Over Half Done with Radiation --- The Good Cancer

I am kind of celebrating tonight. Today was treatment 18 of 35. I am over half way through radiation treatments. And I feel pretty good. 

My last post ended on a fairly up note. I did not have Covid-19 but I certainly had other issues. One thing about this cancer, it sure removes ones dignity. Between having a vital part of ones sex organs removed to being exposed and prodded in the most intimate and personal places, I don't have much dignity left. 

Although I was very pleased that I did not have Covid-19 I was having all kinds of troubles with my bowels. Part of the treatment is to have an empty bowel when you show up for your appointment. For that reason I was attempting to eat in such a way as to keep things moving extra well. Maybe it was my own fault or maybe the treatments where finally doing their damage. Once a week each patient has a planned interview with a nurse, but one can request a meeting any time for any reason. 

So on Tuesday I ask the receptionist that I wanted to see a nurse. She immediately asked me what it was about and I was a little embarrassed to say it right there in front of several people so I hesitated. The other time I asked to talk to the nurse there was no inquiry as to why. So as I hesitated a nurse stepped around the corner and said to me it was OK he was a nurse and they just wanted a general answer to my specific need. So I told them my bowels where upset! He responded "you have said enough I will get someone to talk with you." I had the private meeting with a nurse who advised me to take a laxative and wrote the name of a good one for me to purchase.

The next day I saw my Radiation Oncologist Doctor and by then nothing much and change.  I had a whole series of question that I had written down on my tablet and when he saw I had a whole list he asked permission to just read my tablet. He carefully went through each of my questions and gave me good answers. 

One of the most interesting is that I wanted to know what they were aiming at with the radiation. The nurse had told me that after I had the initial CT scan and the tattoo markers that my Doctor met with a whole team and they had a meeting just about my case. They would have carefully looked at the images and made a plan. In that meeting my Doctor would have worked with the head of the radiation therapists, and at least one or two physicist and other radiation specialists. The nurse said they take significant time planning each patient's treatment, sometimes as much as three hours. That was good to know. 

My Doctor told me that the reason for the full bladder is not so much to get the bladder out of the way, but to help push the bowels out of the way. The bladder can actually tolerate the radiation pretty well but the intestines are especially sensitive to radiation and some men actually cannot have radiation after a Radical Prostatectomy because the intestines sometime occupy the space left empty after the removal of the prostate. It was a good thing that I was fine in that area. As for the aiming, in my case they are irradiating the whole prostate bed and attempting to hit all the spots where the prostate once was touching other parts.  He told me to be very careful about the laxatives because it was more likely soon I would have the opposite problem - diarrhea. Sure enough that is what happened and I was miserable for several days and could not ride my bicycle to my appointments because I could not be more that a few minutes away from a restroom. Obviously I stopped the laxative, but that did not change much. 

I told the head of the therapist what I was experiencing and he told me that he was not giving me medical advise but just his personal opinion. He suggested getting a good probiotic yogurt and mix it with white rice. 

I got those things and started eating that. Also that night I did a little more research on fiber in the diet because they had told me to go low fiber. Logically that seemed wrong to me and I thought more fiber would help everything move through the bowels better. I learned that there are two major kinds of fiber. Soluble and insoluble, to remedy diarrhea you need to increase soluble fiber and minimize insoluble fiber. So an example of soluble fiber is banana. Insoluble would the skins of of a lot of fruits and vegetable. The soluble fiber found in oat bran, barley and some fruits and vegetables tends to absorb water and slow down digestion. The insoluble fiber in whole grains, nuts, seeds, fruits with skin and certain vegetables, on the other hand, can bulk up the stool and help it pass through your intestines faster.

The tech's advise worked for me. After a couple of days my system pretty much settled down and today my nurse seemed surprised that my symptoms had pretty much cleared up and I have been able to ride my bike to my appointments the last several days. In fact some days I rode a round about route and clocked 17 kilometres each day. I am actually able to go up more hills then a could a few weeks ago. I seem to be getting stronger with exercise. I pray this will continue and I will not lose the muscle mass they predicted I would with the ADT drug I am on. 

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The appointments are still a challenge to find that sweet spot with a full bladder but able to hold it for the 10 or 12 minutes that the treatment takes. I have had a number of times when they tell me 5 minutes and 10 minutes later I am still waiting. Today, for example, they had a sign up saying they were on time, and I was timing myself to be ready for my slot. When my time slot arrived I looked over at the sign and they and just changed it to say they were now 15-20 minutes behind. I emptied and was ready and nearly bursting when they did call me. When my treatment was done I said I needed to exit quickly. The tech said if it was urgent they have a urinal available if I think I can't make it to the toilet in time. I was OK but relieved  :) it was over!

When the machine starts it's transit it is above me. It begins while the tech is still in the room and goes 90 degrees around to my left hip and the tech checks the alignment one last time before exiting and informing me it is starting. I must lay VERY still. Then it proceeds around my left until it is directly under me. The sounds change and the radiation begins and it circles clockwise all the way around to my right until it is under me again. The radiation sound stops and for 30 seconds are so it is just quite then it begins counter clockwise all the way around to under my left side. The radiation sound goes off and it transits back to above me. Usually while it is still moving the techs come back in the room and begin to move my bed so I can dismount. During the treatment the bed is a couple of feet higher then when I first get on it. I asked what the hesitation is halfway through the treatment and the tech told me that my treatment starts with one set of aiming instructions and on the first arch it is using those aim points. When it stops half way through they are feeding in new coordinates for it to aim at different spots as it transits back. It is just that when my bladder is full I just want it to hurry up and that pause part way through is challenging!

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Now about the title of this blog. I had heard other prostate cancer patients comment on how infuriating it is for someone to say "Oh, you got the good cancer." Up until yesterday no one had said that to me but then it happened and I did not know what to say. I did not want to embarrass him so I did not say much, but it made me think.

Here is what one Doctor says to his patients diagnosed with this cancer.

“You have prostate cancer . (Pause…) While all cancer is bad, some are much worse than others. Now I want you to listen carefully to what I am about to say. (Another pause…) While no-one knows the future, prostate cancer is most often, not always, but most often, one of the least aggressive kinds of cancer. . . ."

That is why many call it the good cancer. Prostate cancers have a 99 percent 5-year relative survival rate at stages 1 and 2. Prostate cancers either grow very slowly or do not grow at all, and they are very treatable. Prostate cancers that are not increasing in size may not require treatment if doctors do not consider them to be harmful.

Well let me throw in my two cents worth. This is the good cancer because the survival rate is quite high and many of us who have it will die of something else before the cancer gets us. I guess that is the good news. But . . .

It is a good cancer if you do not mind the treatments. And the loss of dignity. It is slightly embarrassing to write about this because it is so personal and intimate and involves a part of the body that we don't usually openly discuss.

Many of us loose most or all of our sexualness (I think I made that word up!) as a result of the treatments. Many loose not only the ability to have sex we may even loose the desire! That does not sound very good.

Many of us become partially or completely incontinent. Now if you don't mind wearing pads or diapers the rest of your life then maybe you can call it the good cancer.

Some treatments remove most of the testosterone from the system. If you don't mind the side effects that can include fatigue, hot flashes, loss of libido, weight gain, flabby muscles, tender and enlarged breasts, and many other less common side effects, then maybe it is the good cancer.

Don't get me wrong. I am glad there are treatments and I am glad that I have a pretty good long term survival prospects. I am thankful for every day I have with my family. But --- Please don't call it the good cancer. Some cancers might be less life threatening then others, but NO CANCER IS GOOD.

There I said it. Take it for what its worth. My perspective on the good cancer.