08 May 2023
Five weeks ago, 72-year-old Peter Aubourg of Thirroul NSW finished up radiation treatment for prostate cancer.
Today he shares a glimpse into his journey in the hopes it will support other men about to embark on radiation treatment: a story that’s honest, tongue-in-cheek and sprinkled with a few Dad-jokes for good measure!
“I was diagnosed with prostate cancer and part of my treatment was radiation therapy with the LINAC.
LINAC is short for Linear Accelerator. A cunning device that accelerates electrons up to near the speed of light, then fires them into a piece of tungsten. The tungsten then gives off photons that hurtle through a heavy duty lens, towards your body.
The lens is rotated around your body, changing the shape and size of the photon beam as it goes. This way it targets the cancer and tries to avoid the other bits of your body you would rather not have damaged.
The photon beam does serious damage to cancer cells, and fortunately, less serious damage to healthy cells that you would like to remain healthy. All in all, it is like a big 3D computer game with you providing the landscape, the good guys and the bad guys, and the hospital providing the machine gun and pulling the trigger. Fortunately for us (who provide the landscape and the cannon fodder), the doctors, and radiation therapists at the hospital are really, really good at this computer game!
My start to the radiation program was the “Simulation” which all seemed low key and non-threatening. I’ll go with that.
There was a chat about the program for the afternoon and then I was given a 600ml plastic bottle of water to drink. AND, I had to finish drinking it in 5 minutes.
Apparently, the reason for drinking it quickly is that it then goes straight to filling the bladder and does not have time to be absorbed by the body and do useful things on the way through.
Having the bladder full is the aim of the game. Turns out that the prostate, bladder, bowel, intestines and other bits and pieces below your diaphragm are not held in position very firmly. This confused heap of plumbing is sloshing about in your belly and pelvis in a very lackadaisical carefree manner. Not concerned where they happen to end up at any moment in time.
This is ok in normal life, but for the radiation treatment, we need the landscape all set up with military precision so that when the photons start flying, there isn’t any ricochet shots and collateral damage.
Enter the bladder. If the bladder is full, it pushes the intestines and bowel into a relatively consistent landscape which is what we need. After an hour, I am put into a CAT scan machine and my body aligned carefully. I really wouldn’t mind having a pee at this stage, but I am encouraged to hang on.
I then have some tattoos put on the top and sides of my belly. These will be used to align my belly to exactly the same spot each time for the radiation. I have never had a tattoo before, but I suppose at 71, it is never too late to give it a go.
The tattoo marks were incredibly tiny. In fact, I had trouble seeing them. I was hoping for a circle with a cross through it like a proper engineering target point, but there you go. The CAT scan, with all its strange noises is completed and that’s it. I can go home.
The radiation treatment proper starts in a week. In that time the clever folks in the hospital will be setting up the program for the LINAC, so that the photons will be fired to just the right spots (they will be using the 3D picture from the CT scan as the landscape in the video game.)
I now have a schedule. Every weekday for a total of 20 days I will go to the hospital for treatment at a time set for each particular day. 55 minutes before that time, I have to skull the 600ml of water so that I have finished drinking 50 minutes before treatment time. I then drive to the hospital. The idea is that by the time I get to the hospital I would be generally feeling like a stop for a pee would be possible, but not urgent.
The bladder is filling up. Shortly after I arrive, a radiation therapist then takes me into a side room for an ultrasound. The same type used for pregnancy tests. Men with prostate cancer are very rarely found to be pregnant, but the ultrasound does measure the fullness of the bladder.
When the bladder is found to have the right fullness, I go to a seat near the room that has the LINAC. I remove shoes, put on plastic covers over my socks and wait for the previous patient to come out. Soon after that I go into the room. Every day, I must say my name and date of birth before we proceed.
I’m not always excited by quality control procedures, but in this situation I am really pleased they are matching the right person with the right treatment. I lay on the platform with feet in a plastic holder and lift up my shirt and pull down my pants so that the machine has an unobstructed view of my prostate, and my tiny new tattoos are visible (to radiation therapists with very good eyesight).
