Prostate cancer treatment: prostatectomy or radiation?

An elevated PSA (prostate-specific antigen) score and biopsy all pointed toward cancer. Dr. Brian Montgomery, an urologist with Carson Urology, ordered a bone scan to ensure the cancer hadn’t metastasized. On bone scans, Montgomery said he uses criteria based on National Comprehensive Cancer Network (NCCN) guidelines to determine if the cancer had spread beyond the prostate to another organ or the bones.

“The higher the PSA, the more likely prostate cancer is present,” he said.

In two years my PSA scored quadrupled to almost 17. Normal is less than four.

I had to wait two more weeks to learn of the results. If the cancer spread, I may be looking at a radical prostatectomy and some type of treatment like chemotherapy or radiation. I had already resigned myself to some type of treatment … there was no turning back.

The weeks between learning of my bone scan results and the next office visit at Carson Urology’s Banner Churchill Community Hospital’s office were long, yet once I met with Montgomery, my fears were erased. The cancer was contained to my prostate’s two quadrants. He said the next stop would be to set up an appointment and discuss the next stage: treatments.

“If you’re metastatic, that basically means high risk,” he pointed out, “but your imagining shows it has not spread.”

Montgomery said I was very fortunate not to have the cancer in more than two quadrants. Statistically, he said the prognosis shows I have a good chance to beat this disease and there’s an 80-85% chance I will not have a reoccurrence of prostate cancer.

“I expected more quadrants,” Montgomery added.

Based on all the tests and the Gleason scores, I was deemed a good patient for receiving radiation treatments instead of having a radical prostatectomy where the prostate and surrounding tissues are removed. The pathologist issued a Gleason grading score of 8, which means I have a high-grade lesion than can spread more quickly than scores half that.

The left base showed adenocarcinoma took up only 5%, but the Gleason score came in at 6.

In November 2019, I scheduled an early-morning appointment with Dr. Gary E. Campbell, a radiation oncologist with more than 37 years of experience. He had local roots, having graduated from Whittell High School at Lake Tahoe. He attended the University of California at Irvine, and medical school at the University of Nevada, Reno in 1983. He completed a rotating internship followed by a residency in radiation oncology at Indiana University Hospitals and Clinics, the same city where I completed by officer basic and advanced classes for the U.S. Army.

Campbell returned to Nevada in 1987 where he became associated with Carson Tahoe Radiation Oncology Associates, now known as the Carson Tahoe Cancer Center. The center became an affiliate of Huntsman Cancer Institute at the University of Utah several years ago.

Our first appointment was short, but Campbell explained the treatments I would receive: 43 radiation treatments, Monday through Friday, over a three-month span. For me that would require a 128-mile round trip, although his office mentioned I could stay in one of the small living accommodations north of the hospital if needed.

Campbell felt comfortable if my treatments started after the new year because of all the holidays. Based on my test results, Campbell said he was very optimistic I would beat this type of cancer. Willing to answer any questions thrown at him, Campbell works with his team to develop a tailored plan for each patient. My intention was to begin treatment in January, but the mother of all colds settled into my body, which delayed any treatment. More delays arose, such as taking an Honor Flight Nevada trip to Pearl Harbor with World War II veterans in early February and attending spring training in early March.

Campbell saw no harm in delaying treatment. We decided March 24 would be the date to begin the three months of treatment.

In mid-March, Montgomery implanted three radioactive seeds into my prostate that would accurately guide radiation beams to not only the affected quadrants but also the entire prostate. The procedure at Carson Urology took less than an hour to complete. Procedures like this are mainly for patients who have a cancer contained within their prostate and is not very aggressive. The seeds allow the radiology technician to perform advanced radiation treatments with more accuracy. I also received a Lupron shot, a type of hormone therapy to slow the growth for prostate cancer.

“The three seeds are set in a triangular patter and helps aim the radiation to the right area,” Montgomery said.

The 43 radiation treatments give a higher percentage of killing most cancer cells. Campbell said statistically, out of hundreds and hundreds of patients, he can tell how they will do with their treatment plans. Chemotherapy, however, is used for advanced prostate cancer and administered on the center’s main floor.

Campbell also said radiation will work on both the prostate and the tissues associated with the prostatectomy, and since The Carson Tahoe Cancer Center is an affiliate of Huntsman Cancer Institute at the University of Utah, he can access their physicians and findings to assist him developing a treatment plan on answering questions.

Based on his 30-plus years as an oncologist, he said technology to treat prostate cancer has improved, and the treatments are better tolerated by the patients and more successful because of the center’s multi-million dollar treatment machines.

“It’s kind of like the latest and greatest, and it’s very precise. We are able to push the radiation doses which is important,” he said.

With each 20- to 25-minute treatment, Campbell said his technicians shoot external radiation beams to the area that’s being treated.

“We want to take away the fear. It’s manageable, and we caught it in time,” he said of my cancer.

Campbell said the majority of patients are successful with their treatments. Statistically, Campbell looks at the hundreds of patients who have undergone radiation treatment, and he can tell how someone will do; unfortunately, Campbell said the treatment is not successful for all patients.

“The majority do OK, but there’s a small percentage where it doesn’t work,” Campbell said.

March 24 has now arrived. My juggling act of driving to Carson City and reporting on the news has begun.

Part three: Three months of treatment, side effects and another PSA. Was it worth it?