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My Bout with Prostate Cancer The intent of this journal is to serve as an informative educational guide to help others understand the process involved in dealing with prostate cancer. I will be as straight forward as I can so you my understand better what to expect and not feel intimidated by the processes and the language used as you try to understand what is and may be going on. If I can help one person understand and feel easier about going through their treatment of Prostate Cancer the purpose of this page will be fulfilled. The subject is a 68 year old in reasonably good health. 5'9" weighs 240 LBS. Although considered obese by by the medical community I am very active and able to work a full day. I take only one prescription a day for acid reflux. Only surgery was Gull Bladder removal 18 months ago.
June 2009, During a routine medical physical examination my Doctor found a nodule on my prostate while performing a standard digital rectal prostate exam. My first thought was that it wasn’t so. Denial was much easer to accept then the reality of the moment. All men are taught that any problems with their Prostate is a death sentence. This is not true today but it is the first thought that come to mind when the words prostate and lump are spoken in the same sentence. My primary care physician immediately set up an appointment with a Urologist and upon my first visit and during another digital rectal exam the findings where confirmed. There was indeed a nodule on my prostrate. The Urologist immediately suggested a biopsy be taken ASAP. The news still came fast and I was unable to control my thoughts and respond in a positive manner. I hesitated because I was unsure of the procedure and I wanted to gather my thoughts and obtain more information about what was happening. I took the next six weeks to look in medical books and on the web about Prostate Cancer and, in particular, Prostate biopsies. In the process of gathering information I came across a book on the subject; Dr Patrick Walsh’s guide to Surviving Prostate Cancer, which has become my bible on the subject. The book is heavy reading and very in depth on the subject but is laid out in such a fashion that each chapter has a high lighted lead in section that summarizes the info in that chapter so you can decide how deeply to read the info in that chapter. I read the lead in sections that pertained to my immediate concerns and then read in detail that which concerned me the most to get the information I needed to get my thoughts back on track. One of my major concerns was that a biopsy could cause tracking or spreading cancer cells out side of the tumor and also the fear of exactly how the procedure was done. The fore mentioned book answered all those questions along with a sit down with my Doctor. I decided to go ahead with the biopsy which was performed in late September. Before the procedure you will be given two special antibiotic tablets along with instructions on taking the tablets and to give yourself an enema an few hours before and to have someone drive you there. I was ushered into a room with an exam type table with an operators station attached on the far side with a computer screen, keyboard and ball type mouse and some other small apparatus I believe was ultrasound equipment. I was instructed to strip to the waist and lay on the table on my left side with my knees up toward my chest. The book explains the process in more detail. You are covered during the procedure. A probe is inserted into the rectum and ultrasound images steer the doctor to the prostate and biopsy needles are used to extract tissue samples from suspect and non-suspect areas. It was a bit uncomfortable but not really painful except for very short time when I believe they injected something to deaden the area inside. There was some minor pain when the actual specimen cores were plucked, if you will, from my prostate. If you are thinking how embarrassing it was, all you guys need to remember that you wife and or girl friends have been put through this kind of embarrassing procedures many times. So suck it up and get on with it. The doctors don’t get any excitement out of messing with your butt. Believe me they would rather not have to do it as much you would rather not have it done. The results came back positive for cancer in three days and the urologist set up a visit to discuss treatment options. During this visit you should take a family member to share the information and to help you make decisions. The doctor went over the types of cancer and how aggressive in was and if it appeared to be contained within the prostate or may have spread outside the gland. Then they explained what type of treatments are available and which they recommend. My doctor recommended radiation therapy. I was diagnosed with an aggressive cancer with a gleason score of 8, 4+4 on the left side that appears to be contained within the prostrate. That means that on a scale with 5 steps, 5 being the most aggressive, the sample cells from in the tumor were a 4 and the second number is for cells near the tumor in the same half of my prostate were also a 4. Thus a score of 4+4 or 8. After hearing the options which included prostectomy, hormone therapy and seed implantation I opted for radiation therapy as my form of treatment and was referred to a Radiation Oncologist. I would find out more details at that visit. Before that meeting my Urologist ordered a bone scan which I under went October 8 to see if the cancer had attacked my bones. Apparently cancer cells are attracted to bone. This is a non invasive process where I received a small injection in my arm and after a two hour wait and I was put on a bench where a scanning machine moved slowly over my body several times. It took about 45 min and was not uncomfortable at all. The technicians here did not give me any idea of what was to happen or how long it would