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!