Chris, Roddy, Luther & others.
Thanks to all posters who've shared their insights on this board. I offer my case-history to date in the hope that some of it may be helpful to those embarking on what can be a bewildering journey. P Ca patients interested in post-op experiences may wish to fast-forward to June 2014.
March 2011- I pitch up at my local urology clinic having scored PSA 4.7. Consultant Mr A performs DRE & can't find any obvious abnormality. Mr. A pens elegantly sarcastic letter to my GP, bemoaning lack of primary care counselling re PSA test & prostate problems in general.
Nov 2011- PSA is now 4.2. Whoopee ! Mr. A says to come back a year later.
Nov 2012 - PSA now 5.4 Locum consultant Mr. B thinks 5.4 high & wants to see me again in 2 months.
Jan 2013 - PSA now 5.88. Boo-Hiss ! Mr B advises TRUS B/X which I don't think sounds my cup-of-tea.
Mar 2013 - PSA now 5. Dr X from a sister hospital in the same trust performs TRUS-BX at my local clinic.
April 2013 - Mild communication screw-up at Urology clinic. I'm seen by a hesitant senior house clinician with a less-than-desirable command of English, accompanied by a medical student. She is under the erroneous impression that I've already been informed of the biopsy result. "No" I say, as brightly as possible in the circumstances, "that's why I'm here" . She looks horrified, & doesn't think to re-assess a situation in which the presence of the student may be inappropriate. I fear she may cry as she tells me I have 3+3 Gleason carcinoma in 5 of the 12 biopsy cores, involving 25% of the organ volume. Oh well.
May 2013 - Appointment with oncologist Mr C who enumerates the treatment options, & books me in for an MRI scan in the summer. Now that I am a confirmed prostate cancer suffererer I read as much literature on the subject as I can assimilate, & decide to modify my diet, which wasn't desperately unhealthy to begin with, to an ultra-low-fat, pomegranate-&-tomato-rich regime, while forgoing any bicycling activity.
August 2013 MRI scan.
September 2013. Repeat PSA & MRI result. Dr. Z tells me that the scan hasn't identified any obvious tumours or evidence of invasion of lymph nodes by the cancer & my PSA has dropped to 3.7, the lowest it's been since we stepped aboard this urological roller-coaster. It's reassuring, but I'm in a limbo of indecision regarding treatment options. Further consultation with Dr Z & Mr D decide me on the "active surveillance" route for the time being.
April 2014 PSA 4.88 & second biopsy performed. Again I've no real problems with either the TRUS-BX or its aftermath, but results are less encouraging. Gleason 3+4 with 2 out of 12 on one side showing some grade 4 cells. Bah ! So much for pomegranate juice.
May 2014, The MDT decide it's time to move me from active surveillance to active treatment, which now encompasses a bewildering array of more-or-less unpalatable procedures - 4 different types of surgery and another half-dozen radiological & hormonal options, all of which are rated as "equivalent in terms of outcome". Such stats are of course meaningless to individual patients. Advanced proton beam therapy available in some EEC countries isn't on the menu, as not approved by NICE. Cryotherapy not suggested as an option at my local, although I'm now intrigued to find that it is available in the UK.
After reading up as much as I can assimilate on websites such as this I opt for Robotic LRP.
June 26th 2014. Robotic LRP at local hospital. No post-op pain or complications & discharged 48 hours later. Very grateful for fantastic NHS care throughout. No real probs with catheter, & I'm even able to hop around on public transport.
July 11th 2014. Catheter removal & flow test, which specialist senior nurse pronounces to be very satisfactory. Sent home with bundle of info-sheets from Prostate Cancer UK & a starter-pack of pads. Pelvic floor exercises initiated, & slow improvement in leakage rates over the next 2 weeks, but still get through approx 6 pads a day. Dry at night, thank goodness. Will persevere with pelvics.
July 25th. Histopathology report indicates clear margins on excised prostate, so relief all round. I'm booked-in for a repeat PSA in 3 months time. Some commenting on this board seem to have to wait for 8 weeks for pathology results, which strikes me as unnecessarily prolonging an anxious time.
I think my story so far indicates the value of consistent PSA testing over several years, but it's salutary to realise that only 9 months elapsed between my scoring PSA 3.7, a level which would not normally trigger a referral, and confirmation of P Ca Gleason 3 + 4 in 7 out of 12 cores.
So that's it for now. Good luck to you all - & thanks again for invaluable support through this forum !