Steve Fabiano:
My name is Steve Fabiano and I am 68 years old. I'm a retired fire chief. And my wife and I have also owned our own restaurants and convenience stores. I was diagnosed when I turned 60, and it was quite a surprise for us. I really didn't know anything about prostate cancer. When the urologist called us back and gave us the results of the biopsy, I didn't know what a Gleason score was. Even though I did do annual checkups for my PSA and DRE, it somehow slipped by everybody. And I was diagnosed with a Gleason 9 and stage 4. So it was quite shocking. And again, we didn't know anything about prostate cancer. So of course we started with Dr. Google,. And the more we did research, the scarier it got.
And so my urologist recommended first thing it would be surgery. Back then that's pretty much the standard of care was surgery and then go from there. So in 2017, I had a prostatectomy. And after the pathology report came back, there was positive margins. So it had spread past the prostate. So now we were talking about other treatment plans. And that's when we switched from a urologist to a oncologist. They decided to start me on ADT and hormone therapy. And that helped the PSA down for a while, but it progressed again. And then we then went into radiation back in 2018, before the PSMA PET scans were available. I went to the University of Michigan and they gave me one based on a clinical trial.
So that came back and that's when we found some spots and they were radiated. And that held my PSA down for a while again, and then it started going back up again. So then we started chemotherapy. I did three different chemotherapies. I did docetaxel. I did Taxotere and carboplatin, about a year's worth of chemo. And that got my PSA down for a while, and then it came back. So then we started with immunotherapy, did a genomic testing, and found out that KEYTRUDA would work and/or NUBEQA. And we did both those with no good results. So then we weren't sure exactly what we were going to do. Help me out here if I'm getting lost.
Cindy Fabiano:
You're doing a good job.
Steve Fabiano:
And then back in last fall, back in September of 2022, it really got bad. It spread to my abdomen. The prostate cancer spread to my abdomen, and it caused ascites, which is the tumor cells could connect to your abdominal wall and cause fluid to build up. And they didn't really have a treatment plan. They decided that they were going to put in a drain tube into my abdomen. And we drained... More my wife did. Every other day, she drained a liter of fluid off, off of my abdomen. And it got so painful. A lot of the fluid had blood in it, so I was anemic. I was getting blood transfusion, and I was spending time in the hospital. I was bedridden for a month, pretty much checking out. It was about the end of life.
I went to Mayo Clinic and they did a PSMA PET scan and said I was eligible for Lutetium-177. This was in November of last year. The problem was they didn't have any. There was a shortage of it. And as soon as they thought they could get it would be January or February. And I knew that I'd probably be dead by then. So went back home to little Grand Rapids, Michigan. And my oncologist said, "Well, there's a place right next door and they've got it." I said, "They have Pluvicto?" And he said, "Yeah. They're a new company. It's called BAMF Health." And we went over there and within a week, I had the first treatment. And my ascites started going down. The pain stopped. By the second treatment, I was back to normal. I was playing golf and pickleball and bicycling. And it was just amazing. So that's my journey in a nutshell.
Cindy Fabiano:
I think the biggest thing we learned was you have to be your own advocate. We were everywhere. We started out with the urologist. And we went to one cancer center and we weren't really happy with... He was an oncologist, but he didn't specialize in prostate cancer. So then we went down to U of M and were there for a couple of years. Then we went out to Mayo. Then we went to Lemmen-Holton. And then we ended up with BAMF. So we've been everywhere. It is just a scary journey. It was the unknown. What Steve didn't mention was when the doctor first gave us the diagnosis, we looked at each other because his PSA wasn't elevated and we didn't know... All he did, he gave us a little scratch paper with his cell phone number on it, and he said, "If you need to call me." And we're like, "Okay." And he says, "Well, you have a Gleason." And he's going on and on. And we're like, "We have no idea what the man's talking about." He didn't explain any of it to us.
And that's where we got into the loop of the Dr. Google. And it was scary, because there's so much information out there that it's overwhelming. But we've been everywhere. I mean...
