate Institute of Swedish Medical Center, Seattle.
• Blood chemistry:  PSA= <0.1 on 12/10/97.  Elevated AST and ALT which returned to normal by January 20, 1998.
• Blood chemistry:  PSA= <0.2  and PAP 1.0 on 1/22/98.
• Blood chemistry.  PSA= <0.2 on 3/38/98.
• Blood chemistry:  PSA = <0.2 and PAP = 1.4 on 6/12/98.
• Blood chemistry:   PSA = <0.2 on 9/20/98 (Hybritech)
• DRE by Dr. Peter Grimm, 10/1/98.  "Prostate is absolutely flat."

Monitoring - 1999 onwards

• Blood chemistry:   PSA = <0.4 on 1/5/99 (Hybritech)
• Blood chemistry:   PSA = 0.287 on 1/10/99 (Immulite 3rd generation).
• Blood chemistry:   PSA = 0.221 on 2/14/99  (Immulite 3rd generation).
• Blood chemistry:   PSA = 0.233 on 3/14/99  (Immulite 3rd generation).
• Blood chemistry:   PSA = 0.21 on 4/20/99  (Immulite 3rd generation).
• Blood chemistry:   PSA = 0.188 on 6/30/99  (Immulite 3rd generation)
• Blood chemistry:   PSA = 0.358 on 8/19/99  (Immulite 3rd generation)
• Blood chemistry:   PSA = 0.262 on 9/19/99  (Immulite 3rd generation)
• DRE by Dr. Peter Grimm, 9/24/99. "Prostate is absolutely flat."
• Blood chemistry:   PSA = 0.177 on 4/30/00  (Immulite 3rd generation)
• DRE by Dr. Peter Grimm, 8/25/00. "Prostate is completely flat."
• Blood chemistry:   PSA = 0.080 on 8/25/00  (Immulite 3rd generation)
• Radiation Proctatitis:   Over 1998 and 1999, I experienced considerable lower abdominal discomfort. To alleviate constipation, I took daily doses of Yerba Prima "Daily Fiber Formula" (largely psyllium). In August 2000, Dr. Grimm referred me to Dr. Steven M. Wegley in Seattle. Dr. Wegley recommended that I stop the psyllium and substitute "Citrucel" (methylcellulose) at 1 tablespoon per day. In addition, he prescribed Miralax (Propylene Glycol 3350) at 17 gm per day. The abdominal symptoms were largely alleviated.
• Blood chemistry: PSA =< 0.1 on 1/02/01  (Quest Labs, limit of sensitivity of test)
• Blood chemistry: PSA =< 0.1 on 9/02/01 (Quest Labs, limit of sensitivity of test)
• DRE by Dr. Peter Grimm, 9/10/01. "Prostate is completely flat."
• Blood chemistry: PSA =< 0.1 on 1/11/02 (Quest Labs, limit of sensitivity of test)
• Blood chemistry: PSA =< 0.1 on 8/15/02  (Quest Labs, limit of sensitivity of test)
• Blood chemistry: PSA =< 0.1 on 11/20/03  (Quest Labs, limit of sensitivity of test using Bayer chemilumiscent method)
• Blood chemistry: PSA =< 0.1 on 4/05/04  (Quest Labs, limit of sensitivity of test using Bayer chemilumiscent method)
• Blood chemistry: PSA =< 0.1 on 4/07/05  (Quest Labs, limit of sensitivity of test using Bayer chemilumiscent method)
• Colonscopy by Dr. Steven M. Wegley in Seattle on 9/20/05. Three benign polyps were removed. Mild radiation damage was noted. Next colonoscopy scheduled for 2009.
• DRE by Dr. Peter Grimm, 9/21/05. "Prostate is completely flat."
• Blood chemistry: PSA =< 0.1 on 9/21/05  (Seattle Prostate Institute)
• Blood chemistry: PSA =< 0.1 in Sept 06 (Quest Labs, limit of sensitivity of test)
• Blood chemistry: PSA =< 0.1 in Oct 07 (Quest Labs, limit of sensitivity of test)
• Blood chemistry: PSA =< 0.1 in Oct 08 (Quest Labs, limit of sensitivity of test)
• Colonscopy by Dr. Steven M. Wegley in Seattle on 10/13/08. No polyps detected. Next colonoscopy scheduled for 2013.
• DRE by Dr. Peter Grimm, 10/15/08. unremarkable

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