World Black Belt Blog
Hanshi Sid Campbell's Radiation Therapy for Prostate Cancer
By HANSHI SID CAMPBELL
A Journey of 4,000 Miles Begins with the First Step in Radiation Treatment for Hanshi Sid Campbell.
The Chronicles of Hanshi’s Personal Journey to Overcome Prostate Cancer.
According to the American Cancer Society’s newly released “Cancer Facts and Figures 2005” report, cancer has passed heart disease as top killer of Americans over the age of 85.
Among the data pertaining to prostate cancer it is estimated that at least 232,090 new cases will be diagnosed in the United States this year.
It is disheartening to realize that the estimated number of American men that will die this year of prostate cancer this year will be approximately 30,350.
The good news that can be gleaned from these prostate cancer statistics is:
Five-year survival rate for patients diagnosed with early-stage prostate cancer: Nearly 100 percent
Ten-year survival rate for all prostate cancer patients: 92 percent
Fifteen-year survival rate for all prostate cancer patients: 61 percent
Five-year survival rate increase for all prostate cancer patients over the past 20 years: From 67 percent to 99
When WorldBlackBelt.com founding member Sid Campbell was diagnosed With prostate cancer in February of 2005 he essentially became a Statistic with the more than a quarter million men that received word From their doctors that they had the big “C”. He became one out of the Six men in the U.S. that would receive word that would that their life Was suddenly going to change because of this disease.
Then, upon research Campbell realized that he was a statistic in more Ways than the ones previously revealed. He discovered that other
Statistics reveal that:
the Chance that a man will die from the disease: 1 in 33
Increase in the prostate cancer incidence rate between 1973 and 1992:
State with the highest rate of prostate cancer deaths between 1997 and 2001:
District of Columbia, followed by Mississippi, Alabama and South Carolina (tie).
After the real shock of hearing that he was a prostate cancer victim, World Black Belter Sid Campbell immediately set out on a journey to seek out the options available to him in coping with this disease. Thanks to the knowledge that he garnered from conversations with several of his students, which are medical doctors, lengthy research sessions on the Internet exploring options, and consultations with the oncology medical experts at the Veteran’s Administration (VA) medical clinic in Martinez, California, he learned that the treatment options for prostate cancer depend in part on whether the tumor has spread.
For tumors that are still inside the prostate, radiation therapy (using x-rays that kill the cancer cells) and a surgery called radical prostatectomy are common treatment options. "Watchful waiting" is also a treatment option. In this approach, no treatment is given until the tumor gets bigger. Watchful waiting may be the best choice for an older man who has a higher risk of dying from something other than his prostate cancer.
Generally, tumors that have grown beyond the edge of the prostate can't be cured with either radiation or surgery. They can be treated with hormones that slow the cancer's growth.
Campbell then realized this there were more than one or two options available to him for his specific crisis and the types of treatment were going to depend a lot on just how extensive the prostate cancer had spread since it was discovered that his PSA (Prostate Specific Antigen) was on the increase from a norm of 4.0 or lower.
So what were his treatment options for prostate cancer?
Prostate Cancer Treatment Options Hanshi Sid Campbell learned that Radical prostatectomy is the surgical removal of the whole prostate gland and the nearby lymph nodes. His doctors conveyed that most men who have this surgery are put under general anesthesia (puts you into a sleep-like state after the prostate gland is taken out, a catheter (a narrow rubber tube) is put through the penis into the bladder to carry urine out of the body until the area heals.
Naturally, he wanted to know the risks and benefits of this radical prostatectomy procedure. His doctor told him that if you are in good health the short-term risks of this surgery are low and the hospital stay at a Veteran’s Administration Hospital like the David Grant Medical Center on Travis AFB in Fairfield, California was usually 2 to 3 days. Afterwards a catheter in inserted into the bladder through the urethra left in place for 2 to 3 weeks while the surgery heals. Adding, that one usually able to go back to work in about 1 month. You shouldn't have severe pain with this surgery. Most men regain bladder control a few weeks to several months after the surgery.
The VA doctor explained that the main advantage of surgery is that it offers the most certain treatment. That is, if all of the cancer is removed during surgery, one is probably cured. Also, the surgery provides your doctor with accurate information about how advanced your cancer is, since the nearby lymph nodes are taken out along with the tumor.
Campbell was also interested in the risks and complications after the surgery. Dr. Darryl Hunter, Lt. Col., USAF said that one could lose a lot of blood during this surgery. Before the surgery, a patient might want to save about 2 units of his own blood in case he needed a transfusion. Another thing that he mentioned was the risks of this surgery are incontinence (lack of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex). Fortunately, only a very low percentage of men have severe incontinence after radical prostatectomy. Up to 35% of men have a little accidental leakage of urine during heavy lifting, coughing or laughing.
