Rex shares how he stopped routine PSA screening after hearing concerns about overdiagnosis, only to be diagnosed years later with metastatic prostate cancer that had already spread extensively to his bones. He reflects on his remarkable response to modern triplet therapy, the importance of seeking a second opinion and having a strong support system, and encourages men to stay informed, consider regular PSA screening, and remain hopeful as new treatments continue to improve outcomes.

My name is Rex Applegate, and my first familiarity with PSA testing was all of the stories in the media back 10, 12 years ago about how PSA testings were leading to false high numbers that led to major interventions that were unnecessary and causing all kinds of complications for patients who did not have prostate cancer, but had a false or a real high PSA. So I had a conversation with my doctor 12 years ago. I had one PSA test and it was normal and I had a conversation with him and I said, "Yes, I will stop doing PSA testing now."

And that turned out to be a bad decision, but it's my decision. I own it. It's on me. Well, I had some symptoms of fatigue and the doctor sent me through a whole bunch of lab tests. And at first they pointed to a liver problem, but then it pointed to bone problems.

So on Cinco de Mayo, 2022, I had a bone scan. And during the bone scan, the technician, five minutes in, said, "Do you feel any bone pain?" And I said, "No." And then 10 minutes later he says, "Have you ever been diagnosed with cancer?" I said, "No." And five minutes later, he says, "Are you sure you don't have bone pain?" And I said, "No." And then at the end of the session, he said, "God bless you."

So I thought, "That ain't good." I'm covered by Kaiser, and Kaiser sent the results of that scan later that evening. And I read the results and it was widespread metastasis in the ribs, hips, pelvis, spine, jaw, and head. So it was bad. That's how I learned that I had bone metastasis, didn't know what kind of cancer it was.

I did a PSA test. My PSA was 380. So my doctor told me, "Yeah, it's prostate cancer." And then during the examination of the bone scan, the doctor noticed, this is my primary doctor, noticed that there was a large growth and mass of cancer in my right hip, right pelvic area. So he was worried about that affecting the stability of the hip. So they did that emergency partial hip replacement so I wouldn't break my hip.

And during that, of course, they extracted some of the cancer and they tested it and verified that it was prostate cancer. So that's what happened with my initial time of diagnosis. I saw the report on the bone scan and my wife was there and I said, "I'm a dead man." That's what I said. I didn't know anything about what was happening.

Later, in the hospital, the Kaiser doctor came and said, "Yes, you have prostate cancer." And here's her words, never forget, she said, "It's not curable, but it is treatable." That gave me a sliver of hope that I wasn't going to die in 18 months. I was home recovering from the partial hip replacement and I was in a lot of pain and I was suffering. And at this point, finally, I had symptoms of the cancer for the first time, and I was at home and I couldn't go to see an oncologist until I was mobile.

So I saw the oncologist on June 1st of 2022, obviously, stage 4B prostate cancer, widespread metastasis. And she told me that she had just become aware of a new treatment regimen as defined in the PEACE-1 studies. And it was a triplet with Eligard and Zytiga and chemo, docetaxel or whatever it is. So I said, "Sign me up. Yeah, I'm for that."

I started Casodex that day. Eight days later, I was urinating more freely than I had urinated in 10 years. And I know now that was because the prostate was shrinking. I didn't know then. After I tolerated the Casodex, I went on Eligard. Two weeks after tolerating that well, I went on the Zytiga and I tolerated that well. So everything was copacetic. I was tolerating the drugs. I was getting weekly PSA tests and all the drug tests, and the PSA just nose-dived.

On August 8th, 2022, two months after, it became undetectable. And I've had tons of tests since then, it is still undetectable PSA. And the most amazing thing was I had a bone scan in December of '22, and the guy doing the bone scan was a different guy, and he didn't know I had cancer. He asked, "Why are you getting the bone scan?"

Because the writeup reported dramatically improved. And then I had another bone scan in April of '23, and it said, "Evidence of treated metastasis." Basically, then I had CT scans. No more MRIs because I got metal in my body. And the original CT scan had shown cancer in the prostate, cancer in the lymph nodes, and nodules in the lungs. Subsequent to the beginning of my treatment, the nodules disappeared.

Obviously, the lesions are still there and ready to recur, but since to this date, there is no progression. I should say this, that in terms of prognosis, at the advice of a friend of mine who's a retired emergency room doctor, he insisted I get another doctor's opinion too, and he gave me some names. And I contacted Dr. McKay's office at UCSD and went to her and got the second opinion.

She agreed with the triplet therapy and she'd seen my scans and she saw that I had a widespread aggressive cancer. And before she saw my first lab results and the second bone scans, she was ready to go to chemo right away. But my oncologist in Kaiser, who's more aware of those, she said, "No, there's no point in doing chemo now."

Then, when I went back to my second appointment with Dr. McKay, who was amazing, who's an credible doctor, she saw the new scans and says "Yeah, no point in chemo. There's nothing there to pound on with the chemo." After months and months and months with undetectable PSA and no symptoms and all that, her line to me was something I'll never forget. She said, "You're in a group of patients that has a positive prognosis." And my Kaiser doctor agreed.

So yes, I'm in this position now of lab tests every two months and whenever I get a next CT scan and a bone scan, we'll see, that's up to the doctors. But I'm in this situation now where I'm in a golden time where I'm blessed by a robust response to the androgen deprivation therapy. The side effects, yeah, I'm more tired. It makes you more tired and you adapt to that. I'm living my life with one caveat, I'm aware that there's a big giant scythe hanging over my neck and I'm one lab test away from a new crisis.

I have had occasion to join a group that meets once a month, eight or 10 of us get together, sometimes 12, and we are all in the same boat. We understand that we have this potential and you can't count on living four years or five years. You might, but we all agree on one thing, and I'm sure you've heard this over and over again, our goal as prostate cancer patients is if and when you start to recur and you have progression again, you utilize the latest, most sophisticated treatment that's available.

And I've asked Dr. McKay about it and I'm aware of the things that she would do right away and it's all over my head. But the whole point is that you try and buy some more time and it's called kicking the can down the road and dying with it, not from it. That's the goal. So that's where I am right now.

So I was blessed with an incredible support structure. It's just absolutely irreplaceable. It just makes a whole lot of difference. It changes your whole mental outlook about the future. I plan ahead no more than a year and usually six, nine months. We're going to Hawaii in April. We're trying Maui again, and we're trying to think of going somewhere in the fall.

It changes your perspective on life because you go through your entire life not thinking about it, and now you have to every day, but I'm doing good. I'm enjoying life and my grandkids come and visit and it's good. It's all good. I've had friends who did do their PSA tests and the cancer was detected early enough to do a prostatectomy. That's not a fun thing for them, but I think that their longevity projections are much better than mine. So, yes, I would have done the PSA tests.

The PEACE-1 protocols have a survivability of average of 54 months and I'm 36 months in. But my doctor told me that patients who have this zero PSA for as long as I've had, have a tendency to keep doing that for a long time. And the record for living on androgen deprivation therapy is 19 years. So you just hope you win the lottery, that's all. Just hang in there, power through it, do what you have to do and understand it is what it is, shit happens and it happened to you and that's the way it is and there's nothing you can do about it, so fight on.