by Hugh Gilmore
If I seem childish in my efforts to avoid prostate gland radiation, let me remind you of where it is located in the human male body: deep down where the sun really doesn’t shine, unless you use a retractor. In a movie, if an angry Power Ranger shot me in the prostate, the special-effects animators would show deadly dotted lines blasting through my bladder into my prostate and out my rectum.
Ouch! You might think, but supposedly it doesn’t hurt. Not then, anyway. The external beam radiation passes through healthy tissue, then through the cancerous tumor, and then through more healthy tissue on it way to the egress. The healthy tissue dies, or is damaged, but is replaced. The capricious cancer cells, though, lose their ability to replicate because their DNA gets tangled and stupid. Ideally: no more cancer.
If that were one-and-done, as they say, I might drink a cup of whiskey, chomp on a bite stick, clutch my prayer beads and let them squeeze that blackhead. But it’s not. Treatment takes place five days a week, for seven and a half weeks. As treatment continues, the damage done to the healthy cells accumulates. In the specific case of the prostate, its proximity to the bowels and bladder may cause those organs to malfunction. Leakage can occur when and where it’s neither sought nor welcome. And may continue for a little while or a big while after everyone has signed off on the radiation bill.
“Don’t worry,” my friends and family and doctors say, “They are able to achieve remarkable precision in targeting tumors with radiation nowadays.” I believe that too. Except – and this is my hesitation point, my biggest reverse-epiphany – I don’t have a prostate gland anymore! It was surgically removed last year. There is no clearly defined target. My cancer is microscopic and will probably not show up on an MRI or CT scan for two years or more. What will they aim at when they radiate my abdomen?
To visualize: slice an avocado in half and remove the nut. Look at the hole or depression left. In my body this chamber (now rather collapsed) is called the prostate bed, or technically, the fossa.
That will be the target of their Buck Roger ray guns. Everyone is whistling in the dark and hoping the cancer cells that were in and around my former prostate have stayed there ever since the mother ship was scooped out a year ago. Since the radiologists have no specific tumor to aim at, they will carpet-bomb the whole prostate bed. This broader target will increase the amount of radiation that will burn my abdominal skin and pummel the healthy tissues that support my urinary and bowel habits.
Can you blame me for wanting more time to think it over? Maybe there’s a key to this dungeon hidden behind one of these moss-covered cobblestones. How’d I get in here anyway? So I asked the doctors, “What if I do nothing?”
“Well,” they said, “you’d probably have two to three symptom-free years and maybe in seven or eight years your cancer would be in your bones in a painful way. Unless it is an aggressive cancer.”
The two-to-three years option sounded good. Boy, what I’d have paid for a working crystal ball if I’d seen one on eBay. But I told my anxious wife that I’d try my best to reach a decision by the beginning of February. If all went well, I’d start treatment in early March and be done in time to make our yearly trip to Montreal for the summer solstice. That’s what I said, anyway. I was really waffling though.
Then I remembered that I had an order for a PSA blood test prescribed by my urologist. I was loosely supposed to use it around May, but I decided to use it two weeks ago. If my three-straight PSA score rises were followed by a drop, I’d delay some more while I waited for a risk-free cure to be invented.
No such luck. My PSA had doubled since early December. It has therefore quadrupled since this time last year. Even though my cancer is still too microscopic to see, it is obviously highly aggressive.
I put the report back in the envelope. I felt sad – frightened, actually – but relieved. Now all my indecision was gone. I knew what I had to do: talk to my wife and then call the radiologist. If you read this report on Wednesday, March 7, I’ll by then be on my third day of external beam radiation therapy. I’ll tell you next week what it’s been like for me.
Hugh Gilmore is a writer, antiquarian-book seller and fatalist who works in Chestnut Hill.