My First Cancer

Lupron: Kim, mixing it up -- and getting the lumps out

A full afternoon at the Seattle Cancer Care Alliance today: the daily radiation treatment, the weekly visit with the radiation oncologist, the quarterly check-in with my oncologist.

• PSA test results came in at “undetectable,” which you’d largely expect, given my hormone-suppression therapy. Prior reading, in July, which was pre-hormone therapy, was 0.11. So that means PSA is down.
• Radiation treatment #20 — check that box. I’m now solidly past the halfway point on the way to 36.
• Another Lupron injection, which, with my Casodex pills, will keep my testosterone fully suppressed for the next three months. Upside: hot flashes in winter.
• My oncologist said today’s Lupron shot would be the last for now. I’ll see him again in January for a quarterly check-up and a PSA test — but no more Lupron and no more Casodex after that.
• And my radiation oncologist said he’s happy, which makes me happy, too. I reported to him that the few side effects from my salvage radiation have, so far, been mild and manageable.

And what, exactly, is salvage radiation? Bob Grindeland posed the question in his comment on my prior post, and that set me off to find an answer. I realized that while it’s a term I’ve heard, read and even used, I’d never pursued a medical definition. After all, “salvage” seemed to convey so much. Maybe even too much: say, the image of saving a ship from being battered on the rocks. But since Bob asked, here goes…

The National Cancer Institute defines salvage as “treatment that is given after the cancer has not responded to other treatments” — in my case, surgery.

The dictionary definition of salvage is more in the vernacular: “the rescue of property or material from potential loss or destruction.” Like salvaging a ship from being battered on the rocks.

Or salvaging me from cancer.

Shooting the radiation machine before it shoots me.

Today was treatment #10 (26 to go) — so two weeks of salvage radiation are now in the rearview mirror. All’s gone well, but…

It’s a bit early for side effects to set in, and exactly what they’ll be, how severe they’ll be and how long they’ll last — well, those are the uncertainties, all of them idiosyncratic to each one of us. However, they did caution me today to be prepared for some side effects: There’s no get-out-of-jail-free card.

Fatigue, though, is a given, but then, fatigue is cancer’s spectral companion and a hidden cost of its treatment.

I’ve now experienced one full cycle of the treatment protocol: Radiation every weekday afternoon followed by a rad onc appointment (on Mondays) and a blood draw (on Thursdays). The blood draw is for a complete blood count (CBC) to keep tabs on what the radiation to my pelvic bones may be doing to the marrow that makes blood cells. Thursday’s CBC proved to be fine.

This is a short post, just a reader-board update. The best news is: There’s no news.

Radiation Treatment #1 (complete with red laser)

I had radiation treatment #1 today, with 35 more in queue each weekday afternoon through Nov 8. No side effects expected for the nonce.

It was easy and uneventful — well, uneventful to my eye. We’ll hope some little prostate cancer cells met an invisible and violent death, but that was nothing for me to see or even feel. The treatment itself involved radiation doses from nine different directions into a band around my pelvis. Ground zero was the prostate fossa, the area where my prostate resided until surgery.

“Lay still and breathe normally,” they told me as I lay on a hard table. The radiation machine circled my pelvis, and the therapists occasionally tweaked the positioning. Some kind of red laser beamed at me from the ceiling next to a sign that warned, Do Not Look at the Laser. All cut and dried, chop-chop. Except.

Except for the frisson, the palpable sensation I’d not had since surgery four years ago. You know how something can happen, and it just drives home and makes vivid the reality of a situation? Surgery drove home, italicized and put in bold my stark reality of 2007: I’ve got cancer, and that’s not good.

Same thing today at Radiation Oncology at the Seattle Cancer Care Alliance. I can’t remember whether today’s realization came while waiting for my first treatment or while talking to the guy waiting for his last; whether I was arranging the schedule for future treatments or was looking helplessly at the radiation machinery arrayed around me. But that old, familiar reality came back and drove itself home:

I’ve still got cancer, and that’s not good.

Cumberland Gap, TN, VA & KY

It was four years ago today that I had surgery for prostate cancer, and in nine days I’ll begin “salvage” radiation for prostate cancer. Surgery, hormone therapy, now radiation. This strikes me as a lot of treatment in a relatively short period of time — and I spent more than half of the past four years on hormone therapy! All courtesy of the two tiny tumors they found in my lymph nodes after surgery.

The much-awaited phone call came Friday with the date and time to begin rad treatment at the Seattle Cancer Care Alliance. I’m thrilled to get this on the calendar at last, and I’ll be even happier to get the actual treatment underway (remind me of this when the side effects kick in).

Yes, it’s my fault we’ve put radiation off for so many months. Too many travels planned too many months ago, but all the doctors were comfortable with the delay. I’m cutting it close, though: We’ll get back to Seattle on a Monday afternoon, and I’ll report for radiation duty at 9:00 the next morning (Sep 20).

My cancer is microscopic for now and shows up on no scans. So I just have to hope that it resides precisely where the radiation will hit, but there’s no guarantee of that.

