Rog T's Cancer Blog - My one year post radical prostatectomy operation review

 Today, I had my one year review, a few days shy of the anniversary of my radical prostatectomy last August. I had a PSA test last week and I knew that the PSA level was undetectable, which meant that I knew the review would be a pleasant chat. My continence is good and I have a level of sexual function, with some assistance from my trusty tablets. In short, I am in as good a position as I could reasonably expect. This time last year, I was in a state of turmoil, not knowing what the future would hold for me. The blog I wrote regarding my pre op assessment clearly contained hints of the disordered state of my mind. 

A year is a long time. A lot has happened. My recovery had several stages. The first two weeks, I had a cathetar, so was pretty uncomfortable. When that came out, the question was whether I'd be continent. I bought a stack of pads, but from day one, I didn't need these. Occasionally, there was a small dribble if I was inpatient and didn't empty my bladder properly. I've found there are two situations which can be problematic. One is where I drink more than four pints of beer and do not have a loo handy. The other, which can be more problematic, is where I am sitting down and I suddenly reach down to my left or right to pick something up off the floor. The strecth seems to open the sphincter to the bladder. A small amount f leakage will occur. The time this is most a problem is at band rehearsals, when I am setting up guitar pedals. It is not really enough to constitute a problem, but it is not pleasant. I did my pelvic floor exercises before and after, which I believe helped. I have tried to limit my caffeine input to three cups of caffinated tea a day (in the morning) and I try and avoid having more than four beers. If I am on a sessions, I'll have a single shot of whiskey instead for the round. Much of it is learning to manage situations. I don't go on massive drinking benders particularly often, so it isn't a big problem for me, but on a couple of occasions I've got carried in the moment and realised my mistake. Fortunately Thameslink trains have loo's. It's when I've taken the tube I suffered. 

As to sexual function, that is more of a work in progress. With the help of Cialis genre drugs, I can function sexually. I've not had what you'd describe as a sponatneous erection without them. I have full feeling when sexually aroused and can reach a climax. It is odd as the sensation is exactly the same but nothing comes out. One of the main reasons that men don't have surgery is fear of losing sexual function. It is not great to have to take pills, but on balance, it is better than death and I have a supportive partner. I discussed this with my surgeon and he said that male sexual function starts to decline from 55. As I am 62 this month, I should accept that I can perform with tablets and not be too hung up about it. 

So what was the alternative? Radiotherapy or do nothing. If I'd had Radiotherapy, I'd have been on hormone therapy for three months, had six weeks of radiotherapy and then had another year of hormone therapy, so I'd still have six months of treatment left. Theoretically, when this was done, my sexual function would have returned to normal. I was very much leaning towards this initially, when the team at UCL told me I'd have no sexual function post op. When Professor Eden told me that the neurosafe surgical procedure offered a far better chance of preserving function, I decided to go for that. I was pleased that I did. I would not like to still be in treatment. As to doing nothing? Well he said that I couldn't be sure, but most likely within a couple of years, given the pathology of my prostate, it would have spread. Then I'd have been on hormone therapy for life. 

The neurosafe procedure is only available privately. I was diagnosed originally in 2011, when I was 49.I have no idea how I'd have reacted to the news that my sexlife would be over.  I personally think it should be a default for all men under 55. It is expensive, but cheaper to the NHS than long term cost of men declining treatment and dying of the disease. 

Life moves on and life goes on. I was considering the future of this series in the blog. For the foreseeable future, I'll still be having quarterly PSA test and bi-annual consultations. There's a more than reasonable chance that it might be a rather boring series of 'everything is OK blogs', I certainly hope so, but only time will tell. Should I continue with it? I'm not a doctor so all I can really do is pass opinions. At some point, I may well put it all in a book of some sort. Would anyone be interested? It cast a shadow over a decade of my life. There are quite a few books on the subject, few have been satisfactory to me, as someone on the journey. Enough blokes get the horrible condition to make me think there is an audience. Who knows.

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About Rog T's cancer blog.

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. This was followed by two 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 2023 I had a RARP radcical prostatectomy procedure that, God willing, has addressed it. 

Got the picture?

Here is a song I wrote to raise awareness amongst men of the need to get checked for Prostate Cancer