Blue Ribbon Year

My journey with prostate cancer. Caution: graphic descriptions of male anatomy

MY BLUE RIBBON YEAR began with a routine Medicare exam on Friday, September 13th, 2024. My blood pressure and cholesterol numbers were in the normal range for a 67-year-old male, but my A1C had risen just high enough to qualify for diabetes. That was disappointing, but not unexpected. My family has a history of type II diabetes and I’ve always had a sweet tooth. My doctor said I didn’t need meds just yet, so we agreed that I’d modify my diet, get more exercise, and recheck my A1C in six months.

A bigger concern was that my PSA had jumped from 4 to 18. I hadn’t experienced any physical symptoms, but an elevated PSA is usually an indication of prostate cancer. My GP told me not to be overly concerned, though. He said that there are other conditions that can cause a high PSA and he ordered another blood draw to confirm the result. The second test came back at 16. Diagnosis confirmed? Not quite. Doctor Chan wasn’t ready to use the C word just yet.

“There’s no reason to panic,” he told me. “I sometimes see patients with a PSA in the hundreds. But l do want you to see a urologist and get checked out more thoroughly. Next week.”

The urologist’s office responded to his referral the same day to make my appointment. Their quick response seemed a bit ominous. I’m used to waiting weeks to get a non-emergency appointment at our primary health clinic. But only four days later, I provided a urine sample to be tested while I was being poked and prodded in the exam room. I faced a battery of questions from the urologist about my personal habits. Questions that no one even wants to hear, let alone answer. But embarrassment became a recurring theme over the next weeks and months.

The prostate is both a gland and a muscle. It produces seminal fluid and also provides the ‘push’ required to power ejaculation. The prostate gland is centrally located in the male groin. It completely surrounds the urethra and sits next to the rectum. The prostate also provides physical support for a man’s bladder. So, it isn't surprising that prostate problems can affect urination, bowel function, and sexual performance. This guarantees that the health questions required for diagnosis and treatment will be intrusive and embarrassing. Having prostate cancer means endless discussions of your urination, bowel habits, and sex life.

My urine test at the urologist’s office didn’t reveal anything unusual, but they did find cause for concern during the ‘digital’ exam. There weren't any red-flag nodules or masses, but my prostate was noticeably enlarged.

“No reason to panic,” Doctor Dai told me. “It may be nothing serious. But l do want you to have an MRI. Next week.”

The MRI appointment was confirmed immediately. Again, the urgency seemed ominous, and again, the doctors all said it was premature to use the C word. Nevertheless, my anxiety level ratcheted up. A few days later, on September 24th, I was lying on my back in the claustrophobic tunnel of the MRI machine. I kept my eyes tightly closed, partly because I don’t like tight spaces and partly because I was dreading what they might find. I tried to think of my happy place and forget where I was for 15 minutes. But reality refused to go away and I needed to know if the outlook would be good or bad. And I got bad. The MRI images showed lesions on my prostate gland. The MRI also showed a prostate volume of 63 cc, a significant enlargement over normal.

“There’s no cause for panic,” Doctor Dai said. “It probably isn’t serious yet. But we’ll have to do a biopsy to see exactly what we’re dealing with. Let’s schedule it for next week.”

Despite all assurances, the trajectory of my diagnosis seemed to be headed downhill. I’d gone from not serious to not serious yet. And the sense of urgency remained. I tried to stay calm and keep a positive attitude for my wife, Debbie, but I had a bad feeling and I did a poor job of concealing my anxiety. The biopsy was performed by Dr. Dai on September 30th, less than three weeks after my GP first noted my elevated PSA level.

Prostate biopsy is a relatively minor outpatient procedure, similar to a colonoscopy, with the patient under a light general anesthesia. A hollow needle takes tissue samples from suspicious areas of the prostate as identified by the MRI scan. The doctor is guided by an ultrasound probe and also does a more thorough physical exam of the gland while they’re ‘in the neighborhood’. The side effects are mild, and recovery requires only a few days of restricted physical activity. The emotional impact was far more severe. I didn’t want to think about the consequences of a negative outcome, but simply having the biopsy forced it on me.

Debbie and I met with Dr. Dai the following week to discuss the results. This was the meeting where we finally used the dreaded C word. Ten of fourteen cores taken from my prostate were positive for cancerous cells. And my specific case wasn’t a slow-growing, compact tumor. For those cases, the treatment might consist of regular monitoring. There may not be a need for invasive treatment if the cancer grows slowly. But ‘wait and see’ wasn’t an option for me. The cancer cells were growing aggressively and had already spread throughout my prostate.

