A plan of attack

So... we're getting close to coming up to date... finally!

I returned from my bike trip on September 20th with my mind made up.  I called my radiation oncologist the morning of the 21st and he had a cancellation that afternoon, so I nabbed it.  I wanted to see what he had to say about Dr. Stone's comments, and also wanted to set things in motion.

It turned out that my RO had been trained by Dr. Stone on the seed implantation methods, so that was good. We made a small change in approach that seemed good to me (we didn't go for a biopsy of the seminal vesicles because my doctor planned to place some seeds in those areas as well).

The plan of attack I decided to go with is three-pronged:

• Hormone therapy
• Radioactive seed implants (in the prostate and seminal vesicles)
• External beam radiation therapy

The hormone therapy has two pieces.  One blocks testosterone receptors, the other shuts down testosterone production. The idea behind this therapy is to block the tumor (or cancer cells) from getting any testosterone, which they grown on.  So, you block the receptors, and stop production of the testosterone hormone.

Technically, the testosterone blocker is an anti-androgen pill, but I have such a silly mental image of a "testosterone blocker"  - a roller derby grrl named Maura Lee Bankrupt - that I can't help but use the less technical term.  Here's a look at her on her way to block those receptors:

I find this a fun way to think about a fairly weird treatment.  So... now I have Maura Lee running around in my body, shutting off all the places that are crying out for testosterone.  Credit for the inventive name goes to a team member on the Black & Bruisers, a local roller derby team in Medford, Oregon.  Go grrls!!!

The other prong, the one that shuts down production of testosterone, is done by getting a shot of a gonadotropin-releasing hormone agonists, also known as a luteinizing hormone-releasing hormone (LHRH) agonist.  Sounds messy... all these agonists running about... doesn't it? And I'm learning more words and interactions than I ever wanted to.  Well, at least I have Maura Lee on my side.

So... I started taking the testosterone blocker pills the same day I saw my radiation oncologist because I needed to be on that about a week before getting my first injection of the LHRH agonist.  I need to work on a visual for an LHRH agonist.

The testosterone blocker the radiation oncologist prescribed was the generic form of Casodex... called bicalutamide.  And, thank heaven for insurance.  This is a generic drug and without insurance it would cost me almost $240 dollars for 30 pills.  At least that's how I read the first statement I got.  My cost was $20... but I was stunned by the uninsured cost.

I saw my urologist later the same week to discuss my decision.  He hit me with a little doctor humor when he walked into the room:  When I said I was ok in response to his question, he said "You look the picture of health...(pause) .... but you're not!"  Oh that doctor humor.  Geez.  Anyway, he scheduled me for a shot of the LHRH agonist - a drug called Trelstar.

I find it disappointing that the main source of information for this drug is the product web site.  That's me being leery of how objective the information is.  I'm on the longer term version of this product, because my shots are 3 months apart.

But a plan was now in place.  Next:  side effects?  Oh boy!