The chance of impotence decreases if the surgeon is able to avoid cutting the nerves. This may not be possible if the tumor is large. Your age and degree of sexual function before the surgery are also important factors. If you're under 50 years old when you have this surgery, you're likely to regain sexual function. If you're older than 70, you're more likely to lose sexual function. Further stating that, “Even if the nerves are cut, feeling in your penis and orgasm remain normal. Only the ability to get a rigid penis for sexual intercourse is lost. However, there are medicines and devices that can help make the penis rigid.
Next, it was pointed out to him that there was the option of radiation therapy. Essentially, adding that there are 2 types of radiation therapy. In one type, called beam radiation therapy, radiation is given from a linear accelerator machine that is much like a large x-ray machine mounted on a gantry. In another type, radioactive pellets (called "seeds") are injected into the prostate gland. This is sometimes called seed therapy or brachytherapy (say "break-ee-ther-uh-pee"). Both types work about the same in curing prostate cancer.
The machine therapy on the linear accelerator is usually administered 5 days a week over 9 weeks, which one might find time-consuming. However, one would not require any anesthesia. The side effects are milder than the side effects that can come with seed therapy. However, seed therapy can be done with just one hospital visit. For seed therapy, one would have to receive anesthesia for a few minutes, but should be able to go home right after the treatment. In seed therapy, higher doses of radiation can be put right on the cancer. You may feel more discomfort after this treatment.
Sid Campbell’s internet research revealed that about one half of patients become impotent within 2 years of having radiation therapy. Many men feel very tired at the end of the treatment period. About 15% to 30% of men who have radiation therapy have urinary burning, urinary bleeding, frequent urination, rectal bleeding, rectal discomfort or diarrhea during or shortly after the treatment. Serious complications are rare. However, a degree of uncertainty goes along with radiation treatment. Since the prostate gland and the lymph nodes are not taken out, a doctor can't tell the exact size of the tumor. The cancer could come back many years after radiation treatment.
Campbell then learned that at 10 years after treatment, cure rates are about the same for radiation therapy and radical prostatectomy. As a healthy male of 60 years of age, this option appealed to him more than the surgery since he was advised that there are no surgical risks for men who have this form of radiation therapy. There's no risk of bleeding. You don't have to stay in the hospital. You'll recover faster. Daily activities can usually go on during the treatment. Incontinence is extremely rare afterward. However, surgery may give you a better chance of cure over the long term.
We interviewed Hanshi Sid Campbell recently and wanted to find out and learn from his experiences after undergoing 9 weeks of continuous external beam radiation therapy (EBRT) at the David Grant Medical Center on Travis AFB in Fairfield, California. We felt that the members of WorldBlackBelt.com, especially the men and seniors in the martial arts could benefit greatly from Campbell’s ordeal.
We wanted to know how he felt before the treatments and understand what changes occurred with him on a weekly basis.
The following interview sheds some light on the clinical as well as the emotional progressions that occurred in his life over the nine weeks that he religiously made the daily one-hundred mile trek in search for the treatments that would eventually control this disease.
WBB: Hanshi Campbell, we learned recently that you were diagnosed with prostate cancer and have made a conscious decision to begin external beam radiation therapy very shortly. What prompted you to make the determination to undergo linear accelerator treatments rather than one of the other forms of treatment for your recently discovered condition?
HSC: Well, the oncology staff doctors at the Veteran’s Administration determined after the biopsy that the soft tissue in the internal left lobe of my prostate has a small1-1/2 centimeter section of cancerous cells that were beginning to spread. And after further consultation with the doctors at the David Grant Medical Center (DGMC) they collectively recommended or opted to suggest radiation therapy as opposed to other alternative methods of treatment. With what I knew after the extensive batteries of tests and deeper research I conducted on my on my own on the Internet, I concurred with their suggestion and on April 12, 2005 I traveled to Travis AFB to the DGMC to get a simulation and take the tests to align the linear accelerator to begin preparing for the daily radiation treatments.
According to the consult I had with the staff oncologists there, the first 51/2 weeks radiation dosages would be focused on the prostate area and the general area surrounding the prostate including the lymph nodes, pelvic bones, lower intestinal track, and urethra as well as the prostate itself. The remainder of the treatments would be called boost but I will explain more about that later. They also informed me that the daily dosage would be 180 centigrade and the entire regimen of treatment would be prescribed at 7200 Centigray spread out evenly over the duration of the treatment. I would have the Saturdays and Sundays off in order to allow the healthy cells to regenerate and repair themselves while the younger immature cancerous cells would not be able fully recover from the damage being caused by the radiation treatments.
WBB: Did you feel that your martial arts training for the past 40 years would contribute to your recovery from this extensive and intensive ordeal?
