Monday, August 12, 2013

Day 43 - Why I Stopped Posting

After two weeks of daily doses of radiation, I got really tired.  I just didn't have the energy, when I got home from the hospital, to turn on the computer to blog.  After 42 treatments I am happy to say that I am done with my daily trips to the hospital.

It is now August and I am finally getting my energy back, so you may hear more from me in the coming weeks.  I don't think I'll write about cancer anymore however.

I'm done with that.


Monday, January 28, 2013

Day 14: Prostate Cancer Staging

Day 14: Radiation Therapy

The prognosis of prostate cancer depends its stage.

It's extremely important to understand the advantages and disadvantages of each treatment option for prostate cancer. The benefits of treatment depend on how large the cancer is and how far it may have spread. In other words, its stage.

The National Cancer Institute has an excellent booklet explaining treatment choices for men with early-stage prostate cancer.

To detect and diagnose prostate cancer and to determine the size and extent of the spread (or stage) of the disease, you doctor may perform tests that involve feeling the prostate, looking at internal parts of the body, measuring the levels of substances in the blood, and examining samples of prostate tissue.

Why is it important to determine the stage of your prostate cancer?

Only by knowing how the cancer is growing and exactly where it is located in the body can you and your doctor choose the best treatment plan for you. There are two systems used to stage prostate cancer:

  • TNM Staging is based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of distant metastasis (M). A number is added to each letter to indicate the size or extent of the primary tumor and the extent of cancer spread.
  • Whitmore-Jewett Staging is a staging system for prostate cancer that uses ABCD. (A) and (B) refer to cancer that is confined to the prostate. (C) refers to cancer that has grown out of the prostate but has not spread to lymph nodes or other places in the body. (D) refers to cancer that has spread to lymph nodes or to other places in the body. 
 It's only after understanding to which stage your prostate cancer has progresssed can you (and your doctor) decide which treatment plan might be best for you.


You can learn more about cancer prognosis at the National Cancer Institute's website.

Update:

I missed posting all last week because, frankly, I was just too tired to write.  My doctor told me that I could begin to feel fatigued but I wasn't expecting it after just 10 radiation sessions.  It's not like the fatigue I might feel at the end of a long day which gets better after a good night's sleep. Rest doesn't seem to help at all.

As it turns out, however, cancer fatigue is very common and there is no way of knowing how bad it might be. My doctor said that it will go away after my treatments are done, so I'm not going to worry about it for now. I just may not feel like writing every day.

On another note, I have decided not to cut my hair until my treatment regimen is completed in March. Giovanni asked me if I was trying to make a point by not shearing my mane.  But, since radiation therapy doesn't make you lose your hair, there is no point to be made.  I assured her that I was just feeling a little lazy and I don't really care how I look right now.  Now that I understand my fatigue, I also know why I don't feel like a bi-weekly trip to the barber.

Cya tomorrow, maybe...

Tom

Friday, January 18, 2013

Day 9: Gleason Grading System

Jackie Gleason, aka Sheriff Buford T. Justice
Day 9: Radiation Therapy

No, this has nothing to do with Jackie Gleason. I just used his pic to get your attention. Your Gleason score is used to help evaluate the prognosis of men with prostate cancer.

If your diagnostic tests and other exams reveal a malignant tumor of your prostate, then your doctor may use the Gleason grading system to help describe the appearance of the cancerous prostate tissue.  In order to do this a pathologist will look at the biopsied tissue under a microscope in order to examine the way the cancerous cells look compared to normal prostate cells.


If the cancerous cells appear to closely resemble normal prostate tissue, they are said to be "well differentiated" and given a Gleason grade 1. This means that the tumor is not fast-growing.

If the cells look fairly irregular and very different from normal prostate cells, then they are described as "poorly differentiated" and assigned a Gleason grade 5.

Grades 2-4 are used for tumors that fall between grades 1 and 5, with higher numbers corresponding to faster-growing tumors.

Because prostate cancer tissue is often made up of areas that have different grades, the pathologist will examine that make up the largest portion of the tissue. Gleason grades are then given to the two most commonly occurring patterns of cells.  By adding these two grades together, the final Gleason score is assigned. Scores on the higher end of the Gleason scale (7-10) usually indicate a more serious prognosis.

