Tag: MRI

My Prostate And Me – Part 12


Well here we are again. After another long hiatus, I thought it was time to update you all. The lack of posts on this subject is purely down to, in part, happenstance and in part, inertia on my part. So, for that, I apologise.

So, my last post was back in 2020, following a five year hiatus. Only 28 months this time, I must be improving.

My previous post ended with me waiting for various scans, which were duly carried out, as follows:

  • 1st August 202 – CT Scan
  • 3rd August 2020 – MRI Scan
  • 11th August 2020 – Bone Scan
  • 25th August 2020 – PET CT Scan

Much as I like playing with all the NHS toys, I could do without the palaver of driving to the hospital, searching for a parking space, then waiting for my turn in the scanning department. Don’t get me wrong, I am very grateful for the attention that I am getting. Anyway, the net result of all these scans was, overall, a positive one. The scans indicating that there was no sign of the cancer around the prostate itself, and, apparently, no sign of metastasis. Prostate cancer apparently tends to migrate to the bones, or so I believed. So also getting the all clear from the bone scan was a positive thing.

Or, maybe the prostate cancer was hiding ?

Although there was no sign of the cancer around the prostate or in my bones, they did discover something in my lung !!! I became aware, very recently, that Prostate Cancer can metastasise to the lungs. So my case became the subject of one of the hospitals multi-disciplinary meetings.

Apparently there was much chin and arse scratching, bone tossing and probably some discussion about how Pompey were doing in the football league. The net is that my urologist talked to the chest doctors. They, the chest doctors, suggested that, whatever it was, was in a difficult to reach place. They further suggested that “we” should wait for 6 months and then have another scan. Then decide what steps to take.

My man, the urologist, didn’t think that was such a good idea. He felt, if this was the prostate cancer, it would be better to be proactive and treat it accordingly. Consequently he decided to start me on a course of Prostap injections.

And so it was that, on the 14th October, 2020, I started my course of Prostap. One injection every 4 weeks. This continued until November of 2021.

During this time, continuing blood tests and a scan showed the “thing” in my chest had shrunk and my PSA levels were dropping. In the words of my urologist, the “thing” had self diagnosed itself to be Prostate cancer. So we continued on with the Prostap jabs until, following a conflab with my urologist, we decided that I should take a break.

Apparently Prostap, along with most medications, comes with its own baggage. One potential side effect is the impact to ones bones, increasing the possibility of osteoporosis. With everything else that’s going on I certainly didn’t need that in my life.

I continued having blood tests to monitor my PSA and each of those was followed up with a telephone consult with my urologist. Always a very pleasant few minutes chatting followed by wishing each other well until the next call.

Latterly the calls included a concern about the fact that my PSA levels were bouncing around up to a new high of 3.2. Thats up from the zero point something I was at once the initial Prostap course was well underway.

At the end of August 2022, during a telephone consult with my urologist, it was decided that I should restart the Prostap injections. I had the first of the new course at the end of September. This time round the jabs are on a 3 month cycle and my next one is scheduled for March.

Following the last blood test, the Prostap, after only 3 months, appears to be working its magic. My current PSA level is 0.4 Great news by any measure..

From initial diagnosis, Brachytherapy in 2015 and thru to Prostap it has been an interesting experience. If, in the future, I have anything significant to report I’ll post again.

Before I go, I would like to thank all of the NHS staff who have handled my various visits to and stays in the Queen Alexandra Hospital, Portsmouth. You have, thus far, been amazing.

The journey, certainly isn’t over, but for now that is it.

My Prostate and Me – Part 11


“See you all in six months !!!”

So said I, five years ago. A lot has happened in those five years although not a lot in the land of the prostate. Or perhaps I should say, not a lot, to my knowledge.

In 2015 we retired, and since then, we rebuilt our conservatory, holidayed in France – 2months and Italy – 8  days. We have spent 3 stints in Australia. Those 3 Ozzie visits totalled 12 months in all with the last trip stretching into 7 months, in part due to the pandemic.

