Case Study
Eleven:
It was five years ago that the realm of prostate
issues first entered my life in a personal manner. I don't recall having
friends or relatives associated with the issues caused by prostate malfunction
prior to that. In truth, the first was probably my younger brother who
ultimately went through an extended and difficult period od treatment and
finally surgery over in Australia. Interestingly, we learnt during our journey
that Perth and Melbourne were particularly sought-after centres of prostate
surgical proficiency that we would eventually need to consider.
However, that was back in 2015. My PSA had
dramatically risen to an historical high rapidly and the process of treatment
was not helped by the fact that, at the time, I was commuting between Auckland
and Christchurch weekly while I was employed to assist those requiring claims
resolution in the wake of the Christchurch earthquakes. The symptom then was an
apparent slowing of urine flow. After being referred to a leading Auckland
urologist it was ascertained the issue had come down to a urinary tract
infection and a slightly enlarged prostate - apparently both ailments were
mutually exclusive.
So, with all the necessary tests and reporting done I
was prescribed anti-biotics and we agreed to monitor my condition rather than
extend the application of prescribed medicine.
Within a period of two months my PSA had thankfully reduced to a more
relieving 3 from the high of 12.4.
Job done, I thought! Just an annual blood test which I
have to admit was not an issue for me - I was very committed to such important
self-discipline for many years!
A little over three years later things rapidly
changed. A regular blood test in April 2019 highlighted a rise of my PSA to a
level of 5.7 - not high by some standards and a little below the 25% increase
since the last test that some doctors apply as a benchmark for further
investigation. However, it had risen quite quickly, and I will. always be
hugely grateful to my young doctor who had the conviction to pursue the matter
further. He got no push back from me!!
Memory is a little faded nearly two years later, but
things moved fairly quickly. My GP quickly got me a referral with a respected
Urologist, Michael Mackay at North Shore Urology. First stop, an initial
meeting to go through all the options to consider and to book in for a biopsy.
The latter was done on June 28th, 2019, and the resulting review
meeting will forever live clearly in my mind - "Sorry to tell you -
you have prostate cancer!!"
That started a frantic two months before I was wheeled
into the operating theatre at Southern Cross Glenfield on Tuesday September 10th
to meet Michael Mackay and his operating robot "da Vinci!".
The journey through those two months was where so much of the learning,
questioning, evaluation, challenging was done before we settled. on the final
process.
This was the time to consider treatment options. The
most prevalent were keyhole surgery to extract the prostate, or radiation, and
for the latter a good number of options. Michael had kindly covered all off
including an interesting process called Brachytherapy. This seemed more of a
positive option than full on radiation and we very quickly became aware of all
potential downsides or outcomes from each.
Meantime, I am thinking that I've got this damned
thing inside me and I want to sort it out, if not get it out as quickly as
possible! We were encouraged to be thorough and not rush by our surgeon and by
our wonderful GP also. I still didn't know too many who had been through the
process other than one mate from Wellington who had the surgery process earlier
that year in Tauranga and had researched the total subject meticulously. The
best advice for me was to do the same. The questions flowed easily - but were
we asking the right ones? Doubt and confusion were high up on the daily list of
things to sort out! Perhaps the on salvation at this time was the knowledge
from Michael Mackay, that the results of the biopsy weren't too bad. Yes, there
was cancer there but in layman's terms it was a low grade, not immediately
threatening and indeed I would still probably die of older age than prostate
cancer. The likelihood of change was minimal so that was a bit comforting.
I paid a visit to a good, well respected mate of mine
up here in Mangawhai where we had now moved to permanently. He had been through
a terrible cancer journey but was so effusive about his much-lauded Radiation
Oncologist, that he insisted I just had to go see him. This was going to be the
make it or break it as to which of the options we went with. With an
introduction made for us, we went straight back to our GP who agreed on the 2nd
opinion and immediately sent a referral through to the wonderful Giuseppe
(Peppe) Sasso at Mercy Hospital. Somehow, we got an appointment on the day he
was due to leave for overseas - what a break for us!
That was certainly a ground break meeting. Like
Michael, Peppe was thorough in presenting the options but just as Michael was
very pro surgery, Peppe was hugely enthusiastic about radiation. We quickly got
to eliminate Brachytherapy and that was through the knowledge and experience of
the man who was once one of the world's leading exponents of that process -
Peppe himself. The trouble he explained was simple. Whereas he had, in the past
done as many as 300-350 brachytherapy operations himself a year in Europe,
there wasn't that many done in NZ any year by a long stretch. Issue -
availability of experienced practitioners and thus we were happy to cross the
brachytherapy option off the list. There were several options for radiation,
but I really didn't fancy staying down in Auckland every weekday for 6-7 weeks
for a radiation burst given we had only recently moved to Mangawhai recently.
