Again, for anyone who hasn’t been following my journey to this point, the intent of my postings is to share a lot of detail of my PCa experience, from pre-diagnosis through SBRT treatment. For someone considering radiation as their primary therapy, this should give you a pretty good idea of what to expect. As I write this, I have completed all five SBRT treatments.
Two days after finishing my planning session I received a phone call from the Cyberknife Coordinator asking me if I wanted to start my treatments the next day. I enthusiastically responded, “YES!” That told me that the RO and the medical physicist had completed their written plans. I was already aware that the Cyberknife schedule had
openings. Besides, the sooner I started treatments, the sooner I could get off this crazy diet. I’d been on the diet for five days now and had settled into a routine, and my wife had gone to a lot of trouble to make it as easy and palatable as possible.
two hours before my first treatment time, I performed the obligatory enema and then emptied my bladder just before leaving the house. As stated in my last post, the regimented intake of water and the emptying of my bladder took place as directed. After checking in, my wife asked if she could see the Cyberknife treatment room. The staff graciously took us back, showed us the room, and answered lots of questions. I found the physical presence of the machine impressive. It has a large base, a boom, and an articulating head that delivers the photons. The head itself is about
two feet by three feet and the shape reminds me somewhat of a praying mantis’ head. I thought that with the addition of a pair of eyes, the treatment head could be a sci-fi villain. When used for the treatment of prostates, the head is fitted with a variable aperture collimator, the “iris,” which is used to change the diameter of the beams during the treatments.
The ceiling of the room has a large recessed area with an inset of a nighttime sky filled with stars. There are light clouds that move across the sky subtly while random stars twinkle. As I lay on the table, this fills most of my view. The staff asks for my music preference and catalogues it so it can be brought up during subsequent treatments. At this point, we have to leave the room so that the Iris can be initialized in preparation for my treatment.
Once they were ready, I went back into the treatment room and was told to disrobe from the waist down and put on a hospital gown. I then moved to the table, laid down, and the radiology therapist inserted a small diameter tube in the rectum. Apparently, this is part of the RO’s “witches brew” of small details that he uses during all treatments to passively remove gas from the bowel and help maintain the position of the prostate during treatment. After that, I was covered with a blanket, my feet were banded together, and my arms were folded across my chest and held in place with a large velcro wrap. Before covering me completely up they put a pulse oximeter sensor on my index finger. I asked about
this later because I was wondering what their procedure was if a patient had a medical emergency during treatment. Although there are numerous cameras in the room, they don’t seem to focus closely on the patient. Most people close their eyes and are very relaxed for the 20+ minutes of treatment. The oxygen saturation of the blood will start to decline if there is any cardio-respiratory compromise during the treatment, so this acts like an “early-warning” system for those monitoring your radiation delivery in the control room.
The treatment table is seemingly on a gimbal of sorts and can move in six different axes as needed. Apparently, the machine will halt treatment if the prostate moves out of a predetermined boundary. I was told that the prostate is considered to be a “dynamic” organ and the therapist occasionally has to adjust the table in order to bring the treatment zone back to “zero.” I recall the table being adjusted once during my first treatment, but for my fourth treatment the robot seemed to complete the path quickly. The therapist told me that my bowels were very clear that day and there was no gas, so the prostate didn’t move. That session was over in 19 minutes.
Once I was all bundled, prepped, and positioned on the table, the RO was paged and checked everything before approval to treat was given. With the all clear, a 12-inch-thick door between the treatment room and control room closed and a red light came on. The robot made a clunking sound, turned in my direction, and the treatment head came straight up my centerline and then stopped about
two feet from my head. It angled back toward my feet slightly, then I could hear the linac spin up. Game on! Every 20 seconds the X-ray machines in the ceiling were taking images and beeping. The table was pretty comfortable so I had no problem lying still. The control room was always staffed with both a Radiation Therapist and Medical Physicist during the treatment. Between prostate positioning and radiation dosing, there’s a lot going on. All five treatments followed the exact same routine.
Due to the diligent efforts of the treatment center staff, I came away from this experience believing my radiation dosages and treatment zones were exact. I’ve read recently that there are many who feel that successful radiation treatment with minimal to no side effects is primarily the result of the RO’s experience with a treatment plan and the techs administering the treatment. I chose to stay local for my primary therapy, although treatment at Duke Cancer Center was an option for me. I have absolutely no regrets.
As I finish writing this, I am two weeks out from my last treatment. On that last day, the staff gave me paperwork to explain possible side effects. I have had no changes in my bowel habits and now that I’m back to my regular diet, my stools are all normal. I may have some increased urinary frequency from late afternoon to early evening, but I’m drinking more (cranberry juice) liquids than my norm. There’s no urinary urgency. After the first week I went back to sleeping through the night without the need to get up to urinate. I have not missed a day of exercise yet and I feel the routine is beneficial to my overall recovery. Three-week checkup with the RO next week. I assume he’ll take me off the Flomax. First PSA right after Thanksgiving.
Time will tell.
64 y.o. at Dx. BMI <25, 3/15/19 PSA 4.9, 4/25/19 3TMRI showing PIRADS 4 lesion, remainder of MRI negative, 5/14/19 MRI fusion biopsy showing Gleason 7 (3+4) favorable/intermediate, T2A,NX,MX, but MRI clear.
Multiple consults with local URO/RO
2nd opinion with Duke.
Oncotype testing: GPS 37
2nd opinion biopsy at JH: downgraded.
Fiducials/Space Oar early Aug 2019
SBRT x5 during Aug 2019
Post Edited (e.noont) : 9/10/2019 6:47:42 AM (GMT-6)