On Monday, Carol and I went for our first visit to my radiation oncologist, Dr. Poins*. He seems like a very competent practitioner and an all-round excellent guy, so we were reassured from the start.
For about 15 minutes before the doctor appeared, Nurse Bardolph* showed us a video explaining the different types of radiation oncology — exterior with relatively powerful radiation, interior with little radioactive beads, upside down with pineapple, and so forth — that are relevant to prostate treatment. It was all quite technologically impressive (we were interested to hear that the treatment team actually includes physicists), and the overall message of the production seemed to be “don’t worry, we’ve got this.”
When the doctor came in, he outlined the specific procedure that he is recommending, which is the external radiation method. While that doesn’t involve the little radiation beads, it will require me to return to my urologist, Dr. Peto*, to have some rice-sized, fiducial markers (“fids”) implanted at various places in my prostate to provide precise targets for the radiation beams. Naturally, I am overjoyed at the prospect of having Dr. Peto run bunch more pointy things up my bum, but in the long run it’s a pretty good bargain if it rids me of the Big C. (Dr. Poins tried to console me with the thought that I will now be able to tell people I have a “gold-plated asshole.” Sadly, since I already am a gold-plated asshole, the procedure won’t really alter my status in that regard.)
I don’t yet have any dates when all the above will begin. I do know that the radiation treatments will go on every day for five weeks, about 15 minutes per treatment.
Probably the best news of the day came when Carol and I were relieved of a misapprehension we picked up on our last visit to Dr. Peto. At that time, he had said that (based on various analytics) there was a 97% chance that the cancer had gone beyond the prostate. We took that to mean it was likely that the cancer had metastasized to other organs. On Monday, though, Dr. Poins clarified that Peto was simply saying the cancer had likely leaked through the thin sheath of the prostate into the surrounding fluid (which is why radiation is a better way to eradicate it than surgery). Based solely on the MRI results from last month, it appears that metastasis, at this point, is unlikely — though that possibility is still open until we have more precise results from the upcoming PET scan (Feb. 11).
In order to clean up any vestiges of the beast that remain after the radiation treatments, once they are accomplished I will transition over to hormone therapy. It turns out that prostate cancer cells are quite manly (not surprising), so they tend to flourish in a high-testosterone environment. The hormone therapy, which should last several months, will drastically lower my testosterone. That should weaken and eventually kill any remaining prostate cancer cells, as well as inspiring me with a powerful urge to buy shoes and listen to Billie Eilish.
Until the PET scan next month, that’s it for the Cupdate. There’ll be more anon.
*Names changed just for the hoo-haw of it.
Ronald Crittenden 