HAMPTON ROADS, Va. — Next step: getting my prostate cancer treated!
Last month I shared I was diagnosed with it, in fact, one area is considered a high-grade cancer which has narrowed by options for treatment.
"This is not one we can watch, sometimes with low-grade prostate cancer we can watch it, but, unfortunately, you don't have a low-grade prostate cancer, so we need to do some kind of treatment for it", says Dr. Robert Given, a urological oncologist with Urology of Virginia.
He added one of those options is surgery to remove the prostate.
"We don't make a big incision; we put you to sleep," Dr. Given said. "We have an operating robot that we hook up to some of those instruments, has a camera and three working arms and the robot doesn't move on its own, I sit at a console. I control the robot's movement."
"You will initially have some urinary incontinence, so your prostate is involved in the control mechanism—so it's helping to hold back some of the pressure from the bladder," Dr. Given pointed out. "Most men get their control back in a couple of months, but it does take some time. So initially, you'll likely have to use some pads and it takes time for that muscle to strengthen to hold back the urine. We have physical therapists that teach some special exercises on how to control that."
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There is another issue Dr. Given says to keep in mind: "Erectile dysfunction—so right afterward you don't have any erections; it does take time. We do what we call penile rehabilitation to help with the recovery of the erections; we usually put you on a daily dose of Cialis which helps improve the blood flow to the penis."
In light of all that, I asked Dr. Given, what he would recommend.
"So surgery has more of a short-term issues getting through, the operation, the recovery afterward, but you don't really see late issues happening with after surgery," he said. "In my opinion, I think it has the best long-term cure rate....as far as the cancer coming back."
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Another treatment possibility is something like a combo option: conventional radiation, involving five-minute daily sessions, for five weeks and followed by radioactive seeds implanted in the prostate.
The seeds are tiny.
Dr. Mark Shaves, a radiation oncologist at Sentara Norfolk General Hospital has a visual reference: "It looks like you almost took a mechanical pencil lead and broke it off in pieces. They're super small."
The seeds are loaded in needles, and using computers, an ultrasound probe and a grid is guided into the prostate, the patient is not awake.
"This monitor is giving me constant live images of the prostate— all the needles, all the seeds," Dr. Shaves explained the process with technology at his fingertips. "So any needle can contain typically between one and five seeds."
Between 60 to 125 seeds could be implanted, releasing low levels of radiation throughout the prostate.
Dr. Shaves is upfront about what someone considering this should they keep in mind about the recovery: "Frequent urination, urge to go, slower stream, getting up more at night and that's going to peak at about three or four weeks after the implant and then subside over the next two to six months."
"If you did choose a form of radiation therapy, studies would recommend a course of hormone therapy with radiation," Dr. Given also pointed out. "So hormone therapy is a shot or pill that lowers your testosterone to very low levels. Studies have shown that for someone with higher grade stuff, higher grade cancer—-adding a course of hormone therapy with the radiation does improve the cure rate. If you did external radiation either conventional or proton beam radiation, we'd usually recommend 18 to 24 months of hormone therapy in someone with higher-grade prostate cancer. The side effects of hormone therapy are most commonly hot flashes, it's like putting you into menopause, decreased energy and decreased libido would be the short-term side effect."
Watch previous story: Kurt Williams's next step on cancer journey: Is it confined to the prostate?
Another radiation treatment option is at the Hampton University Proton Therapy Institute but how is it different from standard radiation?
"When we treat you with a proton as opposed to an x-ray, we can more carefully define the area that is irradiated," explained Oncologist Dr. Christopher Sinesi. "And the prostate is nestled between perhaps two of the radio-sensitive normal tissues in your body: your rectum is right underneath and your bladder is right on top and that exposure to your bladder and the rectum is where side effects and complications come from. When I'm treating you with a proton, generally speaking, I can deliver significantly less radiation to the rectum and the bladder, because these days we do a special procedure where the urologist injects gel between the prostate and the rectum and this gel pushes the rectum down physically away from the radiation field."
As a result of that, Dr. Sinesi believes proton therapy does a better job than conventional radiation in limiting those potential side effects.
"The side effects that I'm most concerned about are bladder and rectal," he said. "You can get rectal irritation, diarrhea bowel symptoms."
Dr. Sinesi says part of the challenge during the 44-day treatment is that the prostate itself, about the size of a walnut.
"And the prostate is a mobile structure, there's nothing tethering it down in your pelvis," he said. "You breathe in and it rides up. You cough it jumps to the side; we cannot have that motion when doing the proton beam radiation."
That's where a device he calls a rectal balloon comes into play.
"So every day when you come for treatment we're going to take this miserable little thing," said Dr. Sinesi. "And we're going to ravel it up and lubricate it and slip it inside the rectum and we inflate it and when you inflate that balloon you prop the prostate up against the pubic bone. Now the prostate cannot move while you're doing the radiation. I've got a stationary target. I don't have to enlarge my radiation field to account for wherever that prostate might be, I treat just the prostate. It makes it fabulously accurate. And this little balloon does not hurt....if you wanna know, I had one in me. It does feel a little peculiar."
Yes, each option has some pros and cons.
In the days to come, I need to move forward with one of them.
But the big takeaway?
Because I caught it early, I have options. So men I encourage you to get screened. A prostate cancer diagnosis doesn't have to be fatal if it's caught and treated early.
