Hi all,
I posted here about three weeks ago that I'd decided on LDR brachy -- radioactive seed implants -- as monotherapy, having decided between that and HDR brachy and SBRT. They were the three options that my RO at Memorial Sloan Kettering (MSK) had said had very good and equal outcomes as monotherapy in a case like mine, and that it was just a matter of preference. You can read about how I came to the decision here.
healthunlocked.com/prostate...
Well, yesterday was the big day, and I'm happy to report everything went very smoothly. I honestly feel like nothing happened at all. In fact, when I woke up in the OR, looking up at the same nurse who was looking down at me when I went out, I was quite confused. She said, "Hi, you're all done." And I said, "Wait, I just got here!" Ha.
Brief details before I go further: PSA had gone to 5.74, steadily rising in 2021. Biopsy in 9/21 confirmed PCa: Four cores out of 12. Two of them 6 and 2 of them 3+4=7. Bone and CT scans all clear. MRI was PIRADS 4, with 1 lesion of 1 cm on left side of peripheral zone. No ECE, no lymph node or seminal vesicle invasion. Smallish prostate (better suited for LDR). So, Gleason 7, favorable intermediate risk.
My RO is pleased with how the procedure went. He inserted 66 radioactive seeds via needles. I had no pain, and still have no pain, just slight soreness if I sneeze or sit on a chair that's too hard. But really, it's nothing. No bandage, no blood. Back to work tomorrow.
Had to do a mini-bowl prep the day before -- a half of a colonoscopy prep; no solid food from noon on.
The next day began with my arrival at 10:40 after which I was laying on a bed, speaking with various nurses and answering a lot of questions -- the MSK staff is amazing, knowledgeable and makes the whole thing much easier.
After the anesthesiologist visited, my RO came by and explained much of what was going to happen, and he answered all of my questions. He then walked me to the OR, and we talked as we made our way through halls and elevators. In the OR I met the whole team, all friendly and professional, some explaining a bit more. There's a portable CT scan machine which takes images throughout the procedure, merging them with the ultrasound images, feeding all into a computer program that helps the RO and team map out exactly where seeds should be placed.
When they're done, but before you're up and while you're still prepped, you get a last full CT scan, which allows them to make any adjustments or add a seed or two while you're still under and in place.
So there's a lot going on even after they're done, and I guess that's why you wake up in the OR. After the nurse said hi, they put me on a gurney. Then my RO wheeled me out, pulling the gurney at the front while others assisted. He explained how everything went as we rolled down corridors, onto an elevator and down more hallways.
In recovery I had to pee and fill to a line in a container before they would discharge me, as others have described. Actually, my RO ordered that I had to have two adequate urinations. I peed fairly quickly into the container, and the nurse was very impressed with the amount! She then suggested I drink some water and then go to the bathroom -- with the container -- so I get the experience of doing it standing up. That I did, and filled my container as ordered.
The nurse then did a sonogram of my bladder, explaining that even if you pee a lot it's still not good if you're not emptying the bladder enough in one urination. After that my RO came by, she showed him everything, and his eyes lit up upon seeing the pee-filled container! He gave me a high five.
I then got dressed and my husband came into recovery, and the nurse went over everything with us re: what to expect, what would be an emergency (i.e. retention of urine) and what to do. This was after a radiation officer came by and used a geiger counter to proclaim that I really wasn't emitting that much radiation and would not trip any alarms. But she gave me a card just in case I get stopped in an airport or whatever. All radiation, by the way, will wear off in a matter of months. And it is no danger to anyone, though they told me just to be safe not to have small children or puppies/kittens (an animal that is still growing) on my lap for more than 3 hours for a period of one month after. That won't be a problem for me. (I have a grown dog, and that's it).
A nurse had called my husband to let him know the details and where to come, and then my RO called him too. My RO went through everything with my husband and discussed in particular the issues that PCa and radiation therapy raise for gay men. He talked about what to expect, what the myths and exaggerations are, and explicitly discussed sexual issues -- what not to do temporarily and how positive the long-term looked comparatively. This is key and gets to what the indispensable Tall_Allen has been writing here.
I then went to another wing of the hospital for a 15-minute MRI. While I was doing that my husband ran into my RO in the waiting room and my RO told my husband he should take me out to dinner, that I was that good to go. Then they both rethought that considering the Omicron blizzard (even though we have vaccine mandates for restaurants in New York City.)
We went home and ordered in, having left MSK at about 4:30. So it was 10:40 am to 4: 30 pm -- and done. (I'll go back for a scan in four weeks, and meet with my RO in a few months). And I've felt good. Had no problem peeing, though the first few times burned a bit, as expected, and there was a little bit of blood, also expected. I also had no difference in frequency. Could have slept through the entire night, but got up purposely just to keep things flowing, drinking fluids.
But with LDR the more acute urinary frequency is two weeks out from the procedure. And some people have talked about getting up four times or more a night. So I'm bracing for that. I'll be working at home for a while longer, thanks to Omicron. So a bathroom will always be nearby.
Haven't ejaculated yet, but believe it or not I lost a lot of volume to my ejaculate last week, before the treatment, a side effect of the drugs for some. Same great, intense orgasms, just a lot less semen. In addition to low-dose Cialis, for the past week my RO has had me on flomax and finasteride (the latter just for 90 days), and both can cause abnormal ejaculation -- it returns once you're off the drug.
My RO thinks it's the flomax, so hopefully I can get off it sooner rather than later. But of course I expect the gradual decrease in ejaculate from the radiation, and my peeing intensity may require the flomax for a while. So who knows where I'll be?!
I'll keep you all posted as I go. And thanks again for this forum and the help and support of so many of you.
Deciding between HIFU and LDR BT
Surgery tomorrow at MSK
Brachytherapy and blocked urethra
