Dave and I met with Dr. Eulau, a radio oncologist at Swedish, and his PA, Lisa on 12/1/20. During check in, Dave noted that he’s been walking 3 to 4.5 miles/day, 75 minutes of which is uphill. His blood pressure was 94/61; heart rate 88bpm. Still on 20mg of lisinopril daily. No longer on hydrochlorothiazide. No urinary symptoms or urgency. Weight loss continues as expected.
Dr. Eulau agreed that any theoretical effect that RCHOP might have had on Dave’s prostate carcinoma is functionally irrelevant from the perspective of choosing his treatment going forward, and suggested that we treat aggressively without delay, however the way he described the options made radiation sound a lot easier to deal with over staying on Lupron long term. When Dave said that his urinary issues went away after beginning RCHOP, but before starting on Lupron, Dr. Eulau suggested that there are many reasons this could be, including resolution of a transient infection related to the kidney stone Dave had.
Dr. Eulau said that the typical approach is “seeds, beam, and ADT.” The seeds are the size of a grain of rice and made of a radioactive isotope of paladium, paladium 103. These are implanted transrectally, after which they proceed to shrink the tumors over the course of several months until they seeds become inert. (The seeds are never removed.) After about seven weeks of this, we augment with beam therapy, which starts by mapping the prostate with ultrasound, and making some freckle-sized tattoos for targeting. After this mapping is complete, Dave will report for 10 minutes of radiation per day over the course of several weeks. This process “dries out” the tissue in the gland. There will be no need to follow beam radiation with ADT in Dave’s case since he has already been on that for several months. This approach has an 80% cure rate. Overall, I feel really good about this approach, and my read of Dave is that he does too.
Dave is getting initial mapping done on 12/8 so we can figure out where to implant the seeds.