The Decision: I Pick IGRT....So Radiate Me

...
Okay, we've arrived at the future: Image-Guided Radiation Therapy. It's the cutting edge in high-dose radiation. The summit of Prostate Cancer High Tech.

I’m betting all my marbles on it.

After a week of hand-wringing and sleepless nights, the final decision for a treatment came easily enough. Could’ve been the promise of hitting the trifecta – high cure rate, no incontinence, no impotence.

Or total exhaustion.

Or maybe it was the mysterious old lady in the hospital who gave Lorraine and me deep, familiar hugs, and whispered “Everything will be fine,” before disappearing down a hallway, into a wisp.

“A sign,” Lorraine called her. “You can’t dismiss those things.”

Okay, maybe, whatever. Admittedly, it was weird. Fact is, moments after the hug and a long conversation with radiation oncologist, Dr. BG, I felt like I’d found a treatment that my gut and head agreed upon.

With the decision came sudden and remarkable relief. The load lifted. My step lightened. Later that afternoon, I even slept.

Not the well-worn path
Initially, choosing radiation over surgery seemed a touch risky. I felt I was going against the gentle nudging of Really Smart Guys Who Should Know What The Hell I Should Do -- two urologists, two internists and one brain surgeon.

Most counseled me to seriously consider surgery – which I did, but it seemed insane. The risks atrociously high. Around 15-50%* for some combination of incontinence and impotency for the rest of my life -- at 55 years old, horribly unappealing odds, even if survivability looked pretty good (95% for my situation).

Now I’m just a layperson, not a medical professional. Still, arguments for surgery as the ‘gold standard’ treatment for guys my age seemed flimsy to me at best. Especially today.

Surgery and high-dose radiation are equal in cure rates for localized, early-stage prostate cancer (like mine), everyone agrees on that point. But there's one caveat for radiation: it may only be good for up to 10-12 years. After that, no one knows for sure if the cancer will return.

No one knows the ultimate outcome because high-dose, targeted radiation hasn’t been around that long; high-dose brachytherapy seeding, for example, was the cutting-edge – you guessed it – about 10-12 years ago. Physicians simply don’t have the data that extends 20 and 30 years, into their comfort zone. So naturally, they tend to be cautious with younger PC patients (40s and 50s), whose cancer is more aggressive and needs to be dealt with in a serious manner.

Hence, the conventional wisdom: Let’s cut it out. Operate! Give radiation to the older guys who, frankly, are staring at shorter life spans, may not be up for major surgery, and just need to put the brakes on prostate cancer.

Which is what happened to my Dad years ago. At 70, he went the radiation route, because doctors believed surgery may be too hard on him – even life-threatening. Sure enough, he survived the prostate cancer, but died of esophageal cancer eight years later.

That was then, this is now
But over the last decade, oncology radiation technology has gone on an Apollo Moon mission. The new technology is astounding. The way they can accurately deliver high-dose radiation within minuscule margins is mind-boggling.

IGRT is the latest and greatest. As the 50-something technician who did my biopsy told me, "It's the biggest breakthrough in radiation therapy in a long, long time. You're lucky."

Yeah, and I'm feeling it: Since patient positioning is critical in how it all works, four 24-carat gold markers – about the size of rice grain – were implanted into my prostate, and the last two hurt like hell.

The IGRT machine -- viewing my nether-reaches with fused CT and MRI scans -- is then able to lock on to my implanted markers before delivering high-dose radiation that PRECISELY conforms to the shape of my prostate. How cool is that?

Even if the prostate moves -- say, from gas bubbles from that bean taco -- the IGRT adjusts daily to any new position. That's huge. The dosage can even be regulated within the radiation beam to avoid sensitive areas, like the urethra. In fact, the usual “spillage” of radiation outside the prostate, compared to earlier external beam and brachytherapy delivery systems, has been minimized from several centimeters down to a one or two millimeters.

That difference -- a Grand Canyan in radiation delivery -- is why IGRT is a game changer.

Save the bladder, protect the urethra, avoid sensitive sexual apparatus from getting singed and scarred by radiation.....and you're still in business for life. No ED. No diapers. No penile atrophy. Thumbs up! Everything's up!

How it works
I will lay underneath the hulking, three-armed IGRT machine 5 times a week, for 9 weeks. Over that period, the radiotherapy will expose my cancer cells to controlled doses of radiation, damaging their DNA. Normal cells also get zapped, but they’re able to quickly repair this damage – cancerous cells cannot. Since prostate cancer grows slowly, many weeks of therapy are necessary to continually damage the DNA in the bad cells.

‘No brainer’
Look, no doctor can tell me if the cure rate for IGRT is better than surgery over the long haul. I get it. The technology hasn’t been around long enough. What they do know is that I’m good for a decade or so; and radiologists like Dr. Green believes that for guys like me -- with localized, early-stage PC -- high-dose radiation is as good if not better than surgery beyond 10-12 years. Meanwhile, the risk of collateral damage is very small.

At 55, that’s makes IGRT, as my brother and two friends concluded, “a no-brainer.”

I did ask both Dr. Green and the brain surgeon-friend whether they thought it wrong-headed of me to take the 10 or 12 years, and gamble that if the cancer came back something else might be available -- like a shot or a pill -- that will be even more miraculous than IGRT, and less toxic.

Not wrong-thinking at all, they agreed. In fact, researchers already had a vaccine for one of the three PC genetic markers that eliminates cancer in 90% of lab rats.

Great. With IGRT and that little old lady's hug just in case, I'm good to go....radiate me.

***

*The percentages of incontinence and impotency vary widely, depending on specific treatment option, grade and localization of cancer, and research source.