I had the markers implanted in my prostate today. These markers are not theraputic; they are only there to help locate the prostate during my radiation treatments. Two were implanted. Each was a bit less than an inch long. They look like a tightly coiled spring. Imagine the spring in a retractable ball point pen, only much smaller and tightly compressed. The idea is that the tissue engages the coils and they do not move - they stay put.
The procedure was kind of like a biopsy in reverse. After I removed the appropriate clothing I got on the table with my knees up toward my chest and my butt hanging over the edge. The same ultrasound probe was inserted and the seeds were implanted slowly and somewhat painfully. This isn't a spring loaded instant deal like the biopsy needles. I had lidocaine shots for the biopsy, but not for this. I have since learned that some urologists do give lidocaine for this procedure. I wish that mine had done so. It was manageable, but real uncomfortable. I found the experience a little more unpleasant than the biopsy.
On the fifteenth I'm having my simulation. The instructions follow:
During this visit, you will have a chance to ask any questions you might have, sign a consent form to begin the treatment process and then proceed to a Ct Scan which will be done in our office.
At the time of the Ct Scan we will be inserting some dye into your urethra. We will be using the urethral dye on just this occasion. We will also be inserting a small lubricated tube into the rectum to stabilize the prostate. This tube will be inserted on a daily basis during your treatment.
You may be more comfortable at the simulation if you perform a fleets enema the night prior to your Ct Scan appointment. Fleets enema kits are available in most drug stores and many grocery stores. The instructions are on the package.
You will NOT have to have enema once the actual treatment begins.
I typed the above instructions exactly as they were given to me.
Well, I'll see you all on the fifteenth.
I am editing this post to answer some questions and present some more info that I forgot yesterday.
My treatment begins on the 22nd - one week after my simulation. Five days a week for 8 1/2 weeks. Total time each day is 30 to 40 minutes. Actual time being radiated just a few minutes. I don't have the exact number. I am to have 43 treatments.
I called the radiation clinic a couple of weeks ago and asked to schedule my treatment time. The nurse said thy scheduled treatment times after the simulation. I pointed out that by then all the good times were likely to be gone and I will have a 75 mile round trip and the reality is that I will delay treatment, but I will not drive in Dallas traffic during rush hour for 8 1/2 weeks. She forwarded me to the chief therapist who said he understood and I got my 2:00 appointment. I am a happy camper.
Image Guided Radiation Therapy (IGRT) is Intensity Modulated Radiation Therapy (IMRT) with an additional step. The prostate is located each day just before treatment. In both of these treatments a simulation is done. Mine was a CT scan, but an MRI may be used instead. I have no idea which is better. As for the daily scan, there are three ways to do it that I am aware of. Some use an ultrasound and some use a CT scan. My clinic uses x-rays which is why I had the markers implanted. I would rather not have had the implants, but I wanted to stay with this particular clinic and doctors, so I had it done.
Day Two - Simulation
I got to the clinic a little early and signed my life away as we do for these things. I was then led to a changing room next to the CT scan room and told to remove my pants, underwear and shoes. I then put of one of those hospital gowns, opening in the back, do not tie it.
After I lay down on the table they shaved the pubic hair just above my penis because that's where one of the tattoo's will be placed. The other two go on each hip at the top of my femur. Then they washed down my penis with an antispetic that was kind of purple in color. They then numbed the head of it and using a big plastic syringe filled my urethra with the contrasting agent. It was a bit cold, but no big deal and no pain. None. To keep the fluid from coming back out they put a clamp on my penis about half way up, or down, depending on your point of view. The clamp looks kind of like one you put on the end of bar bells to secure the weights. It's just a 'little bit' smaller. Once again, no pain and little, or no discomfort. This will not be repeated - it's a one time deal used to clearly define the bladder and prostate boundary.
I then got on my left side and the balloon was inserted. It's about as big around as my little finger and is inflated after insertion. Nothing at all like the ultrasound probe and not too noticeable even after inflation. Just enough to fix the prostate in position. This will be done each time I have a treatment.
Next, it was time to make the mold. It extends from just below my butt down to the bottom of my feet. It feels kind of like a bean bag chair till they pump the air out of it and then it's firm and holds you in place. It's light blue in color and is re-useable.
I was next lined up with the lasers and temporary marks were made on my abdomen and hips. The table then slid me into the scanner and I was scanned for a bit. They came back in and further refined my temporary marks. I was scanned some more - the table moves in and out and there is some noise associated with the process. They came back in and tattooed me. One on each hip at the top of the femur and one front and center about a half an inch above the base of my penis. The actual tattooing pinched because the ink is placed under the surface of the skin. These are permanent marks and are about the diameter of the lead in a no. 2 pencil. The ones on my hips showed a trace of blood.
It's almost over. The balloon was deflated and removed and the clamp was removed and it was time to sit up, adjust my gown and to get dressed. Total time in the CT room was about 30 minutes, or maybe a bit less.
Some personal observations are in order. The table is kind of narrow and doesn't allow much room for rolling around, so be careful. I certainly didn't enjoy the experience, but it was easier than either the biopsy, or the marker implant. If you have any questions, feel free to ask.
