When you get the news of a positive biopsy report for cancer it is devasting. You will have a range of emotions from anger to helplessness or even to being a victim. In truth the diagnosis is none of these things. It is a call to action.
For my next 2 posts we are going to assume a Gleason Score of at least 7, because if your Gleason Score was a 6, the doctor may very well suggest active surveillance. Thus, my next 2 posts are going to assume this higher Gleason Score so we can discuss your options if active surveillance is NOT an option.
In this case you will have 2 options to consider, as we have previously discussed. You will have a Radical Prostatectomy, or you will have Radiation. It is black and white. Your choice is A or B!! There is actually a third choice, but it is not used very often as a first line defense and that is Cryotherapy. Since it is very rarely used as your first choice, we are going to skip it for now.
The goal of this blog and web site is to keep it as real as possible, I am going to write about the choice of Radiation. A very good friend of mine, Jeff Schwenk, is going to describe the process of getting a Radical Prostatectomy. He has been there and can give us a firsthand account of that surgery from the patient’s point of view. (Jeff, thank you so much for your help as if I tried to describe this it would be from the point of view of someone that has seen a lot of these cases but from a very negative perspective; rather than first hand knowledge).
As I described in an earlier post, when I got the diagnosis of Prostate Cancer, after bashing my head against the wall a few times and spending a few days feeling sorry for poor me, it was time to act. I met with both the surgeon who does all of the Prostatectomies for my Urologist’s practice (a very large practice in North Texas, so he does Robotic Assisted Prostatectomies several days a week) and the Radiologist who does all of their Radiation (they actually own an External Beam Radiation system that is designed to do only Prostate Radiation).
The surgeon was very helpful and answered all of my stupid questions at length. However, he was honest and could not tell me that I would not end up with incontinence or impotence. 2 big “I” words that I have no interest in being anywhere near! He did say chances are very low but not 0. That honest answer made my decision for me. Dr. Dahiya fire up the External Beam machine, Goober is on his way!
I reached out, or I should say my wife reached out for me, to Dr. Dahiya’s office to set up my next appointment to schedule Radiation treatment. I assumed it was that easy. We have decided on Radiation so let’s get moving! Not so fast Speedy!
In my Radiation appointment, we were told I had to come back in to do a walk through of a radiation treatment, called “mapping” and get fitted for a Vac-loc, which is a device you lay on every treatment that is specifically made for you. It helps you stay still during the treatment as it is imperative that you do not move while in treatment, which is very easy until it matters then it is nearly impossible. Thankfully the Vac-loc is very helpful.
The last pretreatment decision was to either do what is called a SpaceOAR procedure or not do it! Simple, right? Not so fast. SpaceOAR is simply a Hydrogel spacer that is implanted between the rectum and Prostate to give the Radiation treatment a small amount of wiggle room to keep it from hitting the rectum (at which point you say, Rectum hell, it nearly killed the fool. Then I can say but not if you have SpaceOAR implanted before radiation treatments begin). I decided to have this implant done to keep from having to worry about another side effect if the radiation hit the rectum. The procedure was done in the Urology office and under local. And, yes, there was a little discomfort. Luckily I only felt like I was dying for a couple of minutes and then it was fine. The implant was designed to dissolve in a few months so by the time I was done with radiation it would soon dissolve!
The mapping process was also very interesting. It was literally a complete walkthrough of doing a radiation treatment without the radiation. It helped allay a lot of apprehension to get a live feel of what it was going to be like every day for the next 6 or 7 weeks. We also fitted me for the Vac-Loc, which was really a molded plastic and rubber mat that fit neatly from my feet up to above my knees. I am sure there are some better medical terminologies for this device, but it sure looked and felt like rubber and plastic maybe with some foam rubber mixed in. It was sure helpful when I needed to lie perfectly still for the radiation treatments!! You gotta love modern science!!
My insurance allowed 28 treatments rather than the 48 Dr. Dahiya wanted but that was acceptable to him as he could adjust the radiation to that number of treatments. It is common for insurance companies to accept either 48 or 28 treatments. More or less treatment is unheard of for Prostate Cancer treatment so all was good.
