Remembering My Cancer Treatment
The Truebeam machine used on me looked slightly different, but this is essentially it. Photo probably copyright Varian, used without permission because why not.
Well here we go, with some fun stories about when I had prostate cancer and my subsequent successful treatment process. Now it is a rather dark subject, but there were some funny stories that I can tell about it as well. Plus some interesting facts about prostate cancer and treatment procedures that are totally fun and entertaining.
First off, it was the year 2010. I had some bloodwork done at my doctor’s office, and my PSA (Prostate-Specific Antigen) was higher than normal. Previously it had been below 1, but now it was over 3, so I was sent to a urologist.
I went through several tests over the course of a few months, and the results were in - prostate cancer. I remember just staring at the floor with the urologist (named Pat) talking, and my wife crying. He even said “you don’t seem surprised”. I don’t know what I thought before hand, I had simply braced for the worse. It was caught early, and there were four options given to me for treatment. Each had risks and side effects associated with it. Note that the options, risks, and side effects were from over a decade ago, procedures and side effects have changed, but this was what I was given as choices by Pat (who was really cool about all of this, and handled it very well):
Do nothing. I could elect to do nothing, and simply let the cancer take my life. It could take a decade. Yes this is considered a valid option, and one often picked by someone being diagnosed at say 85 years old who has other more pressing health concerns and most likely would die of something else well before then anyway.
Prostate removal. This would eliminate the cancer completely as it was caught early and had most likely not spread outside of the prostate. At the time the main side effect was a 100% chance of ED (Erectile Dysfunction). I understand they’ve improved the procedure, and now ED can often be prevented, but at this time no, 100% ED.
Radiation treatment. This was the traditional route of chemotherapy and the like. Plenty of side effects, still a fairly decent chance of ED.
Targeted radiotherapy. There was a company called Varian that had a new piece of technology called Truebeam. It used targeted intersecting beams of radiation that would deliver the radiation precisely in one spot with sub-millimeter accuracy. The chance of ED was 50% (at the time, no idea if this still applies). The technique was brand new, there were only four machines currently in use - two at a university hospital in California, and two in the main offices of the doctor’s hospital where my urologist’s main employer was. This was a 5 minute drive from my house.
I decided on the last option. I thought it would be interesting, and I thought I could potentially avoid ED.
The Pre-Process
Treatment started in early 2011. First, I got three solid gold pellet implants into my prostate. While they used local anesthesia, it still hurt like hell. First, guess what opening on the back of your body they go in to do this? It was frightening enough because I was accidentally allowed to see the needle to deliver just the anesthesia itself and that bad boy was probably 8 inches long. There was more than one shot, and each one of them stung like a bee sting.
Each pellet was put in using some type of gun, or at least that is what I imagined that device looked like. It felt like a pistol going up there, and they’d pull the trigger and WHAM in went a pellet. I actually said “ow” on the first one, and they were surprised I felt it. I believe when asked if I felt it I replied with a cheery “YES I FUCKING FELT THAT.” They asked if I wanted more anesthesia, and I said no, just hurry things up and get it over with.
After two more rounds, err uhm, pellets entered my body, that was it. A few days later there was a long MRI session where they collected a large amount of data on exactly where the pellets were and exactly where the cancer cells were, so they had a 3-D map of exactly where everything was in relationship to each other.
The Truebeam
So the process was as follows - I would arrive at the facility early in the morning, in a locker room I’d strip down and put on a gown, I’d wait in a room with a few other guys getting the same treatment, and one at a time we’d get called back to the Truebeam room.
I’d lie on my back on a table, the assistant would lift up my gown to fully expose my junk, and I’d have to remain still. She’d leave the room and speak to me via a speaker with instructions. First, the Truebeam would spin around the table with an x-ray, and “lock onto” the three gold pellets. Next, the radiation would start via two smaller-than-pin-point beams that would administer radiation where they intersected - the MRI raw data would tell the Truebeam where the cancer cells were in relationship to the gold pellets. The system was sophisticated enough that once the pellets were “locked on” by the x-ray it could handle extremely small movements such as blood pulsing through nearby veins, or even such a thing as breathing. I’d stare up at the poster on the ceiling above the table which was a detailed picture of the Milky Way, pondering my existence in the grand scheme of the universe. After roughly 60-90 seconds of radiation treatment everything would stop and they’d say I was done.
