Lets start at the top of the list of ingredients: Vitamin A (as 50% Beta Carotene, 50% Palmitate)- 5,000IU. An apparently authoritative study: Serum Vitamin A and Subsequent Development of Prostate Cancer in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study tells me that taking Vitamin A is good for Prostate Cancer prevention – ‘a statistically significant trend was observed for increased risk of prostate cancer with decreasing levels of serum vitamin A.’ On the other hand, Vitamin A and prostate cancer in elderly men: enhancement of risk another apparently authoritative study tells me: ‘In the men greater than or equal to 70 years, risk increased directly with the amount of vitamin A consumed’. Admittedly this study reported no increased risk for men under 70.

So does this mean that I take Vitamin A until I’m 70 and then stop??

Lets look at the next ingredient on my list: Vitamin C (as Ascorbic Acid)- 120mg. First up, the Louis Warschaw Prostate Cancer Center at Cedars-Sinai informs me that ‘There is much controversy regarding the relationship between vitamin C intake and prostate cancer risk. Some studies show that increased levels of vitamin C reduce one’s risk for prostate cancer. Other studies show that vitamin C has no effect on this risk.’ But in the very next paragraph we learn that prostate cancer tumors consume large amounts of Vitamin C. Hmmmm!!! Let’s investigate further.

A study entitled ‘Effect of vitamin C on prostate cancer cells in vitro: Effect on cell number, viability, and DNA synthesis‘ concludes: ‘results also suggest that ascorbic acid is a potent anticancer agent for prostate cancer cells.’ (Prostate 32:188-195, 1997. © 1997 Wiley-Liss, Inc.) Sounds promising – but wait: on November 16th Healthday reported on a ten year study of 15,000 men over 50 that determined there was no anti cancer effect from taking Vitamin C.

So where does this lead? It certainly discourages me from researching further down the list of ingredients on the back of my multivitamin pack. I suspect that I will find similar conflicting studies about Vitamins D, E, K, B6 etc, not to mention Calcium, Magnesium and Zinc. It is clear that no one has the final best answer regarding supplements and prostate cancer prevention/treatment.

Twenty-five hundred years ago Gautama Buddha advocated ‘the middle way’. I think I’ll take that advice and apply it here. I’ll continue taking my multivitamin to support general health while making sure that I get good nutrition from a healthy diet. I’ll exercise – in moderation- and get plenty of fresh air and sunlight. I’m still taking donations for the holiday in Hawaii:-)

Longer term scientific follow up studies comparing success rates of the various forms of treatment seem to be rare. Where they do exist (eg Short- and Long-term Mortality With Localized Prostate Cancer) the comparisons are between treatments as administered at least ten years ago. There have been many developments in all the treatment options in the last ten years.

So the truth is that I just don’t know for certain whether my prostate will be a problem again at some point in the next 20 years. I am confident and upbeat. Statistics tell me that the early detection and treatment of my cancer point to at least a 91% chance of making it to age 75 and a 75% chance of making it to age 80.

So what can I do to maximise my chances?

First thing is to lose some of the weight I’ve put on in the last six months. Its very clear from all the studies I read that carrying extra weight is not the best way to reduce the risk of any type of cancer. In placing so much focus on my ‘dance’  with pc I failed to  maintain my optimal weight and gained 15lb. Its time to put that right. I’m working on developing a healthy living plan for myself that will include pointers on diet, physical exercise and emotional/spiritual wellness. I will be chronicling my plan, the challenges and successes in future posts.

I have to say that the treatment visits rapidly became routine. Park the car, grab an orange juice, take the elevator, greet fellow patients, get changed into the ubiquitous hospital gown and wait to be called in. The Gantry 2 Technicians (Allisha, Chris, Georgene, John and Phil) at the Francis H Burr Proton Treatment Center were outstanding in their professionalism, warmth and humor. It was truly a pleasure to be greeted each morning with such positivity and care. The experience of getting ‘zapped’ was easy, quick and completely painless.  I have to admit that I frequently felt as if I was in the medical bay on Starship Enterprise being instantly healed by people pointing ‘remotes’.

