Brachytherapy

Prostate Cancer Part II

Brachytherapy (pronounced by most as 'brakie-therapy'),is a high dose targeted internal radiation. This type of treatment is used for several other cancer types as well, including breast, lung, cervical, but I will confine my discussion to the treatment of prostate cancer.

I was given the option of several different treatment types, including (1) prostatectomy, which is the surgical removal of the prostate and associated tissues, (2) external beam radiation, where low dose radiation is targeted at the cancer from the outside, which is less invasive but requires as many as 40 or more treatments, (3) hormonal, which involves the injection of certain drugs into your system to suppress the growth of male hormones that speed the cancer's growth , and (4) brachytherapy.

I chose brachytherepy for several reasons. First, it involves three treatment days separated by two week recovery periods and you are done; second, it leaves all your organs in place so at least you have a chance of them healing and resuming normal function; third, it is very targeted and specific, involving minimal damage to surrounding tissues and organs; fourth, Dr. Ray Richards comes very highly recommended by others who have had the treatment; and fifth, it just seemed like the right thing to do.

Dr. Ray Richards, Radiation Oncologist

My treatments began on January 19th with a 6:00am arrival at the Coral Desert Surgical Center in St. George. Starting about 24 hours prior you have to go through a prep procedure which involves taking a stool softener in the morning, then after a normal lunch begin fasting. You are allowed clear liquids until midnight and after that only a sip of water to take any required meds. Before bed you take two Imodium and a fleets enema. First thing next morning two more Imodium. This prepares your bowels by basically stopping them so that they don't interfere with the procedure the next day.

After checking in at the surgical center you are taken to the prep area where you remove clothing and put on a gown and elastic stockings. They give you some nausea medicine, take your vitals, have you sign consent forms, put in an IV and then wait.

the 'prep' room

Around 7:00am you are taken into surgery, where you are moved onto the surgical table where you sit up while they give you a local anesthetic to numb things a little before giving you the shot in the spine to deaden your lower body. As you feel your feet start to tingle and numbness spread they lay you down and put your feet is stirrup-like apparatus so you are basically in the birthing position. To guide them in what is to follow, they put in a catheter through your penis into your bladder, position a fluoroscope over your abdomen and insert an ultrasound probe into your rectum.

I can see the ultrasound monitor as I lay there listening to the doctors plotting the procedure. The team consists of Dr. Ray Richards, radiation oncologist, Dr Greg Taylor, urologist, a couple of nurses and of course the Anesthesiologist. You know they are doing things to you but it is rather detached, almost like it is someone else because you can feel nothing. It is a little errie watching the monitor and seeing the catheters slowly being inserted, knowing that they are invading your body. It is good that you are convinced it will help, but just the same there is nothing you can do except perhaps scream. Instead I tell the doctors I am doing fine.

They place a template on the perineum between your scrotum and anus. Through this template they insert 18 thin plastic catheters into the prostate gland as pre-determined by computer analysis using the biopsy to determine where to place each one. When this is done a CAT scan assures that they are in the correct position, and you are ready to be 'illuminated'.

catheters in place

the afterloader

nurse Tyler connecting the afterloader

After a short wait you are wheeled into the lead-lined room, and connected to a machine called an afterloader. Each of the 18 catheters is connected to a corresponding port on the afterloader. This machine contains a single highly radioactive iridium pellet at the end of a wire. The pellet is pushed into each of the catheters one by one under computer control. The computer controls how long the pellet stays in each catheter (dwell time), and where along the catheter it should pause to release its radiation (dwell positions). This very precise treatment takes around 20 minutes, after which you are taken to a recovery room for a five hour wait.

During the five hour recovery you can read, watch dvds, visit eat or sleep. After the rest they take you back and hook you to the afterloader again and repeat the treatment. When this is finished they remove the 18 catheters from your prostate and the one from your bladder. They make sure that you are passing urine and that there are no blood clots, and that the bleeding has stopped, then put a diaper on you and help you get dressed. Then they walk you to your vehicle and send you home. The entire event has lasted between eight and nine hours.

Join The Club

I recently joined a new club. It isn't all that exclusive, in fact membership is in the millions worldwide. It isn't even a club that one seeks to join, but rather would avoid. Even so, membership isn't free, in fact is is rather costly. Sometimes it costs your life. Obviously I didn't join voluntarily, rather I was inducted.

If you haven't guessed by now, the club is called The Cancer Club. So you now see why it is not a coveted nor sought after membership. I belong to the Prostate Cancer Chapter. I didn't want to join, and now my main membership goal is to get the certification as "Survivor". I have been reading some statistics which may be of interest:

• About 11.7 Million Americans currently have or have had cancer (does not include skin cancer and other basil or squamous cell types)
• About 1.5 million cases were reported in 2011, not including the above exclusions
• Approximately 572,000 people died of cancer in 2011, 0r about 1500 per day, accounting for about 1 of every 4 deaths in the US, and exceed only by heart disease.
• Death rates for common types of cancer in the us in 2003-7 per 100,000 were: All types-380.8; Lung/bronchus-101.4; Colon/rectal-36.1; Prostate-24.7; Breast-24; Pancreas-21.7; Non Hodgkin's Lymphoma-14.2; Leukemia-10; Liver-9; stomach-5.
• Survival rate for all types was up from 50% from 1975-77 to 68% from 1999-2006
• The National Institutes of Health estimates overall costs of cancer in 2010 at $263.8 billion
• 2011 US estimates for prostate cancer, 240,540 new cases, 33,720 deaths
• Prostate cancer is the most frequently diagnosed cancer in men and the second leading cause of cancer death
• Relative survival rates for treated Prostate Cancer: 5 year 99.6%; 10 year 95%; 15 year 82%.