And so to my prostate …

After our return from the latest Ozzie adventure, I was scheduled for a Urology Consult (telephone) 28th July. As is the norm, these are preceded by the taking of blood samples. As my GP had requested a blood sample to check my blood sugar levels, it seemed appropriate to combine them. So on Wednesday 22nd July, at eight in the morning, I presented myself at my local surgery and provided the necessary samples. I then sat back to await the consult scheduled for the following Tuesday. The next day, Thursday 23rd, I received a call from the GP surgery, could I come in and give another sample.

Apparently they wanted to rule out any potential issues with the analysis of the previous sample. As you can imagine my brain went into hyperdrive, what had the blood sample shown. I duly presented myself at the surgery and gave up some more of my blood. Although the person on the call didn’t know why I needed to give another sample, the nurse taking my blood was a little more forthcoming.

It appears the first sample showed my PSA level was up.  This second sample was to determine if there had been a balls up in the lab or if something more sinister was happening.

Friday I received  call from the surgery asking if I woud be prepared to have a telephone consult, with my GP Dr Mannings,  on Tuesday evening. I pointed out that I also had a telephone consult with the Urologist on Tuesday morning. That’s great quipped the receptionist, you’ll be able to tell the doctor what the results are and what your urologists plans are.

With all this interest in my blood and doctors left, right and centre wanting to speak to me my curiosity was definitely peaked.

So Tuesday 28th duly arrives and I have my telephone consult with the Urologist, Mr Hodgson. Yes, he confirmed, my PSA has risen.

Apparently last June my PSA was 3.6 but these latest blood tests show my PSA at 7.9 and 8.9. A sure indicator that something is going on down in the nether regions although still lower than the 13.3 which was where I was at before having the Brachytherapy

Because of this my consultant wants me to have a series of scans. CT, MRI and full body bone scan. The call is ended with the promise that I will be contacted with appointment details.

Sure enough, later in the day I receive a call from the Scanning Dept., would I be available on the morning of Saturday 1st August, for a CT scan ? Yes of course, and so I am duly booked in for 09:00.

Later the same day I have my consult with my GP. He already knew about the consultants plans but is like a child being handed a bag of sweets, so excited, when I tell him that already have the first of my scans booked.

The NHS is actually working very swiftly and efficiently. Obviously I have Covid-19 to thank for this, the hospitals are operating in a very stripped back mode. All to my advantage.

Over the next few days I receive calls and set up the remaining appointments. Monday 3rd August @ 19:00 for the MRI and Tuesday 11th August for Full Body Bone Scan. The bone scan is in two parts. I have to turn to at 11:15 for a radioactive injection. Go away for a while, then return at 14:30 for the actual scan. Apparently, after the injection, due to its radioactive nature, I have to steer clear of any pregnant women and young children Same advice I was given after I had my Brachytherapy.

I duly attended the three scans. One thing I noted is that I am able to lay completely still during these scanning sessions. They each have taken anything between twenty minutes and forty five minute. At home I find it just about impossible to keep my legs still, whether I am sitting watching TV or laid in bed. Maybe I need to get a huge doughnut installed at home.

For each of the scans I also had an injection. The one administered during the CT, I was warned, would trigger a warm sensation in my nether regions. Something akin to wetting oneself. Not something you want to consider when typically any sensation in the bladder region typically turns into a pee panic. As it happens, the sensation I felt was around the neck and up around my ear. Something like I used to feel when my Mum had caught me out in a lie. For the MRI I was given an injection of Buscopan. When I mentioned that my wife takes Buscopan for her IBS te doctor said it’s the same stuff but won’t hang around as long but that it might affect my eye sight i.e. blur my vision. He assured me it would have cleared my system before I got back to my car for the drive home. As for the bone scan and the radioactive injection I was informed that, other than having to stay away from pregnant ladies and young children, there were no side effects, that I wouldn’t be aware of it in my bod.

All that remained was for me to await the results. I assumed that I would receive a phone call from my consultant, Mr Hodgson.

I did receive a phone call, but not from Mr Hodgson. It was from a yong lady, I assume from the Urology Department reception.

She informed me that she was calling to book me in for a Pre-op Assessment !!!

