The Treatment Plan comes together

I had a tele-medicine visit with the radiation oncologist this afternoon and am thrilled with the outcome of that meeting.  I thought that I would not be able to start the radiation therapy until 2 months had passed from the Lupron injection I had last Thursday, meaning going from late June until early September for the 9 week course of daily care.  He explained that because my prostate is on the small side and is not enlarged, that June 1st is now the target date for the first radiation treatment.  I'm very happy that we're getting started sooner rather than later.  This means my last treatment will be in early August.

What has to happen between now and then?  Next week I will receive a set of elastic bands and an exercise program to fight the muscle and bone loss and the weight gain that results from the hormone therapy.  I intend to follow the program and also keep up my hiking for one to two hours per morning doing my nature photography.  I think the biggest challenge will be overcoming the fatigue brought on by a total lack of testosterone and exercising even though I will have a decided lack of energy.  I'm a stubborn German Lutheran, so all I need is for somebody to tell me I can't possibly do this and I'll do it for sure!

Next, on May 13th, I will have a day surgery in the Westlake offices of the urology practice during which 2 gold seeds will be implanted for precise radiation targeting and a spacer, brand name SpaceOAR, will be inserted between the prostate and the rectal area to protect it from radiation damage and in turn, drastically reduce some pretty unpleasant side effects.  Also, since the prostate shifts around a little bit in the body, the gold seeds will be locked onto by the radiation equipment before each dose of radiation starts.  The more I learn about the most recent techniques, the more amazed I am at the incredible care I am about to receive.

The next step will be 2 separate appointments on May 15th to map my pelvic area, once with a CT scan, another time with an MRI at a different lab.  This information will be fed into the software that will control the radiation, resulting in truly focused, individual treatment.  This approach has allowed the radiation teams to boost the dosages by about 25% over the past few years, making the treatment more effective and safer for surrounding tissue and organs.  These scans will also be used to make a positioning cast of my lower body, so I can be aligned exactly the same each time I get radiation.

That's about all I know for now, exact instructions will be sent to me for what I will need to do to prepare for each of these steps ahead of time.  It looks like the only appointment I won't be driving myself to will be the May 13th day surgery.  My friend Allan Moritz has graciously, but insistently made sure that he will be my chauffeur that day.  Uber and Lyft have got nothing on him!  I'm very grateful for the number of friends from Redeemer and other walks of my life that have offered to do anything that is needed.  It is humbling and makes me very glad I have the friends that I do, helping and praying for me.  Thank you, Jesus! 

Let the treatment begin!

I am beginning this blog post about 20 minutes before I saddle up and head into the urologist's office to get the Lupron hormone injection and hopefully to get some firm dates for next steps.  Up until this point, we have been in decision making mode, determining what the best course of action is.  Now that we have accomplished that, I am anxious to get target dates set up for all of the milestones that have to take place at the proper time and in the right order before the actual radiation therapy can commence. 

I know there will be an outpatient surgical procedure soon to implant the gold seeds used for targeting and I will probably receive the 3 tiny tattoos then, one on each hip and one on the front hip of one leg that will also aid in aiming the radiation precisely.  These tattoos will be about the size of a BIC pen ink dot.  The surgeon is also part of my urologist's practice, which is a real blessing.  Rather than being sent to disconnected specialists all over town, everything is done under one umbrella organization with a few locations that are very convenient for me.  I have reviewed the credentials of each member of my team and it is truly a Dream Team.  My urologist is a recognized leader in his field and did a marvelous job of removing a very large kidney stone for me a couple of years ago.  The radiation oncologist has a long track record, both in Chicago and here in Austin and has treated well over 2,000 men in the past 20 years.  He's also a leader in his field and has access to the most advanced technology available, which is kind of cool to me as a computer guy.  And every one I've dealt with from the receptionists to the nurses to the specialists are all great people and go the extra mile to let you know exactly what to expect. 

I just got back from my Lupron shot, which will last for 6 months and has been shown to make the radiation treatment more effective.  I may see minimal side effects or have one or more of them that are pretty uncomfortable.  The doctor said it varies a lot by individual.  Whatever lies ahead, it's worth it.  I also just made an appointment with the radiation oncologist for next Wednesday to consult with him by telemedicine to get the ball rolling on next steps.  During my initial visit in person with him, I got a wealth of information including a nice workflow diagram of what will occur from beginning to end over the next 4 months or so.  Now all we have to do is assign dates to the next steps and get on with it.

That's about it for now, I'm happy that the process has begun.  There is something about waiting to get treatment, knowing you have a hidden enemy in your body that could be gradually getting worse that could easily rob you of the joy of living each day.  Thankfully, through prayer, the encouragement of friends and their prayers, Bible study and other disciplines of the Christian life, I have been spared dwelling on these thoughts.  I know they don't come from the One who loves both me and you.  We can choose which voices we listen to and I am glad I know the difference.  Thank you, Jesus!

More to follow as the story continues to unfold.  Blessings everybody!