So you see from these statistics that it is a large, expensive club. My chapter has good survival rates but because there are so many cases there is still a fairly high death rate. You also see I have a pretty good chance of surviving for at least 15 more years and by then other risk factors will probably be at least as significant.

My cancer was detected pretty early. I have been having yearly PSA blood screenings done for the past 10+ years, which showed only a gradual yearly increase until this past year where it spiked 1.4 points. Anything over an annual spike of 1.0 is a danger sign. Combined with other risk factors (family history) and symptoms the urologist recommended a biopsy. The biopsy performed in December revealed a malignancy in 6 out of 11 samples taken, with a Gleason score of 6/7. The Gleason score ranges from 2 to 10, 2 being non-aggressive and 10 being very aggressive.

Because of my Dad's experience with prostate surgery, I rejected that option outright and after further consultation decided on brachytherepy, which is a high dose radiation treatment delivered via radioactive wire inserted in needles directly to the prostate. My next blog will describe my treatments, which may be rather graphic and not suitable for women and children so beware!

The Trail Cam 1

Bobcat

Around Christmas 2011 I had the trail cam set up about a quarter mile south of my home. I captured the following video, which I think is quite remarkable as I don't think bobcats travel in pairs too often nor is it common to see them in the daytime.

Coyote

I also caught a coyote, though not as amazing it is still interesting to catch wild critters in the act of being themselves without the interfering with their natural behavior.

Out With The Old and In With The New

A common phrase for the new year, right? Well, this is even a little more literal. I finally got the new barn built and am in the process of tearing down the old one. Would it be prober to call it "De-constructing"?

I designed the barn last spring and had the plans made into construction prints. I decided I probably wouldn't live long enouth to build it myself, so I hired SMJ Homes to build it. Sounds kind of funny, but it is a home for our three horses. I think they did a great job and even ame in under budget!

After the barn was finished I started on attached corrals using old pipe that Dad had collected. I got enough done to put the horses in just in time to start feeding them around the first of December. There is still quite a bit to do on the corrals, but it can wait for spring.

My good friend Norm Kroh has joined the wrecking crew, and his wife has even helped out. They are new to this valley, they recently purchased Mervin's home and moved here from Idaho. They are great people and a good fit here I think, and they seem to like it so far.

I have to admit that this is all a little nostalgic, because I helped Dad build that barn when I was about ten I think. That would have been around 1957 0r 58. All the while I am working I wonder what Dad would have to say about the 'improvements'. I'm sure when he was a few years younger he would have loved it, but as he got older he really resisted change. I suppose that just goes with the territory.

Hiking "The Wave"

My cousin Ed from Saint George called me the other night and said that he had permits to hike "The Wave" on Wednesday and asked if I would like to go. I have wanted to do that hike for a long time, but getting permits is a cumbersome and unpredictable lottery process. Of course, I jumped at his invitation.

"The Wave" is a rock formation in the Coyote Buttes area which is about midway between Kanab and Lake Powell. It is a gorgeous area of sandstone rock formations sculptured by eons of wind and water. It is administered by the BLM and they give out just 20 permits per day, and some days there are over 600 applicants.

The hike is quite moderate, about five miles round trip, mostly over rock and sand. There are a few ups and downs, but probably no more than around 500 feet in elevation gain total. You start out at the Wire Pass trail head, the same place where the Buckskin Gulch hike begins, then follow the wash for about a quarter mile, before jumping out and heading south. For more information on the hike just google "The Wave" Utah, and you will get lots of information.

I met Ed and his dad John in Hurricane at around 6:00am, went out through Colorado City to Kanab, then east toward Lake Powell, arriving at the trail head around 8:00am. It was 9 degrees when we left the vehicle at 8:20, but we dressed warm. Only exposed flesh froze instantly. The beauty of our surrounding made us forget the cold, mostly. Every where you look there are rock formations that dazzle your senses and gobble up memory in the digital camera.

The guidebook says the hike will take around three hours. I told my companions you have to multiply that by a factor determined by the number of cameras present. (T=1.33* # of C) It took us six hours! We had a leisurely lunch nestled out of the wind and it was actually quite pleasant. Two more hikers appeared later, one from Switzerland and the other from somewhere called Florida. We spent quite a bit of time exploring and looking for that great shot. The return trip was a little colder as the wind had picked up and it was in our face most of the way. When we arrived back at the truck at around 2:00pm the temperature was 24 degrees.

All in all it was a great hike, one that I would recommend to anyone wanting to see some spectacular scenery. Below are a few of the 200 plus photos I took.