Disclaimer: I am not a doctor, nor is any of the information in this blog a substitute for informed medical opinion or treatment. If you have questions, talk to a doctor. If you still have questions, talk to another doctor. The information below may or may not be accurate today or in the future when you read this.
September 24, 2013: Well, I’ve had an interesting last few days.
I thought long and hard about whether to share this information on the internet. In the end, I decided that there are lots and lots of men who will be going through what I’ll be going through over the next weeks, months and years. So if you find yourself in my position and are doing research for what’s in store for you, I hope these blog entries prove helpful. This is my journey.
To set the stage: I went in for my annual urology exam a couple of weeks ago. I had no complaints and no particular issues. It’s just something that I’ve done for a few years due to my genetic history: my father was diagnosed and successfully treated for prostate cancer back in the 1980′s, so I’ve known for many years that I was at risk for developing the disease as well. A lot of men do: 1 in 6 American males will be diagnosed with prostate cancer in their lifetimes; even more older men have it and never know it before they die of something else. It is the second most common cancer in American men after skin cancer. And if you have a family history of prostate cancer, your chances of being diagnosed with it are even higher.
So knowing that was a possibility, I’ve been careful to get annual checkups since I hit my 50s. My PSA (prostate-specific antigen, measured with a simple blood test) has been running at about 0.7, which is quite low and a very good indication that there isn’t anything going on with the prostate. This year, however, it doubled to 1.4. Now, usually a PSA below 4 is considered normal and is not cause for alarm. However, given my family history, my urologist strongly suggested that I undergo a biopsy just to make sure there wasn’t anything to worry about. He told me that there was about a 70% chance that the biopsy wouldn’t detect anything abnormal and only a 30% chance that they would find cancer.
Unfortunately, I came out on the short end of those odds. Of the 14 samples they took in the biopsy, 2 came back with a small amount of cancer (one contained 4% cancer cells, the other 10%). My Gleason score was 6(3+3) out of a possible 10 (which is considered low-grade).
So the bad news (which was not entirely unexpected): I have developed prostate cancer. I’ve assumed for a long time that I probably would at some point in my life–I was hoping that it would be later rather than sooner, however. The good news: it’s been caught at a very, very early stage and is 1) not immediately life-threatening in any way, and 2) highly treatable.
Now if I were a few years older, one of the recommended actions is today called “active surveillance”–which is basically to do nothing except keep a watchful eye on your PSA. If it stays below about 10 (your mileage will vary) then don’t bother treating the prostate cancer at all. After all, if you are 85 years old, why bother treating a slow-growing, low-grade cancer when you are probably going to die from something else before your prostate cancer becomes life threatening? Given my family history and the fact that my PSA had doubled in the last year, that isn’t really an option for me at age 58. Although, if there was some promising new treatment on the horizon that wasn’t quite yet approved and accepted, I’d *probably* be safe in doing nothing for a few years until the new treatment was available. My urologist suggested that if I did nothing, in 10 years there was only about a 30% chance that the cancer would kill me (hmmm…I’ve heard those odds before somewhere…).
Since there doesn’t seem to be anything like a pill that I can take that has a 100% cure rate on the horizon anytime soon, I have several options to rid myself of the cancer before it becomes a problem.
First is surgery. Ugh. Even though my surgical options today are far more attractive than when my father had his surgery in the late 80′s (minimally invasive robotic surgery vs. the traditional surgery), it is still surgery and it still has risks: chief among them being incontinence and impotence for at least several weeks, perhaps months, and possibly forever (unlikely at my age, but so far in this journey I haven’t exactly fared all well with the odds). The benefit of course is that the cancer is quickly removed (a couple of weeks to schedule the surgery, an hour or two for the surgery). Zip, snip, gone. A night in the hospital, a few days off work, a few weeks (normally) for a full recovery, and a high success rate: in excess of 95% for my stage cancer and my age group.