Dr. Dai explained that surgical treatment meant total removal of the prostate and the surrounding lymph nodes. She described the probable side effects of the surgery such as incontinence, impotence, and infertility. And my case would be complicated by the presence of a surgical mesh that had been implanted in 2021 to treat an inguinal hernia. The mesh might prevent the surgeon from being able to get clean margins when removing the cancer. There wasn’t any good news.

My initial reaction was a panicky impulse to get the cancer cut out immediately, today if possible. I wanted the damned thing gone. But there’s a mandatory six-week recovery period between biopsy and prostate surgery. That meant waiting until mid-November at the earliest. And Dr. Dai recommended that I get a second opinion from a radiation oncologist before making a final decision about treatment. She also scheduled a bone scan to determine whether the cancer had spread beyond my prostate. There weren’t any more comforting assurances, the cancer diagnosis was serious. The only question left was bad or really bad.

I spent the next two weeks in tense apprehension before getting back to the hospital for the bone scan on October 16th. The urgency felt very real now, and time dragged slowly as I waited for the next piece of bad news. In my mind, the bone scan would reveal whether my case was treatable or terminal. I could almost feel those insidious cancer cells spreading through my body. There was no way to know when they’d burst out.
What if today is that day? What if next week is too late?

A bone scan is done to look for cancer cells that have migrated to other parts of the body. A radioactive marker that binds to cancer cells is injected into the patient’s bloodstream and the scanner creates a full-body image of where the marker accumulates. For some odd reason, cancer cells show up in the bones first, so that’s where the doctors look. If there’s no cancer in the bones, then it hasn’t spread.

The marker injection is relatively painless but awkward. It’s done slowly, over the course of a minute or so, and the patient has to stay still. Then there’s a waiting period of two to four hours while the body absorbs the marker. I was told that the amount of radioactivity in the injection is less than what is received during a CT scan, and that no one ever has an allergic reaction to the marker chemical. The only recovery advice is to drink extra fluids to flush the marker from the body.

It’s important to look beyond the initial cancer site because metastatic cancer is much more serious. The treatment options are more invasive, the side effects of treatment are worse, and the long-term outcome is less likely to be positive. Thankfully, my bone scan was negative (although it did show significant wear in my arthritic knees).

I felt some relief at this bit of good news. Maybe there is light at the end of the tunnel. At least, I wouldn’t have to start out with chemotherapy. But I still needed to decide on surgery versus radiation. So, the next step was an appointment with Dr. Taylor at Evergreen hospital on November 12th.

It was at this point that I ‘came out’ to friends and family. I hadn’t wanted to frighten anyone until I had a firm diagnosis. Their outpouring of support was encouraging. My daughter, Megan, immediately brought me a T-shirt emblazoned with a defiant cat giving the double bird and a caption that reads simply Hey, Cancer. Debbie gave me a St. Peregrine medal. He’s a Catholic saint who lived in the Middle Ages and experienced a miraculous remission of his own cancer. Today, he’s known as the patron saint of cancer patients (as well as AIDS and autoimmune disease). I’m not sure if I believe in the intercession of the saints, but I haven’t taken it off either. When I’m feeling down, I can reach up and touch it. It’s comforting to know that Debbie is praying for me. And my daughter-in-law, Mary, gave me a ball cap with a row of colored ribbons that represent different types of cancer. It says Cancer Sucks in Every Color. I knew about the pink ribbon for breast cancer, but I had to search online to find out that there are actually many colors for many cancers. My ribbon, for prostate cancer, is light blue.

Sadly, cancer is a growth industry (so to speak) with a much too large customer base. Halvorson Cancer Center is just one part of the cancer complex in the west wing of Evergreen hospital. It’s a modern facility that opened in 2012, with wide corridors, pleasant décor, and the latest equipment for cancer diagnosis and treatment.

Virtual Tour: https://www.youtube.com/watch?v=sbYjQFEXYoI  
 

That’s where I went to meet with the radiation oncologist. Debbie went with me to offer her support. The self-described concierge who checked me in for my appointment with Dr. Taylor is a nice guy with a friendly smile. Alan welcomed me to the oncology ‘family’, and insisted on taking my picture.