take. I simply had faith and laid there until they came and said the test was completed. Now you know what to expect. The results of the scan came back as negative for any cancer cells in my bones. The following day, October 9, I met with an Radiation/Oncologist to discuss in more detail the treatment plan for my particular cancer. It was clearly explained that we needed to stop the growth of the tumor ASAP with hormone therapy which would consist of shouting down my production of testosterone which is the main food source for the tumor and that would cause it to shrink rapidly over the next two months and then we would under go radiation treatments on a daily basis to eradicate the remaining cancer cells. That’s it in a nut shell. During the time before radiation treatments are to start I have to have a few procedures done. I will be given an injection of Lupron which will chemically shut down my production of testosterone the major food source for the tumor and should begin the shrinking process. I will also have to get an MRI of my abdominal area which will be used as a sort of road map of my organs to help plan the attack on the prostate and then I will have small metal targets placed in the prostate to aid in aiming the radiation beam directly on the tumor. I will walk you through these procedures as they happen. Fear of any medical procedure comes from lack of knowing exactly what will happen. If I am able to relieve some of this fear by explaining exactly what is involved My goal of helping another person will be fulfilled. I have an appointment on Monday morning, October 12, to receive an injection to start the “chemical castration” as it may be referred to. I am a little uneasy, as any man would be about this process, but my partner is in support of me going ahead. This will be important for any guy starting hormone therapy. Hey guys, remember all those bad jokes about women going through the change of life? You may have to do it now and you will need the help of you partner. Well I’ll keep you informed as I go through the process. It has been a week sense my shot and I don’t feel any changes. All seems normal. On Saturday I got the CT scan the doctor ordered which is to serve as a kind of road map of my organs so they can aim the radiation so as to cause as little exposure as possible to my main organs and get the most on the tumor. The procedure is rather simple and takes about 45 minutes. When you enter the room you are placed on a narrow table and a cover was placed over my mid section and I was instructed to lower my pants below my abdomen . The technician then put a port in my vain in my arm through which she would later inject iodine which serves as a medium to outline you organs. It was like getting a regular blood test draw. The iodine was injected and after a short wait I began having warm feeling throughout my body. At that time technician started the scan by having the mechanism moved over my abdomen several times as I was given instructions to breath or to hold my breath. After the procedure I felt a little faint but a bottle of fresh water and a snack and a rest and all was well again. About three weeks after the injection of Lupron I began having hot flashes and noticed a big change in my ability to hold an erection. They have a list of possible side effects from the Lupron that is about half a page long. So far these are the only side effects I've experienced. I had a slight problem in that area before that was handled with a small dose of the "little blue pill." I will increase the dosage and see how it works. We must remember that in today's world the drug companies have to cover their butts so they list every possible side effect. It's doubtful anybody will have all of them. I will only tell you about mine. Scan results are back and things look good. Dr Mark said there are a couple Lymph nodes showing up , but he was not too concerned. I will be awaiting a call to have a target seed implanted in the Tumor and a test run through before actually starting my Radiation treatments sometime around the first of the year. At about three weeks I started noticing the effects of the Lupron. Hot flashes started and over the next three weeks became more frequent and longer in duration. ED set in during this same time. I have been gaining weight too. Not sure if this is because of the Lupron or because of the Thanksgiving holiday. 12/19/09 I had hoped to have had the target seed implanted by the Christmas holidays and radiation treatments started, but seems I got lost in the system at the University hospital where the procedure was to be performed. I called as instructed early in December and they had no record of me. The procedure had not been ordered. The more I thought about it the more I think my radiologist had something to do with the delay. I sensed he wanted to wait until early spring to begin radiation treatments and didn't want to dampen my enthusiasm about getting started soon. I can see why he wanted to do this because in the last two weeks the Lupron. testosterone blocker, is causing many of my previous symptoms to abate. The acute urgency to urinate has decreased. Surely this was a major symptom of the tumor. I assume then that the tumor is shrinking as the doctor said it would. And I would also assume the longer we wait and let the Lupron do it's job the better the outcome. The Lupron has also taken away most all of my ability and desire to have sex. ED medication has no effect. Seems my testicles are shrinking and my breasts are swelling a little. Can only hope it all will come back to normal. I can't imagine my grandchildren referring to us as Grandmom Chris and Grandmom Bob! I may also be losing a little muscle and gaining some unneeded fat. My weight is dropping a little as I try to diet some, but my size seems to be larger. I failed to mention that shoot of Lupron was very expensive. Sells for over $1600.00. My portion is around $400.00 on medicare. 