My oncologist advised me that a full bladder will help keep the bladder out of the radiation field. To that end, I have been practicing 'holding it'. I have found that urination, followed by a couple of glasses of water a couple of hours ahead of time works for me.
My treatment began today which is a day late due to a day lost last week due to weather. Today is Tuesday, January 23.
When I went to the clinic today, I signed in and was led down to the treatment area. They took a picture for an ID card that I will present each day so that everyone involved will know for certain who is being treated. It wouldn't do to get a plan other than yours. In addition, there is a computer screen in the x-ray vault with the name of the patient whose plan is about to happen.
I went to a dressing room and took of my pants, underwear, and shoes and put on another of those lovely hospital gowns opening in the back, do not tie it. From there it's off to the vault where I was greeted by two therapists and the machine. It's (the machine) about 9 feet tall and 15 feet long with the treatment table in front and a big long arm to the left side as you face away from the machine.
I got on the table on my left side and had the balloon inserted and inflated. Then got on my back and was lined up with the lasers and tattoo's and the mold that holds my legs in place. One is in the ceiling and the others are to either side. The therapists left the vault. Then two x-rays slid out from the machine. One above me and the other to my right side. These are to locate my prostate. I kind of expected R2D2 to stop by. From outside the vault, the therapist moved the table fore and aft, side to side, and up and down to accurately locate my prostate. This is done each day due to normal movement of internal organs.
Then the computer thought about it for a couple a minutes and the big arm ( the gantry) rotated to a position above me. It then it adjusted itsself with very small, slow movements that I didn't even notice at first. It then hummed for a bit and moved to another position. I think it moved to 6, or 7 positions total, but I'm not certain. I'll have more accurate information as I experience this. It's 7 positions, and is "on" about 15 seconds in each position.
My total time in the vault was about 12 minutes and my total time in the clinic was half an hour. Now that I know what to do, it will be even less. It's my understanding that I will meet with my oncologist each Monday after treatment.
That's it for today. I'll give you more information as I learn it.
Varian linear accelerators is where to Google for pictures and brief descriptions of the equipment.
Today I was a little more focused and able to observe more. The big gantry (arm) starts out directly above me and zaps me for about 10 to 15 seconds. It then rotates around to my right. Think of above me as top dead center and the machine rotates to about 135 degree from there. I get zapped for a similar period of time. It then moves to 90 degrees from above and does the same. It then goes to about 45 degrees from top dead center (TDC) and once again does the same. The same process is repeated on my left side. If you have trouble understanding this I can explain it in a different way.
The time the machine is 'on' is not relevant. What's important is how much radiation is administered over what period of time. Nowadays we use Grays instead of Rads as the measurement. My therapists use centigrays - cGy. I am to receive 7740 cGy over an eight week period. This is fairly agressive, I think. (In fact, this is not particularly aggressive. Since I wrote that my oncologist showed me some statistics displaying the relationsip between cure and side effects. At my Gleason stage, more radiation increases the cure rate very little, but adds to the side effect rate.)
To date no side effects. Still too early, I think. I was in and out of there is less than half an hour.
Beginning of Week Two and Meeting With Oncologist
I had my normal treatment yesterday. The same as every other day, except that the computer seemed to think about things a bit longer before zapping me. I'll see if it does the same today and ask the therapists and report back.
I should note that this is an assembly line process. I show up 15 minutes before I'm scheduled for treatment and change into the gown. If they are on schedule, I spend a little time in a waiting room. So far they have been ahead of schedule on four out of five days. Then, just before the previous guy comes out, they call me to what I call the 'staging chair' near the vault door. When the other guy walks out, I get up and walk in. The therapists have just finished changing the covering on the table and I lie down on my left side and begin the process again. A few minutes later, I walk out and say hi to the guy replacing me. It's very efficient, if somewhat impersonal.
To date I have experienced no side effects. None
After I was finished, I went to see the nurse who weighed me (some lose weight during this and they prefer that you don't) and asked a bunch of questions about my urinary and bowel habits and whether they had changed. Then the oncologist came in and asked some of the same questions, prodded my belly (as the nurse had done) and listened to my breathing. He then had my drop my pants and checked (looked at) my anus (the radiation can burn your anus). All of this is done to determine whether I'm having side offects from the radiation.
The doc then answered any questions I had and I left. He showed me the CT scans done during my simulation and I must say they are interesting. It's like I was cut in two at hip level and I'm on my feet and you are looking down at me. In living color, no less. Total time in the clinic was about 45 minutes.
I'll be back when anything changes, or I learn more.
Yesterday, a patient at my clinic told me that to fill his bladder he drinks some water just before he goes in for treatment. Gents, unless your mouth is connected directly to your bladder, that will not do it. Each of us will be different, but here is what works for me. Two hours before treatment I urinate and then drink 16 to 20 ounces of water and then 'hold it'. Two hours before I drink the water, I drink little, or nothing. I don't want to hold it any longer than necessary. I practiced this before I began treatment. The stakes are high.
In the middle of Week Three - today is February 7, 2007.