HSC: For a 60 year old dude they told me that I was in pretty good shape physically but from the outset of treatments they said that I may experience some fatigue and possible diarrhea as the effects from the radiation accumulated, but that was normal. What was really good to hear was that any of these side-effects would subside after the treatments were completed. My medical tests revealed that I had good blood pressure and the intravenous CT-scan, bone scan, MRI, etc. had revealed no abnormalities otherwise. But I would learn after about two weeks of treatment that the long daily 100 mile roundtrip drives from Oakland to Fairfield, California and back would take about two-hours with the actual radiation (zap) lasting about 20 seconds.
WBB: Before this treatment had you paid a lot of attention to the rising PSA (Prostate Specific Antigen) that they discovered with your physical?
HSC: No, I had really not. It was at the suggestion of my good friend and Doctor Jay-El Hinojosa of McAllen, Texas that I decided to get a physical and see if my PSA was OK and everything else in my body was working fine from a medical standpoint. He had even mentioned that many men in their 40s that do not take care of their prostate by getting checks to monitor their PSA could be making a big mistake later on in life. I concur with Dr. Hinojosa and would strongly suggest that any man in their 40s or older see their doctor and look into finding out about the condition of their prostate. A man approaching middle-age would be doing himselve a very big favor later in life.
Another one of my friends, Dr. Marc Stoner, of which I had numerous personal consultations, tells me that in the Eastern countries there is a way to insure that one never gets a prostate condition. The solution? Cut of a young boy’s testicles before he hits puberty! They say it’s guaranteed to eliminate the condition altogether and the poor kid never has to worry about it. (But, honestly I think it’s ok to worry about some things) Some countries swear by this but for the record I’m not one to endorse those sorts of preventive prostate measures.
WBB: You mentioned this phase of initial treatment called simulation. What is that all about?
The Treatments Begin…
HSC:My first week sort of set the tone and pace of what I was to experience throughout the almost 9 week ordeal. Clinically at least. But before I describe the week-to-week routines I must mention how my life and daily routines changed dramatically over the course of the treatments.
The simulation phase was the 3-hour preliminary setup that began at 8;oclock in the morning several days before the treatments were to begin in earnest. The linear accelerator clinicians began taking x-rays through a simulated version of the machine like the one I would be assigned to for my treatments. It was to primarily align the linear accelerator with the computer and get a very clear picture of my lower torso and pelvic region so that they knew exactly where all of organs, glands, intestinal tracks, nodes, and bladder were located when the actual radiation treatment began.
As part of this process I got permanently tattooed with three strategically placed small dots. These small tattoos were placed on both sides of the skin just below the pelvic bones and one was positioned in the front just above the pubic area. Later, when my actual treatments had begun, these were to be aligned with laser beams once I was precisely positioned on the gurney under the gantry of the linear accelerator.
Then, the clinicians made a custom-fitted styrofoam mold of my lower leg and calf-shape that fit precisely to my body position when I was laying face up on the radiation table. This was to insure that no part of me could move even a minute amount while the radiation was being administered, when that phase started. Without any antithetic, while I was still laying on the gurney underneath the x-ray simulator, they inserted catheters through both the urethra and the colon and injected about a 3 cups of contrasting liquid into the bladder and intestines. This contrasting liquid was brown in color and had the viscosity like Chinese dit da jow. The reason for this somewhat painful procedure was necessary was so my urethra, bladder and lower intestinal track would be visible by the x-rays that would aligned with the linear accelerator in order to get perfect positioning of all of my innards. This subsequently was so they would know how to shape and configure the radiation beams during the treatments to avoid hitting anything that need not be radiated and thus minimize the side-effects that could occur otherwise. Then I had another intravenous CT-Scan, and blood test to finish off a three hour session in preparation for the treatments.
Before leaving the DGMC that day, the doctor prescribed a clear liquid medication called mucomyst® (20% acetylcysteine) to help my body eliminate the contrasting dye that they had put into my bladder and intestinal track. I was instructed to drink 4 separate doses mixed with juice over the course of that day and the following morning before the next CT-scan was performed and just before treatments began in earnest. Upon inquiring about the mucomyst® the nurse informed me it was prescribed to help prevent liver and kidney failure as my system tries to eliminate the dye used for coating the inside of my bladder and colon. The part about preventing liver and kidney failure definitely got my attention and I made sure I followed the instructions to the letter.
WBB: Wow! That was an incredible ordeal, just preparing you for the radiation treatments. What was your typical week like after you began the sessions at the DGMC?
HSC: I suppose first I should set the scene for what was to happen every day Monday thru Friday for the duration of my treatments before getting into the regimen of radiation doses. Every weekday at 11:15 AM. was my designated appointment schedule. The treatment was scheduled to last until 11:30 AM thus making my time of actually being a patient every day a 15 minute affair.
