It’s late March, and the first day of many radiation treatments has arrived.
After being diagnosed with prostate cancer several months before this day and confirmed with a core biopsy, my life begins with another chapter to complete 43 radiation treatments over three months.
Although I tried to weasel my way out of driving to Carson City five days a week, I acquiesced by adjusting my schedule on writing news articles for the newspaper group, completing chapters for a book on World War II veterans and attending meetings. Sad to say, radiation treatments can sometimes be more relaxing that attending a two-hour government meeting.
THE FIRST WEEKS
The instructions given to me by Dr. Gary Campbell’s staff at the Carson Tahoe Cancer Center helped prepare me for the sessions. During each daily treatment, the therapists localized my prostate by using an image of the treatment field, and they compared it to original CT simulation images. Specially designed software then directed them to focus on my prostate's exact location. Markers or tattoos arranged over the prostate placement give them a better idea of where to pinpoint the radiation beams.
The first two therapists who worked with me were very understanding and explained the process. Sarah Pimentel graduated from the radiation program at Washburn University in Topeka, Kansas, last summer and began working for Campbell in January. Although she administered radiation differently during her clinicals, Pimentel said learning new ideas from her present position allows for more flexibility.
“It helps having experienced therapists here,” she said.
Pimentel said each prostate cancer patient is different … some experience little or no side effects either during or after treatments, others will have some difficulty.
“We establish open communications with our patients so they can tell us what’s going on,” she said.
I encountered side effects, but, thankfully, they didn’t occur until later in the process. Overall, though, Pimentel and Shanna Kizziar oversaw my treatment for the first three weeks until the therapists rotated to another patient. Campbell said this allows the therapists an opportunity to work with different patients and different treatments. Pimentel said I knew how to position myself on the table which allowed the therapists to complete my sessions quicker and easier.
“Your outlook was positive, but we have some patients who struggle through the process,” she said. “People come in and they have the attitude this will be a horrible experience. They struggle more as opposed to those who say , ‘I will get through this.’”
I did adjust to the juggling of my work schedule, the round-trip commutes between Carson City and Fallon and the daily treatments. Then we had the coronavirus pandemic and the health concerns … and hay fever season. By mid-April, Carson Tahoe Health required a single-point entry, the wearing of face coverings for patients and staff and taking temperature checks. The medical staff rotated every two to three days, some stayed for a week.
Although the checkpoint on the main floor was an inconvenience, it evolved more into a having virtual beer at the cozy bar Cheers or, more appropriately, Cheers on the Hill. The health staff learned patients’ names quickly, so instead of coming in and waiting for them to say,” Hey, Norm. How’s it going?”… it was “Hey, Steve, How’s it going? Let’s take your temperature.”
From mid-April to the end of May, I allowed a little more time for my stop at the entry point. Additional questions focused on the drive through the construction areas on U.S. Highway 50 between the Silver Springs roundabout and Sagebrush, the weather (of course) and what’s Fallon like. I found myself promoting any and everything Fallon including products from Lattin Farms and milk from Sandhill Dairy.
Campbell said the dose of radiation is important, and with each session, the radiation beams to nine different positions that includes the affected quadrants and the entire prostate.
“We give the highest dosage to prostate to eradicate the cancer,” Campbell said.
Despite the higher dose, he said the tissues are spared damage.
Compared to other radiation therapies, he said breast cancer may require six weeks or shorter. With each 20- to 25-minute treatment, Campbell said his therapists shoot external radiation beams to the area that’s being treated.
Radiology therapist Ellen Plewacki said every patient is treated according to information downloaded from a chart to a computer. She and another therapist work with a two-computer system, one of which contains every patient’s computerized chart. The treatment machine — the linear accelerator — receives information on its screen to inform the therapist of the patient’s parameters for directing the radiation.
From the first day of treatment, therapists have the patient lie on the table, and then record where they took and recorded the prostate’s position or, what she said is establishing a tolerance range.
“Every day you get on the table, we set you up within the tolerance,” said Plewacki, a graduate in radiological technology leadership from George Washington University in the nation’s capital.
Plewacki has been involved in the medical field for 40 years.
Once patient identification has been verified, the therapists take X-rays at every session because they’re treating internal anatomy. Plewacki said the X-rays are compared to the CT scan of the region taken on the first day. Since the prostate is not like a fixed bone receiving treatment, Plewacki said the therapists rely on using the three radioactive seeds that were implanted into my prostate earlier this year by Dr. Brian Montgomery, my urologist with Carson Urology.
The seeds not only accurately guide radiation beams to the affected quadrants but also to the entire prostate. Plewacki said the seeds allow the radiology technician to perform advanced radiation treatments with more accuracy.
“It’s a way to indicate where the prostate is located, and it’s not uncommon to have it move a minor bit,” she said.
For every session, the prostate cancer patient lies down on a table, and at a computer outside the treatment room, a technician guides the rays at different angles — nine to be exact — at both the affected quadrants and entire prostate.
“Most of the patients have the same setup and procedure,” she said. “It takes about 2 to 3 minutes to identify the internal anatomy needing treatment.”
During each session, Plewacki said the machine will turn itself off and change shape to concentrate on a quadrant, for example. Campbell said the preferred number of treatments is 43, which is based on numerous studies and tissue tolerance.
Some of the side effects during the final treatments included blood in the urine or stool, softer stools and tiredness, but I attribute some of the tiredness to three hours on the road, waking up at 6 a.m. to begin my day at the computer, and burying my head into the pillow sometime after 10:30 p.m. The Lupron shot’s effects increased with the hot flashes, and I experienced tingling in my feet and more warmth in my calves.
WERE TREATMENTS WORTH IT?
With the end of radiation treatments more three months ago, I have encountered additional side effects from swelling in the legs and ankles, urination and bowel-movement problems, restless nights and some tiredness — both doctors said those effects should go away. In order to keep the prostate small and to fight any cancerous cells that may be lingering, I receive a Lupron shot every three months. My main complaint with the shot is how it causes hot and cold flashes and mood swing. The key is to remain upbeat and positive, but I have, on very few occasions, swung into some dark moods where I become melancholy and reminisce about past events.
Both doctors, however, have repeatedly said the best indicator of how treatments worked is with another PSA (prostate-specific antigen) … and with a score of 2 or below.
“I would anticipate your PSA will be extremely low,” Campbell predicted after I finished the treatments.
In early August, I took my lab paperwork to Renown and had a number of tests done including another PSA. Montgomery said this routine will be repeated every three months for the next two years. My first three-month checkup with Montgomery occurred on Aug. 18, and I had the opportunity to see my first PSA result. Bingo!
The result came back as a negative .02, meaning there is no traceable sign of cancer left in the prostate.
“Just what I hoped for,” Montgomery said.