As we say all too often in the cancer journey: It is what it is.

Sri Lanka, Aug 2011 (Photo by Rebecca Curry)

Truth be told, my prostate cancer journey has thus far been a relative walk in the park compared to the medically invasive and dramatic, life-altering experiences of others. In the time since my diagnosis, the most disruptive event has been surgery, my radical prostatectomy, and that was only two nights in the hospital, plus recovery.

Contrast that with my friend Toby, who was diagnosed in March with Mantle Cell lymphoma and whose life was abruptly up-ended. He’ll undergo his sixth (and final) R-CHOP 21 chemo treatment today — and that’s just a prelude to his stem cell transplant later this month.

So while they’ve been busy poisoning Toby this summer, I’ve been off traveling in Peru and Sri Lanka, living life much as it was before my diagnosis. (Heck, I was traveling when I received my diagnosis!) Oh, Peru and Sri Lanka brought some unintended weight loss and hot flashes from hormone-therapy, but, as I say, a relative walk in Cancer Park.

That’s about to change with my impending “salvage” radiation. My radiation oncologist is now working on the specific treatment plan — the nitty-gritty to maximize the radiation dosage to offending tissue and minimize collateral damage to the healthy. Sometime in the coming days, a phone call will come with my start date for treatment: then five days a week for seven weeks.

I’m ready — even more than ready. I have my Calypso transponders in place, and on Aug 24, I completed the remaining preliminaries: three tattoos to assist in the targeting of the radiation; a custom-made leg cradle to hold me in place; simulation scans for aiming the radiation, and the official signing of the consent form. All I need now is that telephone call.

Radiation will be my third cancer therapy in four years, not counting the experimental drug I took as part of a clinical trial, and not counting the hormone therapy and the chemo med I’m currently on (both are part of the radiation protocol). But there’ll be no more radiation after this — they just don’t do it twice. There are no do-overs, no mulligans.

It either eliminates the remaining prostate cancer in me, or it doesn’t.

Shaman's Ceremony -- Cusco, Peru. During this offering by fire, I learned via phone that my June 17 oral biopsy was negative. Interesting coincidence.

Monday, July 25, 2011. Lots of cancer doings this week, starting today with a full day at the Seattle Cancer Care Alliance. I’m writing this in the infusion waiting room on the fifth floor, soon to be summoned to resume hormone therapy (officially: androgen deprivation therapy). It’s my second round of ADT; the first time, I had one injection of Lupron every three months for a total of nine injections. This time, I’ll be on it for six months (two shots). Oh, and I’ll also be on Casodex, a chemo pill.

I dread the side effects of ADT — hot flashes, fatigue, mood swings, and general chemo-brain. They worsen with time, the longer I go with no testosterone. But prostate cancer feeds on testosterone, and so ADT is a good systemic treatment. While it works. Eventually, some cancer cells become androgen independent and grow quite nicely without it.

My Lupron injection is to be accompanied by an infusion of Zometa, a bone-strengthener to deal with my osteoporosis (another side effect of ADT). Cancer is so special: We get side effects that, for non-cancerians, are their own dreaded diseases.

It’s been so long that I’d almost forgotten that good news is possible in the cancer experience: My PSA today is sideways. There’s this little mind game men play with their PSA tests: What will it be? How much higher will it go this time? A little? A lot? What’s the number I’d dread to hear? So this PSA test, I played the PSA head game yet again: Q: What’s the best number I can hope for? A: No change.

And that’s what I got! Three months ago, PSA was 0.11; same today. Not sure what to make of it, what it all means, but I sure prefer “stable” over “raging.”

Wednesday, July 27. Today was my maiden voyage to an oncologic naturopath, a huge step for me. I grew up knowing medical care as something that came from a pharmacy, a syringe or a scalpel. But I went to a Survivorship symposium at the Fred Hutchinson Cancer Research Center in June, and they had a break-out session on ‘complementary’ (nee alternative) medicine. I was impressed with the two oncologic naturopaths who presented, and now one of them, Dr. Laura James, is on my side.

This step seemed fully consistent with my diet/nutrition efforts and no different than my looming “salvage” radiation (don’t you just love these terms they come up with?): It’s one more weapon to wield, one additional thing I can do and have some control over. I now have four, naturally occurring compounds in my repertoire of daily therapies, thanks to Dr. James. We’re off to a great start.

Thursday, July 28. Final cancer appt of the week (if you’re trying to keep track, the line score is: 1 infusion; 1 injection; 1 blood draw; 2 doc consults; and, today, 1 implant procedure). I now have three tiny Calypso beacon ‘seeds’ in my pelvis. These gizmos are part of my prep for radiation in the fall. Essentially what they’ll do is keep the radiation zapper on target. If my innards move, or I move, the Calypsos tell the zapper to move accordingly. That keeps the rad beam on target and thus reduces collateral damage to healthy tissue.

Since I leave Sunday for three weeks in Sri Lanka, I’m thinking it’s going to be v-e-r-y interesting dealing with TSA when I march through the airport security scanner with these little Calypsos in me.