39 radiation treatments. Eight weeks. Five days a week.

That’s what is ahead of me.

But before treatment number one could even begin, there was another step—one I didn’t completely understand until I was actually going through it.

Radiation simulation.

You may hear it called radiation mapping, CT simulation, a “sim,” or treatment planning.

Whatever your cancer center calls it, this is where the radiation team begins figuring out exactly how they’re going to treat you: where the radiation needs to go, how your body needs to be positioned, and how they can target the area being treated while protecting as much surrounding healthy tissue as possible.

For me, this appointment represented something else too.

It was another one of those moments in this cancer journey when everything suddenly became a little more real.

Okay. We’re really doing this now.

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This Isn’t Treatment Yet — It’s the Road Map

Before all of this, I probably would have simply called the appointment “radiation mapping.”

And honestly, that’s still one of the easiest ways for me to think about it.

They’re creating a road map.

Radiation simulation isn’t usually the first actual radiation treatment. It’s the planning appointment that comes before treatment begins.

The team needs to understand your anatomy.

They need to see how you’re positioned.

They need to understand exactly where the treatment area is and what’s around it when you’re lying on the table.

And for prostate cancer patients, that means becoming very familiar with two things most of us probably never expected to spend so much time talking about:

Our bladder and our bowel.

Welcome to prostate cancer.

Any remaining sense of embarrassment tends to disappear pretty quickly on this journey.

But there’s a reason those things matter.

Your internal anatomy can change. Your bladder fills. Your bowel changes. Gas can move things around.

The radiation team is trying to create a setup that can be reproduced as consistently as possible when treatment actually begins.

MILE MARKER

Radiation treatment may begin at the cancer center, but preparing for it can begin before you ever leave the house.

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The Appointment May Start at Home

Depending on your treatment plan and cancer center, you may receive very specific instructions about your bladder and bowel before arriving.

Your team may want your bladder comfortably full.

They may give you instructions designed to reduce stool or gas in your bowel.

They may tell you when to drink water, whether to eat normally, or how to handle your regular medications.

Here’s something I want to emphasize:

Don’t copy somebody else’s preparation routine—including mine.

Your treatment is your treatment.

Ask your radiation oncology team exactly what they want you to do.

Questions worth asking include:

How much water should I drink?

When should I drink it?

Should I eat normally?

Are there bowel-preparation instructions?

Should I take my medications as usual?

What happens if I arrive and my bladder isn’t full enough?

Those might sound like small details.

But I’ve learned that when you’re walking into something completely unfamiliar, the small unanswered questions can create a surprising amount of anxiety.

Sometimes simply knowing the routine makes the next step feel more manageable.

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Getting on the Simulation Table

When I arrived for mapping, this felt different from a regular doctor’s appointment.

I wasn’t primarily there to sit across from someone and talk.

This was about positioning, measurement and imaging.

The team gets you into the position they’ll need for treatment. Depending on the patient and treatment center, they may use supports or other positioning devices to help make that position reproducible when you return for radiation.

Then comes the imaging.

And one of your biggest jobs as the patient is surprisingly simple:

Stay still.

Which sounds easy until someone tells you not to move.

Then suddenly your nose itches.

Your leg feels strange.

And you become intensely aware of muscles you forgot you had.

But there’s a serious reason behind it.

The team is collecting the information they’ll use to build the radiation plan that will guide your treatments.

Your team may also talk with you about markings, tattoos, markers, imaging or other ways they’ll make sure you’re properly aligned each day.

Again, everyone’s treatment can be different.

Ask what applies to you.

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Does Radiation Mapping Hurt?

This is one of the questions I had—and I know I’m not the only patient wondering about it:

Does radiation simulation hurt?

During the basic planning process, you’re generally not receiving the therapeutic radiation dose that you’ll receive during your actual treatments.

That doesn’t necessarily mean the experience is completely comfortable.

You may have a full bladder.

You may need to lie still for a period of time.

You may already have pain or mobility problems.

And you may simply be anxious.

Anyone who’s been through enough cancer appointments knows that anxiety can make a 20-minute procedure feel a whole lot longer.

Here’s something I think is important to remember:

If something hurts, say something.

If you’re uncomfortable, say something.

If you don’t understand what they’re doing, ask.

You’re not interfering with your care by asking questions.

You’re participating in it.

That’s a distinction I’ve come to appreciate more and more throughout this journey.

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What Happens After the Scan?

Something else I didn’t fully appreciate before going through this:

They don’t necessarily scan you today and start radiation tomorrow.

There’s work happening behind the scenes.