On October 31, 2023 I showed up at 3 PM to begin my new odyssey. I was as ready as I could be and followed doctor’s orders. I showed up after taking Gas X an hour before the appointment and with a full bladder. That was my “pretreatment routine” for the next 6 weeks. You can get used to anything if you have no choice.
One important thing I failed to mention. At the mapping process I got 3 new tattoos!! I found that amusing for someone that had lived for 62 years unmarked and determined to be different from the crowd and never get a brand! But 3 tattoos for the cause of science is a small price to pay, I guess! Seriously though these 3 tattoos were simply a dot on my left and right hip and one in the middle. The radiation technologists used them to help align me before each treatment, so the machine was in a precise location. No room for guessing here in these treatments or you may end up growing a third foot!!
The actual treatment was a lot like Groundhog Day. Same process, new day. You would show up 15 minutes before your assigned time (mine was 1130 every day Monday through Friday, except for the week of Thanksgiving when they were closed Thursday and Friday. You would get a locker, change into a surgical gown and sit a couple of minutes with your full bladder waiting to be called and hoping you could hold it until the treatment was over. Then you could race to the restroom before changing back into your street clothes.
Back to the actual treatment. You go into the treatment room, that got a lot less intimidating as you got closer to done. It was a large lead lined room that contained the External Beam Radiation system, which was huge. The technologist that helped position you put your individualized Vac-Loc on the treatment table and helped you get in position, which meant laying flat on the table in a supine position (see I do remember some of that medical jargon I had to use for over 30 years). Once positioned the tech would say we are ready to begin and head for the lead door. Now it is just you and Rufus, the 20 ton behemoth radiation delivery device. It began on your right side and rotated to the left until it ended up below the table, stopped and rotated to the right until it got back to its point of origin. It then did the same process a second time. Then the tech would suddenly reappear to get you to the freedom of the restroom, your new bestie!! We followed this same process daily for 28 treatments. Interesting aside that each treatment was about 3-5 minutes. Then it was time to ring the bell and loudly declare, like Steve McQueen in Papillon, “I’m still here you bastards!!”
It was interesting as you went through this process to meet other men going through the same ordeal. Unlike most doctor appointments, for Radiation, you went the same time each day. The guys before and after you were the same guys, until they finished their round of treatment, and a new guy would step into their time slot. It was a shared experience you would not wish upon someone you did not like, but we were all going through it and mostly experiencing the same side effects and treatment oddities. It was an odd fraternity but a welcomed conversation for a few minutes each day. It reminded you that you were still sane and functioning and most importantly a day closer to ringing that bell by the front door.
The bell ringing ceremony is worth revisiting. I am not an emotional person and often accused of being void of emotions. So, it was a very strange feeling when you end treatment and are told to go ring the bell to announce to the world that you are done. I was not sure whether to laugh, cry or scream and probably did all three. It was a very moving time to signify that it was over. What do I do now every day at 11:30?
What you actually do is move on with life and say I am post Radiation now. Oddly, I can not say I am cancer free for 5 years. You see your Urologist every 6 months and do another damn PSA test. You know that one, the test that is used continually but tells the Urologist nothing about your condition? Well post operation or Radiation they put a lot of importance to this useless test for some reason. I will get into it much more in later posts but for now I just want to describe what will be done before I (or you) can say we am cancer free.
As I write this post, it is September 3, 2024. Last week I did blood work and then met with my Urologist. Roughly 9 months after my last radiation treatment, my PSA is 0.4 ng/ml. That is good since the Urologist wants me to below 1.0 ng/ml by 18 months post treatment. I am ahead of schedule so I am hopeful this trend continues. For a contrast when I was 6 weeks post treatment my PSA was 0.8 ng/ml. It kind of makes one feel like the guy that jumped off the top of the Empire State building and as he fell past open windows people would yell, “how is it going?” “So far, so good he would say!!” For me it is a long way to the ground but, so far so good!!
My next post we are going to discuss if you choose a Radical Prostatectomy to attack your Prostate Cancer. Jeff Schwenk will walk us through this process. We will then be through the “You have Prostate Cancer” discussion. We will move on to other interesting topics around the Prostate and Prostate Health.
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