Steve Fabiano:
Yeah. And that's a good point, is you really have to be your own advocate. There was one oncologist that didn't want to do chemotherapy. He said, "That's the last thing you want to do." So that's when we switched to Mayo and they said, "Yeah. Definitely. You need to do chemo." And a lot of other treatments that as far as the hormone therapy, there was ZYTIGA and there was XTANDI. And we progressed on so many different treatments, but we had to really help ourselves out in doing that. And I don't know if it's that way for most prostate cancer patients, but you just have to advocate for yourself. That's all there is to it.
Cindy Fabiano:
You know what? Another thing that was really important that helped a lot was Steve was diligent on his journal. Every doctor visit, he would write down every statistic and the notes that the doctor... You don't think about it at the time. You think you're going to remember things, but you really don't. We can go back years and we could see, "Oh, your PSA was whatever. And after this treatment, it was that." So it's very helpful. So that was a really good thing to do.
Steve Fabiano:
Yeah. And keeping track of the side effects, because all these drugs have some very severe side effects that you have to live through, but it's better than the alternative. The first thing was obviously the prostatectomy. And that was so invasive. And I'd never been sick. I'd never even been to the hospital prior to my diagnosis. And wow. Mentally, I went... After I found out that there was positive margins and that they didn't get it all, I went into a pretty deep depression mentally. And thank goodness for my wife. She was right there and she helped me through it. And I can understand where a lot of guys. It's life-changing. It's huge in a lot of respects. And it's demeaning too as a man. So when you go through that surgery, it's tough. And then you start to hormone therapy. Oh, my goodness. The side effects on that are just... I don't want to scare anybody but... And I'm sure most men know of once they get on hormones. I mean, it's kind of like menopause. You get hot flashes. You lose your muscle mass. You're fatigued. You're weak. It's just-
Cindy Fabiano:
Your emotions.
Steve Fabiano:
Your emotions are up and down. It's just hard on you. But we've made it through depending on each other, and it's really helped.
Cindy Fabiano:
It's a disease that men get, but it's both of ours cancer. I mean, it's not just his because it is us. So he didn't ask for anything. It's just we stand behind each other.
Steve Fabiano:
Luckily, because physically before the cancer diagnosis, I was in pretty good shape, pretty healthy. And so when I did the 24 days of radiation, I really didn't have any side effects from that. When we started the chemotherapy, of course, I had side effects from that. Obviously, I lost my hair. What other things?
Cindy Fabiano:
I mean, nausea, just-
Steve Fabiano:
Not anything major. I handled the chemo pretty good. The worst is what I talked about earlier, the hormone therapy and the surgery.
Cindy Fabiano:
The ascites.
Steve Fabiano:
And once it spread to my abdomen, that was the worst.
Cindy Fabiano:
And it happened so quickly. We were somewhere the last day of August, and so it was right before Labor Day. And he started getting the shortness of breath. And within seven days, he was in the hospital and they drained off four liters of fluid off his abdomen. And then five days later, he was back in the hospital and they did another four liters. And that's when they put in the drain tube. So within... I mean, it was days that it went from that to... The ascites, the side effects of it is the shortness of breath because there's so much fluid and then he couldn't eat because it pressed on his stomach. I mean, we didn't think that battle was ever going to be beat.
Steve Fabiano:
Right. And my PSA at that time was 815. And then when I had that first treatment of lutetium, it went down to... What-
Cindy Fabiano:
42.
Steve Fabiano:
42, on the first treatment. So I mean, it was huge. And I know that the Lu-177 affects everybody differently. Unfortunately, it doesn't work for some men. So I'm not really sure why that is. I know you have to have the PSMA expression for the lutetium to attach to your cells, but sometimes it doesn't work. It's unfortunate.
Cindy Fabiano:
And it didn't get all of the... His PSA, it didn't go away. It's still around between five and six. So...
Steve Fabiano:
But we had done a scan afterwards and they found one small metastasis on my right hip. And I just had that radiated. So I haven't got the results back from that. So they're hoping that that was causing the PSA to be around five and that it'll drop back down. So I'm looking forward to that next checkup. This was years after. This happened last fall. So that was...
Cindy Fabiano:
The mastectomy was in '17.
Steve Fabiano:
That was 2017, so...
Cindy Fabiano:
And this is in '22.
Steve Fabiano:
It was six years that I had tried all the treatments. And then that's when it started getting really bad, so... And my first appointment with the oncologist back in 2017, he told me I only had two years to live.