“So everyone will recognize you and know your name.”

“Sure, thanks,” I replied with an automatic smile.

No, I don’t want this, I objected silently in my head. I don’t want to join your stupid family. I’m going to get this thing cut out and be done with it. I don’t belong here and I won’t be back!

I wasn’t in a receptive frame of mind, but I held my tongue and listened politely as Dr. Taylor shook hands and launched into a detailed explanation of my particular case. He covered a lot of the same ground as my urologist, Dr. Dai, but I’d been too shaken up at my meeting with her to take it all in. He also revealed that he was a cancer survivor himself, having undergone prostate removal twenty years earlier.

Dr. Taylor explained that the tissue samples from each cancerous area are evaluated and given what’s called a Gleason score. The numbers range from one to ten and higher numbers are worse. Mine were mostly sixes and sevens. That meant my case was, in fact, serious. Based on my Gleason score, physical exams, PSA level, and various scans, I was given an overall cancer stage of T2a. Or, in simpler terms, an unfavorable intermediate risk. My face must have shown dismay at the word unfavorable.

“Don’t panic,” Doctor Taylor told me. “It’s not as bad as it sounds. You don’t need to put your affairs in order just yet. Your cancer is still very treatable. Your outlook is a matter of years rather than months.”

Somehow, the word years wasn’t comforting. We all expect to have a long, vague number of years. Hearing the word months in the same sentence was disheartening. It made the end seem suddenly specific. But I still had a decision to make about how the cancer treatment would affect my ‘years rather than months’.

Dr. Taylor showed us projected outcomes based on thousands of case histories of similar patients. There’s a progression of cancer treatments, beginning with a surgical removal of the prostate. If that isn’t successful, the next option is radiation therapy. And the final option, for metastatic cancers, is chemotherapy.

The data from similar patients showed that even with immediate surgery, I would have a 76% chance of needing radiation therapy in the next ten years. And there was a 91% chance that cancerous cells were already beginning to invade the surrounding tissues. That wasn’t what I’d hoped to hear, so I had to pause and rethink my options.

Dr. Taylor explained IMRT (Intensity-Modulated Radiation Therapy). It combines an X-ray scanner and a radiation head that rotate around the patient. The beam is powerful enough to damage cancer cells, leaving them unable to reproduce. They can then be broken down by the body’s natural healing processes. The IMRT machine scans the patient in real time so that the beam can precisely target the prostate and adjust for movement of the patient. A computer program varies the intensity and focal point of the beam during treatment. Radiation is always focused on the prostate, but the angle of the beam varies as the machine rotates. This minimizes damage to surrounding tissue. Healthy cells can recover from radiation damage if it isn’t too severe. That can potentially preserve prostate function. Even so, side effects of radiation therapy include fatigue, urinary distress, abdominal pain, and diarrhea.

Dr. Taylor explained that IMRT therapy can treat cancerous cells in the tissue surrounding the prostate gland as well as those within. And the surgical mesh supporting my hernia wouldn’t be a factor. Another advantage of IMRT is that the side effects are usually less severe than surgery and certainly less immediate. With IMRT, I could spare myself the trauma of an invasive surgery, enjoy a more normal life in the short term, and possibly in the long term as well. Suddenly, being in the oncology family didn’t seem so bad. I felt like I should go back and apologize to our concierge.

Deb and I met a second time with Dr. Dai to give her a chance to offer a rebuttal. She looked at the projected outcomes and agreed that Dr. Taylor’s numbers were valid. She also agreed that surgery couldn’t guarantee removal of all the cancerous tissue, but it would guarantee a definitive end of my prostate function. A common reason to opt for surgery, relief of urinary problems caused by an enlarged prostate, wasn’t a factor. Many men find themselves unable to pee because of the pressure on the urethra, but that was one of the few things that hadn’t gone wrong for me. Dr. Dai did point out that surgery isn’t done following radiation therapy, so I couldn’t change my mind later. But when I asked directly for a recommendation, she demurred.

Dr. Taylor hadn’t given a recommendation either. My case resided in that anxious gray area of who knows? If my cancer was less aggressive or less advanced, then surgery would be the best choice for a cure. Get it out and get on with my life. That had worked out well for Dr. Taylor. If my cancer was more advanced, then radiation or chemotherapy would be the only choices. Managing the disease more so than curing it. But I was caught in between with my unfavorable risk. Surgery might be successful for me, but the odds weren’t great. In addition, the numbers showed that my fifteen-year survival outlook would be almost the same with either treatment option.

