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PROSTATE CANCER SUPPORT SITE

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Robert Wallace and Mary live in Alexandria, Virginia, USA. He was 72 when he was diagnosed on December 1, 2009. His initial PSA was 0.3 ng/ml, his Gleason Score was 7 and he was staged T2a. His choice of treatment was Brachytherapy. Here is his story.

My urologist of 10 years believed that he felt something on the latest DRE (Digital Rectal Examination). My biopsy revealed 10% of core left base with cancer with perineal involvement. Elected to have seminal vesicles biopsy on 8 January 2010 and was found free of cancer.

Elected to go with perirectal CT-guided placement. [The perirectal area is that surrounding the rectum - most brachytherapy procedures are through the peritoneum, the area between scrotum and rectum]. Started ADT (Androgen Deprivation Therapy) on 8 January, 2010 with 3 month shot. The CT method appears to lead to more accurate seed placement which is scheduled for 29 January 2010.

The urologist had me on Avodart for 8 years prior for BPH (Benign Prostate Hyperplasia). which apparently masked any rise in PSA. I am the luckiest guy on the planet not dealing with a more advanced case of PC.

 

UPDATED

February 2010

 

 

On the 29th January 2010, I was prepped, IV in, Catheter in and the CAT Scanner that was to be used to guide the seed placement failed to boot up after finishing the seeding for the first patient of the day.

5 February 2010, I had 160 Iodine seeds placed monitored by at least 8 scans of the CAT Scanner using a spinal. I was placed on my stomach, my sweet cheeks were taped open and the operation commenced for about 2 hours. Dr. Panos Koutravellis, with offices in Vienna , VA ( Tysons Corner) used the pararectal technique inserting the needles both sides of the anus to place the seeds. Dr. Iver Kasnetz, Falls Church Medical Center, Falls Church, VA., my urologist of 10 years was assisting along with two nurses and a nuclear engineer.

I left with a catheter because 5th February was the beginning of the 50 inch snow in the Washington Metro area. When the urologist pulled the catheter on the 29th after the failed seeding attempt my urine flow dropped to about 2 to 4 mil/sec for 3 days just from the irritation of the urethra from the removal of the Foley. I did not want to go into retention in the middle of the night and have to count on Fairfax County Fire Dept getting me to Inova Alexandria during the snow storm.

Hence, I requested that the Foley be left in and I would have it pulled in several days time (Mon) in the urologist's office. I had the Foley for a week rather than three days. The only problem I experienced was having a BM. Sitting on the toilet caused stinging in the urine flow into the drain bag.

Right now I am getting up every two hours for bladder void; taking a stool softener and doing better than I ever thought was possible. Urine flow tingles now but does not sting. The catheter gave me a front row seat on the condition of my urine in the healing process. The blood clots cleared on the third bag. A little pink appeared the next morning. The scabs from the exterior needle wounds collected in my shorts half dozen every day for about five days. On the fifth day I noticed scabs inside the low point of the drain tube in the urine that must have numbered at least 25.

I used Tylenol several times per day for 5 days and took Flagyl for three days starting the 4th Feb and Cipro for 10 days starting the 4th Feb.

My radiation shield arrives Tues that will allow me to resume my contact with the public as an usher in the Concert Hall.[This reference to a radiation shield is most unusual. Most literature says that the external dose from seeds is so low that it cannot even harm a child sitting on a seeded man's lap]

I am waiting for problems to fall on me in the next few weeks but so far so good!!! The next step is a flow test mid March to see if I am holding anything in the bladder and another 90 day Lupron shot on 5 April.

Later: Its now 19 February - two weeks after the procedure. I am now able to lift more that twenty pounds. I was able to sleep 3 hours in one stretch last night.

Technical date regarding the radiation pattern. At the time of the implants the nuclear engineer, Dr. Passo measured me at 0.8 Mil Ren front and back and about 0.03 on each hip. The radiation shield was worn into the treatment facility to allow Dr Passo to take additional measurements. The front and back radiation was reduced from 0.8 Mil Ren to 0.015 Mil Ren which Dr. Passo said was safe for anyone at the Concert Hall. I spent the money and took the time for in-situ testing because I wanted to make certain I was not a radiation hazard for the public. It is better than saying I am sorry I believe I did the best thing I could. Now I know I am safe!!

