Archive for Radiation
Dear husband recently underwent 40 salvage radiation treatments (IMRT), and each time he had to lie on a table with a hard plastic “bodycast” resting on his nether parts, his tush exposed. The mold was supposed to help the computer target the right spots.
Lucky for DH, his rear has been crafted to perfection by years of “stairmastering”. I would have died of embarrassment if I had to display my dimpled flesh.
Many times have I gloated about DH’s glorious gluts. So when I thought about the nurses and technicians getting to see this for free, I was a bit resentful. (Really!) I told dear husband:
“I will ask the hospital to ‘reverse the charges’”.
This phrase is a bit antiquated, so I’ll explain that it means “Let them pay us.”
And then there was the issue of who gets to keep the bodycast. I insisted that DH bring it home. It’s his property, after all. And I wanted to put in where it belongs: in a piazza in Florence or Rome. His posterior for posterity.
A couple of weeks ago, around the time of my birthday, dear hubby came home from work and handed me a plastic form with markings all over it. It looked like something a dressmaker might use. Or part of a mannequin. In any case, creepy.
He told me, “Here’s your present”.
I was taken aback because I was expecting a big bouquet of flowers, like last year. So I could only stammer: “Wha-aa-t is this?”
Well, you guessed it: It was the bodycast. Over time I have gotten friendlier with my little “butt-man.” He stands beside me now, keeping me company. The “sculptors” at Sloan Kettering can’t afford to make mistakes, so I must acknowledge that this is indeed a perfect replica of the original derriere. Ergo a masterpiece.
And I got the flowers, too.
Here is a precious story about DH: Once, when he was a little boy, maybe 3 years old, he saw a man with a package standing in the doorway. He could hardly speak, but he walked over to the guy and managed to blurt out: “Deliveries to the rear.” Of course, everybody laughed.
Even back then DH liked order. Well, as life would have it, he got his “deliveries” to the rear.” But not in the way he intended, I’m afraid.
There is something that’s been on my mind for a long time. But it’s part of a larger issue. Let me explain.
About six months ago I heard a commercial on the radio about a state-of-the-art treatment for prostate cancer called “Cyberknife.” It was being offered at a hospital in Long Island (a suburb of NY) that I had never heard of.
Well, I sat up straight, and to quote Anatole Broyard, “my mind became immediately erect.” But my gut reaction was negative: concern, even fear. I thought, not knowing anything at all about the “Cyberknife,” that folks in the PC community were going to fall for it in a big way regardless of its merits. That’s because anything healthcare-related that has the word “cyber” in it is “sexy” these days. Same for “robot”. If you’re a clever marketer, you’re going to find a way to slip those words into your promotional materials
Then it occurred to me, if this Cyberknife is so good, why is it not being introduced by a top-notch hospital? There are loads of them here in New York. I did a brief search online and came up with very little info about Cyberknife, none of which suggested that it was superior to current PC treatments. Seemed that it was indicated for brain tumors.
Recently a friend sent me an article about a robot making rounds for a particular doctor when he is unable to be at the hospital in person. So the next time you go for a check-up, you may hear the words:
”Have a seat. The robot will see you soon.”
And that would be too bad. My friend Hughie, who is on ADT and about to have palliative radiation, told me that his long-time doctor (GP) embraced him the last time they met. And it wasn’t the first time: Hughie had once suffered a heart attack in the doctor’s presence, and it was he who gave Hughie mouth-to-mouth rescucitation — the “Kiss of Life,” as he calls it. And then the doc took Hughie to the hospital in his own car.
It just happens that the last time I saw my own internist and told him all about dear husband’s, he also gave me a (chaste) kiss on the way out. It was for me, like for Hughie, “The Kiss of Life.
“Now show me a robot who could do that.
Moral is: The best thing you can do for your health is find a doctor who really cares about you. And it ain’t easy. I am going to talk a lot more about the doc-patient relationship, because it is so critical to our health. Please chime in.
I have been revisiting the issue of salvage radiation therapy (RT) since Ted just began this treatment last week. There isn’t a lot of good data (only “retrospective” data) about this, so when I first tackled this subject a few months ago I decided I was better off “reading the tea leaves”. But it seems that I may have overlooked some things (been too pessimistic!).
