Thursday, November 27, 2014

What I'm Thankful For: A Cancer Under Relative Control

A remote brachytherapy afterloader of the type that delivered my cancer radiation treatment exactly one year ago, Sept. 25, 2012. It's an electro-mechanical system by which 16 transfer tubes  with radioactive Iridium -192 needles are inserted into catheters in a fixed template (stitched to the perineum) to deliver radiation directly to the prostate gland. I received a total dose of 1920 cGy (centigray), in a treatment delivering one single high dose

It was my sister-in -law, Krimhilde - an Eckist- who first reminded me that gratitude is a "metaphysical concept" that transcends all human cultures and religions. As she put it during our last extended conversation: "Gratitude acknowledges one's basic relationship to the universe as a whole, and giving thanks acknowledges one's place as a spiritual being within it."

In terms of Thanksgiving there are always the usual things people have to be thankful for: good home, loving wife or family, ample food, successful kids, and maybe a general joie de vivre. Others have additional cause, beyond the normal gratitude, especially including having a cancer under relative control, or even being cancer-free.

In my case, the prostate cancer detected in July, 2012, for which I had treatment at the Helen Diller Cancer Center at University of California- San Francisco, in September that year, e.g, see:

at first shocked me, including that I had to have treatment (radiation or surgery) as opposed to just watching and waiting. The months after the final PSA spike was detected were intense and included not only a biopsy but also flying to San Francisco to be evaluated for treatment and then receiving one of the first single high dose brachytherapy administrations. The follow-up PSA - done two months after treatment- showed 2.0 and seemed to indicate the single dose radiation had worked (radiation which also triggered severe urinary urgency and burning)

In my most recent PSA test result, taken 9 months after the last, it was up slightly to 2.68 (from 2.5) I sent this info to my radiation oncologist at UCSF (Dr. Hsu) and he replied that there was no worry, as the result is only up very slightly from the last time. This means that after two years of testing the PSA is just about 0.68 above what the lowest value - two months after treatment. If I am correct, the 'bounce' period is over (PSA varies somewhat at each test) but I have not yet reached the PSA "nadir" the lowest possible value. Dr. Hsu doesn't believe that will happen until the 5 year mark.

He also inquired into the main side effects, which so far appear to be minor burning during urination - which I control by using cranberry extract in capsule form, and erratic erections - which can vary by time of day, from quite hard to flaccid. (Also, with the potential to 'collapse' within a minute or so!) The reason for this behavior was originally described by Dr. John  P. Mulhall:

"Radiation attacks the DNA in our cells. It causes breakages in the DNA, and when this occurs, the cells commit suicide, a process known as apoptosis. Normal cells have better repair machinery to fix some radiation damage while cancer cells do not.  As well as killing off the actual prostate cancer cells, radiation causes injury to the blood vessels that supply the cancer."

The last effect is confirmed at a site (of the National Cancer Institute) which states:

 "Radiation damage to nerves and blood vessels may occur with brachytherapy, and higher doses of radiation may cause more damage"

Re: adverse effects on the arteries from the high dose (1920 cGy) of radiation delivered, I originally tried to counteract these by eating more Omega 3 rich foods, more often and also more veggies. However, by about a year or so ago, I noticed have reached a stage of "diminishing returns" for lack of a better term. Interestingly, if Dr. Mulhall is to be believed (and I am certain he is) then "erectile success rates for surgery and radiation reach the same stage after 24 months."  And since I have now just passed the 24th month, going into the 26th, I can say he is correct.

Some might ask, 'Why be thankful for losing the reliance on your sexual apparatus?', but that misses the point. The point is one is striving for quality of life that first and foremost allows life! Secondly, I can be thankful I don't have to be running around wearing 'Depends" as 50 % of men do after radical prostatectomy-- and 25% after radiation. In the end, it is all a matter of placing things in proper perspective- and besides the "sexual apparatus" can be used in more than one defined way for a loving couple.

Last year, according to Johns Hopkins University stats, there were some 239,000 cases of prostate cancer diagnosed with 29,000 deaths. It remains the 2nd leading cause of cancer death for American males. Rather than fretting about losing one's sex drive, men need to be more concerned at catching it before it spreads secondaries - which can lead to a slow, painful death.

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