As I neared the end of treatment I did notice a slightly elevated discomfort with urination, but not anything that could be in any way described as painful. In the month since I finished treatment this discomfort has almost completely disappeared. I am still somewhat fatigued – but a lot of this probably due to maintaining a very active work schedule throughout and post treatment. Nothing that a good vacation wouldn’t cure. Anyone want to fund a month in Hawaii???

Today comes another ‘tap on the shoulder’.

The September 1st issue of the International Journal of Cancer contains an article reporting on a study showing that prostate irradiation raises the risk of subsequent colon cancer.

Once again it took me a while to realize that the article referred to ‘external beam radiation therapy’ and did not make mention of proton beam therapy. Nevertheless my tricky mind wanted to posit worst case interpretations.

The Information Age gives our brains so much information to ponder that it is easy to slip into these mind games.

I find the most effective antidote to be the regular practice of mindfulness meditation. (A superb guide to this practice can be found at the Introduction to Meditation page of the AudioDharma website). Catching myself before (or soon after) I spin off into a session of doubt and second guessing is only one of the many benefits of regular practice of this meditation technique. And you don’t need to be a Buddhist to practice! No doubt I’ll write more on this in another post

I am still at the beginning of my treatment regimen, having completed 4 of 40 cycles ‘under the beam’, so I recognize that it is very early for me to judge the results of PBT on my own cancer. Nevertheless I can report that I continue to be extremely positive about the effectiveness of this treatment. It is known that one’s attitude towards treatment is an important determinant of a successful outcome so I am currently feeling very confident

A government agency – The Centers for Medicare and Medicaid Services – is about to consider denying insurance coverage for Proton Beam Therapy! You can read about it at:

http://www.pnhp.org/blog/2008/08/01/medicare-national-coverage-determinations/

and at:

http://www.cms.hhs.gov/mcd/ncpc_view_document.asp?id=19

CMS claims that proton therapy is more costly, not widely available, and that no current, comparative studies have been conducted to prove proton is better than conventional cancer treatment therapies.

There is a short window (until September 30th) for public comment at:

http://www.cms.hhs.gov/mcd/ncpc_viewpubliccomments.asp?id=19&expand=Y

It is interesting to note that many of the comments from medical professionals are  critical  of PBT. Some commentators attribute ‘a great sales job’ by NAPT (The National Association for Proton Therapy) as the reason for increasing numbers of men choosing PBT. I completely disagree! The increasing number of men choosing Proton Beam Therapy are doing so because of the positive testimony from thousands of PBT veterans regarding its effectiveness and the enormously reduced incidence of harmful side effects. It is noteworthy that the commentators advocating discontinuing Medicare coverage for Proton Beam Therapy are almost all  health care specialists from competing treatment modalities. Could it be that they fear mass patient desertions as more Proton Beam Therapy Centers are created and more success stories are disseminated? After all, health care is very much a business, and in business loss of market share is a threat.

If you have experience of Proton Beam Therapy please join me in adding your comment at:

http://www.cms.hhs.gov/mcd/ncpc_viewpubliccomments.asp?id=19&expand=Y

(press the orange button at the top of their page)

What I know about proton physics would ‘fit on the head of a pin’ (to quote an olde English expression) but the definition above leads me to surmise that many billion protons would fit there.

