To continue my attempt to share information about recurrent and advanced prostate cancer I have been providing stories of different people’s journeys through the world of prostate cancer. To add to Scott Goodwin’s story I am now going to occasionally publish a story that is a little different.

Pradeep Raj who lives in India has agreed to share his journey. I do not know what his story will eventually entail, but already the stark difference I see is that his prostate cancer was only diagnosed after it had spread to his bones and his PSA had soared. His story speaks to the need of early screening, an issue that in the United States is again up for debate.

Malecare has adapted a policy that only partially supports the NCI Guidelines for prostate cancer screening. We believe that PSA screening must start with all men at age 40 years and at 35 years for men with a direct family background of prostate cancer and for African American men. We do not want to see men only diagnosed once their prostate cancer has spread outside the gland and is no longer curable as is the case with Pradeep.

Now here is Pradeep’s first installment of his journey:

I name is Pradeep Raj and I come from Hyderabad, a reasonable sized city in India. I am a native of the city and continue to love living there. Unfortunately, I have become a little unhappy to see old buildings beginning to disappear, old ways disappear and roads becoming increasingly congested by the day. However, we do have some of the finest hospitals, software centers, colleges, research institutes and pharmaceuticals companies.

I am a Ph.D. geologist and currently work as a hydrologist for the government in the Ground Water Department. I take an interest in teaching and research having published many papers in my field.

In April 2006, on the 2nd Friday of the Month I developed a backache. I skipped work thinking that the backache was caused by my spending too much time at my PC. After resting Friday to Sunday I returned to work on Monday, forgetting about my back problem.

June 2006 I felt a severe throbbing pain in my right thigh. My doctors found a little inguinal hernia that they felt was the cause of the pain. I was given painkillers and subsequently started stomach acid blockers (Proton Pump blockers). I had hernia surgery on 2 August 2006.

Post surgery I was put on the usual routine of antibiotics along with analgesics and antipyretics. As soon as the analgesics were stopped my pain returned! This time the pain radiated down to and below my knee.

My doctors referred me to an orthopedic surgeon. His initial diagnosis was Sciatica, but he was frank enough to tell me that it did not look to him like a classic case of sciatica.

He put me on Diclofenac, a powerful (non-steroidal) analgesic. My symptoms continued so the drug was changed to an extended release version. I still did not have any relief from the pain. Five weeks later I had an MRI.

On 30, September 2006 I had the MRI. I obtained a copy of the MRI images and was able to view them myself using software that allowed some image manipulation as well as image enhancements.

I thought I was seeing lesions in the MRI, so I downloaded other images of lesions that were available on the Internet so that I could compare the images to my MRI. I did this until my hard disk was completely full. I contacted a colleague, Raje, and told him that I suspect something was terribly wrong with me. His comment was simply that I must be mad!

Finally, he took me seriously and called up the radiologist and told him of my fears. Even though it was Sunday and a festival at that time, the radiologist agreed to go to his office and evaluate the MRI images. The radiologist gave Raje the report stating that nothing is confirmed and wished us luck.

At the same time I called my orthopedist and convinced him to schedule an emergency appointment with me. I then told my wife I might have cancer! Along with my wife, Suhas, I went to the orthopedist’s office. I read the radiologist’s report, which said … multiple myloma? Metastases? Lymphoma?

I knew from viewing the MRI images on my PC that I probably had cancer. Despite that, when I read the report tears rolled down my cheeks as I was still hoping that those images were only a figment of my imagination. Unhappily I had been right!

That changed me. I had no idea for how long I will live. I knew metastatic disease meant quick death. Tests for biomarkers were ordered and the wait for the results was agonizing! Each second felt like eternity.

In the interim I was treated for the pain with opiates (Tramadol), but I barely experienced any relief from them. I also started reading about all types of cancers. I quickly find the National Institute of Cancer (NIC), the American Cancer Society (ACS), and so on.

I finally got the results of the blood work from a local lab (Vijay Diagnostic Centre) and a reputed lab in India (Ranbaxy, Bombay). The results from both labs were in agreement; my PSA was 63 ng/mL as reported by Ranbaxy and 70 ng/mL as reported by Vijay.

I had some additional tests as well as a biopsy. What a surprise, nobody expected that I had prostate cancer with distant skeletal metastasis and lymph node involvement! As I feared, I was diagnosed with stage IV prostate cancer. I had a Gleason Score of 7 (4+3).

I was put on an androgen blockade (ADT) along with painkillers. Within 9 months of starting the blockade my cancer became hormone refractory. I am now taking Docetaxel and Prednisone, of which I will write more about in the future.

Being a scientist and being very curious my small home library has become full of books and papers about prostate cancer. I am madly trying to understand what all of this means.

With kindest Regards,


Joel T Nowak MA, MSW