Facing A Biochemical Recurrence
Last updated: April 2021
Following the removal of my prostate in April of 2013 for cancer it appeared that everything was under control. Unfortunately, 2 years later my PSA numbers began to rise. It soon became apparent that I was facing a biochemical recurrence. Put another way ... my cancer was coming back for a second run at me. In 2017 my surgeon suggested it was time to have a serious meeting with a radiation oncologist.
Deciding on hormone deprivation therapy
At that meeting, I learned that the slow rise in PSA suggested the recurrence might be confined to the prostate bed. While no guarantees were offered, it was possible that radiation could possibly stop the disease or at least slow it down. At the same time, we discussed the use of Lupron prior to my undergoing treatment. He explained that the use of hormone deprivation therapy could render the cancer cells more responsive to radiation treatment.
Bring on the night sweats and sleep issues
After looking over the statistics of other men in situations like my own, the hormone shot was administered in January of 2018. Initially, the only result was a very sore butt cheek. By week 3 many changes were occurring. While I am typically comfortable with New England winters I suddenly found the cold was impacting me as never before. Within minutes sweaters became uncomfortably hot. As the days passed night sweats and sleep issues became commonplace. No number of blankets or wool sweaters would keep me warm. The cold felt like it was coming from inside of me. At this point, my radiation treatments had not started.
And then my radiation begins
On my first visit, the radiation technicians put me in a body mold and positioned me on the table for a scan which would then help the radiation oncologist determine the exact location of my prostate bed. Once located 3 individual tattoo dots were placed on my hips and pelvic areas to serve as target markers to line up the equipment for future treatments. Within 2 weeks the oncologist announced he had mapped out his treatment grid and plan.
Intensity Modulated Radiation Therapy
I was to be treated using Intensity Modulated Radiation Therapy (IMRT), an advanced form of external beam radiation therapy used for prostate cancer. IMRT is a computer-driven machine that moves around you -- delivering radiation to the targeted area. The oncologist explained that the equipment allowed him to shape the beams and direct them at specific areas. He noted that earlier forms of radiation could not target as precisely and tended to cause harm to normal tissue. The new approach treated the area from several angles, while the machine automatically adjusted the strength of the beams -- helping to spare healthy tissue. He went on to explain that because the radiation was selective, IMRT allowed for more aggressive and effective radiation treatment and potentially better outcomes.
Much to my surprise, the radiation treatments were quick and simple. I did not encounter any real medical issues over the 8-week period. My main issue was dealing with the unpredictable body temperature swings of taking Lupron. I will go into the many emotional and mental impacts Lupron had on me at another time, in another article.
Combating hot flashes
Several things eventually helped me to deal with the regulation of body temperature. Dressing in layers was key, as it allowed me to bulk up when cold and easily remove clothing as needed. While not really wanting to do so, physical exercise helped me control the hot flashes and night sweats. The more consistent the exercise, the fewer experienced symptoms.
Next was the purchase of a personal battery-powered electric fan. Laugh all you want but the fan was a lifesaver. As the weather got warmer, the acquisition of a second personal fan that offered a water spray option was ideal. Blowing hot air in your face in July and August does not cool you off. Add a water spray and the resulting evaporation was great.
What lessons came from all of this?
My PSA is undetectable as of this writing. The 6-month Lupron shot eventually wore off some 12 months later. Hopefully, it will be the last time for it. More importantly, prostate cancer and its return taught me to accept my fears about my cancer recurring. I learned that telling myself not to worry or being afraid did not make my feelings go away. Today my focus is on finding ways to manage anxiety as I go forward making my routine check-up appointments or scheduling follow-up PSA blood tests.
More personal solutions
In the education and support groups I host or attend, we encourage men to talk about their fears and to write down both their positive and negative thoughts in a journal as an effective way to help reduce anxiety. Throughout this journey, I have also decided to embrace a healthy lifestyle which includes eating a well-balanced diet, exercising regularly, and getting enough sleep.
While I may not be able to control my cancer, I can control how I react to it and I can control what I put in my body ... and in the end, that’s a great feeling.
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