My heart dropped, my stomach did a flip. “Pre-op ?” I said, “pre-op for what ?”  “Well, you came into Urology yesterday” says the young lady. “Nope” says I, “I didn’t, I haven’t had any contact with Urology since the 28th July”. “Oh !” she says “And you haven’t seen the letter ?” Again “Nope” says I, “In fact I would have expected a phone call from Mr Hodgson, not a bloody letter”. She is really apologetic and puts me on hold briefly. When she comes back on line she asks me if I want to wait for the letter, or she could read it out to me. I take the latter option. So, she reads the letter to me. My heart and stomach resume a more calm state.

None of the three scans suggest any spread of  the disease.

Needless to say, this news was not what I was expecting. Nevertheless, it was encouraging. The letter, from Mr Hodgson, set out the next steps to be taken to determine if in fact my cancer has recurred.

Those steps are

  • A PET CT
  • Template Biopsy (to be carried ot under GA and the reason for the Pre-Op)

The PET CT has been scheduled for Tuesday 25th August @ 15:00 and I have had the Pre-Op. This was in two parts. Part 1 was on Tuesday 18th, a telephone assessment which was then followed up with a hospital visit on Thursday 20th, where they carried out an ECG, swabs for MRSA and took a urine sample.

So there we are, all up to speed. I’ll post my next episode after the PET CT and when I know the date for the biopsy.

My Prostate and Me – Part 10,


So at the end of my last post I had just escaped from the QA following my Brachytherapy procedure. This was to be a temporary escape as I had to present myself back at the hospital for a CAT scan.

So the following Monday I dutifully presented myself for scrutiny. Unfortunately it was organised chaos due to a lack of availability of notes. This is not the first time that my notes have not been available although it is more usual for them to not be available for an appointment that has been set up for weeks.

I did press the radiographer as to why it was necessary for my notes to be available when they knew that the scan was to confirm placement of the radioactive seeds in my prostate. I said that I assumed they knew where the prostate was and therefore where to target the scan.

She, very patiently, explained to me that having a scan 3 days after brachytherapy was not normal procedure. The norm is to have an MRI after about a month, so they needed to know if there were any other issues that they needed to be aware of. They did their best to find my notes, even going up to the ward to search on the assumption that they, my notes, were “in transit” due to the weekend.

My consultant must have foreseen this as he had provided me with an extension number on which he could be contacted, even though he was in surgery. I passed this number over to the radiographer and after a short chat with my consultant we were good to go.

So after nearly two hours pfaffing around I had my ten minutes of scanning and we were out of the hospital. Of course there is then a period of trepidation, waiting to hear if I was going to have to go back in for more seeds. As time passed I relaxed, no news is good news after all.

A month after the procedure I had the MRI. This was a much quicker visit than my previous MRI. I guess because this time they were only interested in checking the prostate itself and the immediate surrounding area.

Once again, there is that trepidatious period of time where you wait for the bad news phone call. And, once again, as time passed I relaxed.

The next check point in all this was to be a visit to the consultant preceded by a visit to the vampire clinic.

Which brings us up to date.

Last week I gave the blood sample required to check my PSA levels and yesterday I visited my consultant. After all the pleasantries, how is your bladder, how are your bowels, etc. etc. we eventually got round to the important business i.e. talking about my PSA.

Brilliant news !!

Prior to the brachytherapy my PSA was up at just over 13. Now my PSA reads just over 1. Which, in the words of my consultant means that the seeds are doing their job. My next check point will be in six months when I will have another blood test and another consult.

My thanks to Clotho, Lachesis and Atropos, the three fates (Moirai) for watching over me. I think they were watching over me last December when my operation was cancelled due to a lack of hospital beds. When I think about all the possibilities I am so, so glad that I have taken this path. 

See you all in six months !!!

My Prostate And Me – Part 4


So, It’s been a while, almost exactly a year. Had a fairly intense conversation with a close friend last night. The intensity was about Steve  Jobs and Apple, not my prostate, but that’s another story. Anyway during our conflab I was berated for not adding anything to my blog. In essence he was telling me off for leaving my story on another cliff edge.

