December PCa update

Today I had my 29th treatment of proton radiation therapy at Loma Linda University Medical Center. For these final 17 treatments I have a smaller aperture and bola for each side. Dr. Bush explained that this was the plan so that the initial treatments would also cover a 12mm margin and the seminal vesicles for the first 28 treatments. Yesterday the session took a bit longer as the technicians took more x-rays than the usual 2 taken each treatment to align everything. The extra images were used to re-align everything for these new smaller apertures and bolas.

I really welcome this development as I was concerned about that 12mm margin, but now I understand the approach and just wish I had been more informed about these details earlier. I have also learned there are a wide variety of adjustments and tweaks, including hybrid treatments that use protons for the first half then photons for the second half.

We had our one-hour tour of the other gantries and the “back room” where the protons are made last Sunday. Of course one hour was far too short for me and the whole apparatus was a marvel of tubes and wires and magnets, pumps, meters, valves and all sorts of gadgetry. It is all pretty impressive though smaller than I had envisioned.

I’m now on a regular schedule to start my day with a treatment at 5 AM which works well for me as I wake around 4 anyway. Usually by 5:30 I am in the gym and workout for 30-60 minutes followed by a 30 minute sauna. After breakfast I work online a bit and then go for a walk, hike or ride my bike for a couple of hours. After lunch I do a bit more on the computer and phone until dinner which is often part of some event or another here. Last night it was a nice Christmas party for proton patients, Tuesdays we have a pot-luck dinner in a nearby club house, Wednesdays we get sandwiches and fruit at the Brotherhood of the Balloon meeting and so forth. I think the holidays are a great time to go through treatments here. I have had some urgency and burning that is relieved with ibuprofen. Dr. Bush says this is normal due to the radiation and will stop when the treatments are done. Overall I feel fine and stay busy.

I am scheduled on Amtrak to Sacramento for Christmas and if everything continues smoothly will return for the last 9 treatments to finish on Friday, January 7. OFFICIALSELECTIONsm I’m looking forward to the documentaries about our food supply that will be shown at the Wild and Scenic Environmental Film Festival January 15-17. I’ll be there to hand out iDrive 55 bumper stickers for the Drive 55 Conservation Project and invite all my friends to come to Nevada City to enjoy this event. Our doc is scheduled to screen on Saturday night and Sunday morning plus we are doing an interview in the media center hosted by http://www.seejanedo.com on Sunday that will be streamed online by http://www.cognizantproductions.com

Tim

Posted in PCa

October PCa Update

October was consumed by the CCI petition campaign and the trip to Loma Linda to get the pod made and have the initial consultation.

During my visit they did a CT Scan with me in the pod and they will use that image data to make the gadget that helps shape the proton beam. I met with Dr. Bush and his team for a complete exam and we all agreed to go ahead with the proton beam treatment plan. I’ll have 45 treatments weekdays that take about an hour out of my day.

I have to remember to drink two glasses of water about a half hour ahead to fill my bladder. Once I am in the pod and the tech has inserted the balloon everyone leaves the room while the machinery goes to work. A wheel spins to cause the Braggs peak effect and the protons are delivered through the device. The actual exposure time to the beam is about 1 minute and little effect is felt. The beam switches sides each day.

So, I have had 9 of these so far and no problems to report. The technicians are competent and the process seems well known. I was told the computers make the final adjustments and that there is a half inch margin planned in the treatment. This is to compensate for the inevitable differences in size and position despite all the care taken with the pod and so forth. Due to the holidays I’ll be doing this until mid January, 2010. I should be done just in time for the Wild & Scenic Film Festival where Ryan’s film about Drive55.org will be screened and I am scheduled to hand out iDrive 55 window cling things.

Posted in PCa

September PCa Update

It has been almost 4 months now since my diagnosis 6/5/09. Two months ago I decided my treatment plan would be headed up by big lifestyle and diet changes, bolstered by hormone therapy and finalized with a round of proton beam therapy at Loma Linda which may be followed with more hormone therapy depending on PSA results. The diet and lifestyle changes are permanent.

So, I have lost about 30 pounds by simply walking a lot, riding my bike often and not eating anything with more than 3 grams of fat per 100 calories. No red meat and very little poultry. Lots of fruit and vegetables and some seafood.

For the past two months I have been on Trelstar, a hormone to block testosterone. PSA has fallen to 1.5 as of 9/29/09. My consultation at Loma Linda is scheduled for 10/6/09-10/7/09 and I hope to return mid-October through mid-December for the series of proton beam treatments.

I don’t play games like golf and tennis and as a California native have very little interest in the traditional attractions folks from out of state enjoy. Therefore, while I am in Southern California I will be working on a petition drive to put an initiative on the 2010 ballot to end cannabis prohibition and save California. http://CaliforniaCannabisInitiative.org. This useful diversion will keep me busy and therefore is a big part of my treatment plan.

So that’s my PCa update for now, I feel good and am very optimistic about my plans. I am fortunate indeed!

Posted in PCa

PCa Update

8/12/09 Bostwick Lab report – second opinion on biopsy. A) Right: Adenocarcinoma (Gleason Score 3+3 =6) involving less than 5% of the specimen. B) Left: Adenocarcinoma (Gleason Score 3 + 4 = 7) Involving 50% of the specimen. Gleason pattern 4 comprises 10% of the cancer. Perineural Invasion.

