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 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.

My Prostate and Me – Part 1


Here I am in my 60th year. I have made it through most of my adult life without suffering anything worse than the common cold and the occasional bout of flu. A couple of years back I was diagnosed with hypertension and have been taking tablets ever since to keep things under control. All has been well until earlier this year when I was asked to provide a blood sample as part of the regular monitoring. This time my GP said he noted that I hadn’t been checked for prostate cancer so he added it to the list of things for the lab to check out. Part of their preventive maintenance plan I guess. He told me to call in a couple of weeks to find out the results. and me being me, I forgot all about it and did nothing.

Until ……

Some time later I decided to go and see the doctor about a couple of moles on my shoulder. During the exam I mentioned the blood test and asked about the prostate element. After he pulled up my notes and following some chin rubbing he said “Your PSA is up a bit, perhaps we should book you in for an examination”.

Don’t you think that someone might have said something when my blood test came in ?

After all “No news is good news ….. Right ?”

Did they check the other stuff pertaining to my blood pressure ?

So I was left to go and make an appointment. While I am at the reception desk he calls me back in to the examination room. “Since you are here we might as well do it now” he says. A few minutes later he’s got a rubber glove on and I’m laid down on the couch, facing the wall with my knees tucked up under my chin.

After what can only be described as a “strange and unusual experience” he informs me that his exam was inconclusive, that he really isn’t an expert and feels it would be better if I was examined by someone with more experience. Personally I would rather that he had chosen someone else to practice on.

A week or two later I am up at The QA (Queen Alexandra hospital, Portsmouth) and I’m laid down on a couch, facing a different wall, with my knees tucked up under my chin. This time it is the lovely bubbly Vanessa with the rubber glove. This time I’m told that because I am tall, my prostate is quite high up and perhaps this is why the GP couldn’t feel my prostate. There then ensues a discussion about the length of my GPs fingers, me saying I hadn’t noticed from my position at the time if he had pianists hands and comparisons with Elton Johns chubby pudds. Meanwhile back on the couch… Vanessa thinks that we, I, should have another blood test to compare with my earlier one and that, based on that comparison, a decision would be made as to the need for a biopsy.

An appointment date is set and I am left to arrange a visit to the vampires at my GPs practice. I manage to fit in a  fortnights French holiday in between times, get the blood drawn and await the results.

On Thursday, July 26th, I have a short but bubbly telephone call with Vanessa who informs me that my PSA is once again elevated, that it is probably nothing, but why don’t we, meaning I, have a biopsy just to be sure. You can guess how enthusiastic I am about that. I haven’t been sitting idle, wasting my time. I’ve been on the interweb and found out how these biopsies are performed.

An appointment is made for Tuesday, July 31st. All too soon I am sitting in the Urology Dept waiting room and my name is called. They hadn’t warned me, but en-route to the torture chamber, they ask me to provide a urine sample. If I had known I would have made sure that I had plenty to drink. Needless to say I could not perform. Not a drop. “Stage Fright” says Vanessa.

Once again I find myself with my trollies down round my ankles, laid down on a couch, facing yet another wall, with my knees tucked up under my chin and my bum hanging over the edge. Now that’s an image to scare the kiddies don’t you think.

So the procedure gets underway, cold lubricating gel and the ultrasound wand is put where the sun doesn’t shine, anaesthetic is applied and the numerous biopsy samples are taken with the device clacking away with the sound of an industrial stapler. Job done, my bum is wiped and a man-sized pantyliner applied and I am packed off home, advised not to do anything strenuous. As if.

Thursday, August 30th, and I am once again at the QA. The Urology Dept. waiting room isn’t any more attractive. My name is called and introductions made. This time I am seeing Dr Dominic Hodgson. Where is the lovely Vanessa ?  After the pleasantries I am sitting waiting for Dr Hodgson to give me the “All Clear”.

So it’s all a bit surreal when he tells me that the biopsy has shown that I do in fact have Prostate Cancer.