As it happens I am approaching another significant milestone on this journey and by the time I finish this we’ll be at another cliff edge.

So here we go.

Consultations

Just before Christmas I had a meet with my consultant. Well one of them, seems I have three and they are not as entertaining as the Three Stooges, must be the subject matter. Anyway they take it in turns to see me.

I duly present myself at Urology Reception and after a short wait in the “General” waiting area we are ushered through to sit in a holding pattern outside the consultation rooms. I have been here a few times now and the wall opposite the seats isn’t getting any more interesting. Pride of place is given to a cross-sectional view of the male anatomy.

Urology Care Foundation - Urology A-Z - Ureterocele www.urologyhealth.org
Urology Care Foundation – Urology A-Z – Ureterocele – http://www.urologyhealth.org

I’m not sure if this image is the one I get to stare at, but it’s a close match. I keep expecting some hints on the prime cuts and interesting ways to cook them.

I digress.

So, seated in the consultation room, I am informed that the Template Biopsy hasn’t disclosed any new frightening discoveries. In fact this latest biopsy pretty much supports the findings of the original TRUS (Trans Rectal Ultra Sound)(See Part 1 above). Basically my cancer is quite small, isn’t raging doesn’t on the face of it appear to be life threatening. In my words we are effectively back at square one. That is, the situation is the same as it was around 18 months before.

Relief

 

Obviously, I was quite relieved and commented to the consultant that I had fully expected to have to make a decision following the biopsy results. He was quite interested to know what my decision was going to be. I explained that I would probably have opted for the operation, prostate removal. My reasons being that I would be able to fall back on radiotherapy if the cancer reappeared. Once you have had radiotherapy surgery really isn’t an option.

Lecture

The consultants response to this was to give me a fairly forceful lecture on the possible side effects to the surgical option. Urine leakage and erectile dysfunction being the two headline leaders. He hammered home what a life changing thing incontinence can be and that I shouldn’t go into surgery lightly. For a surgeon he was doing a good job of selling radiotherapy to me. He then went on to explain to me what a difficult operation it is to remove the prostate.

Apparently my weight was a big consideration here and it was at this point he asked me to stand up so he could lift my shirt and demonstrate. He explained that for keyhole surgery, even though this isn’t abdominal surgery, the entry point is through the abdomen. Having entered the belly they then have to turn due south and head deep into the pelvic region. He pointed out that as I was a big lad, with a significant “food baby”, the journey through my entrails would be a long one. That he wouldn’t just have to negotiate his way past all the tubing but would probably have to burrow through extra fat. A new twist was that for the operation I would be tilted head down, meaning that all my fat encrusted viscera would slop up towards my lungs to press against my diaphragm. Wasn’t this a good thing I enquired, won’t this clear the way  and make the operation easier. Nope, this migration makes life difficult for the anaesthetist. Yards of tubing heading north makes it difficult to keep the lungs full of oxygen. After this I wasn’t sure if he was bigging up his role or trying to dissuade me from having the surgery.

After all he is a surgeon, isn’t that his raison d’être. To be fair he did pretty much say that himself, that he just wanted me to be clear that surgery is not the easy option, nor is it without risks. I suppose I could have suggested that he had misjudged his audience since I was pretty well read up on the subject. I don’t let anyone go rummaging around my insides without finding out what they are supposed to be doing and what the pros and cons are.

Carry On Regardless

So, having come to an understanding I opted to carry on with the Active Surveillance with a view to probably having a scan and/or another biopsy. I must have given the impression that I wasn’t wholly convinced by his lecture and he was rather keen that I see one of his colleagues for an alternative view. This I agreed to do and we shook hands and parted company.

Approximately a month later I had an appointment with consultant number three. We discussed the biopsy results, the options open to me and the pitfalls of the various treatments. Once again it was agreed that I should carry on with the Active Surveillance. Part of the Active Surveillance regime is the taking of bloods on a regular basis, every 3 to 4 months, to monitor PSA levels.

PSA is not viewed as an accurate indicator of  the presence of cancer but once diagnosis is confirmed the PSA can give an indication of change.

