Protons 104 -- A Quick Overview

Take a look at this link for a quick overview of proton therapy: http://en.wikipedia.org/wiki/Proton_therapy
You can click the "back" button to return here after.

NBC Spot About Proton Therapy

To see a segment about proton treatment that aired on the Today Show, click here: http://www.msnbc.msn.com/id/21134540/vp/25930361#25930361 . Then click the "Back" button to return here.

Protons 103 -- Shaping the Beam to MY Prostate

You will remember from Protons 101 and 102 (see prior posts) that we solved the "realease the energy inside the body rather than on the exterior" problem and that we solved the problem of getting depth with proton treatment (so that we can treat a 3D object -- the prostate-- rather than a 2D object). Now, let's get personal. I want that damn beam to treat MY prostate -- not be shaped to Joe the Plumber's prostate. Prostates come in slightly different sizes (but, bigger is not better for this part of the anatomy) and shapes so, let's get it to fit ME.





There are two devices that do that. The first is known at the "aperture". You see my aperture below or nearby. This is the hole in the middle of that heavy metal object (lead?). It is designed to fit the silhouette of my prostate. The proton beam hits the lead aperture and stops where there is lead but keeps going where the hole is. On to my prostate. Very nice. But, what keeps the beam from going beyond my prostate after it hits it? This may be confusing, because in Protons 102 we talked about how the beam got its depth. That depth, however, gave it a uniform depth of, say, 2". So, if we were treating a perfect cylinder, that would be great. But, we're not. We need to treat an irregularly shaped object. The aperture gets the silhouette shaping. The 2D shaping. But how do we get the 3D shaping? How do we treat what we need to treat but have it stop where the prostate has little depth (around the edges) but keep going where it has greater depth (in the middle). The answer is the "bolus".


The bolus is a wax-like object. There is a picture of one below. After the beam goes through the aperture, it then goes through the bolus. The wax-like bolus approximates the human body (it is an average of human tissue -- muscle, fat, senews, etc.). Remember that the proton beam goes a certain distance through the body. If it has more body to go through, then it won't go as far. That is what the bolus does -- acts as a faux human body to vary the depth of the beam. The bolus is made up of different depths of wax -- see the sample. After the beam goes through the aperture, it is shaped to my prostate. Then it goes through the bolus and will "release its energy" at the appropriate depth for MY prostate. There is more to this than described -- but you get the essential picture. Take a look at this Loma Linda video for a simple view of how it works. You have to wade through most of the video, and it's pretty simplistic, but it may help: http://www.protons.com/proton-therapy/proton-videos/treatment-preview.html . The most important aspect of this video is that it shows you, about 3/4 of the way through, how the bolus is made. There is no description of the function of the bolus or how it works, but at least you know now from this post how it's done.

Morbidity (have you been reading?) 3/4 Way Through

I posted earlier on the side effects (morbidity) 1/2 way through. I have only 10 more treatments left and it is time to revisit this subject. First, the expected morbidity:

• Urinary burning and difficulty
• Malaise (extreme tiredness on some days)
• Sun burn on my hips from the radiation
• Diarrhea

What have I in fact experienced? As of today, there is no urinary burning. There is, however, a slightly increased sense of urethra stricture. It is slightly uncomfortable on occasion and not at all noticeable at other times. As a prophylactic measure, I have been taking Advil tid (3x/day -- "tid" stands for the latin of ter in die which means, voila!, 3 times a day). It is an anti-inflammatory which reduces the swelling on the prostate which opens up the urethra. Seems to be working. In any event, this is not a problem -- and is supposed to go away.

Malaise? No, not at all. Not feeling tired at all. BUT, the nurse practitioner was surprised at this. It is apparently very common. But, she said that my level of exercise (lots and lots -- see the earlier post -- up to 3 miles now) probably explains the lack of tiredness.

Sun burn? I'll have to check. Maybe it appears a little bit redder. Whatever. Now I'll have to get that all over tan.

Diarrhea? Not on a regular or even a recurring basis. Maybe 5 days in 2 months -- is that out of the ordinary? And once it happened after hot Mexican food. Not an issue.

In sum, the morbidity has been far better than even I, Mr. Optimistic, envisioned.

Video of Actual Treatment

Click on the video below to get a clip of an actual treatment. I will explain in some later posts what some of the equipment you see is. The treatment feels just like getting an x-ray.....I don't feel a thing.

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Come Visit! Our place in Redlands

Here are some pictures of our townhouse in Redlands. Only our niece has come to visit us. Maybe these pictures will entice more visitors. But hurry, I am halfway through. We'll be gone by mid-December

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Side Effects ("Morbidity") Half Way Through

Ok, for the squeamish (sp?) of you, this is a time to skip this particular post. No, no, no, it's not so bad but I'm going to get into a side effect that I have been having at the half-way point. I'll space down so you don't have to look


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For those brave souls, the side effect (I know I got all of you to look!), is minimal. First the medical description..... the urethra is the tube that passes from the bladder to the outside of the body --- for men and women. It's like a flexible straw or tube. For men, it passes right smack dab through the middle of the prostate and then goes through the penis. Some men get BPH ("benign prostatic hyperlasia") - a fancy way of saying that the straw gets compressed by the prostate squeezing on it. When that happens, instead of the McDonalds milk shake straw size that allows the pee to flow freely through it, it gets reduced to that coffee stirrer size straw which is much smaller and hence doesn't allow so much pee to get through. Other things can cause that as guys get older, like infections ("prostatis") and other such stuff.

When my prostate started to get bombarded with protons, my prostate didn't like it so much. Like a lot of people, when it got bombarded, it got irritated. Fancy that. And when it gets irritated, it gets all red and puffy (they tell me). And when that happens, it starts to compress on the urethra and make it smaller. So, the side effect is that it gets a bit harder to pee. It takes a little longer. Sometimes it feels like more needs to come out but it won't. That's it. No burning sensation. No pain. Just different. My doc tells me to take Advil to reduce the inflammation. I'm kind of doing that when I remember to -- more to ward off what might get worse than anything. And, he tells me that the inflammation should go away 2 weeks after the treatment stops. We'll see. I'll let you know. The good part is...now I know something is happening. Before I felt anything, I wasn't sure that this treatment was doing anything at all. Now I do. Phew!