I’d get escorted back into the changing area, get dressed, and do the whole thing over again the next time. I had a total of 38 sessions, 5 per week Monday through Friday. There were a number of times they’d either call me or tell me when I arrived that the Truebeam was down for maintenance or to correct some error (remember this was brand new technology) so the treatment plan ended up lasting 2 1/2 months.
Interesting Bits
The organization my urologist belonged to had a oncology department and I was assigned a pretty cool oncologist named Peter. I simply called him Pete, and he was thrilled with this new technology. We had a number of conversations before, during, and after treatment to just see how it was going, and I would ask him all kinds of odd questions, which he loved.
I told him that after each treatment, I was immediately completely worn out, and it would last a few hours. Was this common, and would it be less pronounced during the course of treatments? He said it happened to maybe one in ten people, and if I was experiencing it then I could expect the same reaction up to and including the last treatment.
A really fascinating side effect was that at the exact moment the radiation intersection beams would come on, I would get this weird oily burnt electrical taste in my mouth, the kind of smell one gets when they are soldering or if an electrical circuit fries. It was like both an oily smell and a taste but neither. Not overpowering, but completely impossible to ignore. When I asked him about it Pete got really excited. “Really? You’re experiencing that?” He had a big smile on his face, and pressed me for details. I asked him if it was common, and he said no, maybe one in a hundred patients would experience it. He took a lot of notes, grinning. When I asked him what causes that, he looked at me and with a big grin excitedly said “we have no idea!”
Pete also told me about another strange side effect - retrograde ejaculation. After treatment there was a possibility that some or all ejaculate during orgasm would end up in the bladder instead of exiting the body, to be expelled later during urination. I asked if that was common, and he pointed out that on the weird things list so far I was batting 1000 so the odds probably wouldn’t matter in my case. He grinned. And he laughed pretty hard when I suggested we should start a punk band called “Retrograde Ejaculate”.
Breast Cancer
One of the other things that Pete loved about this new technology was it allowed for some unique approaches for treating breast cancer. It seems that the Truebeam could be used where other surgical treatments could not. For example, maybe the cancer cells were so close to vital organs that surgery was too dangerous, but with the Truebeam one could lock onto those gold pellets, track the breathing, and during an inhale there was a few milliseconds of a clear Truebeam shot and sub-millimeter precision breast cancer cell zapping. There were females as well as males being treated at this place, and while all of the males seemed rather subdued, the females were in great moods. For all of them this was a chance with more hope, where before they had no choice except chemotherapy or life-threatening surgery.
Again, I had simply asked Pete what the women were being treated for, and he got all excited to talk about it. All of us being treated knew this was cutting edge stuff, and there were Truebeam technicians and tons of scientific eyes watching all of this unfold. Yes, there might have been a feeling of being a guinea pig at times, but there was a much stronger feeling that one was helping to move a new technology forward.
Happy Ending?
This should be obvious, but regular checkups and whatnot are critical. The first indication I had this was a few weeks before my 50th birthday, and yes all of the men in the changing room waiting for their turn for the Truebeam “weenie roast” (BTW a joke that only one of them laughed at, the rest just glared) were much older than me. Start asking your regular doctor about PSA levels in your bloodwork in your 40s.
As stated at the beginning, the treatment was a success. But it wasn’t perfect. I still ended up with ED (worse right after treatment), partial retrograde ejaculation when I took those goofy boner pills, and yet another side effect they don’t put into the brochure - a shrinkage of the prostate which pulled in everything slightly, including reducing the size of my penis by probably 20%. Or as I used to say, “oh crap, now I’m just slightly larger than normal sized!”
I’ve made plenty of jokes about this in this blog post, but just to give you some balance, I was also in the process of writing and recording an album at this time. I wrote a song about it, with the lyrics touching on some of the elements in this blog post, like the Milky Way poster and the electrical taste in my mouth. The song is hard for me to listen to, as it is lyrically and musically dark. Even the monotonous repeating instrumental ending is a bit rough, because boy was I in a dark place when I wrote that. Anyway, feel free to listen to Cryptonomicon’s “Radioactive” from album The Devil’s Dance to understand my darker thoughts from the time.
