IMRT UnderwayOn April 14th my first real meeting took place with the wondrous machine which would cure my cancer. The machine is called a CLINAC 2100C - Therapy Accelerator. I am positioned on the adjustable table under the guiding parameters of the red lasers shining from the ceiling and walls. The lasers are perfectly aligned with the tattoo marks on my body. The custom body mold is then fastened down to hold my body in a precise position.
The three radiation therapists leave the room and a massive steel door is closed leaving me in contact with them via a T.V camera and audio if I require any assistance. The computer then positions and operates the CLINAC 2100C to duplicate the specific radiation angles prescribed by the program along with the appropriate radiation dosage. The machine whirs to one position and fires a continuous burst of radiation for about forty five seconds the first time. This operation is repeated four more times, each at a different programmed angle and each for approximately 30 seconds. The entire operation is painless and takes about 15 minutes. The most difficult requirement is to lie absolutely still during this entire period.
I am told that I receive 1.8 Gray (180 RAD) of radiation per session. The sessions will be repeated 5 days a week for 9 weeks. By April 18, 1997 I have completed five sessions and have no ill effects whatsoever from the radiation. The only noticeable effects of the treatment so far are the periodic hot flashes which occur after I retire at night. This is but a minor inconvenience and will cease when I stop taking the Lupron and the Casodex in another eight weeks.
The most difficult part of this entire operation is that related to the travel to the treatment facility every day. The trip involves a two hour train ride of 100 miles , a half hour subway ride, and a half mile walk. Then the procedure is repeated in reverse. Weather permitting I will walk the 2 miles (about 30 city blocks) back to the train station, in lieu of the subway, after each procedure for the value of the exercise.
I found that I was exhausted from the trip after the first two days. However, by the end of the week my body had become accustomed to the ordeal I felt fine when I arrived home and felt no degree of tiredness whatsoever.
On April 18th, my radiation oncologist called me into his office after the procedure for that day was completed. He had some wonderful news for me! An evaluation of the films taken during the Simulation and the dry run indicated that the first three months of the hormone ablation phase had done a superb job. The ablation had reduced the size of my prostate to about half size, as was expected.
In addition to the size reduction, the x-rays showed that the spacing between the smaller prostate and the nearby organs had "an excellent wide gap" to quote my doctor. The significance of this is that the laserlike accuracy of the radiation beam can be focused on the prostate without damaging any of the surrounding organs.
My doctor indicated to me that I should have no adverse side effects from the radiation for at least 5 weeks and then these reactions should be minimal or perhaps nonexistent. At the end of the 9 week treatment any side effects which do present themselves should rapidly dissipate. This excellent prognosis is due to the wide safety margins produced by the androgen ablation phase and the precision of the machine to direct radiation with laserlike accuracy.
This facility has been using the 3-D Conformal Radiation Therapy for about six and a half years. During this period of time the procedure is being constantly improved based on results gleaned from patient history. The advantage of employing the androgen ablation phase concurrent with the radiation phase is one example of this.
At first levels of radiation amounting to 65 Gray were used on patients. Higher levels of radiation could cause damage unless the mechanics of the treatment was of superb precision. Over the years the precision of the equipment and the computer program improved as more and more patients generated additional operational data. Gradually, the amount of radiation was increased through 75.6 Gray. As mentioned earlier, current data indicates excellent results as the level of the radiation dose approaches 81 grey (8100 RAD).
My doctor indicated to me today that the latest compilation of data on patients who had received 81 Gray (Gy) of radiation indicate "Phenomenal success" in curing their cancer completely. My dosage will be 81 gray. Considering the spacing the ablation phase has provided it now appears that I can expect not only a complete cure in 8 more weeks and virtually no adverse side effects.
April 26, 1997
The end of the second week of treatment. Still no adverse side effects from the treatment. The daily journey to N.Y. is a bit wearing by the end of the week but tolerable.
This week the Radiation Therapist took another series of five "films" one along each of the radiation planes. This was similar to the "dry run" except that the particle accelerator itself was used to expose the films with short bursts of sub-atomic particles. This procedure will be repeated once each week to insure that nothing has changed regarding the orientation of the internal organs or the body orientation during treatment.
May 2, 1997
The end of the third week. Still no adverse reactions to the radiation. The usual "films" were taken again this week to reconfirm perfect alignment and a blood test was taken to insure no changes in blood chemistry. None were found.
During a discussion with one of the doctors I was advised that some men show some negative reactions to the radiation after only two treatments. Others can take the entire 42 - 45 sessions with no negative reactions at all. So the response of one person does not guarantee the same response in another patient.
May 9, 1997 - The Fourth Week
Twenty treatments have now been administered and I still have no adverse negative reactions. The daily trip to N.Y. is now inconsequential and has no tiring effect on me at all.
This week brought excellent additional news from my doctor. He had previously reported "phenomenal" results, based on accumulating data, when the entire treatment includes 8,100 RADS of radiation vs. the 7,560 used previously. This week I asked him to quantify his statement with a number. His words were "Let me put it this way - With the 8,100 RADS and NO androgen ablation the rate of positive biopsy has been reduced 95%.