By preparing each morning I would usually arise at about 5:00 AM and exercise and get showered and make the necessary arrangements for driving the 50 miles to Travis AFB to the DGMC. Because I had some say in the appointment times I opted for the 11:15 AM window so that I would have ample time to drive without rushing to get through the traffic that can at times be quite hectic in the early morning rush hours in the Bay Area. The fist week, this judgment proved to be well founded and I never had to worry about being late for my treatments.
What was also very nice was that at the DGMC there is a cafeteria and usually I would opt to drop in and have a breakfast before I walked down the hall to the radiation therapy department. Over the course of the first week I had the schedule down so well that the moment I walked into the radiation area the clinicians were waiting for me.
So as my treatments began, I entered the linear accelerator chamber and simply got on the table as they fitted me with my leg mold and lowered my jogging sweatpants slightly to expose the tattoos so they could position me properly on the gurney. After that, my job was done and the radiation technicians did the rest of the work. In a mere period that usually lasted no more than 6 minutes they had administered 4 different angles of radiation to the positions that corresponded to the tattoos on my lower torso. There was never any need to don smocks or change out of my street clothes for the treatments. At the end of the first week I personally did not feel any different than I felt before this entire ordeal began. Somehow, I wondered if there was more to this radiation than I was experiencing? At my weekly weigh-in and consultation with my doctor, I mentioned that I felt really good and that no side-effects such as diarrhea or loss of energy had been experienced. He took that in stride but somehow I knew that there was undoubtedly going to be accumulated effects of the radiation as the weeks progressed.
WBB:What was your 2nd week like?
HSC: Actually not too much out of the ordinary than the first week with respects to the radiation. I was getting noticeably more fatigued from making the long drives so early in the morning while continuing to teach karate at night at my dojo in Oakland. The sudden bouts of tiredness I was experiencing the middle of the second week was attributed to that I thought. However by the end of the second week I was noticing that I was starting to nod off while driving back from Travis AFB. The 50 mile return trip was beginning to take a toll on my energy and there was nothing I could do to avoid it.
WBB: That could be pretty dangerous driving and nodding off while at the wheel of your automobile right?
HSC:Yes, you are right. On the weekend of the second week I had done more research on the Internet and discovered that that was when the fatigue usually started setting in from the radiation treatments. It was subtle and almost sneaks up on you when you sit still for any period of time. That is when I decided that I was going to need some help in getting me back and forth to treatments. It was also a time that I was fortunate enough to begin looking into supplements to boost my energy. I also realized that a two-hour nap in the afternoon helped considerably in helping restore my energy so I could teach in the evenings.
The first thing I did to eliminate the dangers that could possibly occur while driving back from the treatments was to elicit the help of many of my friends, students and fellow martial arts teachers in the Bay Area to help me with the driving. Man, that was the wisest decision I made since the treatments began. I set about to create a driving schedule and with the much appreciated assistants from my friends, set up times for each to share in the driving over the course of the remaining seven weeks. For instance, each volunteer would select a day that best suited their schedule and I would coordinate them all so that it was never a burden on them collectively. That really worked out fine and eliminated the problem before it could have been tragic. Of course I would treat each of my friends to lunch at the cafeteria each day as a form of appreciation for their support and much needed help.
You know what? Early on I noticed that when we were driving and conversing the time seemed to pass by quite quickly. When I was driving by myself with no one in the vehicle, my mind just had too much time to dwell on all of the medical and clinical scenarios that I was experiencing. That can really play with your head to constantly be thinking about what your body is undergoing every single day.
WBB: With that problem behind you, what was your 3rd week like?
HSC: The supplement called Xango® that I began taking in the form of a juice seemed to be having some positive effects on my energy level. Along with not having to expend so much energy driving and being acutely aware to road and traffic conditions constantly, I noticed that my energy seemed to be maintained adequately. One side-effect I began to notice was that my colon was beginning to become sensitive from the radiation bombardment on a daily basis.
After my consultation with the doctor and the nurse at the DGMC, they said that sensitivity was common at that point in time and would continue for the period of time the radiation was hitting the general area of the lower torso. What was interesting and concerned me more than anything was the feeling of impending diarrhea although that was not always the case. It was just a feeling or sensation that made me very aware of where every restroom anywhere in my travel path was located all of the time. Not a very good feeling I may add.
WBB: What about your diet at that time? Did you have to alter it to insure yourself that the feelings of diarrhea would be minimized?
