Prostate Snatchers: Third Dispatch from the Front--

Prostate Snatchers: Third Dispatch from the Front--IMRT: BY RALPH BLUM

BLOGGERS: MARK SCHOLZ, MD & RALPH H. BLUM

The co-authors of Invasion of the Prostate Snatchers, blog alternate posts weekly. We invite you to post your comments.

TUESDAY, MARCH 19, 2013

Third Dispatch from the Front--IMRT

BY RALPH BLUM

In my last blog, I said that after all this time living with prostate cancer the uncertainty was beginning to wear on my nerves.  At this point, and having thoroughly researched all my options, the idea of having my prostate fried by electrons doesn’t seem quite so alarming, and as four-letter words go, “cure” has a sweet ring to it.

I’m talking about IMRT, which is short for Intensity Modulated Radiation Therapy. IMRT is a precisely targeted procedure that allows the physician to control the intensity of the radiation beam within a given field. This means that a much higher dose may be given to a tumor within the prostate without an increase in radiation to the surrounding tissue or organs. And if the cancer has spread through the wall of the prostate gland into the seminal vesicles (as in my case) the target field and dosage can be adjusted as necessary.

The big advantage of IMRT over regular external beam radiation is that the beam can be shaped to the exact dimensions of the area to be radiated. And instead of a solid beam of uniform intensity, it utilizes a variety of small independent beams known as “multileaf collimators” that can be turned on or blocked during treatment, varying the radiation beam intensity across the targeted field.

Because of the complexity of the treatment plan, radiation oncologists employ special high-speed computers, treatment-planning software, diagnostic imaging, and positioning devices molded to fit the precise contours of the individual patient. Typically a patient will be required to have several scans, and a team consisting of a radiation oncologist, a medical physicist, a dosimetrist (who sets the radiation dosage), a technician (who does the set-up session), a therapist and a radiation oncology nurse will oversee the treatment.

As with conventional radiation therapy, multiple treatments are required, but with IMRT, the eight-to-nine weeks of treatments (lasting about twenty minutes each) significantly lower the risk of adverse side effects, and the chance of a cure is substantially higher. When I first saw the twelve-foot tall linear accelerator in the treatment room I have to admit I found the idea of having a mountain of energy shot at my pelvis from this giant ray gun--the muzzle of which would be situated barely two inches from my pecker--extremely daunting. And the matter of “rectal burn” cannot be ignored.  However I have been assured that with IMRT rectal irritation is generally temporary, and can be relieved with medication.

So it’s decision time again. I still wish I could safely stay on Active Surveillance, but with IMRT the odds are favorable for a cure, Dr. Bahn has advised me to go for it, as has Dr. Scholz. Even I, the ultimate “Refusenik,” suspect it is time to act.

I’ll keep you posted!

Are K-cups a bad idea?

I am a coffee lover. I love the taste and smell of coffee. I wasn’t a big coffee drinker until I retired in 2006. Before that time, when our department moved into a new building, I would have one, maybe 2 eight ounce cups a day. And that was only because I was the first one in the building and I made the coffee, and we had one of those large two pot coffee makers. Of course the coffee was fresh and always I got the first cup.

When I retired I found out about Gevalia coffee, so I subscribed and was delighted with the flavors they offered. On one hand, I really don’t care about the flavors, per se, because I really, really love the taste of black, dark roast coffee. On the other hand having different flavors spiced up my day. But, to be honest, I really craved the Breakfast blend, and the French roast.

At that time my only problem was, I didn’t know how to make a smaller pot of coffee. I would make one pot and I would finish it in an hour or so. This went on for quite a while and what made it worse, my son who was living with me, after work he would bring home those little donut balls. In the morning I would feast on coffee and donut balls.

The donut balls continued until my son joined the navy and my sugar level got high enough to cause alarm. The pot of coffee continued until 2012 when my coffee pot burnt out and was virtually useless. I then had to go out to the local coffee shop and get a large cup of their breakfast blend. My other son gave me a one cup coffee maker and I kind of liked the idea, one cup. But that device died within a couple of weeks, considering it had been sitting on the top of my kitchen shelf for quite a while.

In the meantime I couldn’t keep my thoughts off of the Keurig coffee maker. The one I wanted was expensive, to me, but I had to have it. For some reason, I don’t remember what, I got a check from my old company, so that day I went and purchased a Keurig Special Edition Brewing System, it was a decent price. Of course there were cheaper coffeemakers out there, but I just liked the way this machine looked.

All in all I thought this was a great coffeemaker and it came with a box of 12 of those K-cup packs. They were great for, 12 cups of coffee. And those pack piled up, in the trash, as luck would have it I believe in recycling. The one thing that troubled me was; those K-cups packs were expensive.

Expensive, yes, running anywhere from 60 cents apiece to, depending on the company that provided the K-cup pack, up $1.20 apiece. What made it so bad was the Keurig Brewing system I purchased only had three cup settings with the largest being only an 8oz cup. All my cups are 16 ounces. Adding an additional insult to me, those K-cup packs can only be used once! So, I would have to use two packs for one cup of coffee.

To me, this was expensive, wasteful and a stupid idea. I did find out, a couple of months later that there was a device, Keurig My K-Cup Reusable Coffee Filter that would fit into the coffeemaker and you could use your own coffee. And, even if coffee was, the cheapest being around $7.00 for one of those large one pound cans of coffee, to which you can get up to 90 cups of coffee per container.

I purchased the device from Amazon.com for only $5! The shipping and handling was $6, though. I later figured out that I could have a great cup of coffee even if I used the same coffee twice, in the filter, to fill my 16 ounce coffee cup. I felt that was much better. I was really on the verge of getting rid of my Keurig coffeemaker and getting a good old fashioned coffee maker that makes one whole pot at a time.

Now that I think about it, though, I am still drinking about a pot a day anyway. But, I love coffee, I love the taste of coffee, and I love waking up in the morning to the smell of coffee brewing. I also love my Keurig coffeemaker. In the past nine months I have had no problems with it, well except the coffee cup selection, but I have gotten over that, now. Coffee, coffee, coffee, you gotta love it! I do!