Spacer in, map done 👉 treatment starts tomorrow!

What just happened

Two prep appointments at Memorial Sloan Kettering, ten days apart. Both were about getting ready for radiation, not the radiation itself.

First, a small procedure to put a protective gel in place. Second, a mapping session so the team could plan exactly where the radiation goes. That's everything that had to happen before the five treatment sessions.

I'm a little on edge about what's ahead. Glad it'll be over sooner rather than later. It's been exactly a year since my primary doctor told me to go see my urologist.

How it went

Spacer day Monday, August 31

The prostate sits right up against other organs. A hydrogel spacer is a soft gel injected between the prostate and those organs, which moves them a little farther from the radiation. Less radiation there means lower odds of side effects.

Dr. Assaf Moore placed it under sedation, guided by ultrasound. The procedure itself takes about 20 minutes; most of the afternoon was waiting on either side of it. I went home after the procedure (escorted by a friend, as required), with a week of no heavy lifting and no bike. The gel stays soft, you don't feel it, and it dissolves on its own over about six months.

One thing that didn't happen: no gold markers. Many radiation setups need small metal markers in the prostate so the machine can find it. The machine I'm being treated on takes a fresh MRI before every session, so it can see the prostate directly.

It was a breeze! Way easier than having 12 cores removed (biopsy).Tap to enlarge

Mapping day Wednesday, September 9

Officially a simulation. Nothing gets treated. I lay on the table in the position I'll be in for treatment, with the spacer in place, and got a CT scan and then an MRI. From those images the team builds a 3D map: the prostate gets the full dose, while the urethra (the tube that carries urine through the middle of the prostate), the bladder, and other nearby organs are kept under set limits.

The prep involved Gas-X, a nightly laxative, and a list of gas-producing foods I now know far too much about. A full, gassy bowel can shift the prostate a few millimeters, and at this level of precision that counts.

The prep isn't a one-time thing. It restarted three days before the first treatment and continues through the last one on October 2.

The two weeks since were for the physicists and Dr. Setton to build the plan.

“We live in a simulation!”Tap to enlarge

What's ahead

Five sessions of SBRT (stereotactic body radiation therapy: a high dose delivered very precisely over a few sessions, instead of the older approach of 40-plus daily sessions). They run every other weekday on the MR-Linac, a radiation machine with an MRI built in. Before each session it takes a new scan and adjusts the plan to where things sit that day. No hormone therapy.

Tomorrow Wednesday, September 23

Setup and treatment start at 8 a.m. The whole process takes about an hour, so I should be out around 10 and home around 11.

Here's how it goes. They line me up using my tats, do a quick MRI, and push the button for the fraction (one treatment session; five fractions make up the full course). The radiation part lasts about 15 minutes.

"Tats" = small, permanent dot tattoos: one on each hip, plus others above and below my belly button. They're used to line me up with the radiation machine the same way every time. Getting tats was not in the pre-game brochure ;|

After that

What to expect, per Dr. Setton: about nine in ten people get some urinary frequency and urgency. It usually peaks around a month after the last session, is noticeably better by eight weeks, and mostly gone by three months. Bowel changes are less likely, about one in five, and usually mild. Almost everyone keeps working and going about their days through it, which is the plan.