More Time to Enjoy Life
He says he was “gifted” with a sunny perspective — something Hickam needed in August 2022 when he learned during a routine physical that his PSA (prostate-specific antigen) level was elevated.
He hadn’t felt any symptoms, but followed up on his doctor’s recommendation and saw a urologist in Kirkland, Washington, where he was visiting family. A second test echoed the first — his PSA level was 6.9.
In the past, a PSA level of 4 or less was considered normal. But some men with a PSA below 4 have prostate cancer and others with readings between 4 to 10 do not, according to the National Cancer Institute. If a PSA level exceeds 10, the chance of cancer is more than 50%.
Deciding on a treatment option
By November, another test showed Hickam’s PSA had jumped above 10. Then, an MRI (magnetic resonance imaging) revealed a possible lesion on his prostate. A biopsy confirmed prostate cancer. A bone scan brought some relief: his cancer was localized to his prostate.
By then, Hickam — who believes in combining optimism with action — had been doing his own research into treatment options. He met with an oncologist in Kirkland and chose radiation over surgery. His new medical team recommended external beam radiation therapy, delivered in 45 treatments over nine weeks, five days a week.
In preparation, the urologist implanted tiny gold-seed metal “beads” (each about 3 mm) in Hickam’s prostate through a fine needle — a kind of tattoo to guide the radiation beam.
Needing to heal from his procedures before starting radiation, he returned to the Coachella Valley. He had moved there three years earlier to continue his 40-year career in golf course management at The Citrus Club, plus another La Quinta course. A year later, with the COVID-19 pandemic, and course ownership changes, he opted to retire.
At home, Hickam continued his research and read about Eisenhower BIGHORN Radiation Oncology, and its use of stereotactic body radiation therapy (SBRT).
Potential for short-course radiation
Not only does SBRT deliver high-energy, concentrated doses to a precise area, protecting surrounding tissues, it does so in just five treatments over one-and-a-half weeks. Hickam was intrigued. “I wanted to get back to my life faster if I could,” he says.
SBRT is also known as stereotactic body radiotherapy. It is also referred to as SABR, stereotactic ablative radiation therapy. This treatment requires no surgery or incisions.
SBRT was initially used for early stage lung cancer. “However, over the last 15 years, we’ve learned that prostate cancer also responds well to SBRT,” says Bighorn Radiation Oncology’s Medical Director, Kamal Patel, MD, who is Board Certified in Radiation Oncology.
For now, the BIGHORN team is focusing its use on early-stage cases. However, not all early-stage patients will qualify. Other factors are considered — for example, an enlarged prostate or significant urinary symptoms might disqualify someone.
Optimizing cure and quality of life
“The good news is for newly diagnosed prostate cancer, we are making great advances every day,” says Dr. Patel. “Prostate cancer is highly treatable and there are lots of options available.”
Patients with localized cancer typically have “an excellent chance for a cure and long-term quality of life,” he adds. “Going into treatment, we look to optimize both goals.”
The planning team includes radiation oncologists, radiation therapists, medical physicists and medical dosimetrists, to ensure each patient receives the most effective dose to kill the cancer cells with the least possible side effects.
In order to implement prostate SBRT, the BIGHORN radiation oncology team upgraded their TrueBeam® radiotherapy system with Triggered Imaging®. In patients with fiducial markers (such as gold seeds in their prostate), Triggered Imaging technology allows the team to take pictures during the treatment to ensure the treatment is being delivered accurately. With this technology, if the patient moves, coughs, or sneezes, the machine will detect the movement and automatically stop. The radiation team will wait until the fiducial markers are back in position and then resume treatment.
On treatment day, Hickam lies on a special mold created for his body to minimize movement. Prior to turning the radiation beam on, the team aligns the fiducial markers. Then, the high-tech linear accelerator rotates around him and delivers the treatment in minutes. While the treatment is being delivered, the team takes real-time snapshots and confirms the dose delivery hit its targets. “If the markers are even slightly off,” says Dr. Patel, “the machine will stop immediately.”
After four more half-hour sessions, Hickam’s treatments were done. He felt no side effects except for a short period of fatigue. At a follow-up three months later, his PSA level had dropped below 4. “Dr. Patel said I should be very optimistic, and I am,” he says.
Now Hickam, 65, can concentrate on following his daughter’s golf game at California State University, San Marcos, and on traveling to favorite places like Jackson Hole, Wyoming.
He is especially grateful to BIGHORN Radiation Oncology. “Every single person I met,” he says, “from the front desk to the nurses, technicians, and Dr. Patel and his entire team, was amazing.”
For more information or to contact Eisenhower Lucy Curci Cancer Center, call 760.674.3602, or visit EisenhowerHealth.org/Oncology.