You should watch this video (about 9 minutes) to get an explanation from the experts.


 My Gleason score was 7 (right on the hairy edge) and that's why I am now visiting Radiation Oncology every day.  If you practice  early detection like I wrote about earlier, then you might not have to endure the same fate.  If you haven't already, please schedule a PSA and DRE with your doctor.

Well, it's the end of my second week.  Only 33 more treatments to go.  On Tuesday, "What is staging in prostate cancer?"

Cya next week.

-Tom

Thursday, January 17, 2013

Day 8: The Next Step - Prostate Biopsy

Day 8: Radiation Therapy

A DRE and PSA cannot diagnose prostate cancer. Abnormal results of a DRE or PSA only indicate that further testing is needed.If you have abnormal results in one of these tests, your doctor may ask you to to have a biopsy.

A biopsy is a procedure in which the doctor uses TRUS (transrectal ultrasound - remember, we talked about this in a previous post) to view and guide a needle into the prostate to take multiple small samples of tissue.  In my case, the doctor took 12 samples.  The procedure itself is a little uncomfortable and takes about 20 minutes.  You will lay on your side on the diagnostic table and you'll hear a "pop" when the urologist clips sample tissue from various areas within the prostate.  The sampling of the prostate tissue doesn't hurt but, it is a strange feeling if you've never experienced having pieces of your body tissue removed before.

Never again will I ever say to anyone, "You wanna piece of me?" 


After the tissue samples are removed from the prostate are then examined under a microscope for the presence of cancer. A biopsy is the only way to confirm or diagnose the presence of prostate cancer.

You won't be in any pain after the procedure and you can go home the same day.  After the biopsy, you may experience some blood in your urine, semen or bowel movements, but that will clear up after about a month.

This isn't a procedure you should fear.  It's a necessary next step to determine whether or not you have to live the remainder of your life in a diseased state. So - if you have to - take a deep breath, close your eyes, and...

So, tomorrow (finally) I'm going to try to explain the Gleason Grading System.  I think I'm going to need some Youtube help again.

Cya tomorrow,

Tom





Wednesday, January 16, 2013

Day 7: Making Sense Of Your PSA Results

NE Patriots Hall of Famer Troy Brown gets PSA screening
Day 7: Radiation Therapy

A couple of days ago I mentioned one of the newer PSA tests, the "Percent Free-PSA Ratio". Well, there are other ways to measure and diagnose prostate cancer using PSA.

 Your Age Is A Factor

Another way of looking at PSA involves age-specific PSA reference ranges. PSA levels naturally increase with age, therefore, higher PSA levels are normally seen in older men more often than in younger men - even without cancer.  An age-specific PSA reference range compares the results of men in the same age group. If your PSA levels are high compared to your age group, then there is a greater chance that prostate can could be present.

PSA Density

If you had your PSA measured and also had a transrectal ultrasound (TRUS), then PSA density (PSAD) can be determined. To calculate PSAD, your doctor will divide the PSA by the size, or volume, of the prostate (determined from the TRUS). A high PSAD indicates a greater likelihood that prostate cancer is present.

PSA Velocity

PSA velocity shows how quickly the PSA level rises over a period of time.  Two or more PSA tests are required over a period of several months. While PSA velocity is not used to detect prostate cancer, the test can help your doctor better interpret borderline PSA results. It is a way to track PSA levels over a period of time.

PSA Doubling Time

PSA-DT is the time it takes your measured blood PSA levels to double.  A shorter PSA-DT may indicate that the prognosis of your prostate cancer may be worsening.

Why Do You Care?

These newer PSA tests can be useful but, because they are new, there is a lot of controversy within the medical community as to their value. If your PSA is borderline your doctor can help you determine which of these tests might be right for you.  A high PSA doesn't necessarily mean that you have prostate cancer and a low PSA doesn't mean that you are safe. The PSA can deliver false results so it is used along with the results of the DRE to provide a more accurate screening.

The DRE isn't as bad as you think.  If you don't believe me, ask Dr. Oz.   Watch him as he performs a DRE (live) on a 40 year old man who always "feared the finger".



Now, that wasn't so bad - was it? If Khemare can do it, then you can do it.  Call your doctor now and get your appointment to get screened.