I began my Proton Therapy treatments last Thursday at the Francis H. Burr Proton Therapy Center at Mass General Hospital. After entering the building at ground level I took the elevator down to treatment level. ( I hear that most if not all proton treatment facilities are ‘buried’ partly to shield radiation and partly because of the tremendous weight of the equipment.) A short wait ended in an invitation to visit the changing room, remove clothing below the waist and put on a hospital gown. I was then guided through a secure door and into what at first appeared to be a labyrinth of corridors with thick, shielding walls. After several turns I entered the treatment room and was greeted by a very relaxed and friendly  group of technicians. The treatment room reminded me of a cluttered version of the sick bay on StarTrek’s (The Next Generation) Enterprise. Sci Fi had become reality. Lying down on the narrow treatment ‘table’ I was assisted to the correct position by the technicians who used lasers and the small tatoos on my sides and lower belly to line me up correctly. An X-ray and UltraSound were used to confirm my position. The technicians then took shelter in a shielded control room.

I kept very still, listened to various buzzes and whirrs from the gantry, and tried to sense whether I could feel a stream of particles (about 1836 times the mass of an electron) bombarding my prostate. In spite of the fact that I credit myself with being a relatively sensitive guy I could feel nothing!

After about two minutes the friendly technicians returned, helped me off the table and wished me “have a nice day”. Quite surreal! I returned to the changing room, got dressed and left the building.

Since then I have had two more treatments – all mirroring the first except that the proton beam is directed from alternating sides of my torso. So far I have experienced no worrying side effects.

Even if Proton Beam Therapy is just one of the options you are considering I urge you to read Bob Marckini’s “You Can Beat Prostate Cancer”

Reading about the rapidly increasing popularity of Proton Beam Therapy in recent Brotherhood of the Balloon newsletters reinforces just how lucky I have been in a) living so close to Mass General Hospital where one of the five US Proton Beam Centers is located, b) having to spend less than 2 months on the waiting list, and c) having doctors who discovered my cancer early enough to create a high probability of successful treatment.

So here’s an interesting question. My treatment is due to start on September 4th. At my treatment planning session I asked my radiation oncologist Dr Shipley about ‘the balloon’ – and, to my surprise he said, “We’re not using it anymore at MGH.” (Just as I was getting myself used to the idea:-) Does anyone else have information about this?? And how can I qualify for full membership in BOB if there’s no balloon?

Answers to the above gratefully accepted in ‘Comments’.

(Thank you Bob for your kind words about this blog)

An interesting event took place towards the end of today. A woman visitor to Omega asked to have the opportunity of speaking with me. When we talked she revealed that she had two or three times experienced a strong image of me “carrying something dark and heavy in my abdominal area”. She also felt that I had 95% accepted its presence there and was “in a dance” with it. Of course I suspected that she must have read this blog, but she assured me she had not. Her psychic abilities seem to be acute. I was interested to hear her say that she did not think that I would die of prostate cancer.

I breezed in expecting some questions, some restatement of the potential side effects of proton beam therapy, and a quick whiz through the CAT scan machine. I was not disappointed. I did indeed receive these – and much much more!

It turns out that the preparation for the CAT Scan involves a couple of “procedures”. One being the insertion of a gold seed at the base of the prostate. This is achieved by the injection of a) novocaine and b) the seed itself with a three inch long probe through the perineum. (If you don’t know what the perineum is – look it up!.) The second “proceedure” was the insertion of a dye into the bladder by way of a catheter. All I can say is that males are not really built for these kind of insertions! After that, the tattoo needle marking my lower belly in a couple of places after the CAT scan was a walk in the park.

Walking to the park-ing lot afterwards I felt proud of myself – even if a little invaded. I am assured that the hardest part of my treatment is now behind me. Could that be a pun?

Below the Surface

The image spoke to me of how little I know about the mysterious processes unfolding in my body. All those cells – what’s happening in them? are new ones still being created? And what meaning do I ascribe to the black lines graffittied over and distanced from what is underneath? – emptiness? – threat? If they’re lenses they fail to reveal or clarify._________ So then, a mystery. But somehow I relate to the tension between the black and the blue and recognize in it something of the tension between what I’ve always sensed as “me” and the “cancer”. We’re dancing together on the same floor, but not yet quite in step.

Thank you Lauren!