Fair Winds & Following Seas'
One Man's Journey with Prostate Cancer Treatment
'Fair winds and following seas' is a traditional mariner's blessing, which describes the ideal conditions for a captain piloting a boat at sea. It's an age-old nautical wish of good fortune and safe travels for those departing on a journey. For boating enthusiast and Lake City resident Marvin Peterson, 64, a new voyage began last May when he was treated for prostate cancer by a team of specialists at the Seattle Cancer Care Alliance (SCCA) Radiation Oncology Clinic at Northwest Hospital.
And what was the simple pleasure he anticipated on the first day after his last radiation treatment?
"I'm going down to my boat and just take a nap," Peterson said. "The waves lapping against the sides...well, it's just so relaxing. I've missed that."
Peterson, who retired from the heavy commercial construction industry, made a promise to himself many years ago that saved his life: annual health check-ups and keeping a positive attitude while helping others in a 12-step program. He faithfully visited Northwest Hospital internist Dr. Alexander Krajina for annual exams. These included a test recommended for men over age 60 to track prostate-specific antigen levels (PSA), a protein produced by cells inside the prostate gland, a part of the male reproductive system.
The second leading cause of cancer death among American men, behind lung cancer, prostate cancer accounts for approximately 241,000 new cases each year. About one in 36 men will die from it and often there are no symptoms in its early stages. In almost a year, Peterson's PSA score increased from 4 to 7. The higher the level, the more likely it is that cancer is present. A PSA of four and lower is considered normal, but anything higher than four indicates cancer may be present.
"Because my PSA level was elevated, Dr. Krajina kept an eye on it," Peterson said. "Then he referred me to Dr. Ireton for further testing."
"Serial PSA screening is useful because I could see a disturbing trend in Marvin's case," said Dr. Robert Ireton, a urologist practicing with Pacific Urologic Consultants. "His PSA levels were increasing, so that alerted me to look closer. He received excellent care because his primary physician was on top of it and sent him over to me."
Based on the rate of rise in his PSA levels, Ireton decided to perform a biopsy of Peterson's prostate and within a week, the results came in as positive for cancer.
"We were just blown away," Peterson said. "My wife and I were in disbelief. How could this be?"
Peterson's particular cancer was graded as a 7 on the Gleason Scale, a system that rates the cancer based on the prostate cell pattern from the biopsied tissue seen under a microscope. The highest score is a 10.
"Gleason scores help physicians not only predict a patient's prognosis and stage of cancer, but it helps guide treatment and shows us how aggressive to be," Dr. Ireton said. "I firmly believe in matching a patient's cancer to treatment. Some need aggressive treatment and some don't. A majority of prostate cancers are slow growing, so my goal becomes helping a patient live the rest of his life without the complications of prostate cancer or its treatment."
Prostate cancer treatment is a collaborative approach, using the skills of surgeons, urologists and radiation oncologists. There are many options for prostate cancer treatment, including a few Peterson considered with Dr. Ireton's guidance: surgical removal of the prostate, brachytherapy (small radioactive seeds implanted in the prostate) or radiation therapy.
The prostate gland is about the size of a walnut and surrounds the neck of a man's bladder and urethra, the tube that carries urine from the bladder.
"Treatment for prostate cancer largely depends on how well the bladder functions," said Dr. Ireton. "Marvin's function was great, so he had more treatment options."
Based upon his relatively young age, good health and active lifestyle, Peterson chose brachytherapy, which was pioneered by physicians at Northwest Hospital 25 years ago. Ireton also used medication to slow the cancer while Peterson awaited treatment. Just two months after being diagnosed, Peterson had approximately 80 radioactive seeds, the size of rice grains, implanted into his prostate during a 90-minute outpatient procedure.
Brachytherapy is commonly used as an effective treatment for prostate cancer, and in Peterson's case, was used with additional radiation therapy. The therapy affects only the tissue immediately surrounding the seeds, reducing damage to healthy surrounding tissues.
The next step in Peterson's treatment included five weeks of radiation treatment, five days a week. Directing treatments was radiation oncologist, Dr. Edward Kim, medical director of SCCA Radiation Oncology at Northwest Hospital. The new center opened almost a year ago. Peterson's radiation therapy sessions were closely supervised by Dr. Kim, using a new Elekta Synergy linear accelerator to deliver high doses of precisely targeted radiation to the prostate. The machine is the world's first fully-digital radiation therapy treatment system with integrated three dimensional imaging. This enables clinicians to see a tumor at the time of treatment. Because Peterson's cancer had not spread outside of the prostate gland, great care was taken to treat just the cancer and avoid nearby normal tissues.
"We want to treat the right spot and not harm healthy tissue," said Kim. "Cancer confined to the prostate is usually slow growing. We often treat it at this stage to reduce the risk of spreading and causing harm in the future."
During his 30 minute radiation therapy sessions, Peterson realized the full benefit of SCCA Radiation Oncology: the expertise of the staff and a true team approach to care.
"I liked their enthusiasm right away and they're all just very caring and comforting people," he said. "From the start, Dr. Kim was a partner in my care and met with me and my wife once a week. In the second week, I had some concerns and he was very thorough in showing me computer images of my radiation area. Every time I went in, he was there to supervise the treatment.
"The entire team at SCCA made a huge difference in my treatment. They were always checking, always doing. Dr. Kim's nurse, Wendy, was always on top of everything. I also appreciated easy access to Dr. Kim when I needed it."
Peterson is also thankful his wife of 41 years, Anne, attended appointments with him.
"That really helped me," he said. "It's another set of ears to help decipher everything, because sometimes a patient can't focus."
Fortunately, Peterson didn't have many side effects from his treatment and believes this stands as testament to the SCCA Radiation Oncology team's expertise.
"There can be a lot of side effects to prostate treatment, but I only had some pain in the third week and used pain medication for a few days. I breezed right through it," Peterson said. "As I lay there during my last treatment, covered up with a warm blanket and holding on to a 4-by-6-inch "donut" to keep me from moving, I thought about how blessed I was to get this caught early and to be so close to home for my treatment."
Dr. Kim said prostate cancer treatment requires follow up, and Peterson may not know for several months if the treatment has stopped the tumor growth. His PSA levels will also be monitored.
Close to home for Peterson includes keeping a watchful eye on his boat, Cimarron, a 34-foot trawler standing sentinel in a Seattle slip waiting for fishing cruises to resume with family and friends along the Gulf and San Juan islands. His son and six grandchildren ranging in age from 2 to 10 years old,
"It's exciting," Peterson laughs. "It's a high energy deal and we're always counting heads! I am so thankful I get to continue to be in my grandkids' lives."