  

The journey begins

“You’ve got prostate cancer.”  Exactly what I expected my urologist to say recently as he explained the results of my biopsy which was performed in March.  My PSA had gone from less than 4 to 6.6 between my November annual physicals.  A second blood test also came back in the same range.  I knew about this before my hip replacement last December.  I had asked each of the doctors involved to consult and decide what the best course of action was and the consensus was to do the hip first, let it heal for 3 months and then figure out what was going on with the prostate.  I had a biopsy done of the prostate about a month ago after chances of infection following the hip surgery had subsided.  The coronavirus pandemic meant that I received the news via a teleconference on my laptop.  My urologist removed a kidney stone for me a couple of years ago and we’ve got a great relationship.  He commands my utmost confidence and I’m blessed that he’s a straight shooter.  He explained that the biopsy showed that “active monitoring” was not a good option.  I don’t have a real aggressive cancer, but it does need treatment.  The most probable treatments appeared to be radiation or surgery.  Rather than decide on next steps right then and there, my doctor suggested I read a 500 plus page book called Guide to Surviving Prostate Cancer by Dr. Patrick Walsh, just updated in 2018.  I’d highly recommend it to anyone that wants to know everything there is to know about prostate conditions, their treatments, side effects and the chances for successful outcomes.  Each chapter has a “Reader’s Digest” summary of the pertinent facts, giving you the opportunity to skip over sections that don’t apply to your situation.  It’s only about $15 for a Kindle version, I carry it around on my phone as a reference.  It has helped me to be a much more informed patient, which I am sure was the whole idea of pointing it out to me.  I can’t emphasize enough how important it is to be an educated medical consumer, understanding the pluses and minuses of each option that is considered for your own individual treatment.  That way, when a course of treatment is decided upon, you are going into it with eyes wide open and many of the fears that might have manifested themselves due to ignorance will be put to rest with knowledge, facts and the interpretation of them by your doctors

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After receiving my biopsy results, the next step was to consult with the radiation oncologist.  He had sent me a comprehensive packet of information about the various forms of radiation and hormone treatments that are often used in combination.  His materials and what I learned from the book allowed us to have an educated conversation about what his recommended approach could do for me.  I’m very grateful for the transparency that both he and my urologist have had when it came to my questions.

I learned that in general, most patients in my position could flip a coin and decide to cure the cancer with either surgery or instead with a combination of hormone therapy and radiation that has almost identical results.  There are several factors unique to my personal situation that make surgery riskier in terms of permanent side effects, so after one more telemedicine consultation with my urologist last week, we have decided to pursue the radiation/hormone treatment option.  Thankfully, Medicare and my supplemental insurance will cover most everything.

The first step in the process will be this Thursday afternoon when I get a Lupron shot that will drop my testosterone levels to nothing for the next 6 months.  This will help shrink the prostate some and will slow the cancer, since this type of cancer is fueled by testosterone.  Radiation treatments, probably 5 days a week for 9 weeks, will begin in late June.  In preparation for that, I will need an office procedure in which 2 gold seeds the size of a grain of rice will be implanted in my prostate to aid in pinpoint targeting of the radiation to minimize damage to surrounding tissues and organs.  A gel spacer will also be placed between the prostate and the rectal area, this recent innovation has been shown to minimize damage and side effects that previous radiation treatments caused.  

I am expecting some side effects, particularly towards the last 3 weeks or so of radiation.  I call some of them the 3 “I’s” for incontinence, impotency and the possible need for Immodium.  Many patients don’t get all of these and their severity can vary quite a bit.  In most cases, things are back to normal a few months after the radiation ends and hormone levels return to normal.  Other problems, mostly associated with the hormone side of the treatment include fatigue, weight gain, bone and muscle loss, hot flashes, depression, irritability and more.  Sounds a lot like menopause to me!  I’ve always looked at the fine print on TV ads for various drugs and thought to myself, “I’d rather just stick with the condition I already have!”  There are ways to fight back against these side effects, the most effective ones being diet and exercise.  Being a stubborn German Lutheran, I will fight through the fatigue and force myself to obey doctor’s orders.  My plan is to continue hiking at least 2 to 3 miles per day as I do my nature photography and work on upper body conditioning as well.  Carrying 15 to 20 pounds of photo gear through the woods for at least 2 hours a day is not a bad workout.  Being out in God’s incredible creation is a powerful counterbalance to depression.  The antics of the animals, birds and whatever else I see never fails to bring a smile to my face and this time of year, new life in the form of ducklings, owlets, baby squirrels and many others is precious.

There will be more posts here at this blog as my journey continues and as time allows.  I want to be an encouragement to others who find themselves facing the same thing, so please feel free to share the address to this blog.  I’ll leave you for now with one more thought.  Early detection of cancer is a huge advantage.  It gives you more choices for treatment plans with a much greater chance of being cured. And treatments are light years ahead of where they were even 20 years ago.  So please spread the word that annual screenings for prostate cancer, particularly if there has been a history of it in the family, are not optional but very, very necessary.  Ladies, encourage the men you love to take annual physicals seriously and men, you need to man up and just do it, even though checks for prostate and colon cancer are not usually our happy places!

Please keep an eye on my Facebook page which is devoted mostly to my passion for nature photography.  I’ll announce updates to the blog there.  

God's blessings everybody!  Live long and prosper...