One thing that shocked me about reading this was: We know there’s a lot of stuff about PC that we don’t know. But I realize that there is critical info that we do know about, which, for some reason, is not being incorporated into clinical practice.
What I’ve found out is:
* Experts agree that post-RP radiotherapy is “underutilized”
* There is some evidence that RT may be effective even in men with advanced disease.
* Post-op RT should be started ASAP. It can make a big difference if the patient starts radiotherapy when their PSA is at .5 vs. 1.0, vs. 2.0. The differences can be really significant.
Also, the factors that have previously been considered critical for RT success may in fact not be so. MSK has recently developed a nomogram that is supposed to accurately predict the success of salvage radiotherapy (in the med lit they call this “sRT”). (Journal of Clinical Oncology, 2006 ASCO Annual Mtg. “Predicting the outcome of sRT for recurrent PC after RP”, by Stephenson, Scardino et al.)
And maybe “prophylactic RT” (adjuvant), should be done as a matter of course on high- and even medium-risk men. Salvage RT is also thought to work, but the results are not that clear.
There is a consensus that if RT is going to be given, it should be started sooner than later. *So why is it standard medical advice after a positive PSA to advise the patient to wait 6 mos. before doing anything? It just doesn’t make sense.
When Ted’s PSA started to rise back in January, I was advised by some “elders” online to seek help immediately, i.e., to visit some oncologists. We did this, even though it was “AMA” (Against Medical Advice). I am glad for that insider info, but not everybody has access to it. And even though we started early, it took 5 mos. until T. actually got the RT. (Getting records, consultations, switching his insurance, etc.)
The first person we saw was Dr. Peter Schiff at Columbia Presb., a highly-rated radiation oncologist. I was surprised when he told Ted, who had a PSA of .14 at the time, that he should begin RT as soon as possible. Not this minute, necessarily, but within a couple of weeks. Well, I thought I was smarter than the doctor: it seemed that he was “rushing to judgment”. Turns out he was right.
I have a stack of papers on this subject in front of me, which I have reviewed carefully, but mostly I will quote from Endotext.org, a medical reference source, which I know to be reliable and current. Also, what they say is consistent with what I’ve read.
“Treatment of Post-Prostatectomy Recurrences”:
A number of retrospective comparative series have examined the potential benefit to adjuvant radiotherapy.
*Unselected series have suggested biochemical control rates in the combined surgery plus adjuvant radiotherapy cases of 52-93%, compared to surgery only rates of 25-74%. More concordant results were seen in two published matched pair analyses which showed surgery only freedom from biochemical failure (FFbF) of 55-59% which was increased to 88-89% with the addition of radiotherapy.”
Also noted: “Grade 3 toxicity” and urinary incontinence problems were not increased by the addition of RT.
This combination of randomised trial data (amounting to level 1 evidence) suggest that there is an unequivocal capacity for post-RRP adjuvant radiotherapy to approximately halve the chance of having a future PSA-detectable tumour recurrence in pT3 / margin positive patients, while maintaining a low level of toxicity. More maturity to the data is awaited to determine the overall impact this has on distant metastases or survival.
The role of salvage radiotherapy is far less clearly defined, with no prospective studies of efficacy or toxicity to guide decisions. Retrospective analyses suggest that the PSA level prior to initiating the salvage radiotherapy is strongly predictive of outcome, with some series suggesting that treatment at PSA levels below 1 ng/mL do substantially better than those above this level. This PSA effect has been shown to be independent of the PSA doubling time, potentially indicating that these patients benefit from early referral for treatment regardless of PSA dynamics.”
Indeed, one series demonstrated an independent benefit to the use of immediate adjuvant therapy rather than waiting until requiring salvage.
Larger series typically show a 5 year biochemical control rate in the order of 50% typically (501, 505), and over 70% for those with a pre-treatment PSA of less than 1 ng/mL and an operative Gleason score of 7 or lower (502).”
“Despite the apparent ability to provide a substantial chance for long-term control in relapsed men, there is concerning data that post-RRP radiotherapy may be under-utilised. Only 55% and the 38% of the biochemical failures in the observation arms of the EORTC and SWOG randomised trials respectively underwent potentially curative salvage radiotherapy . . .
Take care and bear with me while I learn to blog.