1/01/10 Got a call from the radiology department last week asking if I had been contacted by the people that are to implant the target seed. Apparently they have been trying to contact me at an old phone number. I guess we're all not on the same page. I suspect I well be getting that call soon. In the mean time, we are on hold. The hot flashes have increased to around thirty a day. Yes, I counted them. Urinary symptoms continue to turn toward normal except for the frequency during sleep hours. No more racing for the bathroom. The urgency is manageable. 1/25/10 Today I had an early morning appointment to have target seeds implanted in my prostate. Before hand I was given some photo copied instructions that were difficult to read and not very accurate but I knew where the campus was located so we just started asking questions upon our arrival and We found the office. I expected the procedure to be similar to the biopsy, Lots more equipment around the table this time. The technician had me strip from the waist down and put on one of those hospital gowns open in the back and I got on the table in a knees to the chest position with my butt facing out. He began by checking my prostate with the conventional digital method. Then he inserted the bulb sending unit for the ultrasound unit. Attached to this are mechanisms for injecting pain killers and for inserting the targets. It was very uncomfortable this time. I knew the procedure would not take long so I just tried to settle in and bare with it. The Doctor came in and finished the procedure. They put in three targets. And I felt every one going in. It was very uncomfortable and it down right hurt. So be ready. The whole procedure couldn't have taken more then 15 minutes. Afterwards a brisk walk and a bottle of water helped me settle down. I drove home just to keep my mind off what they did to me. A stop for a little breakfast snack helped too. As I talked to the technician after the procedure I found out he was a survivor also. They are all around us in places you would least expect. Here again is the lesson about surviving cancer. We must stay positive and go with the process because it really does work. 2/08/10 Within a few days of the implanting of the targets at University Hospital I began having problems with urgent urination and burning. I thought this was simply an after effect of the procedure. The symptoms worsened and I called the nurses at Exempla St Joes, that is where I am to have the radiation treatments and where my Doctor for the treatments resides, and they ordered a UA. Sure enough I had contracted a urinary infection. E coli no less. Although E coli is a very common source of Urinary infections I believe it happened at University Hospital during the above procedure. My guess is they spread the E coli from my bowel to my urethra or bladder with a wayward puncture. A prescribed antibacterial drug is taking care of the problem quit well. Today, the 8th, was my visit called a simulation at Exempla St Joes. I was a bit stressed after what happened with the last procedure but I tried to stay confident. For this procedure I was instructed to do two fleet enemas, one the evening before and the second a few hours before. I thought this was because they intended to go into my rectum for this procedure which added to my worry. This was not the case. After checking in I met the tech, Jeff, that was to do the procedure and was instructed to drink two cup of water because my bladder needed to be as full as possible. Jeff then took me to the procedure room and we sat down and he went over exactly what we were going to do today. This was a nice touch and made me feel very comfortable. A CT scanner was the main piece of equipment used. I was asked to drop my pants and sit and then lay on the bed of the scanner. They covered my private parts with a small towel. I was given a rubber ring to hold with both hands to keep my arms up out of the way and another ring was placed on my feet to help keep them still. A quick scan was taken to see that my bladder was expanded and that my bowel was empty. That was the reason for the fleet enemas. To empty the bowel as best as possible. Another tech had joined us and he told me he was going to place some sort of die in the end of my penIs . This was done with little discomfort and the scans began. After several passes and measurements they put little marks on me to be used for aiming during the actual treatments. A few pin pricks for the tattoos and we were done. The techs told me it was not necessary to disrobe only to drop my pants to my thighs. I believe it more comfortable to remove my shoes and wish I had removed my pants and just left my shorts on. Fumbling around with half on half off pants in the name of privacy creates an awkward situation in a room with two other guys. You may consider this if the situation arises. After lying on that flat panel for the 15 or so minutes I felt a little off balance when getting of the machine. The techs offered a hand and in a minute all was well. I was then showed a short video about what to expect during the up coming treatments and a nurse went over the procedure with me and answered any questions I had. It felt real good to be treated with respect and caring and gave me a good attitude about the start of the actual radiation treatments in two weeks. Next week I get another Lupron shot. Received the shot and am back on the process of losing my manliness a little at a time. The hot flashes at night are the most bothersome. They occur about every two hours and can last up to 30 minutes. I throw off the covers and reverse the pillow so the colder side is toward my head and just wait it out. February 22, 20010 My first radiation treatment was today at 1:30 PM. I seemed a little anxious in the couple days leading up to the treatment. Most of this was simply no knowing what to expect. The book covers the different types of radiation and how it