HSC: Yes, I am glad you mentioned that part of my treatment. Actually, the nurse provided me with a diet sheet that outlined the recommended diet that I should undergo if I felt like a bout of diarrhea was about to begin. It is called a low-residue diet and lists all of the foods that are discouraged as well as which should be eaten during that phase of radiation. For instance foods like lettuce, leafy greens and easily digested foods were taboo. Likewise with fried or foods that were hard to digest. Too much hydrochloric acid in the digestive system would exacerbate the sensitivity and that could induce diarrhea within several hours. For the remainer of my treatments I stuck pretty close to the suggested low-residue diet just to be on the safe side. And, by doing so, it alleviated most of the symptoms. The only time I think I had a problem was when I ate some won ton soup that did not agree with my sensitive system. At least I believe that was the reason for several days of diarrhea. Other than that I did not have any real problems with that although I did still have the constant sensitivity well into the sixth week.
WBB: How about the 4th week, what was that like?
HSC: I started taking a lot of nutrition in addition to my typical dietary regimen, primarily to strengthen my immune system. In addition to taking Xango® juice from the mangosteen fruit, I continued taking Hawaiian noni juice, lots of beta carotene, enzymes, and essential supplements that cover all of the basic nutrients that the body needs to heal itself while boosting my energy level.
Clinically, I noticed that I was beginning to have difficulty urinating and I pretty well expected that to happen since the urethra was being blasted everyday Monday thru Friday. As with the colon, the sensitivity was becoming quite noticeable and to urinate was like trying to pass razor blades through the urethra. The reason for that, I found out, was that the urethra runs directly through the middle of the prostate and when the areas become irritated constantly they swell a bit and therefore the urethra becomes smaller and thus the bladder has a more difficult time passing fluids through the narrow passage. Interestingly, it would almost immediately subside by midday Saturday since I was not receiving the radiation at that time. But would start again by Tuesday of the following week.
So, on my next consultation with the doctors on Tuesday I mentioned that to him and he prescribed a modern drug called Pyridium® (phenazopyridine) in 100mg tablets. I researched and found out that it contains a sulfa medicine and a urinary pain reliever that work together to alleviate the symptoms pretty well but I can tell you that it definitely turns the urine a bright shade of orange almost the color of carrot juice, but, it seemed to work pretty well. My usual dosage of phenazopyridine was 200 mg taken three times daily. I always followed the instructions and took them after meals to reduce the chance of stomach upset. I was to take the 40 tablets until they were all gone.
I was also prescribed a medication called Terazosin® in 10 mg. capsules. I was to take two of these daily to relax the smooth muscles at the neck of the bladder so the fluids could pass through the urethra easier. The following day I noticed that the 20 mg. does seemed to work enormously well and I still take them as my cells continue to heal.
WBB: Now that you are approaching the half way point in the prostate cancer radiation treatments, what is the major differences you have noticed since you began the therapy?
HSC: As I have mentioned earlier, the journey both mentally or emotionally and physically has given me time to think many things out and reason why the doctors have done the different procedures that they have at certain times during the treatments. I have some solace in knowing that I am not the first, nor will I be the last that walks the path of a cancer victim who has went through similar treatments.
Emotionally, it has been a rollercoaster ride. By that, I mean there are days that I wish this ordeal would be over tomorrow and I would know that everything will turn out alright. But, you see, I also know that there are no guarantees that things will be OK. One day I am hopeful and the next day I am skeptical of just how effective the treatments will be. It really plays with your head that way but I try to put faith in the doctors and rely on their vast wisdom and experience acquired from dealing with this for generations.
Physically, the body is adapting to the treatments as the doctors expect it to do. I’m just living in this body and trying to adapt to what it is undergoing. One day in consultation with the doctor, he asked me how I felt at that point in the treatment and I told him that I did not know how I was suppose to feel. My tiredness seemed more a relaxed state of being rather than an exhaustive one. He seemed somewhat puzzled with my answer but he knew that physically I appeared fine. I was not haggard, despondent, downbeat and my energy was quite good considering the circumstances. Even my weight had been maintained and I was getting plenty of rest so I guess that I felt normal in that respect. It was just that I knew that with every dose of radiation, it was gradually destroying cells in my body. His response after seeing my energetic spirit showing through just said whatever you are doing continue to do it. I had to smile since he knew I was continuing to workout and teach in the evenings throughout the ordeal.
WBB: So you think the working out had something to do with keeping your energy level high?
HSC: Yes, I really do. In fact, even the doctor commented that people that are constantly remaining physical during the radiation treatments tend to have a higher threshold to tiredness than those that have led a sedimentary lifestyle. We who are in the martial arts that value that way of life are never really too far from being in touch with our bodies. So, in experiencing the minimal of fatigue at the half way point, I have to say that I have seen and met other patients twenty years my junior at the DGMC and after sharing stories of our experiences and seeing just how energetically challenged they are, it gives me some idea of the extremes that the body can go through while trying to maintain a reasonable level of health.
WBB: How has your well-being been challenged at enduring such an ordeal?
