Cancer – reasons for hope in the near future

[Alex2507]

Prostatectomy, completely removed

Twister Mat being flown at half mast today.

 

[Swerd]

I still got that catheter tube, so I’d appreciate it you don’t mention “half mast”.

 

[TLS Guy]

I still got that catheter tube, so I’d appreciate it you don’t mention “half mast”.


Sent from my iPhone using Tapatalk

Sounds as if things went well. Take it easy!

 

[Swerd]

Sounds as if things went well. Take it easy!

It all went very easy. But I really didn’t know what to expect. I haven’t had real surgery in a Hospital since 1975. A lot has changed since then, including the patient!

Maybe I was lucky. The surgeon & anesthesia crew were very good. The hospital nursing staff earn 5 stars. Georgetown U Hospital is a teaching hospital, part of Georgetown Med School.

I suppose that fully robotic surgery for prostate removal has a real benefit. I don't hurt nearly as much as I had expected. There are many (5 or 6?) small incisions that were made during surgery, for access and draining, but they are small enough to be glued shut rather than sutured. The do hurt some, but they're small, and I can deal with the pain without resorting to heavy duty pain meds. The surgery does take longer, about 4 to 5 hours, due to the machinery working in much smaller steps than the human hand can do. So, I'm now a fan of robotic surgery.

 

[Swerd]

As of 2 hours ago, I AM HOME!!!

 

[Out-Of-Phase]

Congratulations Swerd, well done. Now, onto recovery for you. Rest easy. I only wonder if I will be in the same boat as you someday. I wish there was a fool-proof testing procedure for prostate cancer. I've heard that our current testing methods are chancy at best.

 

[KEW]

Good luck with your surgery tomorrow.

I had my second treatment with the proton beam machine today. So far so good.

A totally amazing machine. The process starts by splitting hydrogen atoms to generate the protons. These are accelerated in a giant circular cyclotron, to 60% of the speed of light. Then go through a collimator, which is three stories high to make a precise narrow beam of protons. They are then fed to the four treatment rooms. The beam is shifted between the rooms. It even shifts between rooms during repositioning. The techs tell you when you are next for the beam. When it is assigned to your room, the techs say, "we have the beam!". Then you hear the beam make its precise strokes. It is so precise that it literally pencils the target, like a child precisely coloring a picture. In my case it is aligned in four different approaches, two from the left and two from the right.

Each time you can hear it is "penciling" something roughly spherical. As it starts and ends with a very short pulse, but in between you can tell the "pencil strokes" are gradually getting longer and then shorter. I estimate it takes 90 to 120 seconds to "pencil" the prostate from each trajectory.

So precise positioning is crucial. I had four markers placed in the prostate when the rectal shield was placed, and some tattoos placed at the simulation session. The position for each session is done under Xray control.

The protons have to be accelerated to just the right speed for each approach. For those of you who remember the physics of Einstein's theory of relativity as you speed up an object it gets heavier. So as the protons are accelerated in the cyclotron they get heavier. So the computer accelerated them to just the right speed so they get to the correct mass to reach the intended target and no further. They release their energy in the target. If you could accelerate a tiny sub atomic particle like a proton to the speed of light it would be infinitely heavy.

I am totally amazed that anyone would develop such a complicated and massive machine to treat human disease.

Thanks for the description.
Proof positive that we are living in the future!
(sometimes I wonder, especially on matters of society making progress)

 

[Swerd]

I wish there was a fool-proof testing procedure for prostate cancer. I've heard that our current testing methods are chancy at best.

The PSA blood test, alone is not fool proof. But yearly PSA testing plus biopsy and MRI if the PSA rises above 5.0 can be trusted.

I knew my family history. After my PSA rose to 5, I saw a urologist who did a biopsy. It was negative. For a few years the PSA hovered just above 5, and then rose to ~9. An MRI followed by a 2nd biopsy made it clear that I had early stage low grade prostate cancer.

