Radical prostatectomy post op consultation four weeks on - Rog T's cancer blog

 This monring I had an 8am call with Professor Eden following my radical prostate biopsy on 9th August. Professor Eden was pleased with the results. The pathology report showed that 10% of my prostate was cancerous. This was a far higher percentage than I'd previously thought (4% was mentioned).

Here is what the pathology report said

Microscopy: Adenocarcinoma of acinar type; Gleason score 4 + 3 = 7, right lobe; 3 + 3 = 6, left lobe; Approximate tumour volume 10%; There is no extraprostatic extension and the tumour does not involve the base/bladder neck or seminal vesicles; There is no lymphovascular invasion; The apical, base/bladder neck and circumferential margins are clear of tumour. The paraffin sections confirm the frozen section findings of clear margins. There is focal fibrosis in the right lobe posteriorly that would be in keeping with previous HIFU. 

Here is what the picture looked like. Note being a pathologist I cannot really draw too many conclusions, but I am assuming that the circles on the picture denote cancer. 

This is positive and seems to indicate that with regards to the cancer I am cured, although I will be having regular PSA tests for the foreseeable future to ensure that this is the case.  With regards to continence, I have had no major accidents. There is a small degree of spillage, mainly after urinating, if I forget to count to 10 before 'tucking up'.

As to the erectile function. Professor Eden has written to my GP to request tadalafil 5 mg a day to try and restore function. According to the professor, the nerves in the area are quite bruised. The medication, which is similar to viagra, will help stimulate blood flow. 

Professsor Eden feels expressed the opinion that surgery was definitely the correct option given the condition of the prostate. I am relatively lucky in as much as the cancer was caught at an early stage and had not spread beyond the boundaries of the prostate.

In life, you have to deal with the cards the way they are dealt. This journey has been a difficult one. I imagine that for the foreseeable future, every PSA test will be dreaded and any positive results treated with great relief. Cancer is deemed a lifetime disablity. For me, the process was a slow burn over 12 years. In the intervening time, several of my friends have also developed the disease. One in eight white men and one in four BAME men will fall foul of this disease. Just consider that when you are out with friends. I am a passionate believer in men getting screened, be it PSA tests or MRI scans, which seems to be a more accurate measure. If I hadn't had a PSA test in 2011, I'd not have known. I would have found out when the cancer had spread. Men do not talk about these issues, which is not healthy behaviour. Some people have said to me that things like erectile function are private and have questioned motivations for speaking about it here. To me this is a childish and foolish view. I belong to several Facebook prostate support groups  (here's one and here's another) and through these I've learned a lot. Sharing information helps you to get the best options. If the medication I've been prescribed has the desired effect, I will mention it here, so that if there are people who are being given different treatment options that don't work see it, they can ask their doctors. Likewise, if it doesn't work, I will ask my doctors about other treatments I've heard about. 

Bear this in mind. There has never been a better time in the history of the planet to be diagnosed with prostate cancer. It can be devastating, but there are new treatments being developed all of the time. There's more and better support for everyone. The treatment I had, with neurosafe and nerve sparing was not available when I was first diagnosed. When my uncle was diagnosed in the 1970's, his testicles were removed, to lower his testosterone levels. Things have moved on. Sadly, my Uncle died eventually due to the cancer. If any member of your family has had Prostate cancer, you are far more likely to develop it, so you really should be considering a test. Early treatment is the key. 

I wrote a song to encourage men to get tested, based on my own experiences. If you like the music, please come along to the Dublin Castle, Camden Town on Fri 15th September, to help me celebrate my survival of this phase of my life!

--- About this feature 

For those of you who are regular readers and have read the previous posts on Cancer, there's what this is all about. I write this blog because knowledge is power and if you know what you are dealing with, you have more weapons in the locker to fight it. It is a personal view, I'm not medically qualified. This is for the sole purpose of information for those who are interested.This is the latest installment in my occasional series about how I'm adjusting to living with a big C in my life. 

 For those of you who aren't, here's a quick summary. I'm 61 years old and in October 2011 I had a prostate biopsy following two "slightly high" PSA tests - 2.8 & 4.1. The biopsy took ten tissue samples and one of these showed a "low grade cancer" which gave me a 3+3 on the Gleason scale. I was put on a program of active monitoring. In early February, I got the results of the a PSA test - down to 3.5 and an MRI scan which found absolutely nothing, two more tests in 2012 were at 3.5 and 3.9, in 2013 my test was 4.0, Jan 2014 was 3.8, August 2014 was 4.0, February 2015 it was up to 5.5 and my latest in August 2015 was down again at 4.6. In October 2015 I had a transperinial Prostate biopsy, that revealed higher grade cancer and my Gleason score was raised to 3+4 (Small mass + more aggressive cancer). On 22nd Jan 2016 I had HIFU (Hi Intensity Focused Ultrasound) treatment at UCHL). 

My post procedure PSA in May was 4.0 which was down, followed by 3.7 in August, and 3.5 in October which means that the direction is positive . However in January the follow up MRI revealed "something unusual which requires investigation" After a follow up biopsy, it appeared this was nothing to worry about. My two most recent PSA tests were Ok (3.7 and 4.6) and an MRI scan in March was very positive. A PSA in October 2019 was 4.6, so stable and good news, the last in May 2020 was 5.45 a small rise, so worrying, however after a review against the most recent MRI, it was decided that this was fine. My two latest ones in February 2022 was 6.7 and October 2022 was 6.6 was stable. 

In March 2023 had an MRI scan that showed 'significant change'. This lead to a biopsy that indicated a tumour of 4mm that had a gleason score of 4+4. A PSA test in June saw a rise to 12. On 9th August, I had a radical prostatectomy and am currently recovering. Early days, but hopefully the surgery has curedthe problem of cancer. The new challenge is to recover full continence and erectile function.

Got the picture?