Miguel Rueda’s story over the past decade has been about terrible luck, being lucky, and then making the most of that luck.

It was fall 2014, and Rueda, then 42, was the University of Colorado Athletic Department’s senior associate athletic director at the time and knew the difference between normal discomfort and something else.

A “something else” led him to request a physical with CU football’s team physician, University of Colorado School of Medicine and UCHealth Sports Medicine’s physician Dr. Sourav Poddar.

Rueda’s prostate-specific antigen (PSA) number came in at about 30 ng/mL – well above the normal range. A couple of weeks later, he followed up with CU School of Medicine urologist Dr. Al Barqawi. Yet to see that number, he asked, “What are you doing here? You’re too young to be here.”

Men without risk factors (being African American and having and immediate family members with a history of prostate cancer, principally) don’t usually test for prostate cancer until they’re 55, and most diagnoses happen with men in their 60s.

“I don’t want to be here,” Rueda responded. “Can you just tell me why my PSA is so high?”

A biopsy showed cancer with a high Gleason score throughout the prostate, and further testing found more troubling details. In addition to the typical adenocarcinoma, Rueda’s prostate contained a rare small-cell neuroendocrine cancer which would complicate treatment. And the cancer had spread to nearby lymph nodes, the seminal vesicle, and the bladder. Rueda’s PSA had had skyrocketed to 95 ng/mL. Few patients in such straits survive five years.

He got the news via cell phone on Jan. 20, 2015. He was driving in his hometown of San Francisco with his wife Andrea, his brother Kevin, and his kids Gabriel, Isabella, and Christopher, who were 12, 10, and 9.

Barqawi told him: “You have cancer, and it’s not good.”

“I can still hear his voice,” Rueda says.

Multimodal prostate cancer treatment starts

Dr. Elizabeth Kessler, a CU School of Medicine genitourinary medical oncologist, and her colleague Dr. David Raben, a radiation oncologist, took the lead in Rueda’s care at UCHealth University of Colorado Hospital on the Anschutz Medical Campus.

They and University of Colorado Cancer Center colleagues including pathologists, urologic oncologists, and surgical oncologist Dr. Paul Maroni considered options for Rueda’s treatment. The goal was to extend his life. They considered approaches including surgery, radioactive pellets (brachytherapy), radiation, chemotherapy, and hormone therapy.
They settled upon the latter three. Given the cancer’s spread, a prostatectomy to remove the prostate would be no more effective than radiation in treating Rueda’s cancer, they determined. They suggested he seek out a second opinion, which he did, and which met with agreement. The treatments started with hormone therapy plus radiation therapy in spring 2015.

The goal of hormone therapy, Kessler says, “is to take away much of the fuel source to the prostate-cancer cells by lowering the amount of circulating testosterone in the system.” Radiation therapy, which Raben performed Monday-through-Friday for several weeks, attacked the cancer cells head-on. In late summer, Rueda started what would be six rounds of chemotherapy (docetaxel) that wouldn’t end until just before Christmas.

Given the diagnosis and the demands of treatment, Rueda transitioned earlier than planned to a new role at CU-Boulder, becoming associate athletic director for health and performance. Mike MacIntyre, CU’s head football coach at the time, floated the idea of helmet stickers or T-shirts in support of Rueda during his cancer fight. Rueda shut it down.

“It was a wonderful gesture,” he says, “But you know, I’ve been behind the scenes my entire life, and I thrive there. I worked really hard, and I loved what I did, but people like me aren’t always comfortable being pushed out into that sort of spotlight.”

A new drug for prostate cancer: olaparib

The treatment quelled the cancer, and his PSA numbers plunged. Less than two months after finishing chemotherapy, the former high school cross-country runner did his first-ever half marathon in Austin, Texas, and then followed up with the Steamboat Marathon in June and the Portland Marathon in Oregon in October. But by then, despite staying on hormone therapy, his PSA numbers were on the rise, and cancer had spread to lymph nodes in his neck.
Kessler put Rueda on abiraterone acetate (Zytiga) to further suppress male hormones. But, within months, the cancer was resurgent.

“Oftentimes, men can be on abiraterone and can maintain stability for a couple of years,” Kessler says. “Unfortunately, in Miguel’s case, the cancer was shown to grow in less than one year on it.”

Here is where good luck finally made its appearance. Raben, the radiation oncologist, had been working with ovarian cancer patients on a drug called olaparib (Lynparza), a PARP inhibitor. The drug impedes cancer cells’ ability to repair their own DNA, which slows or stops tumor growth. Kessler and Raben had also noted a small study published in the New England Journal of Medicine that found the drug, used off-label, seemed to work for prostate cancer patients.
Cancers with the BRCA2 mutation best known for its complicity in breast and ovarian cancer seemed to respond particularly well to olaparib – and that mutation was found in Rueda’s cancer (though not in his normal cells, meaning the cancer had developed the mutation despite his not having inherited it).

Kessler convinced Rueda’s insurance company to cover olaparib, which he started taking six months before focal radiation therapy on the lymph nodes on his neck. By late 2018, Rueda’s PSA numbers had plummeted.

Making the most of gifted years

Six years later, he’s still on hormone therapy and olaparib, which the U.S. Food and Drug Administration approved for prostate cancer in 2020. His PSA is below 0.2 ng/mL and his scans are clean.

Rueda has not let his good fortune go unexploited. He talks to his older son Gabriel, now a senior at West Point, almost daily. He and Andrea fly to San Antonio, Texas, to watch Isabella play soccer at Trinity University. Son Christopher is running track and gearing up to graduate from Broomfield’s Prospect Ridge Academy. The Ruedas have skied the Swiss and Austrian alps and traveled together to Spain and Turkey.

“I’ve had this conversation with both my daughter and my son recently, for different reasons – they brought it up,” Rueda says. “I have to be careful how I say this: I’m not grateful for the disease, but I appreciate how much it’s made me a better father. How much it’s made me a better friend, a better husband.”

He continues to work hard for the CU Athletic Department. He lifts weights and does cardio, which Kessler and colleagues recommend to all patients on hormone therapy. And he’s on a medication to help maintain bone density. But fatigue from having his testosterone supply throttled for nearly a decade does weigh on him.

“A low testosterone level is going to cause a body mass loss, bone density loss, increased blood pressure, increased blood sugar, increased cholesterol,” Kessler says. “We’re basically trying to work against all of these side effects that we know occur.”

Despite Rueda’s disinterest in the spotlight – and in being known as a cancer patient rather than the person he is – he’s sharing his story, because someone else once shared theirs. She was a breast cancer patient with a slim chance of survival.

“I think she was given a 2% chance to live, and she beat the odds, and she was sort of there for me as a person,” Rueda says. “So, if I can help people with this diagnosis, if I can help others see that it’s possible, I’m going to do it.”

In January, Rueda formalized his role in helping other cancer patients by becoming co-chair of the University of Colorado Cancer Center’s Office of Community Outreach & Engagement’s CARES group.

He’s grateful for the years he has gained and the help he’s gotten along the way from family, friends, physicians, nurses, and so many others.

“I fully believe that there’s a physical part of things and there’s the mental, and that has an impact on the physical. My doctors and caregivers from UCHealth allowed me to have the right mindset that I’m sure has extended my life,” Rueda says. “I never thought I would live nine years, right?”