 

[Dan]

Modern (last five years or so) MRI techniques have added a lot. They identify suspicious spots in the gland to target rather than random biopsies. The areas MRI identify are marked by a radiologist and fed into an ultrasound (US) machine and while the US is done, the color coded MRI data is overlaid on the US image. The operator usually a urologist can then target the MRI spots while seeing the needle move in real time on the US images thus being sure the suspicious areas are sampled. This is what gave Swerd the positive biopsy.

The surgical techniques have also improved a lot as Swerd just experienced though I don't know much about them. I do know the nasty complications of incontinence and impotence are much lower now than they used to be.

I check my PSA regularly as I am next in line for the Swerd family curse.

 

[Out-Of-Phase]

I get the PSA blood test once a year. But I have read that that alone is not enough because it can generate false positives. My doctor mentioned that the 'gloved finger' test isn't enough either because you can't touch the entire gland, you can only touch a small portion of it. It sounds like the MRI exam is the answer.

 

[Dan]

I get the PSA blood test once a year. But I have read that that alone is not enough because it can generate false positives. My doctor mentioned that the 'gloved finger' test isn't enough either because you can't touch the entire gland, you can only touch a small portion of it. It sounds like the MRI exam is the answer.

MRI is too expensive to do routinely. The PSA is fairly specific but not very sensitive . This means it can miss many cancers. But when it is positive it is likely but not 100% due to cancer. This is based on a cut off of 4 ng/ml. However most but not all of the low PSA cancers are low grade. In fact most prostate cancers are low grade and not aggressive. These can be watched or treated less aggressively with radiation or high frequency ultrasound. Obviously we could use a better blood marker but it doesn't exist yet. An ideal screening tool s cheap, and highly sensitive (few false negatives) although high sensitivity (few false positives) is not necessary and is often undesirable. The two factors work opposite each other. High specificity comes at the expense of sensitivity.

MRI is too expensive and limited in availability to use fro screening. The finger is basically free albeit no fun but is nearly useless. Ultrasound by itself doesn't really work either but as I said previously it is excellent to guide a needle to an area identified by MRI.

For more info on PSA I suggest these studies:

Sensitivity and specificity of prostate-specific antigen for prostate cancer detection with high rates of biopsy verification - PubMed

In this article we explain findings from the Prostate Cancer Prevention Trial (PCPT) concerning the operating characteristics of PSA for biopsy-detectable prostate cancer, with special emphasis on a subpopulation of men with PSA less than 4 ng/ml, what is often regarded as the "normal" level of...

pubmed.ncbi.nlm.nih.gov

A Review on the Clinical Utility of PSA in Cancer Prostate - PMC

Prostate cancer has come to share the oncological centrestage among male cancers. The availability of Serum Prostate Specific Antigen, PSA, as a marker has encouraged it’s use to diagnose both cancer and cancer recurrence. Some clarity is required ...

www.ncbi.nlm.nih.gov

 

[Out-Of-Phase]

Thank you Dan.

 

[TLS Guy]

I completed my 10 day course of 5 proton beam therapy treatments today for my prostate cancer.

I'm glad to report that I have tolerated it very well, and the side effects have been far less than advertised.

The only significant side effect was slow some bladder spasms after the third treatment. These quickly resolved with alpha blocker medication.

I have not noticed any fatigue and had very mild brief discomfort after the third treatment.

Tonight, as I write this I would not know I had been touched.

All patients that I dealt with who had photon radiation had pretty miserable side effects.

If I don't have problems in the next couple of weeks, I will regard this treatment as a massive advance in the treatment of prostate cancer, at least in this series of one. So far this has been an easily tolerated therapy.

I have to say that the care and attention from all of the Mayo Clinic staff who participated in my care was just incredible. Once again I am greatly indebted to the Mayo Clinic.

 

[mtrycrafts]

....

Tonight, as I write this I would not know I had been touched.

...

Maybe you were not touched?

Part of an undisclosed DBt trial?

