The End of the Beginning

Ursula and I were in Jacksonville this week for the last part of the preparation for my proton beam treatment.

Monday, we got to Jacksonville in time for a tour of the proton beam facility. After a brief lecture about how it works, we visited one of the treatment areas. This area is also known as a gantry, because of the large superstructure that rotates around the patient. The proton beam comes from a cyclotron, is reduced in energy as needed for each patient, and is directed to the beam-delivery "snout" in one of the three gantries. There the beam goes through a collimator, a large and heavy brass disk into which is carved the exact shape of the patient’s prostate (or whatever location is being treated). The brass collimator is set into a carved Plexiglas disk to further modulate the shape of the proton beam to match the desired 3-dimensional treatment area.

Tuesday at 8 am, I cleared out my lower intestine with the help of the Fleet company. A couple of hours later, the SpaceOAR nurse specialist reviewed my records and forms. She gave me an antibiotic injection, Valium, and hydrocodone, and took me to the treatment room. There my doctor cleaned and numbed the anal / perineal area. With the aid of a rectal ultrasound system he went through the perineum to place three gold markers (fiducials) on my prostate. Then, again with the aid of the ultrasound, he determined the exact place between the prostate and the lower intestine to inject the twin components of the SpaceOAR. The two components reacted with each other (much like epoxy components combine, but with different results!) to form a foam that then expanded and turned into the semi-solid SpaceOAR. The SpaceOAR will remain in place for several months, and then be absorbed into the body. While in place it will provide Space between the prostate and other Organs At Risk, primarily the lower intestine. I spent the rest of the day back at our apartment at Third and Main, where I avoided sitting down–especially on hard surfaces. I had additional Valium and hydrocodone available if I needed it, but I didn’t. I had some soreness, but the main symptom was a feeling of fullness in the area because of additional pressure exerted by the SpaceOAR on my bladder and lower intestine. My mind interpreted the pressure as a need to both urinate and defecate, whether there was really a need or not. I slept poorly that night, as my mind and body continually disagreed about what I should do. My body is supposed to adapt to this situation within a few days, at most.

Wednesday, I reported to PTI at 7:30 am, and started the process to bring my bladder to a large and reproducible size. First, I emptied my bladder and drank two Styrofoam cups of water. While waiting for the water to percolate to my bladder, I went to a treatment room where I was positioned onto a firm bed where a bean-bag-like thing was pushed into the nooks and crannies around the lower half of my horizontal body. By pumping out the air, the tech converted the bag into a form-fitting pod. I’ll use the same pod throughout my proton treatment to start me off in the same position each time. I also got an X in permanent marker on each hip. The pod, hip marks, and already inserted fiducials together help make sure my prostate is in exactly the same place for each treatment.

A CT scan then determined that my bladder wasn’t as large as they wanted it, so I drank a third cup of water and waited another 15 minutes…while holding my position in the body pod. Another CT scan showed that my bladder still wasn’t large enough, so I drank a 4^th cup of water and waited another 15 minutes…still holding the same position.

Finally, everything was the way they wanted it, and they did an MRI of the area to record the exact position of the prostate, the bladder, the SpaceOAR, and everything else in the vicinity. That was it for the day, other than a visit to the Pavilion next door to update some routine blood tests.

My reward for the two-day process was an appointment card showing the date of my first treatment: Tuesday, May 16. The card didn’t say how long the treatments would last, 5 ½ or 8 weeks, but my nurse promised she would check; later that day I got a call from the doctor to tell me it would be 8 weeks. Allowing for some non-proton treatment days for holidays and system maintenance, it appears my last treatment will be about July 12.