His urologist explained that there were two standard treatments for prostate cancer: surgery or radiation with or without testosterone suppression (also known as androgen deprivation therapy, or ADT). As he wrestled with the choices, he pushed his care team for alternatives, but they told him these were the only treatment options. Put off by what he’d heard about conventional X-ray radiation, he opted for surgery.
Elworthy’s surgeon used nerve-sparing techniques, removing the prostate while attempting to preserve the surrounding nerves to increase the likelihood of maintaining normal sexual function following surgery.
“Unfortunately, it still had negative effects,” Elworthy said. “I ended up with stress urinary incontinence that has really impacted my life.”
Even worse, his six-month follow-up after surgery was not favorable. His PSA was detectable and kept going up over the following months. Elworthy asked his providers about next steps; that’s when he learned about proton therapy, which is unavailable in Colorado.
Intrigued, he decided to visit proton therapy centers to find out more. One of them was Fred Hutch Cancer Center in Seattle.
“I had read about a clinical trial at Fred Hutch that would benefit me and hopefully present others with better treatment options in the future,” Elworthy said. “Everyone at Fred Hutch was so responsive. It was very fast and straightforward to get to see specialists, including one of the clinical trial researchers. I got to consult with Dr. Jaime Takayesu about proton therapy, too.”
Elworthy had developed a urethral stricture after his 2023 surgery, which is a narrowing of the ureter, the tube that carries urine from the kidneys to the bladder.
Urethral strictures can obstruct urine flow and potentially lead to kidney damage, and it presented a challenge for the follow-up radiation treatment. Takayesu wanted to target the surrounding lymph nodes and the prostate bed, but worried that it would make the stress urinary incontinence and urethral stricture worse. Elworthy pushed for a more conservative plan.
“Dr. Takayesu worked with my sensitivities,” Elworthy said. “She was very professional and one of the kindest clinicians I’ve met throughout this two-year ordeal. Her expertise and care are top tier.”
According to Takayesu, standard of care is to treat the prostate bed, where the prostate used to be, and the lymph nodes in the pelvis.
“But because of his surgical complications, we decided to treat the lymph nodes only, which is less toxic overall than treating both areas,” Takayesu said. “We used protons to decrease the dose to the bladder, to ensure that radiation didn’t contribute more to his existing urinary issues, and so that we could come back and treat the prostate bed more easily if we had to in the future.”
Using this approach meant that Elworthy was no longer a candidate for the clinical trial that had drawn him to Fred Hutch. But he said he truly appreciated the strong case Takayesu made for using proton therapy to his insurance provider.
“She went to great lengths to present a case for protons to my insurance, with so much attention and detail. I am extremely grateful,” said Elworthy.
Elworthy started proton therapy in January 2025 and found that it was so much easier than what he expected from radiation treatment. The most challenging part, he said, was filling his bladder before treatment because he didn’t have full control over the muscles there.
He suffered some side effects, including bouts of diarrhea, which are less common with proton radiation than with traditional X-ray radiation; he also experienced some fatigue, but was still able to join a gym and run part way around Lake Union several times a week.
“The staff were a pleasure to interact with,” Elworthy said, “and the waiting area is ideally suited for this challenge in life. The personal touchpoints before radiation were so much better than expected, the people so decent and humane and a wonderful cast of characters. It was all a heck of a lot easier than I expected.”
Elworthy finished proton therapy in early March and testosterone suppression via ADT in July 2025.
Today, his PSA is undetectable, and his testosterone levels have bounced back. His red blood cell count is still slightly low, but nothing that his providers are too worried about.
“I’m relieved to be done with all the treatment, and I’m feeling optimistic,” Elworthy said, adding that he has two vacations planned and is considering a trip to Australia as well. “In the event you have to deal with cancer, the care and expertise of Fred Hutch is worth exploring.”