In the end, I chose to avoid surgery and go for a better quality of life in the short term. And I can still hope that my prostate function returns over time while the cancer doesn’t. So, I embraced my oncology family and asked Dr. Taylor to schedule me for radiation therapy. I was ready to get started right away, but it turned into another case of hurry up and wait. The first step was yet another scan on November 27th. This time it was a CT scan to get an accurate map of my prostate and my pelvic bones. The CT scan confirmed that the prostate was enlarged (53 cc). It also showed that my pubic arch is high enough to make me a good candidate for brachytherapy.

There are two methods for irradiating prostate cancer. IMRT is external and brachytherapy is internal. IMRT requires 15-minute sessions at the hospital five days a week for six to ten weeks, while brachytherapy is a one-time outpatient procedure. Brachytherapy involves implanting radioactive seeds within the prostate gland to deliver radiation directly to the cancer cells. A needle is used to place the seeds, and they're inserted upward through the pelvic opening. Women have a wide pelvis with a high pubic arch to accommodate childbirth. Men have a narrow pelvis and their pubic arch may be too low to allow access for brachytherapy. In that case, a full 10 weeks of IMRT is required to deliver the prescribed radiation dosage.

Dr. Taylor used all of my diagnostic data to prepare a customized treatment plan and presented it to the oncology review board the first week of December. I was approved for 6 weeks of IMRT followed by a brachytherapy boost. The IMRT sessions would treat the cancer from the outside in. Then the radioactive seeds would finish the treatment from the inside out. For me, the combination of the two therapies would be more effective than either alone.

But I still wasn’t quite ready for irradiation. I learned that there’s a less obvious fourth therapy for prostate cancer and I would actually be starting with that one first. It seems that prostate cancer cells feed on testosterone, and they also need it to reproduce and spread. Using an androgen blocker prevents a man’s body from producing that testosterone fuel. That starves the cancer and shrinks the prostate gland. And a smaller prostate enhances the effectiveness of the radiation treatment and also reduces the impact on surrounding tissue. So, on December 4th I got my first dose of hormone therapy.

There’s an endless stream of supplements advertised on TV for low-T. I got the opposite of that, testosterone depletion. My oncologist gave me an injection of the hormone blocker Eligard and in the new year I began operating on no-T. It's a time-release gel that lasts for three months, so there's no option to change your mind if you don't like it. The hormone therapy comes with its own set of side effects, similar to menopause, including fatigue, irritability, and hot flashes. It’s frustrating to deal with, but it might save my life. I struggled with my usual yard work and some days I napped all afternoon. And the hormone treatment also causes smug comments from the women in your life, "Now you know what we go through." You’d think they might be more sympathetic, but I guess I wasn’t all that sympathetic when the situation was reversed.

The no-T hormone blocker was effective, my prostate volume shrank by half, to 24 cc, over the next three months. I received a second Eligard injection in March of 2025. I was already showing real improvement by then, even though I hadn't yet received any radiation. Those months seemed like a lifetime as I waited to begin my radiation sessions. I continued to have anxious thoughts about stray cancer cells breaking loose and wreaking havoc in my body. The uncertainty threw a shadow over our Christmas celebration. We met with another oncologist, Dr. Hsi, on January 15th to discuss the details of my treatment plan. He would eventually take over from Dr. Taylor to perform the brachytherapy procedure. But still, I wasn’t quite ready for radiation. Dr. Hsi explained that I needed to have another procedure first, similar to the biopsy, to implant three tiny gold beads in my prostate gland. The beads would serve as targets for the IMRT machine so that it could precisely locate the prostate during each radiation session.

Dr. Hsi scheduled the target implantation for March 5th but there were (what else?) more scans to be performed first. I actually got two scans on Feb 26th. A CT scan to remap my now shrunken prostate gland, and another MRI to measure tissue density. The MRI would identify cancerous cells, and the CT would show exactly where those cells were located. The data from the two scans would be merged and the results would be used to create the treatment program for the IMRT machine.

This time, the scanning process started the night before with a laxative and a clear liquid diet. It’s important for the patient’s internal organs to be in the same state for each IMRT session. The preferred state is an empty rectum and a full bladder. So that’s what I needed to do for my preparatory scans. I felt empty as I left the house, but I sipped at a bottle of water on the way to the hospital to make sure I was 'fully' prepared.