HSC: Frankly, I must say that I have discovered that the mind is a very powerful tool when one’s survival has been challenged with cancer. But, on the other hand, it can be so potentially devastating that it can cause you to doubt your own abilities to fight for that survival.
For instance, being the calculating person that I am, I got into mathematically counting all of the numerous things my body was undergoing. Like I started calculated that each day I travel 100 miles to and from the Medical Center. That’s 500 miles a week and will total a little over 4,000 miles by the time I complete the almost 9 weeks of radiation therapy. That’s like a trip across the United States with some mileage left over for some side trip. But, you know what? I would travel 50,000 miles if I got the superb treatment I am getting at the David Grant Medical Center. I asked a doctor friend that is in civilian hospital services what the cost of treatments like I am receiving would cost and she said it could reach as high as $180,000.00 for the treatments and all of the consultations, medicines, etc. It stunned me at first but I can believe it after seeing (and experiencing) all of the things one must go through to deal with this malady. From that perspective my well-being is good considering that I served during the Vietnam conflict and all of the treatments as a veteran is absolutely free. But, for ones that are not that fortunate or could not afford that amount of money for treatments, their mental condition and physical well-being may be very bad.
Then these was the counting of the amount of radiation that I was receiving on an accumulated basis.
Paradoxically, here I am walking around with almost 3500 Centigray (Rads) of radiation in my body and that can surely affect your well-being in a negative sense because you know that is not normal so it challenges me mentally and physically to make sense of all of this anguish.
WBB: You mentioned that at just beyond the half-way mark in your treatments that the radiation was shifted to “Boost” therapy. What is that all about?
HSC: Actually I was shifted to boost therapy at about two weeks past the halfway mark and a point where they begin to refocus and configure the radiation beam so it hits the prostate and soft tissue at about 1.5 centimeters around it. I was led to assume that means all of the exterior tissues, organs, colon, lymph nodes, tubes, vessels, intestinal walls, perineum, etc. in the general vicinity of the prostate region that may have had potential cancer cells, have been damaged enough and ultimately reduced to scar tissue and can not reproduce or cause further harm to my body. I say this because the doctors confide that it is virtually impossible to detect minute carcinoma cells at the molecular level with an X-rays, CT-scans or other specialized equipment. So, to be on the safe side and not take chances, they radiate the general area around the exterior of the prostate first, before they tighten the beam to only the immediate prostate gland area.
So, basically the boost phase will entail receiving 9 different angles of radiation of a similar dosage as to what I was previously receiving which was180 Centigray or Rads of accumulative daily dosage. The difference being that they will narrow the beam and focus on the prostate and not broader areas around it. The nine zaps will be administered in a spherical 360 degree arc with the prostate being hair-lined in the middle of the orbital pattern. Two of the zaps will hit the same direction twice. I'm still not sure which angles were hit twice each day but I believe the clinicians varied it with each consecutive treatment in the spherical pattern. The thing I recall most about the first day of boost therapy is that it took about 45 additional minutes to shoot a battery of new x-rays of the 9-angle configured radiation beams. But, in retrospect, I can see where they would want to be very precise with the radiation beam since they were narrowing the focus of the Centigray. In any case, the boost therapy will be used for the duration of all my treatments at the DGMC.
WBB: During the last 3 weeks or so did you notice any more adverse or side-effects from the boost therapy?
HSC: Surprisingly, no! If anything, the side-effects from sensitivity to the colon and urethra actually subsided since they were no longer being hit directly by the radiation beams. I did notice somewhat of a decrease in energy and I am not sure if that was from the radiation or the fact that I was becoming more active in my teaching and martial arts training at the dojo.
WBB: What was your last day of radiation treatment like? HSC:Well, it was the day I joined the 7200 Centigray Club! I actually received a powder blue ribbon lapel pin that symbolizes that I have undergone treatments for prostate cancer and lived to tell about it so to speak. Of course there was a lot of anxiety since I had waited nine long weeks anticipating that fateful day. I had suddenly reached the prescribed goal that the doctors at the DGMC had set for me at the outset of the treatments. Looking back it seems like eons ago.
But treatment-wise it was no different than any other of the days over the past almost 9 weeks. But from the time I arose and met the day I knew that it was going to be one of much excitement and long awaited anticipation. Here was the day I would walk into the David Grant Medical Center and see many familiar faces (and some I will not perhaps see again in my life) as I go about the usual routines of walking through the front door and greeting the staff at the information counter. Then I’ll proceed to the elevator and press the button that will descend me to the 1st floor of this huge complex. Walking out of the elevator I will then turn left and take the first long corridor that leads toward the Radiation Therapy Department. Should I proceed straight and go to the cafeteria or make a right at the corridor that leads to MRI section of the hospital where the oncology radiation therapy is administered? Yes, I will opt to take care of the things that I have been waiting for since I began this journey of 4,000 miles. As Elvis Presley would say, “Take Care of Business.” (TCB) and since I have always liked his advice about such matters, I decided to turn right at the MRI corridor in order to bring some closure to a part of my psyche that has long anticipated such finality.
