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I think my PC is hereditary. My Father had PC however he didn’t die from it; open-heart surgery took his life. My brother who is 6 years younger had PC. His treatment was radical Prostatectomy in 1997 his PSA is now less than 0.1 and he is doing fine. My Mother died of breast cancer at the age of 42. After my brother’s surgery I took an interest in PC. I started getting the PAACT publication, reading books, and reading all the material my brother had gathered before his treatment. I was born September 11, 1932. September, 1997 I had an annual physical done at Ochsner Clinic and all my tests showed good except my PSA, which indicated 5.0 ng/ml. My digital rectal examination (DRE) was normal. There were no nodules or irregularities in the gland.. My doctor said this PSA was a little high so he referred me to a urologist at the Ochsner Clinic. The urologist scheduled a biopsy, and took 6 samples. The samples checked negative. He suggested that I run another PSA in one year. December, 1998 Dr. Radzikowski, located in the Lady of the Lake complex, ran a PSA. It checked 4.5 ng/ml. My digital rectal examination (DRE) was normal. There were no nodules or irregularities in the gland. January 2000 Dr. Carter, a urologist located near the Lady of the Lake, ran a PSA and a Free PSA II test. The PSA indicated 5.8 ng/ml and the Pas II was 12%. My DRE was normal. There were no nodules or irregularities in the gland. I had no problems urinating. This meant that the probability of cancer was 37%. Dr. Carter and I talked and decided that we would not run a biopsy now, instead we would wait 6 months and run another PSA test. July 2000 Dr. Carter ran another PSA and a PSA II test. The PSA indicated 8.6 ng/ml and PSA II was 12%. My digital rectal examination (DRE) was normal. There were no nodules or irregularities in the gland. This meant that the probability of cancer was 38%. A biopsy was run this time and the results came back positive. The pathology report was: Infiltrating poorly differentiated adenocarcinoma, Gleason grade 4 and 4, for a Gleason score of 8. The tumor extensively involves one core and exhibits a small focus of involvement of a second core. There are hyperplastic changes in the remainder of the biopsy tissue. Dr. Carter then sent me for a bone scan to determine if the cancer had spread. The bone scan was negative. August 2000 I met with Dr. Carter to discuss staging of the cancer and possible treatments. I brought my outline of questions and he answered all of them. (Prostate Cancer Questions) The cancer was staged as T1c. This meant that, according to the partin tables, organ confined 37%, capsular penetration: 40%, seminal vesicle involvement: 15%, and lymph node involvement: 8%, my chances of cure weren’t good. Dr. Carter suggested one of two treatments, surgery or radiation. I asked him about seed implant. He said that one of the urologist in his group performed this treatment. I them asked him about the combination treatment seed implant and radiation. He said that they didn't do this. I asked Dr. Carter if I decided to go out of state to get treatments would he still want to be my doctor when I returned. He said by all means that he would be glad to. I then proceeded to make plans to get other opinions. Dr. Carter’s nurse, Betty, helped me get a consultation appointment with Dr. Johnson at Mary Bird Perkins. The meeting was scheduled for August 16 at 10:00 AM. I called and got a consultation appointment with Dr. Schnell at Radio Therapy Clinics of Georgia (RCOG) for 10:00 AM August 9, 2000. RCOG required a CAT and the original biopsy plates. Betty helped to get this done. August 9, 2000 Elsie and I arrived in Atlanta Tuesday Aug. 8. We attended a seminar at the clinic that night. Dr. Critz, the Medical Director and Founder of the clinic, was the speaker. He spoke on the history of ProstRcision. This is the name of the PC treatment performed at RCOG clinic. There were about 60 patients in the audience. Many interesting questions were asked. I was able to get around and talk to many of the patients. They were from all over the world and each spoke very positive about treatments and how they had traveled the long distances to get to this clinic and the confidence they had in the way the clinic operated.
Dr. Critz came into the examining room and talked to Elsie and I. Our discussion was about cure rates for different stages of PC. Once a week on Thursdays all the doctors meet to discuss the acceptance of each new patient. I would be notified after that meeting as to whether I was accepted. While I was in the clinic I visited a number of workers. I talked to clerks in the office, radiation technicians, receptionists, nurses, and department heads. I wanted to get a feel of their attitude toward their job. They all seemed to be very happy and enjoyed their work very much. I had made my decision. RCOG was going to do my treatment. I called Dr. Johnson’s office and canceled my consultation appointment. August 16, 2000 I was notified that I had been accepted as a patient at RCOG. August 31, 2000 11:00 AM My first appointment for a pre-operation examination was with Dr. Miller, my assigned urologist in Atlanta, at 11:00 August 31, 2000. He performed a pre-op examination. September 1, 2000 10:30 AM I went to Meridian Mark Hospital in Atlanta and the first step of my ProstRcision treatment began. 94 radioactive I-125 seeds were implanted into my prostate. These iodine seeds were tiny metal capsules, 5 mm long and 0.5mm in diameter. These seeds were used because each seed:
The I-125 seeds were implanted into the prostate using an ultrasound-guided transperineal implant technique. This minor surgical procedure was performed in the hospital operating room. After general anesthesia, my legs were placed in stirrups, and an ultrasound probe was placed in my rectum. The ultrasound machine enabled the implant team, consisting of Dr. Miller and Dr. Schnell, to easily view the prostate gland on a television monitor. Then, while looking at the prostate on this monitor, Dr. Miller inserted 25 thin, hollow, eight-inch needles through my perineum (the skin between my testicles and anus) into the prostate. The needles were inserted from the bottom (the apex) of the prostate to the top (base) of the gland and also into the seminal vesicles, small organs, which are attached to the top of the prostate.