Cindy Fabiano:
12 to 24.
Steve Fabiano:
12 to 24 months with stage 4 metastatic prostate cancer. And that was tough to take. And I don't know why anybody would do that, say that, because who knows how long you've got to live? And here it is six years later and I'm still here. So that would be one thing that I would hope that they would change is trying to say, "Hey. You're going to be dead in 24 months." So...
Cindy Fabiano:
But what else was interesting is the PSMA scan, because his PSA was... Before the chemo, he had the PSMA scan and it didn't show anything. Many times it did not show anything. So we're like, "Oh, okay." He didn't qualify for the Lu-177 until this past November when it finally showed when it got into his abdomen. And we were excited that they were showing because before that, it was... You would think that you'd be able to see it with prostate cancer all through your body, but nothing. Nothing would show.
Steve Fabiano:
Yeah. The metastases were too small. No. It's very rare. It's not rare that your prostate cancer spreads to other parts of your body, but to spread to an organ, it's pretty rare, and then to spread to an abdomen is like 10% of patients it happens to. That's why nobody had a treatment plan. They didn't know exactly what to do. And if it wouldn't have been for Mayo Clinic and determining that I was eligible for Lu-177, I'm not sure what we would've done. Probably I wouldn't be here.
Cindy Fabiano:
That's right.
Steve Fabiano:
This lutetium is so new, nobody knows what the long-term prognosis is going to be, but right now, I feel better than or I feel as good as before I was diagnosed. And the last six years I've been in a lot of pain and a lot of side effects. And this is truly the best I've felt. And nobody knows how long it's going to last. It could come back next week. It could come back next year or five years from now. Hopefully, it's a long-term thing. But nobody knows. So we're just hoping for the best.
Cindy Fabiano:
We still have three treatments that will be available. So you can have six. And so they're saving the last three.
Steve Fabiano:
Yeah. And that's a new thing too. When they had the clinical trial to approve this Pluvicto, they gave six treatments. Because of the toxicity, they figured that six treatments was the most you could have. And they gave the whole six treatments. Didn't matter what your PSA or anything else your metastases were doing. Well, I've done so good on it that they said, "Let's save these last three treatments," so when it comes back, I can still use them. So that's exciting too, because it's going to come back. There's no cure for it. So it will come back. It's just a matter of when.
Cindy Fabiano:
Actually, we started having Sunday dinners. We have 13 grandchildren. And as many of them could come, they came and they all brought food. And Steve, it drove him crazy because he was exhausted and really wasn't hungry, but it was important for the kids to be able to see him. And so it worked out. It was great. They really rallied and... Yeah.
Steve Fabiano:
I'm going to reiterate what Cindy said, and that's to advocate for yourself. That is so huge. Do your research. This is going to be a great website that you're putting together because that's exactly what we need. I'm just amazed, after I was diagnosed, I started talking to friends and everything, how many men had prostate cancer. I never even knew it. And I'd ask them, "What was your Gleason score?" And they'd say, "What's a Gleason score?" I just was amazed. And September is prostate cancer month. And I asked everybody, "Do you know September's prostate cancer month?" Nobody knows that. There's no fundraising. There's no races for the cure. Men are not organized. That's what they need to do. They need to advocate for themselves and they need to get involved and they need to talk about it. Because once I would say, "Well, you do? You have prostate cancer? What'd you do?" and then all of a sudden, we were having a big conversation. I was finding a lot of information out. So that's what I would hope that your website can do, is get the information out.
Cindy Fabiano:
Oh, just love him. That's the biggest thing. Stand behind him. Even the side effects of your first... When they did the biopsies, I mean, we didn't even know the side effects. And remember, you were bleeding so bad and we thought, "Oh, no. Is this normal? Is this abnormal?" It's the lack of communication that the doctors have with the patients about things that... They assume that we know a lot and we really don't. They need to educate patients better.
Steve Fabiano:
As a typical man, I didn't say anything and I just kept on going to work and didn't want to burden anybody with anything. So again, that's thinking of men, and so...
Cindy Fabiano:
Men don't like to share, especially publicly. And if they'd realized how many men this affects, it might make a huge difference.