Entering the Radiation Department, I went right into the clinic and went through the routines that I had grown so accustomed to over the past months. In a mere matter of six or seven minutes it was over! Then I shared a few farewells with all my new found friends at the David Grant Medical Center. I will always have a special place in my heart for Candy, Lenny, Julie, Larry, Susan and Doctor(s) Darryl Hunter and Roland Engel for the treatment, compassion and support the provided during this ordeal. They were truly a godsend and made my experience there at the DGMC one that was as pleasant as possible under the circumstances. Bruce, Eddie and Maurice in the cafeteria certainly added another dimension of pleasantness to the experience since I had spent considerable time in the cafeteria.
WBB: What is next with your follow up?
HSC:Almost a month after my final treatment I was scheduled for blood work and a lab report that is to be done 5 days prior to seeing my oncologist Doctor Dow at the Oakland VA Outpatient Clinic. In fact, he was the one that originally diagnosed me with prostate cancer after seeing that my PSA (Prostate Specific Antigen) was too high during my physical.
Before that long awaited appointment I had an injection of Zoladex® to help insure that the PAS hopefully stabilizes in the lower range numbers below 4.0. I have since learned I will be injected with the Zoladex® every three months for a while after the treatments and monitored for the affects on my PSA after the treatments are concluded. This is all about keeping the PSA low (which is good) at minimizing recurrences of such conditions in the future.
WBB: What were the results of your follow up?
HSC: I returned for my appointment with Dr, Dow on July 18th, 2005. and he was pleased with the results from my radiation treatments. Naturally, I was ecstatic with the results when he informed me that my PSA had been lowered to 1.0. Now, for a cancer survivor that is something to really get excited about I tell you.
WBB: Do you have any words of advice for the male members of our WorldBlackBelt.com organization?
HSC: Yes I sure do. Firstly; I would recommend that everyone over 40 years of age start looking to getting physicals on a regular basis. Not just a basic physical but one that covers blood and lab work and x-rays as well. Then, when the results are known, pay especially close attention to the PSA and the numbers associated with it. Catching prostate conditions early is one of the reasons that the success and survival rate is high as it is these days.
I would also recommend that all of our members get a good health insurance policy and start looking very closely at their diet
Lastly; I would hope that all of our WorldBlackBelt.com members would spend as much time learning about their bodies as they do understanding their respected style of martial art. One can never know what the future holds but sure makes sense to know what potential dangers lurk within our own bodies. Regular check-ups can make all of the difference in the world at learning about these dangers.
End Of Interview
Conclusion…Watchful Waiting and Prostate Cancer Overview
What are the risks and benefits of watchful waiting
Many prostate cancers are small and grow slowly. Because many men with a slow-growing tumor have the same life expectancy as men who don't even have prostate cancer, it may not be necessary to treat very small, very slow-growing prostate tumors. Also, some men feel that the side effects of treatment outweigh the benefits. In watchful waiting, you get no treatment, but you see your doctor often. If there's no sign the cancer is growing, you continue to get no treatment. Hormone therapy can be started if the cancer starts to grow
It can be hard to tell if a small tumor is going to grow slowly or quickly. Your doctor will get clues about the way your tumor will grow by checking your prostate-specific antigen (PSA) level, examining the biopsy tissue and giving you a rectal exam. The choice of watchful waiting is up to you.
What is the purpose of hormone therapy?
The purpose of hormone therapy is to lower the level of the male hormones, called androgens, which are produced mostly in the testicles. This is because androgens, such as testosterone, help the prostate tumor grow. Monthly shots can be given or the testicles can be surgically removed. Once the testosterone is out of your body, the prostate cancer usually shrinks. Hormone treatments are most often used in patients with cancer that has already spread beyond the prostate gland. While prostate cancer usually responds to 1 or 2 years of hormone therapy, after some time most tumors start to grow again. Once this happens, the treatment goal is to control symptoms. No treatment can cure prostate cancer after hormone therapy stops helping.
What happens after prostate cancer treatment?
You should get PSA (prostate-specific antigen) blood tests every 6 months for 5 years, and then once every year. A rise in PSA levels usually means that the cancer has come back. A digital rectal examination should be done once a year.
Radiation therapy uses high-energy rays to kill prostate cancer cells, shrink tumors, and prevent cancer cells from dividing and spreading. It is nearly impossible to direct these rays only at the cancer cells. As a result, they may damage both cancer cells and healthy cells nearby. Radiation doses are usually small and spread out over time. This allows the healthy cells to recover and survive, while the cancer cells eventually die.