The tech put me in the CT scanner first and told me to lay very still until the scan was verified as good. And then she surprised me by tattooing a small dot on each hip before allowing me to change position. I hadn't really noticed it before, but the CT machine has laser beams (similar to a laser level) that are used to line up the patient. There's a beam that runs lengthwise along the center of the body and another that runs across. The IMRT machine has a similar setup, and the patient’s position on the exam table is adjusted by lining up the dots with the laser beams. Yes, my tattoos are permanent, but you almost need a magnifying glass to find them.

Then it was on to the MRI scan. The two data sets are overlaid to map tissue density onto the 3-D prostate map, so I wasn't allowed to eat, drink, or pee in between the two scans. That was to ensure that my organs remained in the same position for each scan. Holding it in for another 40 minutes was the most difficult part of the process. The MRI was supposed to take ten minutes, but it seemed much longer. I asked and the tech confirmed that they'd run it twice to make sure the two data sets matched. If they hadn't lined up, I'd have had to start all over with another CT scan.

The oncologists used the scan data to fine-tune my treatment program over the next month. Both the angle and the intensity of the radiation beam are calculated to maximize energy delivery to the cancer cells and minimize damage to the surrounding tissue.

Target implantation was an outpatient procedure, much like the biopsy, under a light general anesthesia. This time, instead of taking tissue samples out, a hollow needle was used to insert three gold beads into my prostate. Again, the doctor was guided by an ultrasound probe, and again, recovery required only a few days of restricted physical activity. My orthopedist took X-rays of my arthritic knees and hips shortly afterward and the 3 target beads show up clearly in my pelvis.

Target implantation was accompanied by an injection of SpaceOAR hydrogel to create a temporary spacer pad between my prostate and rectum. Moving the two organs apart means less radiation damage to the rectum. And less damage means fewer side effects. A follow-up CT scan on March 10 verified the placement of the target beads and the post-gel position of the prostate. The results were satisfactory and I was finally scheduled to begin my radiation treatments on March 24.

I had a total of 28 IMRT sessions, 5 days a week for 5 ½ weeks. A session lasts about 15 minutes and the patient merely has to lie still while the machine does its thing. The IMRT techs said I did well. I seem to have a talent for staying inert and motionless. Deb says that's no surprise to her, because I've been honing those skills since retirement. But it actually wasn’t that easy to remain still because they want the patient to have a full bladder. So, I put on a mask of cheerful calm, but inside I was fleeing in panic to the restroom.

For me, managing my bowels and bladder was the most difficult part of the process. The treatment plan required a specific configuration of prostate and rectum. And the easiest state to achieve is rectum empty and bladder full. So, I ate a lot of fiber and used a stool softener to improve my regularity. And I sipped on a 16 oz. bottle of water on my way to the hospital every day. Then I had to hold it until the session was completed. It was a real struggle if my session was delayed even a few minutes. And it got more difficult over time as the cumulative radiation exposure added up and began to irritate my bladder.

The external radiation is delivered with a Varian Truebeam system. Each session includes patient alignment and a scan prior to the treatment. The scan must show the prostate and bladder in the proper configuration before the technician proceeds with the radiation. A couple of times, I had to get off the table, use the bathroom, and drink more water to get everything just right.

The technicians always left the room while the machine did its thing and I was curious enough to do some research about the intensity of the radiation. How dangerous is it? The beam is quite intense, enough so that it can damage or destroy cancerous cells deep inside the body. For comparison, IMRT provides a megavolt dose of radiation for three minutes per session, while brachytherapy provides a kilovolt dose for three months straight.

I also found out that the imaging on the IMRT machine is done with a real-time X-ray scanner. It's not too different from what my dentist uses these days. It can detect the outline of the organs, and the gold target beads stand out like the full moon (or an amalgam filling). The machine locks on to the targets to deliver radiation precisely where the doctor wants it. The beam is a long, narrow cone and the machine can change the focal point as well as the intensity as it rotates. This allows the ‘sharp end’ of the beam to move in and out as needed. And the beam is adjusted to follow small movements of the patient’s body on the fly. It can actually treat lung cancers that move with every breath! Here's a link to their brochure:

https://varian.widen.net/s/7kc2jwlv7p/truebeam_brochure_rad10452a_may2022

Each IMRT session begins by climbing onto the exam table and lowering your pants to reveal the alignment dots tattooed on each hip. The table elevates and then slides the patient backward into the IMRT machine. The tech uses the laser guide to do a rough alignment of the patient using their hip dots. Then the X-ray scanner swings out from the side and the machine rotates around the patient to check the configuration of bladder and rectum. If things look good, the real-time scanning begins and synchronizes the machine with the target beads in the prostate gland. I learned to recognize this sequence and I’d breathe a little sigh of relief when the machine made its final incremental shift. That meant I’d successfully managed my bowels. If the machine retracted the scanner head, then I knew we’d have to start over from scratch. A couple of times I did have to get off the table and visit the restroom to ‘clear the decks’, or guzzle some additional water.

 

Once everything is properly aligned, the radiation beam is activated and the machine rotates around the patient to zap the cancer cells. At the same time, the real-time scanner maintains a lock on the target beads in the prostate to follow any small movements of the patient.

I didn’t experience any pain during my radiation treatment, but side effects from the cumulative radiation damage began to show up in a couple of weeks. The IMRT sessions kill cancerous cells in the prostate, but they also damage tissue in the bladder. With my prostate and bladder irritated, I experienced a frequent and urgent need to pee, accompanied by a burning sensation in my penis. The burning is called referred pain, caused by damage to nerves that travel through the prostate.

So, I had to make a mad dash for the bathroom every couple of hours (even at night) and sometimes I didn’t make it in time. At other times, nothing at all happened when I got there. It was both frustrating and embarrassing. I soon learned the location of every public restroom between home and the hospital because I couldn’t hold it for the entire half hour drive.

The physical fatigue was even more frustrating. I’d gotten my first dose of hormone therapy in December and another in March, so I was already suffering symptoms of low-T. A month of radiation made the fatigue even worse. And my inability to sleep through the night didn’t help.

Fatigue is insidious. It sneaks up on you and gets a little bit worse every day. The world keeps getting farther away and even small efforts become tiring. Walking to the bedroom is a hike. Grocery store aisles seem to go on for miles. Going up and down stairs is like climbing a mountain. Mowing the lawn becomes a marathon slog. I found myself waiting until I had two or three reasons to get up from my recliner. It just wasn’t worth the effort to make two trips. In the comic books, gamma rays give you super powers or make you ‘hulk out’. The reality is exactly the opposite. I didn’t completely lose my ability to function as a man, but the hormone therapy effectively suppressed my desire and the fatigue made it seem like too much effort anyway.

The oddest side effect was the loss of my leg hair. I don’t know why it happened or why it was so specific. I didn’t lose any more hair on my head (I’m still balding, but not quite bald). And I still have the dark blonde hair on my chest and arms, but even a year after the radiation, my legs are still as smooth as a competitive swimmer’s.

The support of family and friends helped keep me going through April. Debbie made me a countdown chart and provided stickers so I could mark off each radiation session. And the IMRT techs presented me with hugs and a certificate of completion after my final treatment. All of the hospital staff were very caring. From the first day, they told me I was part of the oncology family and greeted me by name when I came in for treatment. I also got to ring the gong. It's a bit silly, but also kind of nice. The family of a cancer survivor donated a small brass gong that's mounted on the wall near the IMRT machines. There's also a plaque that reads:

Strike this gong,
For you have been strong,
It's tone to clearly say,
My treatment is done,
This course is run,
And I am on my way.

But even though I was finished with IMRT, I wasn’t done with radiation. I got the month of May to recuperate somewhat before moving on to brachytherapy. I had yet another CT scan on June 5th to remap my prostate. My other oncologist, Doctor Hsi, performed the brachytherapy procedure on June 11th. It was an outpatient procedure, similar to implanting the IMRT target beads, but I spent a lot more time on the table.
The experience was very different from my neck surgery in 2004 (a ruptured disc requiring spinal fusion). That operation put me under so deeply that it took weeks to feel normal again. This time the anesthesia was much lighter and I felt fine the same evening. I got an IV, of course, and then I was wheeled into the OR and transferred onto the operating table. Inflatable cuffs were wrapped around both legs. They pulsed slowly to prevent blood clots. Sensors were attached to my body in various places to monitor my pulse, oxygen level, blood pressure, and temperature. An oxygen tube was arranged around my ears and under my nose. I have sleep apnea, so I was also intubated after the anesthesiologist put me out. Waking up was relatively normal, except that I had peed the bed. Too much IV fluid combined with my bladder irritation. But it was just one more indignity in a long list of embarrassing moments.