Tomorrow, I want to talk to you about the biopsy.

Cya tomorrow,

Tom






Tuesday, January 15, 2013

Day 6: Take A PSA Test - Yes or No?

Day 6: Radiation Therapy

Last May (2012) the U.S. Preventative Services Task Force published a report recommending against PSA screening for men of any age. The task force said that, while PSA screens may detect cancers, a lot of the cancer would never do a man any harm. However, biopsies could lead to infections and treatments could leave a man impotent or incontinent. They concluded that the potential harm far outweighed the benefits.

The advice is "outrageous," said Dr. William J. Catalona, a urologist at Northwestern University Medical School in Chicago who co-wrote a commentary in "Annals of Internal Medicine" that argued the task force had erred in its interpretation of the science.

"PSA testing is really a boon to men, and they're throwing it out because they underestimate the benefits and overstate the harms," he said.

So you can see that there is a battle raging in the medical community as to whether or not you should get screened for cancer on a regular basis.  Choosing to get screened or not is up to you, but your decision should be made out of the best information available and a clear understanding of what's at stake - not emotions or feelings.  So I want to talk a little bit more about the PSA - actually, a lot more about the screening process - what you can expect; what various PSA tests are available; and how to interpret the results.

I always believed that you are responsible for your own health and, while a doctor is the professional, the decision on which medical course of action to take is ultimately yours.  So you should be as well-informed as you can possibly be.

It starts with deciding whether or not to submit yourself to the screening process depicted in the chart above.  If it is determined that you have cancer, and how far along your cancer has progressed, it continues with which treatment options are available.

So if you're one of those guys with your head in the sand, it's time to pull it out.  Don't be afraid to go to the doctor; and don't be afraid if you get bad news.  It's much better to know what you have to deal with and then go for it. 

Tomorrow, we'll go into some detail about the full screening process with some explanation of this chart.
 
Update:

As for me, the therapy is going well.  I no longer have any anxiety about lying under the Trilogy. I know that it's going to make seven passes at my body from different angles.  I know that each burst will last from 7-10 seconds.  Piece of cake.

Cya tomorrow,

Tom







Monday, January 14, 2013

Day 5: The PSA And The Dreaded DRE

Day 5 Radiation Therapy:

I told you last week that no one knows what causes prostate cancer. Any man can get it, but if your father or other close relative had prostate cancer, then you have an increased risk of developing it also.  If you're African-American you should get screened every year after you hit age 45 because the numbers say you are at an even higher risk.

So, what is screening all about?

Actually, because prostate cancer can be a slow growing cancer, a man with less than a 10-year life expectancy would most likely die of some other illness.  In that case, he is not likely to benefit from screening. If you're not sure, the American Cancer Society has guidelines for cancer screenings and you can find them on their website

When you decide to get screened, your first option is the dreaded DRE (digital rectal exam). The DRE is a quick and safe screening technique in which a doctor inserts a gloved, lubricated finger into your rectum to feel the size and shape of your prostate. The prostate should feel soft, smooth, and even. If the doctor feels a lump or hard irregular area he may order a biopsy.  The entire prostate can't be felt during a DRE, but most of it can be examined, including the area where most prostate cancers are found.

I avoided the DRE for years and my cancer progressed a lot further than it should have. My reluctance is why I am in radiation therapy now.  This is a disease you want to detect early so it will be easier to cure.

Please don't make the same mistake. It can be a little uncomfortable but it's worth a little discomfort for a few seconds to know the truth about the health of your body. Don't let your mind get the best of you.  Just take a deep breath and ...

PSA (prostate-specific antigen) is a substance produced by both normal and cancerous prostate cells. When prostate cancer grows or prostate diseases are present, the amount of PSA in the blood often increases. PSA levels are considered in a normal range of 0-4 nanograms per milliliter (ng/ml). If the results are greater than 4 ng/ml then your doctor may suggest a biopsy. The biopsy is the ONLY reliable test to accurately diagnose prostate cancer.

Getting a PSA test is relatively simple.  Your doctor will take some blood and send it to a lab. When your results come back, however, they could be a little confusing. Just because your PSA level may be elevated doesn't mean you have cancer. You could have BPH (benign prostatic hyperplasia), a type of non-cancerous prostate enlargement or prostatitis (inflammation of the prostate).