Radiation therapy may be used when prostate cancer has not spread beyond the prostate. Like prostatectomy, radiation therapy works best when the cancer is located in a small area, and it can help prevent the cancer from spreading further. In early stages of prostate cancer, radiation therapy may cure the disease.
Radiation therapy also may be used for pain relief in prostate cancer that has spread to the bones (Stage M+) or that is no longer responding to hormonal therapy.
There are two ways in which the high-energy rays can be delivered. Radiation therapy involves either external beam radiation or a type of internal radiation called brachytherapy. These types of radiation therapy are discussed below.
External Beam Radiation Therapy
In external beam radiation therapy, the rays are delivered by a machine, and the radiation is given in brief sessions, usually one session each weekday for several weeks. Many patients compare the treatments to having an x-ray. The procedure itself is painless and lasts for just a few minutes.
Recent advancements in external beam radiation therapy have led to three new methods of treatment that are described below. These developments may help reduce side effects and increase treatment success.
It is important to remember, however, that newer treatments are often considered experimental until they can be shown to have the same success rate as more standard forms of therapy. In addition, these newer types of therapy may not be available at all radiation centers. Your physician can advise you on the right treatment for you.
3-Dimensional Conformal Radiation Therapy (3D-CRT)
One of the newer types of external beam radiation is 3-dimensional conformal radiation therapy, in which high-tech computers are used to identify the location of the cancer inside the prostate gland. The next step involves the creation of a special protection device that the patient wears during the treatments. This device is similar to a body cast, but it is molded out of Styrofoam TM and helps to keep the body still during treatment while the radiation is aimed at the cancer. When the patient wears the body mold during the treatments, the radiation beams can be aimed more accurately to target the entire prostate gland. The idea is to be able to direct a high dose of radiation only toward the prostate, while reducing the amount of radiation that the surrounding healthy areas receive.
If the healthy tissue can be spared from the effects of radiation, side effects should be lower and therapy success higher. Conformal Proton Beam Radiation Therapy Conformal proton beam radiation therapy is another new type of radiation therapy. This technique is similar to 3-dimensional conformal radiation therapy, except that it uses protons to produce the radiation beam. Protons are microscopic particles that produce energy in the form of a radiation beam. The proton beams can pass through healthy tissue without damaging it, yet still be aimed at cancerous tissue to destroy cells.
Intensity Modulated Radiation Therapy (IMRT)
Intensity Modulated Radiation Therapy (IMRT) is another form of external beam radiation therapy. In IMRT, patients lie in a partial box, and the air is drawn out of a vacuum bag that surrounds the patient in order to immobilize him so he remains still. Computed tomography (CT) is used to create a 3-D picture of the prostate and surrounding organs so the radiation rays can be delivered only to the prostate gland. IMRT is more precise than other external beam radiotherapy procedures because it doesn't use a single beam of radiation. Instead, IMRT uses many, thinner beams to precisely target the prostate gland and spare other nearby organs from radiation. As a result, the prostate gland receives a high dosage of radiation with a lower dose affecting the surrounding healthy tissues. IMRT is administered in short sessions five times a week for approximately seven weeks.
Advantages: Major surgery usually can be avoided by using external beam radiation therapy. External beam radiation therapy may optimally treat prostate cancer in its early stages and may help extend life in later stages. It rarely causes loss of urinary control. IMRT is a technological advance in the use of external beam radiotherapy. It allows physicians to treat tumors with a higher dose of radiation, retreat cancers that have previously been treated with radiotherapy, and more safely treat tumors that are located close to other organs. IMRT also reduces the amount of radiation administered to nearby organs compared to other forms of external beam radiotherapy, thereby decreasing side effects.
The newer techniques mentioned above look promising in terms of less chance for adverse effects and greater chance for success. Disadvantages: External beam radiation therapy can cause a variety of side effects. Most of these are minor and disappear after therapy stops. These side effects include tiredness, skin reactions in the treated areas, frequent and painful urination, upset stomach, diarrhea, and rectal irritation or bleeding.
There is a chance of some permanent side effects. Bowel function may not return to normal even after treatment is complete.
When an external machine provides radiation therapy, development of impotence may occur up to 2 years later in some patients and can be a permanent side effect. This is especially important for the younger patient to consider when thinking about different treatment options.
Radiation therapy may be inconvenient because patients need to make frequent visits to the hospital or clinic for treatment (about 5 times per week for 6-8 weeks).
If the prostate cancer doesn’t respond to or progresses with radiation therapy, the cancer cannot be retreated with radiation, and surgical removal of the prostate is complicated after radiation.
Finally, the newer types of radiation therapy mentioned above may not be available at all radiation therapy centers.
Your physician and local radiation center will be able to tell you the specific types of treatment offered at your center.