In 2013, Allan Odden was 70, newly retired from a career as a college professor, in good health, walking four miles a day, playing golf and bridge, and ready to enjoy many more years with his wife, Eleanor. When he went for his yearly physical, his doctor asked if he wanted a PSA test. He had last had one in 2011, and it was low – 1.4 ng/ml.
Allan got the test. His PSA had gone up to 2.53. The next PSA, a few months later, was 4.29. The next one, in 2015, was 5.04. But he was told not to “rush to judgment.” To wait and see. By the fall of 2017, his PSA had risen above 7. “My internist said it was now time for me to see the urologist.” Finally, he got the free PSA test – and his free PSA was very low. Then he had an MRI, which showed three possible lesions that could be cancer; some of these spots had Gleason 3 + 3 cancer, and a couple had Gleason 3 + 4 cancer. The doctor strongly recommended treatment sooner rather than later – either surgical removal or radiation. Allan, who divides his time between Chicago and Sarasota, Florida, chose surgery at Northwestern University’s Memorial Hospital. The surgery went well, although the surgeon told him that his cancer had grown a bit and the prostate sac had “bulged” a bit – but the lymph nodes were cancer-free. Incontinence afterward was a challenge, but Allan did Kegels and other exercises and regained bladder control.
A month after the surgery, his PSA, which was supposed to be undetectable, was 0.12, and the pathology report had found, as Allan described, that “microscopic amounts of cancer, not visible to the naked eye, had escaped the prostate sac around the area of the bulge.” The PSA, though low, had doubled by December. Allan made an appointment to see a radiation oncologist at Northwestern, who (after a bone scan and MRIs of his abdomen and pelvis showed no cancer) recommended a short course of hormonal therapy (ADT) as well as eight weeks of radiation.
The radiation treatment itself, Allan found, was “a piece of cake.” Five minutes a day, for 39 days. However, getting ready for that five minutes each day proved more challenging.
“Low Residue” Diet
A nurse educator told Allan that he needed to go on a “low residue” diet. Allan, who has written a book about his prostate cancer journey, is funny, analytical, and heartfelt. He relates this conversation: “She said that means a diet with very little fiber, as the goal for the radiation was to have as clear a colon as possible. And then I said that I’ve been told for years to eat lots of fiber, in order to be regular, which would then clear my bowel so it would be perfect for the radiation treatment. But not perfect enough, she insisted. She continued by saying you should eat very little fiber, no bran flakes, no oatmeal, no raw vegetables, no whole grain bread or crackers, no prunes or prune juice, no fruit with skin or seeds, etc. No eating, pretty much, of my actual diet!”
What could he eat? White bread, white rice, white pasta, mashed white potatoes, super-cooked vegetables with the skins removed, no beans or peas, “as they cause gas and would inflate the colon, pushing it near the prostate area,” clear juice, canned fruit and veggies, etc. “I looked at her like she was crazy, and she said, ‘I’m not your cardiologist, and this is just for eight weeks of radiation.’” Allan worried about constipation from a diet that would produce “Elmer’s Glue in my gut,” and “she said that over time, it wouldn’t do that and would make me regular. She said I just needed to trust her… And then she said, ‘Oh, there is one more thing. While we want an empty colon, we also want a full bladder. And this is what you need to do: empty your bladder 60 minutes before your radiation appointment and then drink 24-32 ounces of fluid so when you get here, you’ll have a full bladder.’”
Not what a man who has just relearned how to control his urinary sphincter wants to hear.
But Allan managed it, and fortunately, his radiation oncologist told him he didn’t need to drink quite that much water. Armed with literature from the nurse showing the fiber content of various foods, “I found canned soups with zero fiber. I found crackers, even tasty crackers, with zero fiber or less than 1 gram of fiber in a 40-cracker serving. English muffins, made with processed white flour, have very little fiber. Most fruits have a lot of fiber, but honeydew melon does not, so I bought one. I bought Rice Krispies instead of Bran Buds and Rice Chex instead of Shredded Wheat. I decided to have lots of fish, as that is easy to digest (and I needed a successful bowel movement every day before 9:30, as my radiation appointment was for 10:30). Eggs are low in fiber.
“Weird though it was, the diet actually worked. I did stay regular. The nurse was right.” Arriving with a full bladder made for some suspenseful rides on the express bus to the hospital, but he managed that, too. “I was a very fortunate man to have had very few side effects,” he says. During the course of his treatment, “I also continued my other activities – bridge two days a week, dance lessons two days a week, and golf on Tuesday morning. And now my chances of success were well over 95 percent and my PSA was already reading zero.”
On the last day of his treatment, Allan rang the gong in the radiation center – a celebration ritual – and posed for pictures with some of the staff he had come to know over the last two months. He is now ready, he says, “to enjoy every minute of the rest of my life.”
Note: Your dietary needs during radiation may differ depending on your health status. Check with your doctor and, if recommended, a nutritionist or dietitian. Read more tips from radiation oncologist Dr. Daniel Spratt on preparing for radiation treatments here.