Peppe was also comforted by the biopsy report that we didn't need to rush
things and he proposed that we wait 6 months as he would like me to be a
patient in a new, shorter radiation trial he was planning. But first we had to
have an MRI to take a closer look at that dreaded thing inside me.
That was done on August 27th. Clarity of
part of the MRI imagining was in part compromised by the parts that made up my
left hip replacement nine years earlier. However, the MRI report appears to
suggest no major cancer presence. The definition was PIRADS 2 which is defined
as "Low - (clinically significant cancer is unlikely to be present)."
Armed with all of this information my dear wife Ali
and I returned to my GP and we made the decision to go with the surgery through
Michael Mackay. I simply wasn't comfortable in just waiting around, doing
nothing while there was a living cancerous 'thing' inside me.
We got a very quick option date for the surgery and at
0630 on Tuesday September 10th we arrived at the hospital. Yes, we went through
all the potential downsides again including the potential for loss of male
virility and were convinced the risks were far outweighed by taking decisive
action to remove the prostate - and with that hopefully any chance of future
prostate cancer.
Thank god we did! Again, in layman's terms my
interpretation of what was found is as follows. "More cancer than had
been anticipated and at higher levels than the moderate levels identified in
the biopsy. Some of it - not a lot, but never-the-less some at the most
aggressive grade 5 and a small element apparently just outside the capsule. Our
hearts sunk. - what if - what if??"
So, the recovery began, and we learned to live with
"the bag" although to be fair that really wasn't an issue. Patience
is a critical factor here (not necessarily something I am know for) and as the
pain from "da Vinci's six incisions gradually abated my bladder control
and flow slowly returned to normal. That said, it did take to a good three
months to feel comfortable. You just have to get on with all the elements
associated with such an operation and make the most of life and any discomfort
you may feel regarding happenings in those nether regions.
Over time, like a lot of things, memories fade and it
is difficult to recall all the experiences that, at the time, I said "I'll
have to remember that." I can recall the elation of getting "back to
normal" and having the catheter taken out. A couple of nights later I
slept through the night for the first time in ages and hadn't needed to trip to
the loo. One morning I awoke about 6:30 am, duly did my business and noted a
relatively large piece of dried blood come through my flow. I thought nothing
more of it having been told numerous times that this would happen. However very
shortly afterwards I was doubled up in the most excruciating pain I have ever
experienced. I screamed, momentarily passed out and screamed again and Ali
called the ambulance. They couldn't do much when they arrived as the pain had
dissipated somewhat. As it transpired, I experienced something that is very,
very rare. At the time of planning to remove the catheter I was given a
cystogram to check all was well with the bladder, etc. All appeared fine, but
it seems that a little blood clot had probably come out of the area of the
bladder that had been "sewn up." Just microscopic, but urine dripping
into the parts it is not meant to go most likely caused that unbelievable pain.
It happened once again that day and Michael Mackay, to
his endearing credit, got me to come straight back down. He checked everything
out, re-inserted the catheter and we have never looked back. The way I Iook at
it, this was an absolutely rare occurrence, but just added a little bit more to
the overall experience - no doubt the one element I could have done without.
Even with best surgical care there is always the possibility of something
unexpected happening.
So, the only remaining element of angst was the
results of my first and subsequent PSA tests. Six weeks after the operation I
had my first one, and thankfully it came in at a low 0.06. The lingering
concerns about whether the cancer had escaped the capsule were greatly reduced.
Happily, I can report that subsequent tests (now out to six monthly) have all
continued to come down, and we currently sit at a level I have never been at.
What they call " immeasurable," as it is below 0.05. Wonderful!!
Fifteen months on I feel fine. Sure, I get up to empty
the bladder through the night, (normally just once), but even that is getting
less and in fact might well have more to do with my penchant for enjoying a
chardonnay or two. Only one function hasn't improved, but then we were well
advised on that and Michael Mackay was very happy to provide me with a script
for the little blue pills. No worries - we are alive and very thankful we took
the collective decision to have the operation there and then and extract the
prostate in total.
As it transpired that, for me was a lifesaver, without
being too dramatic about it. It is interesting just how the most sophisticated
external exploration of what is inside us can't always deal up the reality of
what is actually happening. There were risks and other potential results from
all the possible forms of treatment - good and bad. In my case, I am convinced
that the ultimate risk would have become much more of a reality if we had just
waited because the cancer would have got me before age did!!