There are laser lines projected on to my belly and the radiation therapists push and pull until I am exactly lined up as I was back when the CAT scan was taken. I am firmly told not to try to help in this process. Just lay there like a piece of dead meat.
The radiation therapists then leave and shut the door. I am alone in the room with this giant one-eyed robot thing. Stay calm, lay very still.
The machine starts to rotate and then some big plates swing in from the sides. These are taking a type of CT scan which checks that I am in the same position I was in when the original CT scan was taken, and the prostate, bladder, bowel, intestines and assorted bits and pieces are all in the same spot.
The big plates swing back out of the way. All is quiet. I understand that now the radiation therapists are making sure everything is ok. By this time my bladder is very full and I am busting to have a pee. Time is moving very slowly.
If all is well, the platform I am laying on moves up to a new position and the radiation head moves to its starting position. The head then starts to move, and the radiation treatment begins.
The head moves 360 degrees in one direction and then reverses back to the start. The radiation is on for a total of 2 minutes. I cannot feel anything. Totally painless.
Although, I am sure with my bladder ready to burst, I probably would have difficulty feeling anything else. The machine goes quiet, the doors open, and the radiation therapists come back in. The platform that I am laying on motors out of the range of the one-eyed robot and is lowered down.
I sit up, swing around and put my feet on the floor, pull my pants up, grab my things and pace out of the room with no time to waste. I reach the toilet and have the pee I have been waiting for. Ahhhh, better. One down, 19 days to go!
I did say “If all is well…. “ the process continues. This is not always the case.
The bladder and bowel are not always as cooperative as one would hope. Be warned, the following is what one of my friends described as “not polite dinner time conversation”. Some days I would turn up having drunk my 600ml of water but not feeling like I needed to go at all. The ultrasound would show a miserably empty bladder. In this case I would have some more water and wait.
Once the bladder started to become full, it was remarkable how quickly it would reach a seriously full level. This timing would have to match when there was a time spot for me on the machine. When things started to get desperate, the radiation therapist suggested I just try to empty the bladder a little. What! No! Well, when I got home I did do an experiment in the privacy of my own tiled bathroom and found I could just pee a little then stop. I’m going to have very strong pelvic floor muscles after this month.
On one occasion after the pre-radiation CT scan, I was told that my bowels were not empty enough. “Could you empty your bowels, but do not empty your bladder”. What!
Remarkably, I found I could. My skills in visceral gymnastics were sufficient that I was able to have the treatment each day. That is, until one day I was told that I had constipation (there
was no escape, it showed on the CT scan). Then followed various gentle attempts to remedy the situation which were not entirely successful. I will not go into details about what followed, but if you have experienced the joys of preparing for a colonoscopy, you will get the drift.
I turned up the next day light, buoyant and ready to continue. After the pre-radiation CT scan, all when quiet, the doors opened and I was given the bad news. “Your bowel has moved. It is in a new position.”
Now the internal landscape had completely changed and so the program for the video game would be all wrong. I had to start from scratch. A new proper CT scan to map the landscape and another few days to create the program for the radiation.
I returned the next week with 7 days to go. All went fairly smoothly on those days, but the effect of the radiation accumulates as you get closer to the end.
Not surprisingly, since my prostate had been shot at for 20 days. I visualised the prostate looking like the western front in WW1 after a sustained artillery barrage: mud, bodies, wreckage and bomb craters for as far as the eye could see.
I generally would feel tired by the time I got home and flop down and not feel like doing much the rest of the day (perhaps the WW1 visualisation was not helpful). This fatigue continued for a week or so after the treatment finished.
Then suddenly the fatigue lifted and I was on my way to recovery. Even farting with confidence.
Thankyou thankyou thankyou to the doctors, radiation therapists and staff at the Illawarra Cancer Care Centre at Wollongong Hospital. They took great care each day to make sure that everything was exactly right for the radiation treatment. I really appreciated that!
While doing this, they helped me and the other patients to navigate what is a weird emotional event with cheerful good humour. Again, thankyou!”