Answers from the doctor visit

A bit delayed on this post, mainly... check that... entirely due to a migraine that took me out and stomped all over me. But things are better now, and the relief from the pain is SO goooooooood.

So... I posed a few questions to my radiation oncologist when I saw him this week. Some of them were rather obvious, from his point of view, but they helped clear things up for me.  At any rate here are the questions,

1. Q. What tells us we've succeeded in this venture to knock out the cancer?
   A. PSA tests. Ideally, PSA should be at a zero level (0.something) but we don't start running other tests and scans until the PSA level bumps over 1 or 2.  There are too many false positives and in the past we did other tests and biopsies which didn't lead to anything.  So, we wait until it bumps over 1 or 2 and then we start looking.
2. Q. What follow-up routine will we set up?
   A. We'll set up a series of PSA tests every 6 months for the next 5 years, and we'll be giving you a stack of test forms for the lab with dates on them... so we'll have all that at the end of the treatment.
3. Q. About the hormone therapy, why does the Trelstar LA continue so far beyond where I'll be taking the bicalutamide?
   A. Essentially, continuing the Trelstar LA (an LH-RH agonist) keeps the pituitary gland trying to signal the testicles and adrenal glands to product testosterone. But because we've already depleted that hormone no testosterone production happens.  So, we want to keep testosterone production at zero for a year. After that, we let it run... and testosterone production may take as long as a year to start up again (if it starts... sometimes it doesn't).

Those were the main questions I had.  There are some more that came to mind... but those I'll put on the next page.I wondered about the curves... performance curves if you will... of the radioactive seeds and absorption rates in the body. I don't think I got this question across very well, mainly because I was afraid I was taking too much of the doctor's time.  But really, he got into the bit he told me, and I expect he would have been very involved if I had been better about the verbalizing my question. 


But even so, the overlap of the treatments and the resulting curves is interesting.  I'll try to find some graphics to support this, but for now...

• When the seeds were implanted, they were at 100% of their strength. Given about a 9.5 day half-life, when I saw the doctor two days ago they were at about 12.5% of their strength.
• As that curve continues to decay down to close to zero, we'll begin the external radiation, targeting the prostate and some areas around it (seminal vesicles and lymph nodes)
• The effect is to keep destroy the reproductive cycle of the cancer cells. When they try to divide, they can't, so the cell dies.

I also found that the term I should be using for the external radiation is intensity modulated beam radiation therapy (IMRT), rather than external beam radiation therapy (EBRT).  (That link is a long read, but informative about the preparation steps as well.)  And I'll probably find out that I've got this term wrong too.    I'm getting used to finding out how wrong I am!  

I also found out that when they did the seed implants they also placed several gold markers that will help in making sure they have the correct position of the prostate when it comes to the radiation treatments.


So, the next steps are to go in next week for the scans they'll use to set up the computer model for the radiation treatments. And they'll also make a kind of mold to keep me motionless during the radiation.
Radiation treatments will begin in early February, which is almost 2 months to the day from when the seed implants were done... which means that the seeds will be at about 1.5% of where they started.


I love this. Really.


It's interesting in such a detached way. Like unraveling a bunch of twine or something like that.  I mean, other than some side effects, all expected and within expected limits by all the experts, this quest for understanding what is going on within me has only this blog as an outward sign. I don't feel sick, or diseased, and because of that I think I should be as strong and capable as ever. But I'm not. I forget that there is some serious stuff going on in me now... while I sit typing this, while I sleep, all the time... and that if it hadn't been found a different kind of serious stuff would be taking place just as silently.


In other ways, I'm all too aware of it. From the calendar packed with doctor's appointments and lab visits, to the stream of bills coming in, to the occasional comment from some caring friend that sends me into a crying fit (yes... I do... and they ambush me just as much as some other tears).  I make jokes about all this being due to hormones, but really, it is so hard to tell when the emotion or side-effect is something coming from me or coming from something that's being pushed and shoved by all this mucking around with my body.  And I have it easy.  It's not like chemo at all.


And thankfully, it's not like a migraine.  :-D