There are newer PSA tests you can take to detect the presence of cancer.

The Percent Free-PSA Ratio is a blood test that measures how much PSA circulates by itself (unbound) in the blood and how much is bound together with other blood problems. If results are borderline and percent free-PSA ratio is low (25% or less), then prostate cancer is more likely to be present. If the results are higher then you may be able to avoid the biopsy.  Woohoo!  Believe me - you don't want a biopsy.

Tomorrow? More about the PSA than you're ever going to want to know...

Update:

Today is my 67th birthday!

Today, I asked Giovanni why radiation therapy makes me tired. She told me that the Trilogy is killing cancerous cells and some healthy cells.  She said it's like the flu infecting your body's cells - when healthy cells are attacked then the body fights back. "Don't you get tired when you have the flu?" she asked.

I guess that makes sense but I'm going to look into this a little deeper.  I don't think getting nuked is anything like catching the flu.


Cya tomorrow,

Tom





Friday, January 11, 2013

Day 4: TGIF

 
Day 4 Radiation Therapy:

It's the end of my first week of radiation therapy and I am starting to settle into the routine of driving to the hospital every day.  The thought occurred to me that blogging about getting nuked every day is going to get old very soon, so I have decided to try to add some real value here.  So, instead of trying to keep it light by adding a little levity to the process, let's get real.  This is serious stuff.  Cancer is no joke but it isn't anything to fear if you understand how to deal with it.  So, these blog posts are about to morph into a layman's explanation of "what every man should know about prostate cancer".

For those of you who don't use Mr. Google or didn't pay attention in 10th grade Biology, the prostate is one of the male sex glands. Yes, sex! But not that kind of sex. The prostate adds nutrients and fluid to the sperm. During ejaculation, the prostate secretes a fluid that is part of the semen. It's about the size of a walnut (the nut reference is not a joke) and can be divided into the left and right lobes. It lies just below the urinary bladder and surrounds the urethra - and there lies the problem. The urethra is the tube that carries urine from the bladder and semen from the sex glands out through the penis.

Besides a PSA test, one of indicators of prostate issues is difficulty urinating.  If you're the kind of guy who shies away from the doctor's office because you dread a digital rectal exam, then grow a pair!  You could be asking for trouble. If your stream is getting weak, or if you have to urinate frequently (especially at night), or you don't feel like your bladder is getting emptied when you urinate, your prostate may be beginning to enlarge and squeeze the urethra.

By the way, I just found out that the prostate gets enlarged after ejaculation and actually takes about 3 days to shrink back to its normal size. So much for those guys who claim they have sex every day.  I know they can't pee.

No one knows what causes prostate cancer. However, it is known that the growth of cancer cells in the prostate are stimulated by male sex hormones - especially testosterone.  That's why, as I explained previously, my doctors gave me female hormone therapy for 3 months to shrink my prostate before radiation therapy. 

Prostate cancer is relatively slow growing but don't let that give you a false sense of security. Go see your doctor. Next week I will write a little bit about how prostate cancer is detected and diagnosed.



Update:

Honey Hush, my extremely flamboyant compadre, announced today that this was his 38th day and he will complete his therapy next week.  Then he ostentatiously sashayed out the door as, I am sure, only he can.  I'm starting to wonder about him.

Cya next week.

Tom

Thursday, January 10, 2013

Day 3: Nikki Giovanni

Day 3 Radiation Therapy:

I love Nikki Giovanni. A friend introduced me to her book, "Black Feeling Black Talk Black Judgement", when I was at Cam Rahn Bay in 1968. I was hooked. The book was controversial and making the rounds among the brothers because of the incendiary nature of some of the poems in the collection but, personally, it taught me more about black identity than anything I had read up to that point in my life.

I remember a white news reporter interviewing Nikki during her more controversial years and asking her how a colored woman got a name like Giovanni (clearly Italian).  Nikki looked him dead in the eye and replied, "Before I was born, when my mother married my father, his last name was Giovanni."

A very smart, savvy black woman not to be messed with. Anyway, I only mention Nikki Giovanni because the woman who is doing my cancer treatments reminds me of her.  Not her politics or personality - she just looks like Nikki Giovanni as I remember her back in the '60s.