is administered, but still you don't really know. I went to the waiting area as instructed during a previous visit. The technician came exactly on my scheduled time. She was friendly and confident. She asked if my bladder was full. I answered that I had just visited the restroom. She explained that I should have my bladder full during the treatment to lessen the chance of radiation hitting my colon and possibly leading to diarrhea. So we joked a little and I drank a cup of water. This probably would not reach my bladder before the treatment but we gave it a shot. I will keep this in mind and make sure I drink plenty before my next treatments. They lead me into the room where the machine was located. It was not as over powering as I thought it would be. Very much like the drawing in the book. A large overhead projector of sorts that lined up over a small table where I would be placed. There were some other pieces that stuck out on the sides on the unit. Very similar to the CT type scanner except for the arms protruding out instead of the ring that moved over you. The technicians, another person had joined us, had me step next to the part of the machine where I was to lie down and one of them held a towel in front of my private area and had me drop my pants below my "bum" and then sit and put my head on a headrest toward the machine and my feet at the far end. As they explained in detail what was about to happen. A rubber ring was placed around my feet, shoes on, with a sponge between them and I was given another ring to hold with my hands. The little towel ended up covering my private area. As they adjusted my position on the table I was told that it was important to remain still and first they would rotate the machine around me and take some pictures of the line up and then have the Doctor review them and OK the positioning for the actually treatment which would take about two minutes. That is exactly how it went. You feel nothing. Total elapsed time was about 20 minutes for this first time. I was given my new time for my everyday treatment and off I went. The hospital offers valet parking for radiation oncology patients which is very nice so you can buzz in, get your treatment, and buzz out. March 1 I am starting my second week of treatments and so far nothing has changed. The technicians here at Exemptla St Joes work in a very friendly and efficient manner. Very deliberate and confident in their actions. This makes the visits much less stressful. April 15 Today was my last of 39 radiation treatments. I have had little discomfort from the treatments. only some urgency when urinating. They say that all went well and I will need to monitor my PSA count in the future and be aware of any symptoms that may occur. I have no burns on my skin and I feel nothing inside. I only feel very tired. I was aware of this feeling from my previous radiation experience 52 years ago. At this time I want to stress that every male should have a PSA test done at least once a year. This test is becoming the preferred method of detecting prostate cancer. During my treatments I did a few things to insure the best possible outcome. First I made sure my bladder was full or as full as I could deal with during the treatments. I also ate a good healthy amount of food which included my new friend, 2, 4oz cups of yogurt every day to ensure that I was able to have my bowl close to empty during the treatments and last, It is of the utmost importance that you maintain a positive attitude which includes developing in your mind the idea that what is growing inside of your body is NOT welcome and it must be expelled. You must meet every day as a new gift and another day to get this thing out of your body. I will continue with the Lupron injections for 18 months. As we spoke earlier, this blocks the production of testosterone which is the major food source for prostate cancer. So we have given the tumor a good sunburn and now we will continue to starve it. That's the plan. Until any future happenings I will leave with this thought. Early detection is a major key in survival so get your PSA checked at least once a year and watch for any increase in the readings. A special "thank you" to the people at Exempla St Joes for there work in taking me through this scar in my life. July 12 During the three months sense my last entry I experienced an ever increasing amount of fatigue. It would drag me down in the early afternoon. Also an increase in the urgency to urinate. I had to place emergency jars around so I could deal with it. I mean you feel like you have to go and then it just happens. Around the first of July both of these symptoms started to go away. As of today I am feeling little fatigue, except for the fact I have gained twenty-five pounds over the last six months and the fact I passed my sixty-ninth birthday, I feel like a knap in the afternoon but otherwise feel pretty good. I got my scheduled Lupron shoot June 25 and at the same time a blood test for PSA. The PSA test came back as undetectable. Great news. I had a scheduled visit with my Doctor today and he confirmed that my Prostate is smooth and that the PSA is low, actually lower then expected, because the Lupron which stops the source of food for any prostate cancer by blocking the manufacture of testosterone. I will continue on hormone therapy, Lupron, for the next year and monitor the PSA level when I recieve my shoots every four months. He does not want to see me again unless there is a problem. Good news. Anoyher reprieve for this ol' guy.
Sense I started this journal I have got a lot of feed back from survivors. Here is a list. Prostate Cancer unless specified other. Fred in New Jersey, 2 yrs. Ilene in Virginia, 15 yrs (Brest Cancer) Mel in Jersey, 3 yrs Tim in Denver, 3 yrs Pandora in Denver, 12 yrs (Uterine Tumor) Jim in Chi Town, 5 yrs Phills step father, 10 yrs. Louise's brother-in-law 6 yrs.
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