The other major option is radiation. Until a few years ago, radiation was considered a poor option compared to surgery (and still is for some patients, but for mostly different reasons than before). Radiation treatment uses ionizing radiation (x-rays, in the treatment I considered, but there are other options) to damage the DNA of the cancer cells so severely that they cannot reproduce. Unfortunately, it does the same thing to normal, healthy cells–which used to be a common and unavoidable side-effect of radiation treatment. So the trick in using radiation to treat cancer is to target the radiation accurately enough so that the cancer cells are disrupted, but do so in a way such that as little normal tissue surrounding the cancer is harmed as is possible. As you can imagine, there are a lot of very important structures *near* the prostate that you don’t want damaged (see “incontinence” and “impotence” for starters). Fortunately for me, radiation treatment via x-rays has become much more targeted in recent years and has a very good success rate of treating the cancer without overly damaging the surrounding tissue (feel free to read up on RapidARC if you are interested). Today, the success rate for this type of radiation treatment is approximately equal to that of surgery: both north of 95%. And the radiation treatment has far fewer side effects: flareups of hemorrhoids if you have them, possible diarrhea, and possible difficulty urinating if the urethra becomes irritated during treatment: all of which are treatable and subside once the radiation treatment is concluded. Unlike surgery, there’s no hospitalization, no time off required (other than the 10 minutes of so per day of treatment–8 of which is prepping for the actual radiation treatment–5 days a week for 9 weeks), no recovery time, and minimal of side effects risks (other than one big one I’ll tell you about shortly) other than those I’ve already mentioned. And in my case, the treatment center closest to my home is less than 2 miles away.
The one big side effect to be aware of isn’t really a issue for someone my age, but would be if I was much younger: the treatment itself can *cause* other cancers (why do you think radiologists step behind lead shields when operating x-ray machines). I was told by my doctor that I’ll have about a 1% chance of contracting some other cancer from the treatment in the next 30 years. Well, in 30 years (assuming I don’t get run over by a bus before then) I’ll be 88, and who knows what cancer treatments will look like by then. So it’s not something I’m going to lose sleep over.
There are other treatment options, of course. Some approved and some you have to travel to other countries to receive. If I had a late-stage aggressive cancer where neither surgery or radiation had a high success rate, I’d certainly be giving some of them my attention. Since I don’t, I’ve decided to go with the radiation treatment. Approximately equal success rates for curing the cancer, and far fewer risks and side effects as far as I’m concerned. For me, it seems like an easy decision.
I start treatments next week, and I’ll keep you posted as to how it goes.
October 1, 2013: At the beginning of last week, I went in to the oncology treatment center nearby to have a CT scan done in preparation for my radiation treatments. Fortunately for me, the treatment center is less than two miles from my house, so it’s a quick five-minute trip to get there most mornings (perhaps six if the traffic light down the street has just changed).
Now, I’ve had CT scans before so I knew in general what to expect. But there were still a couple of interesting wrinkles. After a short wait (why, Dear God, do doctor’s offices in Florida invariably have Faux News on–with audio–in waiting rooms? Ugh!) I was directed to the CT scanning room, and instructed to lie on the scan table. The radiology technologist had me lay on a sheet (so she could easily move me around) and put a blue padded mat underneath my legs. After she had me positioned where she wanted me, she drew three target cross-hairs on me with what amounts to a Sharpie pen: one on each hip and one on my abdomen below my navel. Then, she hooked the blue padded mat to a hose of some kind and filled it with what I imagine is something like spray foam insulation: It puffed up a bit before hardening as she formed it into a soft molded tray for my legs to rest in while I’m undergoing treatment. It apparently helps insure that I will be lying in exactly the same position when I come in for treatment. Interesting side note: there is a lighted transparency photograph filling the ceiling of the room with a peaceful blue sky and spring Redbud trees in bloom. It’s very nice and quite relaxing (which I’m sure is the point). It gives you the illusion that you are lying in a peaceful meadow, staring skyward–a peaceful meadow not in Florida, however, since Redbud trees don’t grow here.
After all that, the tech exited the room and performed the CT scan. The table I was on slid in and out of the large torus CT scanner a couple of times, and in a few minutes I was done. Before I left, the tech injected a tiny pinprick of permanent ink at the center of each of the target crosses that had been drawn on me. Although they refer to them as tattoos, they really are just small black dots, not much bigger than the period at the end of one of these sentences.
I was told that the CT scan would be used to build a 3D model of my pelvic area (and my prostate in particular), so that my treatments could be properly programmed into the computer that controls the RapidARC treatment system. And with that, I was done for the day, instructed to return the following Monday for my first treatment.