The only amusing thing about all of my procedures was the way the hospital staff had to cover their bases. I got the same question, phrased in the exact same way, from a nurse, the anesthesiologist, and the surgeon before each procedure.

“In your own words, what are we going to do today?”

I’m glad that Dr. Hsi knew. He implanted 53 radioactive seeds in my prostate to deliver additional radiation directly to the cancer cells. Hollow needles penetrated the perineum from below in a circular pattern centered on the urethra. They made 12 tracks with multiple seeds placed in each as the needle was withdrawn. This created a cylindrical array within the prostate.

The radioactive seeds have a half-life of 17 days, so the radiation is therapeutically effective for about three months (the intensity drops to about 2% in 100 days). I had a follow-up CT scan on July 21st for a final QC check of the seed placement. My groin was considered ‘hot’ for the first month after the procedure. I was told to avoid sitting close to a pregnant woman and to not hold a baby in my lap. The residual radiation can trip an airport detector for up to a year, so I got a medical card (get out of jail free) to show TSA if I travel by air.

Dr. Hsi had prescribed Flomax (tamsulosin) even before the brachytherapy procedure to prevent issues with urination. I’m not sure how effective it was for me, but I continued to take it until November, when I developed unusual leg pain. That’s a less common side effect of Flomax, but the pain went away when I stopped taking it. And I didn’t notice any worsening of my urinary symptoms. I was also prescribed Phenazopyridine after the brachytherapy to relieve the urgency and burning sensation from nerve damage. It was somewhat effective, but it turned my urine a startling orange color. And we were warned that it could stain the toilet bowl, so I stopped taking it after a few weeks. I mostly depended on Ibuprofen and Tylenol for pain relief. Less inflammation allows a stronger stream and results in less pain. I’d always used aspirin in the past, but my GP advised against it due to the increased risk of internal bleeding. I actually did experience persistent rectal bleeding in the spring of 2026. I was worried that it might be serious, but a colonoscopy determined that it was merely hemorrhoids.

With luck, the cancer will be gone by the time all of the radioactive palladium-103 decays to inert rhodium (the rhodium will remain in my body as a permanent souvenir). The doctors tell me I have an 85% percent chance of being cancer-free in 10 years. That’s their definition of a cure. But I have to wait the whole 10 years to find out. They’ll continue to check my PSA every 3 to 6 months to watch for a recurrence.

The Brachytherapy radiation reinforced all the same side effects I experienced from IMRT and they persisted through the fall of 2025. The fatigue was both mental and physical. I found it almost impossible to focus on my writing, and it was an all-day struggle just to mow the lawn.

In the spirit of full disclosure, I ordered a shirt for myself that says: CAUTION RADIOACTIVE (I had to have a little fun with it). And I told my friend Gerry that I wasn’t allowed to put my hands in my pockets, to avoid getting fingernail cancer. That was silly enough to make him laugh out loud. I felt surprisingly good the day after the brachytherapy procedure (probably just relief), but that didn’t last long.

It was a relief to be finished with my treatment, but also a bit of an anti-climax. I was left with a feeling of ‘what do I do now?’ Cancer overshadowed my life for more than a year. And it will be months or even years before I know whether the cancer is really gone. Of course, nobody has a guarantee, I'm just more aware of my mortality now. The side effects of my treatment eased over the winter, but even a year later, I still experience urgency sometimes and the burning sensation is still there. The doctor says that may be permanent. At least the fatigue is mostly gone.

The early results were encouraging. My PSA was down to 0.145 on October 8th and stayed low through the spring of 2026. I’d hoped that this story would wrap up in 2025. But cancer is a gift that keeps on giving. On June 26, 2026 my PSA was 2.23. That’s not considered especially high, but it’s expected to remain below 1.0 after therapy. Once again, the doctors say not to panic. About thirty percent of prostate cancer patients experience a temporary post-treatment PSA ‘bounce’. I'll have another blood test in September to monitor the trend. If my PSA goes back down, great. If it continues to rise, then I'll need to consider further options. My urologist brought up the possibility of a PET scan or another biopsy, but I remain in limbo for now. And even if my number does go down again, I’ll still be in limbo. I’ll still be waiting to see if the cancer is gone or just lying in wait. That’s my life now. All I know for certain is that cancer sucks.