I asked Giovanni (what I now call my radiation therapist) about the side effects of getting concentrated doses of radiation every day for 9 weeks. She assured me that I probably wouldn't feel anything, if I felt anything at all, for at least 2-3 weeks.  I asked her what those side effects might be and she replied that I might experience some difficulty urinating or I might not be able to control my urination and become incontinent, or I might not be affected at all. She added that I might get constipated or I could get diarrhea or I might not experience any change at all.  She continued that I might experience sleeplessness or I might find myself sleeping excessively or my sleep patterns might not change at all.  She continued with her litany but I'm not going to go into it right now.  I feel like I'm in a Celebrex commercial.

Stop using Celebrex and call your doctor at once if you have a serious side effect such as: chest pain, weakness, shortness of breath, slurred speech, problems with vision or balance; black, bloody, or tarry stools; coughing up blood or vomit that looks like coffee grounds; swelling or rapid weight gain; urinating less than usual or not at all; nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); skin rash, bruising, severe tingling, numbness, pain, muscle weakness; or severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling. Less serious side effects of Celebrex may include: upset stomach, diarrhea, bloating, gas; dizziness, nervousness, headache; runny or stuffy nose, sore throat; or mild skin rash.

I decided to just wait the 2-3 weeks and try to be aware of any changes with my body.


Parking
When I walked out the front door of the hospital after my treatment, I handed my parking ticket to one of the parking valets. He returned in about 5 minutes with my car and held the door open for me as I handed him my ticket.

"As-Salaam-Alaikum," he said as he took my ticket and walked past me.

I watched him scurry off to retrieve another car but called out to him, "Wa-Alaikum-Salaam."

I am not Muslim but anyone who grew up in the '60s, or ever picked up a copy of "Muhammad Speaks", or bought a bean pie from a black guy wearing a bow tie knows that "Wa-Alaikum-Salaam" (...and unto you peace) is the standard reply. The attendant stopped, turned and smiled and said something else in Arabic.  I was stumped.  I had no idea what he was saying so I waved my hand and said, "shukran", the only other Arabic word I knew (something I picked up from watching too many movies about fighting terrorists in Iraq).

His face lit up and he flashed me a thumbs up.  Whatever he said to me, "shukran" (thank you) was apparently the right response.  Go figure.

Cya tomorrow,

Tom

Wednesday, January 9, 2013

Day 2: Honey, Hush!

Day 2 Radiation Therapy:

Today the waiting room wasn't as crowded as yesterday.  Now that I have a standard daily appointment time for my treatments, I expect to be in and out in about 1/2 hour.  It takes more time to find a parking space and then, of course, even though I have an appointed time, there is the waiting room time.

About three months before I was scheduled to take begin radiation therapy, I received medication and a hormone shot in the stomach.  The estrogen reverses the effect of male testosterone and shrinks the prostate. They want the target area to be as small as possible for the radiation.  There are side effects of the female hormones.  Some men grow breasts.  Luckily, I escaped that fate.  Some have hot flashes like women experience during menopause.  I get 15 to 20 hot flashes a day and, believe me, they're not fun.

When I arrived today, there were five other patients in the waiting room.  Two of the men (there are two women vets also being treated) were talking about the effects of their hormone treatments.

"Honey, hush!", I heard one of them blurt out waving a magazine in front of his face, "I feel like a waterfall. I'm just gushing out all over."

"Man", the other one complained, "can't you just say you're sweating? You sound like my grandmother."

I had to leave the room because I really didn't want to laugh out loud at my newfound comrades.

I learned a little bit more today about the radiation machine I am going to visit daily for the next nine weeks. It's a linear accelerator manufactured by Varian.  The Varian Trilogy is the world's first image-guided radiation therapy system optimized for both conventional and stereotactic approaches to treating cancer. It costs about $4 million and my therapist told me that it is the latest in IMRT technology.  I don't understand yet what IMRT even means but I will definitely find out.

I continue to be seriously impressed with the quality of treatment vets receive at a VA hospital.  Not many civilian hospitals can afford the equipment the government invests in for veterans.

Cya tomorrow,

Tom