I am gradually gettig used to things and have developed a routine that is efficient and comfortable. I have experienced no side effects to date. Energy level is still good and I am still exercising daily. I had my weekly meeting with my oncologist Monday and couldn't even think of any questions to ask. Just what I wanted - no surprises.
End of Week Four
Yesterday ended my fourth week and still no surprises. My energy level remains good and my urinary and bowel habits have not changed. My ejaculate is almost, but not quite, dry. I expected it - just didns't know when it would happen.
Some of the guys show up just on time, but some of us live some distance away and get there early (don't want to be late). A couple of the guys bring their wives and they wait in the waiting room and talk. I have found a Starbucks about five minutes away and I go there and read. This removes my anxiety about being late, but I'm not in the clinic any extra time.
I have found that they run a bit late on Monday and Wednesday, due, I think, to extra x-rays that are taken on those days and due to new guys starting Monday. Fridays and Thursdays are early, because some have finished their treatment and the new ones don't start till Monday.
I am finding that drinking the water any more than two hours ahead of time is just misery. I'm now doing it about an hour and 45 minutes ahead of when I expect treatment. I'm getting good at lining myself up on the table. Twice last week, they didn't have to move me at all to get me lined up with the lasers. What a talent.
End of Week Five
23 down and 20 to go. I lost a day this week since the machine was broken. They occasionally have problem with Lenore. Bluebird suggested a name I picked this one from the Poe poem The Raven.
To date I have no side effects. None. I'd like to give you a more interesting post, but it's routine. See you next week, or when something interesting happens.
End of Week Six
28 down and 15 to go. I am finally beginning to have some side effects. I have developed a loose stool and my energy level is down. When I feel the need for a bowel movement, I don't put it off for too long. I've had no embarrassing incidents and I intend to keep it that way. I have been exercising each day after treatment with decreasing enthusiasm and energy. I have fallen asleep sitting up in my chair a few times and that is not like me. I think I will try doing my cardio in the mornings and my resistance (weight lifting) after my treatment in the afternoons.
I expected to loose weight during this process, but have instead gained a pound or two. I usually spend 100 to 120 nights a year in hotels, which means many restaurant meals, which means a lot more calories than eating at home. I attribute the weight gain to eating more protein and too much snacking. Too much of a good thing is still too much. I am eating additional protein because it is my understanding that protein helps to heal damaged tissue. I may be all wet, but I'm doing anything I can to help myself and those who are helping me.
I feel fine and am sufferring no discomfort, or pain. I am, however, anxious for it to end. It's tedious and I am bored.
I have added to and re-written some of my previous posts to make them more accurate, or more clear.
Big Note: If you choose radiaion, please research carefully and note the difference between IGRT and IMRT. I have noted that some on the forum do not realize the difference.
End of Week Seven. 33 treatments down and 10 to go.
Last week I experienced some fatigue. None this week. I recovered over the week end and have had good energy all week. I'm exercising differently. I now do my cardio in the morning and my lifting in the afternoon after my therapy. Still kind of a loose bowel, but no worse than last week and maybe a bit better.
When I met with my oncologist on Monday, I told him that if I didn't know I was having therapy, I wouldn't know I was having therapy. He said that some experience more side effects than others and he doesn't know why. He thinks drinking the water helps avoid urinary problems. I have none of those.
I'm still eating more protein than normal to promote tissue healing, but have no idea if it does any good at all. I have not gained, nor lost any weight. Nothing more to add.
End of week Eight. 38 treatments down and 5 to go.
Not much to report this week. I was tired Sunday and Monday, but not the rest of the week. Maybe a bit today. No change in side effects except that my bowel habits have gotten better. Everything functions as it did prior to treatment. I gained one pound from last week. Amazing.
I was thinkiing that I should tell you how the table moves after the markers are x-rayed. It feels like the table sometimes moves a bunch, but it actually doesn't. Less than a quarter of an inch at the most. I thought that it never moved vertically, but it does most every day. I just can't feel it.
That's All Folks! Friday, March 23, 2007. It's over.
Had my normal treatment today. Afterward, I thanked the girls for being so good to me, they gave me a big hug and a completion certificate signed by all the staff and I was out of there.
A note about my fatigue. I was tired during week six and thought that except for a couple of days I have completely recovered. Not says my wife - not to normal energy levels. She is correct. I was very tired Tuesday and today. I took a nap both mornings. I don't think I've taken a nap in 20 years, but I needed to this week.
When I met with my oncologist Monday, he said that he expected my loose bowel and fatigue to be back to normal within three weeks, or a month. He also said that 60% of the guys are like me - almost insignificant, or no side effects. about 30% have more noticeable, but manageable side effects and about 10% are miserable, usually during week two and three due to swelling of the prostate.
I have an appointment with my urologist on April 2 and will report the results here.
Glad It's Finished,
Just got the results of my first post treatment PSA. My uro wanted it to be 2.5, or less which is half of my highest PSA. I wanted it to be 2.1, which is half my lowest PSA. It turned out to be a 1.9 which is a very good result. I am happy with it. I'll get it checked again in October. My uro said that it will go to some minimum level and stabilize there. He doesn't much care what that level is, just so it doesn't go up. I'll check in again in October.