The day after Christmas, I met with Dr. Daniel Chin, a radiation oncologist with John Muir Cancer Center. Dr. Chin has 24 years experience and did his residency at Stanford. Knowledgeable, direct, busy and with few of the warm fuzzies I get from Dr. Chao, but knows his stuff. That said, he was aware of the SpaceOAR gel implant and they did not do them because the last time he really looked at it, it was new, Medicare did not pay for it (i.e. nor did most insurance and it was $3k a pop (now about $2500)) and "data was still early as to if it made a difference." I'm pretty well read at this point and there's good data to back up the practice with more and more clinical data coming in. Besides it just makes sense that if they've gotten very precise with their machinery and can come close to delivering high dose radiation almost in a 3d manner to just the tumor/organ that they wish to destroy, then pushing the rectal wall away from the prostate by a couple centimeters (they literally are immediately next to one another) just makes intellectual sense. I just wish they could do the same thing for the bladder.
He did state that he was perfectly comfortable working with it in place and noted the added benefit that Dr. Chao, who has the experience placing the gel, could also place the gold (yes there will be gold in my pelvis so make sure someone sifts the ashes when the day comes!!!!) fiducial markers in the gland so that even as I move and my organs move throughout the day, when it comes time to get nuked, they can always adjust for movement. (Side note: Have you ever considered that our organs all shift throughout the day? I'd never really considered it.....but it makes sense )
He did a thorough (good Lord prolly THE most thorough palpation of that organ I've ever had when conscious) exam and stated that he could feel an extremely distinct tumor on the right with just a firmness on the left but not at all the irregularity of what he felt on the right. The issue started and has always been on the right, so this was no big news to me. It did, however, lead me to ask about the possibility of just "killing" the right side of the gland (in retrospect a silly question but you don't know if you don't ask) as opposed to the frying the whole damn thing. It was a flat out no. In his opinion and that of, I've come to realize, any responsible RadOnc or surgeon, if you tried to do that, you'd inevitably leave high grade disease and I already "most certainly have" mets from my little friend running around in my body. All or nothing from the physician's perspective.....and I'm afraid he's right.
This radiation would be palliative in nature to keep the tumor from penetrating other organs. It is not curative although it seems it might buy some time and with the latest technology, it seems with little likelihood of long lasting, severe side effects. A possibility but a markedly reduced likelihood from even 2 years ago and with the SpaceOAR implant, bad side effects are even further reduced. Nothing is risk free, but this is as close as it's gotten with radiation in that part of the anatomy and it's pretty good these days.
That was not the case when I was diagnosed 5 years ago. Radiation was a sure way to kill tumor and gland and one could be pretty sure there would be extremely unpleasant side effects that were likely long term.
Scheduled one more appointment with my favorite urologist (and I've had 3 and he's the only one I've ever liked, so when I say favorite, I mean it's ok if he pokes around in places because he's empathetic, super nice, compassionate, straight forward and gentle) to discuss all this with him and get his take.
I had that appointment and he was the nice, professional, compassionate, straightforward guy that I last saw almost a year ago (things had been really good for a while until about Septemberish). He agreed the radiation made good sense from a palliative perspective, wasn't convinced the SpaceOAR was needed (he makes a good case but I disagreed) and reminded me he had my back with other physicians when it came to anything regarding my pelvic organs. Dr. Jeremy Lieb is an amazing doc and I am so lucky to be a 10 minute walk from his office.
Now that the new year has begun and new (more expensive) insurance has kicked in, I can move forward with this. I don't like the idea of radiation being introduced into my body, even in a targeted, computerized way; it can cause a host of problems as time goes by and I like those prospects even less.
I also don't like the idea of giving up my prostate. When I was diagnosed, there was never even a discussion of surgery or radiation or anything to destroy/remove the gland due to it being Stage IV and in my lungs. Kinda like once the cow is outta the barn, there's no point in shutting the door. But now it's more of a try to slow or prevent the really ugly complications that can happen if the tumor keeps growing unchecked. This is not the typical progression of 98% of PCs but it's mine and always prompts the commentary from a new physician, "Mr. Miller, you certainly don't have a typical case"......or......"Scott, you have a very unusual case." Yes, thank you. I'm very aware at this point. I can't ever just be like everybody else ya know..........
Therefore, insurance authorizations, hospital and physician all on the same page, I should have the spacer and the gold (remember, SIFT THE DAMNED ASHES!) fiducial markers implanted next Friday by Dr. Kenneth Chao, who has implanted the spacer 35 times before. Dr Chao went to UT San Antonio and did residency at an educational hospital in Michigan. He knows and has specialized in this procedure and he has been extraordinarily patient, empathetic and human with me.
My energy is lacking. Haven't been to the gym in way too long and trying to get myself back to walking me and/or the dogs. My neuropathic pain has had an uptick and I am feeling what is becoming less a discomfort and more at times pain in the pelvic/perineal areas. So my lil' friend (you have to say that with a Tony Montana accent of course) is growing and I either get my glow on or end up in an operating room in a few months trying to untangle stuff.
I've chosen to get my glow on. If anyone want's to cook a roast, let me know and I'll strap it to myself for a small fee.
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