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PROSTATE CANCER SUPPORT SITE

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Dave Landrum and Patricia live in Oklahoma, USA. He was 52 when he was diagnosed on August 17, 2006. His initial PSA was 5.6 ng/ml, his Gleason Score was 6 and he was staged T1c. His choice of treatment was EBRT (External Beam Radiation Therapy) - CyberKnife®. Here is his story.

After I received the initial diagnosis of having prostate cancer it did not really hit me for some time. I was referred to a urologist after an annual physical where the PSA has risen from a prior test. The urologist did the biopsy which was positive involving two cores less than 3%. My urologist told me I had 1-2 years before I really had to do something. I had read that the survival time frame was about 10 years and I thought I would wait as long as I could (ignoring the facts I suppose). My uncle died from prostate cancer primarily because he did nothing after diagnosis. I had always been in control of my life, career etc, and I could not control or change this. I felt the biopsy created more problems that bothered me, i.e. blood in urine for a couple of weeks and in the semen for many months. It was disgusting and ugly and pretty much destroyed my sex life. After this experience I did not want to do anything and just let what God gave me, have me. Several friends convinced me otherwise so here I am.

My urologist advised me of several treatments but seemed to really want to do surgery, which I was against at all costs. One of the treatments he did not advise me of was the CyberKnife® , which I found on my own. My regular doctor referred me to an oncologist (who had not heard of Cyberknife® for prostate) who then referred me to a radiation oncologist at St. Anthony Hospital in Oklahoma City. Dr. Young assists her partner Dr. Medbery who is the Cyberknife director for the hospital and both seem to be top notch.

I have read many things on the Internet, probably too many, because I am still confused as what to do or even if I need to do anything but I have made a choice and will move on even if it turns out wrong. There are so many conflicting articles and suppositions about what to do or when to do it. To make a long story short I decided on the Cyberknife due to the precise radiation and reduced side effects. I had gold "fiducial markers" placed in the prostate that the Cyberknife reads prior to sending the radiation. All the printed material on the Cyberknife says it is "non-invasive" but I consider the fiducial markers which are placed similar to the biopsy and catheter as "invasive". I also had a CT scan and MRI for the prep work.

I am not looking forward to the radiation even though it is only for 5 days beginning Monday 10-29. I have spoken to individuals who had almost no side effects and others who had some side effects. It seems like the most prevalent side effects are burning on urination and diarrhoea. Since no one on this site has had the Cyberknife, I will post what happens to me as soon as I can.

Later:

Posted November 5, 2007: I started my first Cyberknife treatment today. Prior to going I did the normal bowel prep with nothing by mouth after midnight and did the enema in the morning before the treatments. It took 1 hour and 45 minutes and was painless. The machine looks like something from Star Wars. I had to lay on a table while the machine moved around and administered the dosages. The only problem was trying to remain still for the full time frame, got a few itches and almost cramps but did not scratch or move. There are no side effects yet and I drove myself to and from. I will have four more treatments this week and will post the outcomes.

Later - posted November 7, 2007: Day two of the CK treatment and all is well. No side effects and the procedure was over in about an hour and a half. The CK procedure has three stages with the first being 35 minutes, the second being 40 minutes and the last one 20 minutes. There is a short break between each but you still cannot move or get up. Knowing the breakdown helped the time go faster today.

November 8, 2007: Day three of CyberKnife treatment: Again the treatment went very well. I was apparently a little more mobile today as it took about 15 minutes longer due to my movements. I was comfortable today and almost dozed off. I am glad the machine does not just "shoot and go" when you have a movement. The technician explained the movement could be from the bowels also and I noticed this morning that I felt like I still needed a bowel movement long after the enema. Starting to feel a little tired by afternoon, but not bad, may just be that I stay up late so I can relax easier during treatment. The only other thing I have noticed is a small pain in one kidney that comes and goes. It may not be related to the CK treatments since I don't think they shoot through it? I have noticed a slight drop off in urination stream during the day after treatment, but by night seems almost normal. Only two more left.

Later - Posted November 12, 2007: Day four of CyberKnife treatment: Only one more day to go! Again today was uneventful and very easy and finished at noon. I was able to remain still much better today for some reason and it went very fast. No more pain in the kidney or abdominal area and I think I know why. I cut my dose of Dulcolax from two pills to one the night before. I read where you are not supposed to take it if you have abdominial pain, maybe it was the cause. Or it may have been my body missing something, like an ice cold beer and some red meat. I have been on a low fiber diet this week so as to produce as little "residue" as possible.

I noticed nothing during the treatment (except I now know the number of tiles on the ceiling of the treatment room). The only side effect I noticed today was when I first attempted to urinate after returning home. It may be due to not having anything to drink since midnight the day prior and not having any H2O in my bladder. I just dribbled a little on two occasions and the last one was just a little uncomfortable afterwards. Not burning but just uncomfortable. Will see if I need a prescription for Flomax. By 4:00pm today my flow was better but not strong (no Flomax use yet). It seems to get better by day's end so we will see how it goes. My family noticed that my face appears like a little sunburn or flushed and it does appear a little red. Is this an expected occurence anyone has seen? Overall the experience thus far has been outstanding.