 

[Swerd]

I completed my 10 day course of 5 proton beam therapy treatments today for my prostate cancer.

I'm glad to report that I have tolerated it very well, and the side effects have been far less than advertised.

The only significant side effect was slow some bladder spasms after the third treatment. These quickly resolved with alpha blocker medication.

I have not noticed any fatigue and had very mild brief discomfort after the third treatment.

Tonight, as I write this I would not know I had been touched.

All patients that I dealt with who had photon radiation had pretty miserable side effects.

If I don't have problems in the next couple of weeks, I will regard this treatment as a massive advance in the treatment of prostate cancer, at least in this series of one. So far this has been an easily tolerated therapy.

I have to say that the care and attention from all of the Mayo Clinic staff who participated in my care was just incredible. Once again I am greatly indebted to the Mayo Clinic.

Very good news. I'm glad to hear it.

 

[ryanosaur]

@Swerd , @TLS Guy

What/When is the next marker for your respective treatments and prognoses?

 

[Swerd]

I'm excited that I'm able to say my original title for this thread, Cancer – reason for hope in the near future, turned out to be a good choice. Both my case, and TLS Guy's case seem to have good outcomes. To stick with medicine's conservative nature, you're not cancer-free until all the tests and evaluations are done. But at this point, I am rather confident that both of us will be there soon.

TLS Guy has to recover from any possible after effects, if any, from his proton radiation.

And I have to get my damn catheter removed – tomorrow. At 10 am EDT, if you hear what sounds like an air raid siren, that might be me. Apparently, there will be some time, hopefully only weeks, until I regain control of my bladder muscles. Note, that my cockeyed optimism is holding out for no chance of remaining incontinent for long.

When I first started this thread, I only hoped an outcome this good was in the cards. I love it when I'm right .

 

[Swerd]

@Swerd , @TLS GuyWhat/When is the next marker for your respective treatments and prognoses?

I have no more treatments other than recovering from surgery. My prostate cancer had not become metastatic. Under those circumstances, surgery has a better than 97% chance leaving me cancer free.

Sometime later this summer, I will visit the urology surgeon for a PSA blood test. My last PSA value was 10.1. I don't know how long it takes, but it should eventually drop to very low or undetectable levels, <1.0.

 

[TLS Guy]

@Swerd , @TLS Guy

What/When is the next marker for your respective treatments and prognoses?

I will see the radiation oncologist in three months and get a PSA. PSA will then be drawn every six months after that for 5 years. The nadir (low point) of the PSA usually occurs between 36 and 40 months apparently. Anything over the doubling of the nadir from that point out is regarded as treatment failure.

I'm told success is comparable to the total prostatectomy that SWERD underwent.

This Proton beam therapy for prostate cancer is relatively new, and so results will become clearer in the future. Since I was not a candidate for surgery, then my only other option would have been standard photon (X-ray or gamma) radiation. This proton beam unit was donated to the Mayo Clinic by one individual. So the Mayo Clinic charge the same for proton beam as photon radiation. Other centers have to charge much more, which makes getting approval and payment a significant issue. Mayo have been operating this proton beam unit for 5 years.

I should state that most proton beam centers use scattered beam technology. Pretty much all studies have been done with this technology, comparing it to photon therapy. Mayo is one of very few centers offering pencil beam proton therapy. So far the results of studies are not in. However this therapy is far more precise and should result in fewer side effects with better results and hopefully fewer secondary malignancies. However there are no definitive results to show that cure of prostate cancer, local damage to bowel and bladder, and secondary malignancies are improved with the new pencil beam therapy units. Theoretically it should be a better way of treating prostate cancer but only time will tell. I am part of this ongoing study comparing these therapies.

I consider myself to be very lucky to be so close to the Mayo Clinic. It is only 1 hour 20 minutes door to door from our home in Eagan.

 

[ryanosaur]

As before, my continued thoughts and wishes to both of you as you journey forward!