With the Androgen Ablation process included the cure rate will be closer to 100%". That is certainly good news! This also points up the rapidly developing advance of radiation as a treatment for prostate cancer and the value of having that treatment administered by an institution with a very massive experience in the 3-D technology - 11,000 + cases and 6 years in the case of this cancer treatment facility.
Last November, when I first met my radiation oncologist he indicated that the cure rate would be 60% for the radiation alone and 70% if the androgen ablation is included in the treatment - about the same cure rate as surgery (Radical Prostatectomy) or seeding (Brachytherapy). Besides increasing the cure rate, the androgen ablation also shrinks the prostate and increases the spacing between the prostate and nearby organs so that collateral damage is eliminated or greatly reduced. Now, six months later, the accumulated test data, from prior years, has indicated that an increase in radiation to 8,100 is feasible and that this will effect a near perfect cure. A cure rate of over 95 % is higher than any other form of treatment including all present surgical and nonsurgical procedures. Again - a vast benefit as the result of going with a leader in the field of cancer research which has a massive history of patient treatment and response in its archives.
May 16, 1997
The end of the fifth week. I have now crossed over the halfway point in my treatment.
At this point in the treatment I have come to realize that there is a side effect of the treatment which has become more noticeable. Specifically, I note the increase need to urinate. At present it is necessary to go to the bathroom about 4 times after I retire. There is also some increase in urination during the day (about 6 times). My review of the literature points out that this is a normal response to the radiation and should not become more acute.
Fortunately, control of my bladder is perfectly normal so there are no serious consequences except perhaps the interruption of a good nights sleep. My references point out that the condition should disappear about 2-4 weeks after the treatment stops.
May 23, 1997 - The Sixth Week
During my weekly meeting with my doctor I presented the subject of the only two minor side effects I have noted to date. (1) The need to urinate four times after retiring vs. once before the treatment started and (2) rectal irritation. The latter is a mildly irritating sensation, at the lower rectum, during a bowel movement.
The doctor indicated that both symptoms are common among 3-D radiation patients and that both would vanish after the completion of the treatment. During the developmental phase of the treatment a multidisciplinary study was conducted to determine the cause of rectal irritation. It was found that this symptom was simply a case of low order hemorrhoidal inflammation. Having been treated for a major outbreak of this malady many years ago I knew the symptoms were similar but to a much lesser degree.
Fortunately both of these temporary side effects of the radiation can be easily alleviated.The urinary problem is resolved by the administration of 2 mg of Cardura (Doxazosin). This is an alpha blocker used to treat high blood pressure but it is also effective in relieving the temporary urinary problem. The rectal irritation can be reduced by the use of Hydrocortisone suppositories administered prior to bed time and by taking sitz baths a few times a day or at least before retiring.
I tested the efficiency of the Cardura to resolve the urinary problem experienced after I retire. The results were astounding! On the first night a single 2 mg tablet of Cardura immediately reduced the need to urinate from four times to one - which was the normal amount before my treatment began. The rectal irritation has also virtually disappeared as a result of use of the Hydrocortisone and the use of Metamucil.
5/30/97 - The Seventh Week
The temporary post bedtime urinary problem has largely disappeared with continued use of Cardura and sensible liquid intake which includes little or no liquid intake between my final meal and the time that I retire. The "rectal irritation" has also largely vanished. I have discontinued the sitz baths and rely on the Hydrocortisone and Metamucil.
6/6/97 - The Eighth Week
I have begun to notice some side effects from the Cardura. These include: watering of the eyes, itching on the back of the neck, and eventually a small red rash on my face. Checking the medical literature seems to confirm this as a possible Cardura side effect. I have discontinued taking the Cardura with no adverse effect.
6/13/97 - The Ninth Week
I have noted an inclination toward greater fatigue related to the travel to treatment in New York from a suburb of , N.Y. This entire daily trip, including treatment, takes 7 hours to complete. I have made it a practice to walk the 30 city blocks from the hospital to Grand Central Terminal at least three times per week. On other days I make use of the subway. By Friday I find that I am beginning to notice the fatigue.
7/13/97 - One month after treatment
Virtually all of the adverse symptoms developed during the later stages of treatment have disappeared. Within two weeks after treatment I felt superb once I had rested up from the regimen of daily travel for treatment. My sexual activity has returned to normal without impairment. In fact, the wear and tear from the travel was a greater factor than that from the treatment itself.
If I had been able to obtain the SAME EXACT treatment in a local facility, I would have considered the side effects of the treatment virtually inconsequential.
8/5/97 - Seven weeks after treatment
I returned to the treatment center for a post-treatment checkup. A digital rectal examination by my radiation oncologist indicated that my prostate is now perfectly normal. Any abnormalities observed prior to treatment have now vanished.
The blood test taken today indicates that my P.S.A. level is now 0.17!!!! A successful treatment is indicated by a P.S.A. level of less than 1.0.