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As a pastor and retired police officer, Bruce McVety is no stranger to death. He's witnessed others passing on and has counseled those dealing with its finality. Bruce also has faced his own mortality more than once.
Bruce's fate first became uncertain in 2010 when he was diagnosed with prostate cancer. At the time, Bruce was treated with radiation therapy, and it seemed to work. For seven years, Bruce had tests to check his level of prostate-specific antigen, or PSA. His numbers remained normal, and life with his wife and family went on.
But in March 2017, Bruce's PSA was elevated. The resident of Princeton, Illinois, again was forced to confront a future in doubt. Bruce's local medical team attempted to locate the cancer cells that were triggering the PSA rise. MRI and CT scans were done, but imaging came back negative for cancer.
For the next six months, Bruce's PSA levels were monitored. Each month, they got higher, and in August 2017, he had another scan. Afterward, Bruce was told that the scans were negative. But that wasn't all the doctor said.
"I remember him looking at me and saying to me he wanted me to go to Mayo Clinic," Bruce recalls. "He said: 'Bruce, there is something in there, and I can't find it. I'm a smart man, but the people at Mayo are a lot smarter than me and have access to a test that I don't have.'"
In September, Bruce met with Mayo Clinic physicians Eugene Kwon, M.D., in Urology, and C. Richard Choo, M.D., in Radiation Oncology. A short time later, Bruce underwent a pioneering test developed at Mayo Clinic that would change the course of his future.
A Choline C-11 PET scan, which Mayo Clinic designed and received Food and Drug Administration approval for in 2012, allowed Bruce's team to see what conventional scanning technology could not: the location where his cancer had spread. Following the scan, Bruce's team devised a treatment plan that involved proton beam therapy and hormone therapy. When Bruce returned to Mayo for a repeat PET scan six months after his final proton beam therapy session, there was no trace of cancer.
"I don't see miracles around every corner," Bruce says. "But I do believe God is capable, and he works by opening doors. This was incredible to see the doors open."
The first door that opened for Bruce was receiving a referral from his hometown physician to Mayo Clinic. The second was having access to the Choline C-11 PET scan. The scan involves administering a chemical tracer, called Choline C-11, into the patient's vein just before the test. Prostate cancer cells readily absorb choline, so when patients are scanned, areas that have absorbed the tracer are highlighted. In Bruce's case, the test revealed nine spots of cancer within his abdominal and pelvic lymph nodes that had previously gone undetected.
"This is really about the imaging we do here," Dr. Kwon says. "We are able to demystify what's going on with the cancer, then assign a very aggressive and sometimes combined form of therapy."
Bruce's therapy entailed taking a medication called Lupron — a form of hormone therapy that suppresses the amount of testosterone the body makes. He also had 26 sessions of proton beam therapy. While the area of lymph nodes that Bruce's cancer had metastasized into was extensive, the fact that cancer had not spread above his diaphragm meant radiation therapy might be a viable option to shrink the growths and to possibly offer a chance of cure.
"Any other hospital might send me home to die, but Dr. Choo said: 'This is Mayo Clinic. We do things differently here,'" Bruce says.
His care team opted for proton beam therapy for several reasons. They included the significant lymph node involvement in Bruce's abdomen and pelvis; the vital organs located near the affected lymph nodes; and the potential for significant side effects to those organs from traditional radiation therapy.
"The proton beam has a unique physical characteristic," Dr. Choo says. "As it enters the body, the tissues and normal organs in front of the target still receive some radiation. But when the proton beam reaches the target, the bulk of its cancer-fighting energy is released, and not much radiation goes beyond that. This means much less radiation to normal organs beyond the target. Proton beam can be an important tool to maximize the chance of tumor control while minimizing radiation side effects."
Using the results of the Choline C-11 PET scan that identified the locations of the recurrent cancer, Dr. Choo devised a map of Bruce's tumors and created a plan to target them with proton beam therapy. That plan included administering the therapy through Bruce's back. When proton beam therapy is delivered that way, explains Dr. Choo, it spares many of the organs nearby from being exposed to unnecessary radiation.
"Once it delivers the radiation dose to the target area, the areas beyond that — the small bowel, the large bowel, the stomach, the liver, and some of the kidney — don't get that much radiation because there's no exit dose with proton beam," he says.
Having the proton beams enter Bruce through his back also minimized the side effects of radiation. Typical side effects can include nausea, vomiting, diarrhea and fatigue. Despite the large area that received radiation, Bruce says he experienced no side effects from the treatment.
"I looked at the people going through it all, and their physical conditions were often so serious. Yet I was getting the treatment, and walking around and exercising. I couldn't believe that I wasn't having any side effects," Bruce says. "I talked to Dr. Choo about it and said, 'I don't feel sick enough to be here.' And he said, 'You are very sick, even though you don't realize it.'"
The use of proton beam therapy still is relatively new, and few studies exist about its overall effectiveness in treating prostate cancer. Due to the lack of data on the utility of proton beam therapy for a situation like Bruce's, his medical team couldn't be certain how well the treatment would work against his advanced disease.
Despite the uncertainty, Bruce's team felt that the proton beam therapy, at a minimum, would decrease radiation side effects. This translated into an improved benefit-to-risk ratio for proton beam therapy, according to Dr. Choo. It was a strategy that paid off.
Bruce's proton beam therapy concluded in November 2017. Six months later, Bruce and his wife, Elaine, returned to Mayo Clinic, so he could have another scan. Afterward, Dr. Kwon had surprising news for them: Bruce's cancer cells were gone.
"They couldn't find it anywhere. From my eyes to my thighs, there was no evidence of cancer," Bruce says. "Dr. Kwan said it doesn't mean I'm cancer-free because it can hide. But there was no evidence of it, and I should live a normal life."
Six months after that appointment, in December 2018, a second Choline C-11 PET scan confirmed the results of the first. Bruce's cancer was nowhere in sight. At that time, he was able to stop taking the Lupron.
"The part that's fortunate for this gentleman is he got the imaging, which then showed the location of the relapsing cancer," Dr. Kwon says. "With the PET scanner, we're able to identify the exact location of the prostate cancer. Without it, the whole thing is sort of blind mystery. In his situation, we had a good idea of where the cells spread, which triggered a very specific form of therapy. That's the magic and the miracle of treatment here at Mayo."
While is too early to say whether Bruce's cancer is cured, his progress so far is encouraging, Dr. Choo says. For the next few years, Bruce will return to Mayo Clinic for repeat Choline C-11 PET scans every six months.
The renewed health Bruce experienced since his treatment at Mayo Clinic has been bittersweet. In August 2018, just three months after learning his cancer was gone, Elaine died unexpectedly. The loss of his wife, says Bruce, brings into focus the grace and fortune by which we live.
"The reality is that we have very little control over the future," Bruce says. "That doesn't mean we're fatalistic and we don't plan long range. But all of those plans have to be held in the sense of if it is God's will. This experience has reinforced in a very stark way — especially with the loss of my wife on top of it — that there is no guarantee for the future as far as living in this sphere, this dimension, is concerned. We live one day at a time."