Today I started my treatments. Not as bad as you’d think but still I’ve got awhile to go. We (my wife and I) chose to do external beam radiation as the primary treatment and today I finally started what is going to be a six week treatment plan.
There are a lot of treatment options and given my overall health and age this course made the most sense. Let me explain how we got to this decision.
After the shock of “the call” wore off and I was able to think again we got an appointment at the cancer clinic. First my urologist emailed me some links to information and the cancer clinic’s web site. Then both Heather and I did our research and we made this long list of questions, and printed it out.
At the first appointment in the clinic we met with a nurse, urologist and radiation oncologist. The first thing they did was to give us this folder with all kinds of information – basic prostate cancer facts, treatment options, lists of resources and a printed copy of the pathology report.
The nurse showed us all the info and had us watch a short video on the clinic then the urologist came in. She the went though the pathology report line by line explaining what each item meant and where I was in the scale of things. For those of you who want to know here are the basic stats: 2 out of 14 cores with cancer cells, Gleason 3+4, stage T1C. I won’t bore you with the other details. Basically this is an intermediate stage cancer that is most likely contained in the prostate, probably – maybe a little on the edge there on the lower left. Mostly good news but still something was there.
That answered about a third of the questions on our list and made some pointless to ask.
There are a number of treatments and it boils down to about 5 basic choices (of course there are variations but basically this is the list):
Active surveillance (or watchful waiting) – do nothing and see if it gets worse
Surgery – yup, rip that sucker out.
Drugs – hormone therapy
Brachytherapy – stick radioactive seeds in to the prostate
External beam radiation – sit in front of a linear accelerator for six weeks
Personally I was hoping for the do nothing option – I’ll just go home and come back when you’re not so busy with all these sick people. Okay?
“,”No said doctor. “This cancer needs to be treated.” What was annoying about that answer was that she pointed to the pathology report and the factors that indicated treatment. I hate it when they are right.
I have a bit of high blood pressure so the urologist thought hormone therapy wouldn’t be a good first choice. We ruled out surgery because of concerns about my breathing and weight while under general anesthesia that came up during my gallbladder operation. Surgery would be a good choice but not really worth the risk factors for me. And I really didn’t want surgery – I told the doctor, “If I am dying you can operate. Otherwise I am still using my prostate and if there are other treatments I’d like to try those first.”
She agreed and that was it for urology. She handed me back the report, looked at our list of questions and said, “I think radiation is a better choice I’ll get the other doctor.”
Then the radiation oncologist came and quickly agreed with his colleague. I was interested in the brachytherapy where they implant the radioactive seeds because it would be a one time treatment. Well turns out that would require general anesthesia and would have some of the same risk factors as surgery. Also the pathology report showed a slight chance of there being some cancer on the capsule that surrounds the prostate. The doctor explained that the seeds don’t always get that but the beam radiation can be set to do that.
Well then – there ya go. External beam radiation here I come. I’ve always wanted to play with a linear accelerator…
Frankly I thought the choice would be harder but the facts in my case just dropped right into place and the decision made itself. I do credit the doctor with a bunch of sensitivity and not pushing us to a decision. We all thought beam radiation was the best choice but he said, “Well, why don’t we see if it passes the sleep test. I’ll send a note to your urologist about what we talked about and you let me know later in the week what you want to do.”
I was very sure at this point that I wanted to proceed with the beam radiation. All the answers to our question in the sheet made the choice quite clear. He did agree to tentatively schedule the next step in the process but he would still have a staff member call in a few days to confirm. I like my doctor. Cool dude – haven’t found out if he’s a surfer yet but he looks like he could be a suffer dude. Bet he drives an old beat up VW bus and has the Santa Cruz tide tables memorized.
Anyway, the decision did pass the sleep test and it was off to treatment land. They give you this long list of possible side effects that sound scary but I am not going into that today. I’ll just report what really happens.
The treatments started with the placement of gold seeds into the prostate. Yup – back to the biopsy lab and have things put in rather than taken out. Read my post on the biopsy for details. Same fun but only three sticks not 14. I’ve been telling my friends that I now have gold balls. One friend asked, “I thought it was brass?”
My reply, “You need brass balls to let them stick gold balls up your rear.”
Then you have to wait for about ten days for the next step which is a ride in the CT machine that they call “simulation.” Here is the text of an email I sent to a friend describing the procedure:
Today I got a CT scan to verify the targets in my prostate and create the treatment program which included fun activities like getting shaved, having “permanent markers placed” and getting “contrast” injected into the prostate.
Guess where they shaved.
The contrast goes in the output.
Now I have three little tattooed dots on my hips and where they shaved so at the next visit they can accurately place my body back on the machine. When they said “permanent” markers I wasn’t thinking it would include ink in a needle – something else I got wrong.
Before the little treatment they had me drink 32 oz of water so I would have a full bladder – let me tell you how fun that was to lie still for 20 minutes when I really needed a toilet. Well I did manage to stand up without flooding the floor and I guess Heather is right – I can move fairly fast when properly motivated…
Other than that I am having a great day. 🙂 <- SEE MY SMILE.
My friend’s reply was, “Great a man turns 50 and the next thing you know he’s shaving body hair, getting tattoos and drinking heavily.”
For the record – the water drinking part was the worst, so over all not a bad deal.
After simulation I had to wait another 10 days while the doctor checked the scans and programed the data for the real treatments.
Today was my first real treatment. I’d like to complain about the procedure but I can’t. It was easy, painless and the staff at the clinic treated me great. The only thing that was weird was the water. For every treatment you have to have a full bladder. The instructions are to drink 32 oz of water an hour before the treatment. And then don’t pee until and 90 minutes later – after the treatment. And you have to lie completely still for the last 20 minutes.
So if that is the only thing to complain about. Cool.
I’ll be doing periodic updates on my treatment with a few supplemental posts on prostate cancer related topics I’d like to pontificate on.
I went the seed implant route with conformal radiation afterwards. The side effects were much less going this route, although I did have to go under a general as you say. For the conformal radiation they just used magic markers covered with clear tape fo alignment. I was never shaved and wasn’t supposed to drink but a little water before each session. Despite repeated attempts I never got a good dean of how much a little water is…
I’m relieved that your radiation treatment was not scheduled at the Stanford linear accelerator.