My next question is to anyone who has finished treatment (or the DOCs) and their travel experience post treatment. I am wondering how soon I can plan to travel by air (just a general ball park). Or would it be best to pass until say January. I have several work trips to make to California (1 hour from OKC to Houston then a 4 hour flight from Houston). If you travel you know how airports and airplanes can be especially during the holidays, and with our new body change was wondering how you were affected. Any experiences or suggestions would be appreciated. Again thanks to all for a positive experience so far rather than the one I was dreading so much.

Later:

Day five and final day of CyberKnife treatment. This was the slowest day by far and I guess I was in a hurry to finish and must have moved alot or as the tech thought some bowel movements. Had a great conversation with Dr. Medbery yesterday and Dr. Morrison today who took time to answer some questions for me. The night last night was rough with frequent urgency and "dribbles", until I took the Flowmax (2:30am) and within an hour all that stopped. No Flowmax side effects until this afternoon and a slight vision blur but not too bad. This cleared up and have not had any other side effects from the medication.

Later:

DAY #2 POST TREATMENT I am on day two after completing 5 Cyberknife treatments and feel normal except for the frequent urination. I am on Flowmax which helped tremendously when I had the "dribbles" and could not urinate after session #4. I take the Flowmax at night prior to bed. I am now experiencing frequent urination from about every 10 minutes to as long as two hours between episodes with an average of every 30 minutes, 24 hours a day beginning after #5 through the AM on post day #2. I do drink lots of water (12 glasses a day) and this morning had three cups of coffee for the first time since starting treatment, and it is probably a contributor for today. Urination is sometimes normal and sometimes has a "twinge" to it. Not a burning feeling but just a slight uncomfortable sensation, especially during the "dribbles". The Doc has recommended to cut back on the fluids and come in and get my urine tested for a urinary tract infection.

Late in the Day #2 after treatment, I began having urination urgency as quickly as every 10 minutes. I cut back on my fluid intake as suggested and was taking Flowmax and Phenazopyridine. The Phenazopyridine turns your urine orange and is supposed to help with the urgency. About half of the episodes were merely the "dribbles". The only relief I could get was a hot bath and as long as I was in there the urgency was less and would go away. However, it got stronger as the evening progressed and I was not looking forward to a night of getting up every ten minutes to "dribble". As bedtime neared I took one 200mg Ibuprofen hoping it might help. My wife suggested that I lay in bed with several pillows under my legs to take the pressure off the bladder. She said they recommend this to pregnant women to help relieve the pressure. Behold, I was able to sleep until about 4:30am then got up every 30 minutes. I had previously used the Phenazopyridine for urinary pain after the catheter but it did not seem to help much then or now, nothing close to the Ibuprofen which was a blessing. I am assuming it was the Ibuprofen and not a quick healing. I took two Ibuprofen's this morning (Day #3 after treatment) after the urgency started to go to every 15 minutes and have not had even a twinge (well maybe one twinge) of the urgency in over 4 hours and not a problem at all. At least I can go to the store now!!!

 

DAY #10 post treatment This is the best day ever. I am almost back to normal and only had three urinary episodes each were very near normal. I also had one bowel movement and it was much better and although not normal close to it. It looks like I am out of the "side effects" and getting back to normal. I have no other side effects nor do I feel bad.

If the Cyberknife works as believed, and these are the worst side effects, then I have hit a home run with this treatment. Good Luck to all.

 

UPDATED

December 2008

 

This is an update from my treatment in November 2007. My PSA was 10 immediately after the treatment and has steadily moved downward until last summer when it went up from 4.3 in June to 5.07 in October. The Doctors all said this might occur but is expected and normal for radiation.

I still have to urinate frequently but not any more than prior to treatment and have a slight "sensation" during urination but not unpleasant. Usually at night I experience some of the "dribbles" prior to urinating but then a slow flow starts. During the day it is normal, so I do not know why the difference.

Experiencing some minor ED problems but have meds for that although have not used them yet. The side effects scare the hell out of me. Although the thought of a 4 hour erection might be a good thing!!!!!

The oncologist says it may be up to 18 months or longer before the PSA bottoms out. Some guys have gone down quicker than mine. I have been traveling extensively with no problems whatsoever. I quit the Flomax long ago, but carry it with me just in case.

If this treatment proves to be effective for me as it has for others so far, it is by far the best (and easiest) you will find. I know there is not much history yet, but it has to start somewhere.

Good Luck to all and have a happy holiday season with long life and low PSAs.

Dave Landrum

 

UPDATED

March 2010

 

 

I am about 27 months post CyberKnife® treatment and my PSA has not gone down like most of the patients (who are in the 0.99 range) but it has gone down from a high of approximately 10 to 2.01. The remaining side effects are

1) slight ED, which is specifically that I am not as strong as it once was and is more difficult to obtain an erection

2) some lack of interest in sex

3) still have frequent urination from 2-5 times a night

4) and am starting to notice some weird bowel movements in that I have to go 2-3 times a day and when the urge strikes I have to right then.

Other than that it seems they got the cancer and I only have to go back every six months for a check up now. I would still do CyberKnife® if I had to do it over again.

Dave's e-mail address is: dmlandrumjr@cox.net