YANA - YOU ARE NOT ALONE NOW

PROSTATE CANCER SUPPORT SITE

BRONZE

Nigel H and Trisha live in United Kingdom . He was 57 when he was diagnosed in June, 2008. His initial PSA was 9.1 ng/ml, his Gleason Score was 6 (3+3) and he was staged T2b. He is undecided as to his choice of treatment . Here is his story.

I presented at the GP with blood in urine and semen, but had modest urinary difficulties too. GP noted "hardness" in my prostate from DRE, and so I went to the urology department of my local hospital (Gloucester Royal Infirmary).

Three week later, I had a cystoscopy (looking for bladder/urethral problems, I think), and found that I had a very large diverticulum of the bladder. (Actually, it was even quite 'fun' to see live the trip through my urethra and into my bladder, and in and around the diverticulum itself.) No cancer of the bladder or other abnormalities were apparently visible. The urology specialist's DRE seemed more 'thorough' than my GP's (or do I mean "more uncomfortable") and she said she could feel hardness "on both sides", so they ordered the biopsy. (I also had an ultrasound scan of the region, also without any (negative) result.) I remember being amused at being referred to then as a "young man" -- I hadn't been called that for quite some time!

Although I was nervous about the biopsy beforehand, I really can't say that it caused me any problem and the people were wonderfully caring and careful. Three increasingly tense weeks later, I met the consultant urologist, to get the results. I knew he had bad news, as he didn't 'look me in the eye', and one of the attendant staff had a 'What you need to know about Prostate Cancer' booklet in her hand. The biopsy showed one positive core from nine on each side. (I don't know whether this is normal, but the procedure was to collect the cores into two batches (nine from left side and nine from right side), and the two went off to path labs separately. So, although they knew that one out of nine was positive for PC from both samples, they couldn't tell from where in the prostate the positive samples were taken. The Gleason score assessed was 3+3=6 from both samples (but I don't know what proportion of the positive cores looked cancerous).**

Two 'staging' procedures followed, within the next three weeks: a CT scan using some kind of marker, and an MRI scan. Neither showed any definitive signs of metastases, but the CT scan showed an "abnormality" in my left kidney (it just looked like a bright spot to me), which the radiographer apparently thought might just be an artefact of the procedure (whether hardware or software, I didn't find out), so I was referred for a renoscopy (scope of the ureter/kidney).

A further three weeks later, and I get to stay for half a day at the hospital, as this procedure can only be tolerated under general anaesthetic. (That made me nervous, as I had never had a general anaesthetic before: nervous enough to rewrite my will beforehand.) Unfortunately, although the investigation itself went fine, I had contracted an infection, which took two separate courses of antibiotic (and six weeks) to resolve. The investigation did not reveal any kidney problem, which was good news.

So, I am now in the position of evaluating the treatment options. As it seems my PC is confined to the gland, initially it seemed that all options were open, and I went to see the oncologist who carries out the brachytherapy locally (and because his good reputation had preceded him -- at least as far as my GP's surgery!) I was attracted to the promise of a short hospital stay, but, mostly, to the expectation that this choice would minimise the risk of impotence. In considering the suitability of men for that treatment, however, an important issue is the degree of obstruction of urine flow, because in the first few weeks after the radiation sources are implanted, the prostate swells, which can lead to further obstruction. So I'm just now going through urine flow-rate tests to assess this.

So, my current position (like many others, I expect) is that I am waiting to gain more information, before deciding what to do. (My wife would like me to "get a move on"!)

Nigel

 

UPDATED

November 2008

 

 

I have decided 'for the time being' to choose AS. My PSA is stable (after two further tests) and I'm content for now that I cannot improve my situation by 'rushing' into treatment. Apart from yourself, I have spoken to many men, and read others' stories, and I have concluded that, for now at least, the 'quality of life' factors outweigh the 'potentially shortened lifespan' factors for me. Obviously, this is very much a personal judgement, and others will prefer to 'get the tumour out' almost whatever the impact to their quality of life.

Nigel's e-mail address is: nigel_harrison@lesoftco.co.uk

Initially, six needle biopsies were the order of the day, although twelve needles are the 'standard' now. Eighteen is unusual. What Nigel relates here is very poor practice indeed. A good pathology report should indicate precisely where the samples came from and the amount of positive material in each sample. [back]