The radiation oncology team uses the images and information gathered during simulation to build your treatment plan.

They’re determining where the radiation needs to go.

How the treatment will be delivered.

How they’ll approach surrounding tissues and organs.

And how they’ll reproduce your position when you return.

Eventually, radiation treatment may begin to feel almost routine.

You arrive.

You get positioned.

Treatment is delivered.

You leave.

But behind those minutes on the treatment table is a plan that required considerably more preparation than most patients ever see.

That’s why this appointment matters.

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From Zero to Thirty-Nine

And then comes the part I’m about to begin.

Treatment #1.

Then #2.

Then #3.

And eventually, #39.

Thirty-nine sounds enormous when you hear the number all at once.

Thirty-nine appointments.

Thirty-nine trips.

Eight weeks of having cancer treatment become part of your daily schedule.

But I’ve decided I’m going to track the treatments throughout this next chapter.

Not because I want my life to become a countdown clock.

Because I think there’s something powerful about being able to see progress when you’re standing in the middle of something difficult.

One treatment completed.

One more Mile Marker behind me.

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I’m Taking You Through This in Real Time

That’s also what I want this next chapter of Jonesing for the Journey to be.

I’m not looking back five years later trying to remember what radiation was like.

I’m taking you through it while I’m actually going through it.

The preparation.

Treatment number one.

The side effects.

The good days.

The difficult days.

What happens after five treatments?

Ten?

Twenty?

What does fatigue actually look like for me?

What bladder or bowel changes do I experience?

What happens emotionally?

And what happens to ordinary life when cancer treatment becomes something you schedule around five days a week?

If something turns out to be difficult, I’m going to tell you.

If something turns out to be easier than I imagined, I’ll tell you that too.

Because I’ve learned something important during this journey:

Fear loves an information vacuum.

Sometimes hearing from somebody who’s actually walking the road can make the next step feel a little less frightening.

That doesn’t mean my experience will be yours.

It means maybe knowing what’s around the next bend makes the road a little easier to travel.

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Five Questions to Ask Before Radiation Begins

If you’re preparing for radiation treatment yourself, these are five questions I believe are worth discussing with your own radiation oncology team.

1. Exactly what area are you treating?

Ask them to explain it in plain English.

You shouldn’t have to pretend you understand medical terminology you don’t understand.

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2. What do you need me to do with my bladder and bowel before each treatment?

Not what somebody on Facebook does.

Not what I do.

What does your treatment team want you to do?

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3. What happens if my bladder or bowel isn’t in the right position when I arrive?

Will you wait?

Will I need to drink additional water?

Will I need to use the restroom and start again?

Knowing the answer before it happens can remove a lot of unnecessary stress.

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4. What side effects do you expect during my specific radiation treatment—and when do they usually begin?

I think those two words matter:

My specific.

Cancer treatment is not one-size-fits-all.

Ask what your team expects based on the treatment you’re receiving.

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5. If something changes between appointments, who do I call?

Get the number.

Put it in your phone.

Know who your contact is.

When something happens during cancer treatment, that’s not when you want to be digging through a stack of paperwork trying to figure out whom you’re supposed to call.

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And Maybe There’s a Sixth Question

There may actually be one more.

It’s whatever question is sitting in the back of your mind that you’re worried sounds stupid.

Ask that one too.

I’ve learned again and again that sometimes the question we’re hesitant to ask is exactly the question that needs to be asked.

That’s why Ask One More Question has become such an important part of what we’re trying to do with Jonesing for the Journey.

Don’t confront.

Don’t assume.

Don’t walk into the appointment believing you know more than your medical team.

But participate.

Ask.

Clarify.

Understand.

Take an active interest in your own rescue.

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The Next Mile Marker

The next time you see my radiation-treatment counter, it won’t say zero.

Treatment #1 is next.

I’ll show you what happened.

How long it took.

What it actually felt like.

What surprised me.

And whether the reality matched everything I had built up in my head before walking through the door.

Then we’ll keep moving.

One appointment.

One treatment.

One Mile Marker at a time.

Cancer changed our plans.

It didn’t get to steal our purpose.

So we keep asking questions.

We keep moving forward.

And maybe by documenting this road as I travel it, I can make the road just a little easier for the person coming behind me.

I’m Mike Jones.

This is Jonesing for the Journey.

And so… the adventure continues.

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Watch the Video

🎥 Prostate Cancer Radiation Mapping: Is It Painful? | My Experience

Watch the full video on YouTube

Ask One More Question

If you’re navigating cancer appointments, treatment decisions or conversations with your medical team, download my free Ask One More Question guide at JonesingForTheJourney.com.