Changing Perspectives

And so it was I found myself once again at the QA, being given an opportunity to brush up my male anatomy and finally sitting in one of the consultation rooms. No consultant this time as I was seeing the Nurse Specialist. She talked me through my history and pointed out that my PSA levels had gone up. Previous readings had plateaued but the general trend was up. Her advice, based on 18 years of experience, and taking into account my age, she was of the opinion that it was time to take action. This was a contrast to the position taken by the consultants who were prepared to let me continue with the Active Surveillance. We kicked the subject around and it was agreed that I should go for a MRI scan and that I should then see the consultant to discuss the results.

MRI

If it’s good for nothing else, prostate cancer is introducing me to some new life experiences. TRUS, Template Biopsy and now an MRI. Everyone that I have spoken to, that has had an MRI, have said that they didn’t enjoy the experience. I wouldn’t say that I enjoyed it either but I didn’t actively dislike it either. I did, however, find it interesting. It’s noisy and a bit claustrophobic especially when you are my size. As your lower extremities disappear into the centre of the doughnut the hole begins to look a bit small. And when the table moves further in and your belly and chest further fill the available, visible, free space I suspect that the experience is similar to sausage meat being transported towards the sausage skin waiting on the tube at the outlet on the mincer. Another interesting thing I noticed was that as the MRI is clacking and clanking away the muscles in my left leg started to move in time with the noises. Not twitches as such, just a slight pull. Similarly, my wedding ring was also pulsing in time. These sensations varied with the tone of the MRI. Eventually it was all over and I left the QA to await the call to go and discuss the results.

Decision Time

Time moves on very quickly when you aren’t keeping an eye on it. Before I knew it I was back at the QA staring at that same wall with the same diagrams and posters. Still no recipes. And then into the consultation room.

Much to my surprise he told me that the results were really quite good. That is the MRI showed quite low levels of cancerous cells and that these cells do not appear to have moved onto other areas. All in all the MRI was pretty much repeating what the Template and TRUS biopsies had shown before. The only fly in the ointment was the steady upward trend of the PSA which didn’t seem to be echoing what the scan and biopsies were saying. Once upon a time doctors told you what was going to happen and then got on with it. In these PC times it’s all about patient choice. The trouble is the patient is necessary best qualified to make the decisions. Even if they have all the facts in front of the. And that’s the dilemma that i was confronted with.

I had the diagnostic results all laid out before me. I had all the options for treatment defined. I just had to make a decision.Anyone who knows me will know that I can’t make a decision when I’m in a restaurant with menu in hand. And then it doesn’t really have life changing implications if I make the wrong decision. Here there was no truly wrong decision to be made but the implications were momentous.

Decision Time

In the end I decided to go away and think on it. Subconsciously I probably knew what my decision was, but mentally I wasn’t ready to say it. I pondered for several weeks and then contacted the QA and told them to put me on the waiting list for surgery. The consultant had told me it would probably be a couple of months before I got a surgical appointment so I was looking at December / January.

Appointments & Disappointments

A couple of weeks ago, on a Tuesday, I got a call informing me that my appointment had been made. It was for the following Friday. Three days notice.  Unfortunately I had other plans. The proposed day of the op we were due to go away over night and a week later we were heading up to Merseyside for a few days to spend time with family. Hotels had been booked and paid for and I wasn’t prepared to pass on those. The young lady tried to persuade me otherwise, telling me that “it’s really important that I had this operation”.

I wondered who she thought she was talking to. Wondered why she might think that I didn’t know the importance of the surgery. After all, I’m the one carrying the infected walnut around inside me. I’m the one going through the various biopsies, scans and blood tests. I’m the one who is being nagged by various family members to get on and have it done. She did, does, sound very young.

So, disappointed, she said she would call me again when they had another appointment for me. And that call came yesterday.

I have a busy week, next week. Monday I meet with the consultant. Wednesday I go for my pre-op meeting to see if  I am fit to have the op. and Friday at 07:00 I have to present myself at Theatre reception.

I’ll let you know how I get on.

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