In 2009 my cancerous prostate was surgically removed when. I was 52 at the time. I was fortunate that the cancer was caught when it was because there was no evidence of spread outside my prostate. Following treatment for prostate cancer it is strongly advised to have an annual PSA (Prostate Specific Antigen) test. I have followed this regimen annually since 2010 and, until early 2020, my PSA was so low that it was not recordable. However, in January 2020 my PSA registered as 0.1 which my doctor was not concerned about. In February 2021 my PSA doubled to 0.2. The doctor advised that 0.2 is the threshold above which they become concerned. He prescribed a follow up PSA test two months later and it came back as 0.3. This means that the cancer is back.
It turns out that in approximately 30% of men who have their prostate removed the cancer will come back. "Removal" of the prostate really means "removing as much as possible without doing collateral damage". The prostate is not like an eyeball - it is intertwined with many nerves as well as your urethra so some prostate material is left behind during surgery. In some cases this can become cancerous. Lucky me - that is my situation.
I next had a bone scan to see whether any cancer had spread to my bones as this is where prostate cancer will often migrate. The scan was negative. I also had a CT scan which came back negative. The oncologist was pleased with these results, as I was I! These results suggest that the amount of the cancer is likely to be quite small and is most likely, but not certainly, located in the prostate bed - where my prostate used to live.
The only treatment option is radiation. Chemotherapy is not an option. Last week I began a course of 33 radiation treatments. Today I had my 6th treatment. Treatments are daily except for weekends and statutory holidays. This means I will be finished in mid-December. I haven't longed for Christmas this much since I was 3 years old.
I am told to expect significant fatigue at roughly the half-way point and possibly some bladder or colon irritation after six or seven treatments. So far so good.
Notwithstanding having cancer again, I feel extremely fortunate for three reasons:
- the cancer appears to have been caught early.
- I live 15 minutes away from the Allan Blair Cancer Centre.
- I don't need surgery; if I did, it most certainly would have been bumped indefinitely by all of the socially irresponsible unvaccinated idiots who are tying up our health care system after catching preventable COVID-19 and bumping all sorts of medical treatments, many of which are much more dire than mine.
Preparation for treatments is very easy. Your bladder must be full and your bowel empty for the treatments. This means a daily dose of a very mild laxative which works like a charm with no discomfort at all (Restoralax - I highly recommend it). It also means peeing one hour before the treatment and immediately drinking 500 ml (2 cups) of water. That's it for preparation. Having a full bladder and empty bowel helps to move vital parts as far away from the radiation target as possible. It is also strongly advised to avoid coffee as it is a diuretic and can be hard on your bladder. Also alcohol is to be avoided during the treatment course (the presence of alcohol makes things harder for your body which is having to cope with radiation).
Before treatments can begin you must attend a session called a CT simulation. You lie on a platform that is part of a CT machine and with your clothes and shoes on. With nurses holding a "modesty towel" over your nether regions you pull down your pants and underwear to mid-thigh. They then position your body so that four laser beams shine on your skin - two of them shine on the hips, one in your groin and one beneath your belly button. They then give you tiny freckle-size tattoo dots to mark the position of each laser beam. Next the CT machine runs and scans to tell the radiation oncologist where your innards are so they can determine where the radiation needs to be targeted. The bladder/bowel prep has to be done before this procedure also.
I was given a printed schedule with the times of my treatments for the next 5 days. I show up 5 minutes before my appointment (they won't even let you in the door if you are earlier - probably a COVID-19 rule). I place may printed schedule in a tray at the reception desk and walk down the hall to a waiting room. Very quickly after than a technician comes for me and we walk to the room where the radiation machine is located. It is made by a company called Varian, a US company located in Palo Alto, California. Varian became part of the Siemens organization, the German conglomerate, in April 2021.
This is what the radiation machine looks like:
Note that there is a cabinet on the left which is sitting on the floor of the room with the words "Varian Medical Systems" printed on it. This is the part of the machine that generates the radiation. There isn't actually any "radioactive" material in the machine (i.e., no cobalt or other radioactive isotope). The machine uses a linear accelerator to create the radiation. Note also that there is a vertical seam between the cabinet on the left and rest of the machine. The entire rest of the machine to the right of that seam can be rotated 360 degrees around your pathetic diseased-ridden body as it lies on the bed. Note that the bed has an accordion structure underneath which allows the technician to fine-tune the position of your body from their control room.
You lie on the bed with your knees and head supported in special foam cradles, with your clothes and shoes on. Similar to the CT simulation, technicians hold a "modesty towel" over you while you pull down your pants and underwear to mid-thigh. They then position your body so the four tattooed dots line up exactly with four laser beams that shine on you (and which hopefully have been properly calibrated to be in the same position as those in the CT simulation room!!!).
The technicians then leave the room and devices emerge on either side of your body. In the above picture these are in the retracted position, folded back against the machine. When extended these devices do a scan of your innards - the entire structure rotates slowly 360 degrees around your body to do the scan. This is to verify that your bladder is sufficiently full and your bowel is sufficiently empty in relation to what they were like when the CT simulation was done. If not within tolerances you either have to drink more water or you have to try to take a dump - fortunately neither has happened to me yet.
After about a minute a horn goes off and a red warning panel flashes on the wall to warn anyone foolish enough to be hanging around that electrons or protons of whatever will start hurling towards the helpless lump of flesh and bones (and more fat than there should be) on the table. Then you can hear the linear accelerator fire up - it makes a fairly high pitched whining sound - all I can think of is the original Star Trek but so far Scotty has not made an appearance and I haven't been beamed anywhere. I just lie there with my mind imagining that my innards are turning into crispy bacon. Then the business end of the machine (the round head that is above the table in the picture above) starts rotating slowly around my body a full 360 degrees. It then stops for two or three seconds and then proceeds to rotate in the other direction a full 360 degrees. It then shuts off, I pull up my underwear and pants and say goodbye. The whole procedure from walking to the treatment room to walking out takes roughly seven or eight minutes. On my way out I pick up my printed schedule on which someone has initialled beside the time of my next appointment and/or has modified some of the future appointment times.
The people at the Allan Blair Cancer Centre are the nicest, kindest, warmest health care people I have encountered anywhere. Everyone I have had contact with, from the oncologist to the nurses to the technicians, are extremely good listeners and equally good communicators. They exude a quiet confidence which gives a patient great confidence.
The beam of radiation is directed at a target inside your body that is lined up with the axis of the machine. As the head of the machine rotates around this axis the target gets radiated for the full treatment period while all other flesh, bones and organs are only radiated momentarily as the machine rotates - ingenious.
This is how the machine rotates.
This shows the beam of radiation being directed from the linear accelerator and through a prism or some similar-acting component and then through a series of metal leaves to regulate its size (I assume much like how the aperture of a camera lens is varied).
This is a picture of the linear accelerator (I have no idea if this is from exactly the same machines I am being treated with but it is probably a reasonably close facsimile).
The morals of this story are:
- If you have never had prostate cancer treatment MAKE SURE YOU ARE HAVING REGULAR PSA TESTS AND PHYSICAL EXAMS.
- If you have had prostate cancer treatment MAKE SURE YOU KEEP ON HAVING REGULAR PSA TESTS.
- Nobody wants to get cancer, of any type. However, if caught and treated early your chances of living a longer and healthier life are greatly improved over someone who can't be bothered to have these simple tests performed. If you are squeamish of doctors, suck it up and get tested.
Please donate to cancer research.
I look forward to the next 27 treatments and then Christmas when I might be able to have a drink or two again!