Oh, boy, here comes juicy part about prostate cancer treatment

One typically harvests in the fall, not sows with seeds in autumn.

In my case, though, dumping about 80 radioactive titanium pellets - called “seeds” in official oncology parlance - into my slightly larger-than-walnut-sized prostate gland on Sept. 10 will be a good thing.

Finally, after week after seemingly endless week of visits with white-coated doctors talking about the black threat of cancer, a date with the surgery room was announced.

Only that Dr. Jon Prescott bulks at calling his seed-sowing work surgery. If anything, the good radiological oncologist fumes about surgery the way a surgeon might dismiss anything else but.

What’s going to happen on that date is something called a “brachytherapy,” a really fancy word with all kinds of Greek-to-me meaning.

In this hour-long procedure I’ll be wheeled into an operating room reserved just for me - and probably several other men in need of Prescott’s handiwork that day - and be conked out with some sort of happy juice.

Good thing, too, as what will come next is not really something that I have any desire to undertake while awake and kicking.

During a brachytherapy procedure the unconsciousness male (this is after all, a guy thing) is laid out on his back. His (my) legs are then spread-eagle-split-apart while the feet are harnessed into stirrups.

Yep, if you think this is just how a woman undergoes a pelvic exam you’d get a lollypop from a doctor.

It’s really the closest thing a man can get to experiencing child birth, though in all honesty us guys are fast asleep while the women folk are very much awake.

Yeah, we may be wimps but we’re SMART wimps.

For the next hour Prescott will work with my urologist Dr. Lawrence Wolcoff in a two-person tag-team. Their collective goal is to hunt down and search out the cancer during their seek-and-destroy mission.

A ultrasound fluoroscopic device will be inserted into my rectum, guided the short distance to the nearby prostate gland. This tool will help lead the doctors to the promised land where the nasty business of cancer is found.

Prescott will make a minimalist insision into what's called the "perineum," that piece of flesh located just down the street from the scrotum and slightly up hill from the rectum.

He'll then employ his dart gun, so speak. He’ll fire the 80 or so roughly rice grain-sized pellets, each of them strategically placed so as to maximize the power of the Iodine-125 radioactive isotope that is the delivery system’s warhead.

In brachytherapy’s Dark Ages of the 1960s and 1970s doctors would install seeds indiscriminately. That shotgun approach left useless gaps and seed overlays.

Such random, hit-and-miss procedures didn’t help brachytherapy’s reputation. That is, until starting in the 1980 and working through the 1990s the researchers hit on the capital idea of accurate targeting.

Seed implantation further blossomed in the full sunshine of the 21st Century.

Now, says Prescott, for men with early stage prostate cancer like what I have, the 10-to 12-year survival rate by undergoing a brachytherapy is equal to or better than the radical surgical removal of the prostate.

Thus, the one-time “gold standard” for curing prostate cancer - surgery - is being outrunned and outgunned by sending in the titanium canisters with their fully primed radioactive isotopes.

It’s going to take some time for the radiation to work, of course. What it does is not kill the cancer cells outright as much as the radiation destroys their DNA. This prevents the cancer cells from reproducing.

Then too, says Prescott, there are fewer adverse side effects than with radical surgery. Just as these side effects are less severe also, says Prescott.

What I can anticipate following the seed implantation is just a few hours of recovery in the hospital and more than likely I'll be discharged the same day. That compares to a several-day hospital stay when surgery is undertaken.

Also, says Prescott during his most effective sales pitch, very few men who’ve have a brachytherapy must likewise wear a catheter inserted into their penis for a period of days. Say “ouch” if you wish at this juncture. If you’re a male you are permitted.

At home a patient should take it easy for a few days, relax and not lift anything much heavier than a call to your wife to bring you a beverage and snack along with the television remote control device.

On the downside is that I’ll likely encounter frequent night-time urination, possibly on the order of every 90 minutes or so, for a couple of months. And this necessary bodily function will also probably come with some pain for a while, too.

But I encountered that condition a few weeks back when my prostate gland’s four nearby lymph nodes were removed for their biopsy. So I understand what’s ahead.

Considering that men who elect or must undergo surgery likewise must often wear a protective undergarment for up to several months, the brachytherapy further became a no-brainer.

Another goody: The odds for encountering erectile dysfunction and impotency are lessened via a brachytherapy than with the removal of the prostate gland through surgery. Besides, there's all kinds of stuff that a doctor can prescribe for those conditions.

About the only suggestion that a urologist offers is for a patient to wear a condom for the first few intercourse trysts. That's to protect against an escaped radioactive seed from being accidentally implanted into a woman's vagina.

Lessened as well is the risk of post-operative infection. That is because the brachytherapy procedure is minimally invasive, a term I’ve picked up during my Internet wanderings regarding prostate cancer and its various treatment options.

Is everything all bright, cherry and roses? Not at all.

Since we are dealing with radiation, the government has to stick in its regulating nose. The standard protocol says that young children can’t sit in your lap for two or three months and that you and a pregnant woman need a three- to six-foot diameter no-fly-zone for about the same duration. The government’s concern is radiation exposure to these at-risks groups.

I asked Prescott if this advisory includes dogs, since my two Labrador retrievers view my lap as their personal bed sheet.

His answer was “no.” Thank heavens, too. I was worrying that I would have to find a used lead apron of the kind radiologists use when giving X-rays.

Another item or two; the chances for temporary diarrhea exists along with possible fatigue due to the radiation, some Internet sites suggest.

Yet I consider all of these potential and probable short-comings to be trifling when compared to radical surgery.

Or, worse, doing nothing at all.

And that, alas, would have happened if I were living in Sweden with its government-run health-care program. Or any other similarly run state-sponsored health-care program, says Prescott.

The reason being is that such systems are far more stingy about doling out preemptive medical care than in the United States.

If I were in Sweden, says Prescott, the best I could hope for with my stage of cancer would be to undertake a watch and wait requirement that would track how fast the cancer grows with a likely seven-year wait until some sort of action is taken.

And that, I’m afraid, very well could have led to the cancer in my prostate spreading and becoming a truly life-threatening disease.

All without so much as a government “oops, we’re sorry” apology from a bureaucrat who thinks of numbers, risks and life expectancy odds more than the needs of a patient with a time bomb ticking away in his groin.

Thanks, but no thanks. September 10 can’t get here soon enough for me. After all, Ohio’s archery deer-hunting season is right around the corner.

- Jeffrey L. Frischkorn
JFrischkorn@News-Herald.com
Twitter: @Fieldkorn