Fast forward a week: Yesterday was my first day of treatment. I had been directed to drink about 20 oz. of water a half hour before my appointment, and to make sure I had my, er, “morning constitutional” before hand. They explained that they want your bladder full (not bursting full, but comfortably full) so that it inflates and slightly pulls away from the prostate; similarly they want your lower bowel empty for the same reason. (And yes, they had given me the same instructions to follow before my CT scan the week before…as much as possible they want your internal organs all arranged exactly as they were in the reference scan during the course of the treatments.)
I arrived about 15 minutes before my scheduled appointment. (Again with the Faux News…seriously people! This is an oncology center where you are dealing with people who are dealing with a lot of stress. Does it really make sense to be showing a television channel who’s mission in life is to fill its viewers with outrage?) After another short wait, I was led to a different room by two different technologists. The treatment room is set up in a similar manner to the CT scan room, except this time the transparency sky is a fall scene looking up into a blue sky framed by red and gold white oak, sycamore and sweet gum trees (also trees that don’t grow in this part of Florida). Seriously, what’s wrong with a sky full of palm trees?
Except for the fake autumn sky, the treatment room looks like nothing less than a set from a Star Trek movie. There are cameras, speakers, microphones, and flat panel computer monitors hanging from the ceiling. The RapidARC machine itself takes up the center of the room, looking very, very science-fictiony. The techs place my blue molded pad created last week on the table (which for some reason called a “couch”) and I’m once again instructed to lie on a sheet with my legs in the pad. They then move me around a bit to line up the tattoos they made the previous week (green laser target sights…cool!) and put transparent stickers with cross-hairs lined up on the tattoos (which I’m told to leave on, though they’ll replace them if the fall off). Then they adjust the table (sorry, couch) up, left and right to position me where they want me. When I’m close to the proper position, both the techs leave the room (although I can still talk to them if I need to) and the treatment process starts. First, the machine (not a torus this time, but a rotating assembly with three “heads”–check out any of the videos of the RapidARC machine online) does a quick CT scan of my pelvic area to compare to the reference CT scan. The techs (and computer) then remotely move the table to adjust my position into the exact configuration they want me in for my treatment. When they are ready, the treatment actually starts: the arms that extend from the machine rotate around me twice, and I’m done. Total time: 8 or 9 minutes to get me in position and about 90-100 seconds of x-ray radiation directed at my prostate. As with any x-ray I’ve ever had, there is absolutely no pain or sensation of being irradiated at all. Afterwards, I have a brief visit with my doctor to see if I have any questions (which I don’t). He’ll be checking in with me every Monday during the course of my treatment to make sure things are going as they should. And a few minutes later, I’m home again. One treatment down, 44 to go.
And now, 24 hours later I can report that nothing feels any different than it did pre-treatment. I know from talking with my doctor that there are some side effects I will have to be watchful for (which I discussed last week), so I’ll be keeping an eye out for them over the next few weeks, but so far I’m very impressed.
Go modern medicine! I’ll update everyone next week or when there’s something to note.
I just have a quick update for everyone this week. I’m in the middle of week 2 of my radiation treatments. So far, everything I was led to expect about the treatments has proven true. The treatments themselves are painless and quick. And so far I’ve noticed no evidence whatsoever as far as side effects. So far as I can tell, I feel exactly the same as I felt before I started the treatments (and I hope that continues to be the case). I’ve kept up my daily walking (3-4 miles every weekday morning) and have so far noticed no fatigue…one of the potential side effects.
Now if I can just do something about having to listen to Faux News every morning when I go in for my treatments…
I’ll check in again with you next week.
October 9, 2013: I just have a quick update for everyone this week. I’m in the middle of week 2 of my radiation treatments. So far, everything I was led to expect about the treatments has proven true. The treatments themselves are painless and quick. And so far I’ve noticed no evidence whatsoever as far as side effects. So far as I can tell, I feel exactly the same as I felt before I started the treatments (and I hope that continues to be the case). I’ve kept up my daily walking (3-4 miles every weekday morning) and have so far noticed no fatigue…one of the potential side effects.
Now if I can just do something about having to listen to Faux News every morning when I go in for my treatments…
I’ll check in again with you next week.
