September is prostate cancer awareness month. If you’re over 50, please get tested.

Since our last update in July, Paul has undergone a battery of tests in preparation for his radiation treatment (which is now scheduled to begin in mid October.)

Paul started Androgen Deprivation Therapy in July and has begun a series of shots that block his production of testosterone for three months at a time. If you’ve ever heard the TV or radio ads touting the symptoms of “low T” that’s what he’s been experiencing. He’s definitely having some side effects but so far they’ve been tolerable. It’s frustrating to not “feel like yourself” (especially when you feel young and healthy in every other way) but we have to keep reminding ourselves that it is temporary.

Additionally he’s been poked and prodded, had MRI’s and CAT scans, blood work, casts made for radiation, fiducial markers and an OAR spacer inserted and even gotten a couple of tiny tattoos that will be used to aim the radiation. And, as of today, we have his radiation dates scheduled.

He’ll begin external beam radiation treatments (EBRT) on Friday, October 19th and he’ll have one weekly treatment on each of the subsequent Fridays for five consecutive weeks. EBRT focuses X-rays on the prostate from a machine outside the body. The doctor will direct the radiation right to the gland and pelvic region and adjust the dose to target the cancer – ideally without damaging the rectum, bladder or surrounding areas. The treatment takes about 10 minutes, and it doesn’t hurt. It’s usually done daily over the course of four to five weeks but Paul has opted for a higher dose treatment given weekly. This is similar to “CyberKnife” – a branded procedure that our insurance won’t cover because of the stage and degree of Paul’s cancer. He can expect some fatigue, but he should be able to keep working.

If all goes well, his last treatment will be on Friday, November 16th, the week before Thanksgiving. And we will surely be giving thanks to have his treatment in the rear view mirror.

Just to set expectations, we will not know immediately if/how the treatment worked. After radiation treatment for prostate cancer, the primary indicator is a PSA score. However, since Paul is currently undergoing Androgen Deprivation Therapy and is on a testosterone blocker we won’t be able to get an accurate PSA until he stops ADT therapy and the drugs get completely out of his system. This could literally be years as the doctors want him to stay on it the ADT regimen for at least a year following radiation and possibly longer.

The research shows that three years of androgen-deprivation therapy can improve the results of radiation treatment. But long-term hormonal treatment is expensive, and it often produces unpleasant side effects. To find out if short-term androgen treatment is beneficial, Harvard researchers studied 206 volunteers with clinically localized but high-grade prostate cancer. Half the men received standard external beam radiotherapy; the others received the same doses of radiation plus six months of androgen deprivation with an LHRH agonist and an antiandrogen. After an average follow-up of more than four and a half years, the men who received combination therapy enjoyed a higher overall survival rate (88% vs. 78%), a lower risk of dying from prostate cancer, and a lower risk of requiring additional cancer treatment. However, combination therapy produced more breast enlargement and impotence.

So, the longer he can stay on the ADT therapy the better, but even six – 12 months should yield some long-term benefits.

In happier news, we are getting married in late January 2019 and going on an amazing honeymoon in S. Africa. So there is LOTS to look forward to.