Dr. Schnell then injected three to eight radioactive I-125 seeds through each hollow needle while it was pulled out of the prostate. I had 94 seeds spread throughout my prostate and seminal vesicles. Some of the seeds were placed in the middle of the cancer as was mapped out by the sextant biopsy. Two gold seeds were implanted as target seeds to be used later in the conformal beam radiation treatments.
Courtesy of Radiotherapy Clinics of Georgia
Transperineal Prostate Implant Courtesy of Radiotherapy Clinics of Georgia (Note: This wasn't me.) My ultrasound-guided transperineal implant took about 30 minutes from the time the first needle was inserted until injection of the last seed. The seeds were equal to approximately 12,000 Rads of radiation with a half-life of 60 days. I left the hospital at 6:00 PM and went to the motel. Elsie and I removed the catheter at 6:00 AM the next morning. I felt very good after the operation. I just couldn’t sit comfortably. We stayed in Atlanta one day and drove back to Baton Rouge on September 3. September 24 We arrived in Atlanta at the apartment we had made arrangements to rent when we were in Atlanta on August 31. September 25, 2000 11:00 AM The first thing I did was to fill out a 21 questionnaire. The questions evaluated my urinary, rectal, and sexual health. Dr. Schnell then reviewed the questions and answers with me. My treatments were scheduled at 5:00 PM each day Monday through Friday. I was off for the weekends. I had access to Dr. Schnell or one of the other doctors at anytime I needed it. ProstRcision is a complex process that involves great precision with both the seed implant and follow-up conformal beam radiation. Precision conformal beam radiation is given by a 24-MeV linear accelerator. These machines require precise alignment to the seeds coupled with the design of customized, individual blocking devices by the doctors to block out unnecessary radiation to the bladder, rectum, and sex nerves. This precision alignment of the treatment set-up is called simulation. Simulation is performed on a Ximatron CX simulator and dedicated CT scan simulator. Using laser beams, with me lying on the simulator, pants down, and with a napkin over my private parts my prostate was precisely lined up using the seeds as a target. X-rays were made to confirm alignment. This process took about 45 minutes. Small dots were tattooed on my hips and belly to ensure proper alignment each time treatment was given. Computerized dosimetry plans were performed and approved by Dr. Schnell, and then the first accelerator treatment was scheduled for 5:00 PM in the afternoon. Quality Control during Treatment The quality of treatment delivery is rigidly and continuously monitored throughout conformal beam radiation by careful monitoring of patients. This is done in two ways. 1. When the block treatment is being given with the linear accelerator, X-rays are made with the linear accelerator machine at each day’s treatment and the doctor reviews each one. These X-rays help ensure that the treatment machine will line up precisely on the prostate gland throughout your treatment. This is needed because the prostate moves. Without seeds outlining the prostate, doctors using ordinary conformal beam radiation treat a larger area in case the prostate gland moves. As a result, they often miss the cancer. All this does is unnecessarily irradiate the adjacent rectum and bladder and cause complications. 2. The 21-question questionnaire is used to provide the second method of quality control. Each Monday, men answer the questionnaire before being treated. The questionnaire evaluates urinary, rectal, and sexual health. All of the previously treated men’s answers have been entered into the RCOG ProstRcision database, The weekly questionnaire is reviewed each Monday by a doctor with the patient, and adjustments are made, if needed, in how the conformal beam radiation is delivered. The answers of men currently under treatment are compared with the ProstRcision database and serve as a guide in determining how the accelerator radiation is delivered, whether medication should be given, whether new blocks are needed, and whether machine angles should be changed. This quality control reduces the chance of complication from treatment. First Week of Treatments September 25-29 The first week of linear accelerator treatments were done without the lead blocks. My treatment was 75 Reds of radiation administered to each hip for 120 degrees starting at 20 degrees and going up to 140 degrees. This was a total of 150 Reds. The beam had a designed rectangular shape of 9x11 mm. The treatment took 3 minutes. September 30 and October 1 Some friends from Baton Rouge came to Atlanta and we had a late breakfast with them on Saturday. October 2-6 I filled out the questionnaire and met with Dr. Schnell. No problems and no changes were necessary. The second week of treatment was done with the lead blocks. My treatment was 75 Reds of radiation administered at 15 degrees above the