Novermber 5, 2013: As of Monday this week, I have completed 5 weeks of radiation treatment for my prostate cancer and have four weeks of treatment remaining. So I’m very much past the half-way point (yay!). So far, the treatments have been painless, with only minor symptoms presenting themselves (a weak urine stream, due to inflammation of the prostate…totally expected…and some minor irritation like hemorrhoids…which Preparation H completely relieves). I guess I can’t complain. Compared to the side effects of the surgical procedure, this is a walk in the park.
I’ve also been able to maintain my level of energy (one of the side-effects of radiation treatment commonly mentioned is fatigue). Prior to the start of my treatments I had been walking 60-80 miles a month for the last few months. In October–through my first full month of treatment–I logged a total of 74.39 miles walking. Right on schedule. I think it really helps, so if you find yourself facing radiation treatment for prostate cancer, I would strongly encourage you to find a way to include some physical activity as a part of your daily routine if you can.
Starting this week, my radiation treatment has been altered slightly. For the first five weeks of treatment, the ionizing radiation that’s been used has been directed at both my prostate and the nearby seminal vesicles. For the last four weeks of the treatment, they’ll be irradiating only my prostate. This is actually a smaller dose of x-ray radiation: before, the RapidARC machine would make two rotations around me to deliver the dosage, at around 45-50 seconds for each rotation (for a total of 90-100 seconds of x-rays). For the remainder of the treatments, the machine is doing a single rotation around me in about 70 seconds, so by my calculation about 30% less radiation (and focused on a smaller area).
One of the common questions I get asked is “How will they know they got it all?” Well, in 2-3 months after my treatments have been completed, my urologist will start monitoring my PSA regularly. If the treatments are successful, it should drop to 0.0 (or very close to it) and stay there. If it starts going up, we’ll know that they didn’t get all the cancer and we’ll have to explore other options. By the way, that’s the same way they follow up all treatment, even the surgery. Having a PSA close to 0.0 is the end goal of all treatment to remove prostate cancer.
So all in all, I’m quite pleased with the treatments, and fully expect to be pleased with the results.
I’ll let you know how it all turns out as soon as I know.
December 5, 2013: On Monday December 2, 2013 I received my last radiation treatment for prostate cancer. I started my therapy on Monday September 30, 2013, and received a total of 45 treatments: one every weekday except for Thanksgiving.
I am happy to report that the side effects were minimal (difficulty in urination at times as well as irritation of some minor hemorrhoids) as compared with the known side effects of the surgery (incontinence and impotence, at least for weeks or months and possibly forever). I am looking forward to those effects subsiding in the next few days in the absence of further treatments.
My follow-up PSA testing will not begin until March 2014, to give my prostate a chance to “settle down” (my Doctor’s words) and stabilize from the treatments. At which point the desired (and expected) outcome is that my PSA will drop to undetectable levels from the very low 1.4 level that I had when I was diagnosed. So until then, I’m assuming that the treatments have been successful and am looking forward to resuming my life with no worry about prostate cancer.
As I reported at the mid-way mark, I never experienced any of the fatigue symptoms that I had read about prior to starting treatment: I was able to continue my morning walks (although I only got in about 65 miles during November due to a sprained ankle I suffered on Veterans day that kept me from walking very far for a few days). I don’t know if the regular walking mitigated the fatigue, or if the treatment regiment I received never produced the fatigue, leaving me with ample energy to exercise regularly. In any case, as I said last time, if you are beginning radiation treatments I would whole-hardheartedly recommend that you find time to exercise regularly (if you are able and if your Doctor approves, of course).
I’ll update everyone in March when the first of my PSA results are available to confirm that my treatments were successful. In the meantime, I hope these last few blog entries were informative and helpful. If you’ve been following along (or find these entries in the future), thanks for your time and attention. If you are facing a similar journey with treatment for prostate cancer, I wish you the very best and I hope that you have an experience similar to mine.
March 23, 2014: It is now approximately 100 days after my last radiation treatment for prostate cancer, and time for my follow up with my urologist. I stopped in two weeks ago to have my blood drawn for the PSA test that would tell us whether the treatments worked.
I went in Friday morning to find out. The news: a PSA of 0.6. Good news! Because my prostate wasn’t removed (meaning, I still have one), I’ll always have a non-zero PSA. But it dropped from the 1.4 reading in September (up from 0.7 the year before) that prompted the biopsy that discovered the cancer. For the next year or so, I’ll follow up with a PSA test quarterly (and less frequently following that). As long as it stays low, I’m likely in the clear.