Later:22 FEB update for those persons interested in using the lead impregnated shorts.

I dressed for the Concert Hall using Depends under regular tighty-whities and the two pound lead impregnated shorts. The assignments for the Concert Hall was at 7 PM so I voided at 6:45. It was sold out house: I was busy with 80 patrons for 30 minutes. My contact with each was 5 to 10 seconds, which is well below any kind of threashold that could cause problems making the need for the shield un-necesary. However, because of the shield I was able to safely sit within 3 feet behind patrons with out concern and listen to the program. Otherwise I would had to stand for the performance six feet away from any patron. For those planning on using the shield, be aware that it is impervious to water. I found this out when I voided at 9:30; I was wet from body perspiration that did not evaporate through the shield.

Yes, I did buy a 16 count package of Depends. I used the same one every night for a week starting the day my catheter came out! I am 38 days into a 90 day Lupron shot as part of the ADT. I have not had any side effects from the shot. My Uro wants me to have another 90 day shot in April. Maybe the Advodart interacted with the Lupron and reduced the side effects?

 

UPDATED

March 2010

 

 

5 March 2010 marks 4 weeks living with the seeds and the 90 day Lupron shot. I had a PSA test much too early but since I had scheduled an annual Physical before I was diagnosed, I had them add the PSA test to the blood work order.

PSA 24 Feb 2010 was 0.2 down from 0.3. I am up 4 times a night for a visit to the tinkle station! During the day I have learned to recognize that when I get out of a chair I have 90 seconds to find a toilet. Stool softeners helped the hemroid. No accidents yet.

The Lupron kicked in this week with Hot Flashes at several a day. Flowmeter test the end of next week before I see the Uro. I am wearing the leaded shorts to the concert hall until 5 April.

 

UPDATED

April 2010

 

 

My urologist took a Urine sample on the 15 March 2010, grew the culture; prescribed Macrodantin on 25 March and I spiked at 102 on 26 March after two tablet. and wound up spending quality time with the great emergency room crew at Inova Fairfax Hospital, Fairfax VA. I was admitted to the hospital and the intravenously administered antibiotics from the ER needed help over the next two days to knock down the fever.

I am not sure who I should reach out too when I have the next Urinary Infection. This is the second UI I have had using my Uro's medication and both times it has gotten out of control.

I was able to park my car today and hold voiding for 5 minutes while I walked to a rest room. I was very happy I made it with no leakage.

I am currently on 750 MG of Leviquin for 10 days from the hospital to finally clean up the infection. Maybe that is why I got 3 hours of undisturbed sleep last night. Things are better.

 

UPDATED

June 2010

 

Apr 2010 my PSA had dropped to 0.1. Received a 90 shot of Trelstar on 8 April. Still having urinary tract issues.

May 2010 The Trelstar has hit be harder with hot flashes that the Lupron. I got very concerned about UI after my hospitalization about early detection. I have made arrangements to see my GP rather than my urologist regarding UI.

Jun 2010 The Trelstar is still kicking hard and will until early July. Urinary problems starting to get a little better.

I have changed my diet to more salmon, fewer potatoes and lots of dark green veggies and more fruit. I have not gone to the vegan diet but have replaced beef with chicken. As add more aerobic exercise to my program and change my diet I wonder it any of these changes will make a difference as to the probability of having a PSA rise several years out that will signal my participation in life ADT! [Trelstar® is a form of ADT]

 

UPDATED

July 2010

 

 

22 JULY Urinary issues predominate with stress averted just in time; it controls my life.

The 90 day shot of Trelstar is now still active 114 days after injection. The hot flashes are getting lighter but they are still waking me at night. I have been getting Urinary infection too often, but caught last one very early and was treated with Leviquin, 500mg.

I am not sure that I will have any worthwhile future comment regarding my treatment unless my PSA starts to rise.[Hopefully Robert will continue to comment as time goes by - the best thing that newly diagnosed men can hear is that "Life goes on after a prostate cancer diagnosis"].

Robert's e-mail address is: bob22312@verizon.net