8/12/09 I had the dreaded colonoscopy and elected to skip the sedation. What a great decision that was! Honestly, I have had much worse experiences in a dentists chair! It was also really interesting and informative to watch the high resolution color video monitor of my innerds. I got the all clear call a couple days later and the most painful part of this medical procedure is the bill. Ouch – at least it satisfies my high deductible for the year, and I don’t have to do it again for ten years.

8/28/09 LabCorp PSA Test: 8.2 ng/mL (from 9.7 on 5/6)

9/2/09 Dr. C says PSA should have dropped more but we will wait another month and see. Meanwhile I had another 3.75mg Trelstar shot and next time it is to be a 3 month shot. I had some hot flashes during the month prior and this shot made my rump a little sore. I feel a bit odd, but nothing serious enough to stop my regular activities.

9/4/09 Loma Linda called and I am scheduled for my consultation on Tuesday, 10/6 and 10/7 to measure me up for my custom pod. They will then have me back a week to ten days later to begin the eight week series of treatments. So, mid October through mid December I will be in SoCal.

Proton Beam Therapy

I posted my story to an online listserv and have had several responses with glowing support of Proton Beam Therapy.
Proton therapy has been practiced at Loma Linda University Medical Center in Loma Linda, CA for 17 years. Additional proton centers have been established at Massachusetts General Hospital in Boston, Midwest Proton Radiotherapy Institute in Indiana, MD Anderson in Texas and University of Florida Proton Therapy Institute in Jacksonville. Proton therapy is also practiced in Europe and Asia. And at least 16 new hospital-based proton treatment centers are in the design, construction or planning stage around the world. http://www.protonbob.com
So I sent an inquiry to the Loma Linda folks since that is the closest to me.

I also sent an inquiry to Oakland based CET http://www.cetmc.com because they offer a unique method that removes the radiation from my body after each treatment and Oakland is a 2 hour train ride away.

Posted in PCa

July RT Consultation

Had appointment with RT Oncologist Dr. Leibenhaut on July 1 who did the most thorough exam to date, including a DRE. He assigned a CS of T2B and told me his recommendation would be surgery because my staging indicates I would have a 25% chance of not needing radiation therapy, which also means I have a 75% chance of ALSO needing RT anyway. He said the risks were about equivalent for side effects but that RT would likely lead to a new cancer 15-20 years later. He was also confident of success, and willing, to treat me with a triplex of Hormone, EBRT and Seed Implants. He told me of a clinical trial I barely qualified for that would involve a control group that does just the seeds.

Posted in PCa

June more details emerge

6/19/09 I was scheduled for a follow up appointment June 23rd but they called on June 18 and reset the appointment for June 26th. I asked about referrals for further tests and to a radiation & medical oncologists which seemed bewildering to the girl that called. I also asked if it was possible to communicate with Dr. Crawford via email for simple questions. The girl didn’t know and called me back a few minutes later to say no to everything. I will just have to wait until my next appointment.

6/26/09 Questions to ask Dr. Crawford:

What is the size of the tumor?
37 G per Ultrasound during biopsy

What treatment do you suggest?
Surgery (Radical Prostatectomy) or Radiation Therapy

What other tests should I have?
CAT Scan marginally useful, bone scan expensive and rarely positive

At this appointment Dr. Crawford clarified his Clinical diagnoses is T2A. He gave me a referral for consultation with Dr. Leibenhaut whose office called the same day and set me up for Weds, 7/1/09 at 10 AM

Posted in PCa

Prostate cancer diagnoses

From http://en.wikipedia.org/wiki/Prostate_cancer

Prostate cancer is classified as an adenocarcinoma, or glandular cancer, that begins when normal semen-secreting prostate gland cells mutate into cancer cells. The region of prostate gland where the adenocarcinoma is most common is the peripheral zone. Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN). Although there is no proof that PIN is a cancer precursor, it is closely associated with cancer. Over time these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma) forming a tumor. Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum, or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system. Prostate cancer is considered a malignant tumor because it is a mass of cells which can invade other parts of the body. This invasion of other organs is called metastasis. Prostate cancer most commonly metastasizes to the bones, lymph nodes, rectum, and bladder.

Diagnosis
Normal prostate (A) and prostate cancer (B). In prostate cancer, the regular glands of the normal prostate are replaced by irregular glands and clumps of cells, as seen in these pictures taken through a microscope.

When a man has symptoms of prostate cancer, or a screening test indicates an increased risk for cancer, more invasive evaluation is offered.

The only test which can fully confirm the diagnosis of prostate cancer is a biopsy, the removal of small pieces of the prostate for microscopic examination. However, prior to a biopsy, several other tools may be used to gather more information about the prostate and the urinary tract. Cystoscopy shows the urinary tract from inside the bladder, using a thin, flexible camera tube inserted down the urethra. Transrectal ultrasonography creates a picture of the prostate using sound waves from a probe in the rectum.

On June 5, 2009 I got the result of a biopsy diagnosing cancer in the left lobe with a Gleason grade of 3+4 = Score of 7, present in 5 of 5 cores, involving 60% of needle core tissue, and measuring 38 MM in length. Doctor noted the Stage as T2 with N0 and M0 because there have been no tests or biopsy to determine these (Node & Metastasis)

So, yes, I do have prostate cancer. It gets way complicated from here. At this point it is an “Intermediate” stage but I haven’t had any tests that will confirm or deny if Nodes are involved or Metastasis (spread). At this point the prognosis is good with nearly 100% “cure” rate if it is caught early enough. There are a variety of treatments and tests to choose from so if we caught it early enough and if it has not spread I have a good chance to get through this OK.