tattooed mark of each hip. This was a total of 150 Reds. October 7-8 Elsie and I spent Saturday walking up and around Stone Mountain. Sunday we moved into Hope Lodge. Hope Lodge is owned and operated by the American Cancer Society. There are 34 apartments for cancer patients under treatment. The rent was free. We donated money to the American Cancer Society before we left. We met some the most interesting people while staying at Hope Village. They will remain our friends forever. October 9-13 I filled out the questionnaire and met with Dr. Schnell. I was beginning to have slight problems with urine flow so Dr. Schnell put me on medication consisting of cranberry pills, Advil and flomax. I also was getting tired in the afternoon. When this happened I would go to bed and sleep for about an hour then I was good to go for the rest of the day. Dr. Schnell said that this was a normal symptom. The third week of treatment was done with the lead blocks. My treatment was 75 Rads of radiation administered at 15 degrees above the tattooed mark of each hip. This was a total of 150 Rads. Forth, Fifth, and Sixth Weeks These treatments were just like the third week treatments. I had no more urinating problems however I continued to get weak in the afternoons. I still was taking the medication Dr. Schnell had given me. November 5-9 I did the questionnaire thing. The treatments this week consisted of different blocks. The new blocks had one hole about the size of my thumb. The seventh week of treatments was for the treatment of the seminal vesicles. I received 17,250 Rads of radiation during my total treatment, seed implant plus radiation. There were approximately 100 PC patients treated each day. November 10, 2000 We returned to Baton Rouge after being away for almost two months. Elsie and I had thought the 7 weeks of treatment away from home was going to be hard to endure. It wasn’t we enjoyed it. We met some of the nicest people in the world while staying at Hope Village Apartments and these people will remain our friends for life. December 1, 2000 I had my first PSA test done at Dr. Carter’s office. It tested 1.7 ng/ml. This is what it was supposed to be. I will do this test in 3 months and then every 6 months for the rest of my life. RCOG requires that I do my 21 questionnaire each time I have my PSA test run and send this in along with my PSA result. This data goes into their Prostate Cancer Database from which they use to publish their medical papers. I have had zero problems with impotency or incontinency. March 6, 2001 I had my PSA test done today at Dr. Carter's office. It tested 1.0 ng/ml. So far it is right where it is suppose to be. I sent my 21 questionnaire to RCOG. June 1, 2001 Had my PSA run today. It tested 0.6 ng/ml. September 1, 2001 Had my PSA run today. It tested 0.7 ng/ml. This is 0.1 higher than last time which is still within the predicted range. March 1, 2002 Had my PSA run today. It tested 0.4 ng/ml. Still good and going down to where it is suppose to be. August 30, 2002 Had my PSA run today. It tested 0.3 ng/ml. Still good and going down to where it is suppose to be March 3, 2003 Had my PSA run today. It tested 0.1
ng/ml. Still good and going down to where it is suppose to be September 2, 2003 Had my PSA run today. It tested 0.1 ng/ml. It is below the predicted range. March 1, 2004 Had my PSA run today. It tested <0.1 ng/ml. It is below the predicted range. September 2, 2004 Had my PSA run today. It tested <0.1 ng/ml. It is below the predicted range. March 1, 2005 Had my PSA run today. It tested <0.1 ng/ml. It is below the predicted range. September 1, 2005 Had my PSA run today. It tested <0.1 ng/ml. It is below the predicted range. March 1, 2006 Had my PSA run today. It tested <0.1 ng/ml. It is below the predicted range. September 1, 2006 PSA tested < 0.1 today. March 1, 2007 PSA tested < 0.1 today. September 1, 2007 PSA tested <0.1 today March 1, 2008 PSA tested <0.1 today September 1, 2008 PSA tested <0.1 today March 1, 2009 PSA tested <0.1 September 1, 2009 PSA tested <0.1 today March 1, 2010 PSA tested <0.1 September 1, 2010 PSA tested <0.1 |
At 10:00 AM the next morning my wife and I met with Dr.
Frederick J. Schnell Jr. (Left Courtesy of Radiotherapy
Clinics of Georgia). He gave me
another examination. My digital rectal examination was normal. There were no
nodules or irregularities in the gland. Dr. Schnell had studied the biopsy
slides from Baton Rouge and he said that he thought that the Gleason score was
too high and would change the score to 7. My stage was set as T1c. He examined
the CAT and concluded that my prostate was 25 cc (very small) and normal for a
seed implant. I had no urination problems. This meant that, according to the
partin tables, organ confined 49%, capsular penetration: 40%, seminal vesicle
involvement: 8%, and lymph node involvement: 3%, my chances of cure was a little
better. Dr. Schnell said that with this treatment I had a probability of 30% of
becoming impotent and less than 1/2% of being incontinent.
