Case Study Ten:
I
was diagnosed with prostate cancer three years ago, at age 79. My PSA, zero or
close for years, had slowly risen to around 4. Physical inspections of the prostate showed normal. Ahh - the
thwack of the rubber glove. Other than getting up at night to pass urine (three
times nightly by then) I had no symptoms, but a routine GP check-up showed the
prostate to be enlarged. A PSA test returned 14.3 and she referred me to
Urologist Chris Hawke. He confirmed her findings, took samples and organized an
MRI scan, transrectal ultrasound and biopsy and PET/CT scan. These were
completed by mid-February 2018.
Chris
told us that prostate cancer was confirmed, Gleason score 4/4. It was big,
aggressive but confined to the prostate.
The
options were -
1. Do nothing. It could be 10 years
before symptoms appeared but by then
it was likely to be untreatable. Given my age this was a possibility but we decided, not for us.
2. Interventions. Brachytherapy was not available because of
the cancer’s location. That
left surgery, radiation, or chemotherapy.
The
latter two did not appeal. Surgery in the form of radical robotic prostatectomy
was his recommendation and we opted for that. Waiting times in Auckland led to
surgery at Grace Hospital, Tauranga (which was outstanding). It had the right
equipment and was affiliated to Southern Cross.
Surgery
was on 5th April 2018. Scheduled time was about four hours but
problems with the catheter extended mine to six. Radical prostatectomy is done
with the patient facing downward and tilted head down to keep the innards away
from the equipment so on arrival back in the ward two hours late, my face was
bunched up around my nose. This plus the two hour extension caused my wife some
angst. The procedure was painless, initial recovery steady and I was discharged
on day three with catheter in place, heaps of information about the road ahead
and various medicines for pain, etc. (in the event, none were needed).
There
were regular follow ups with Chris. The cancer was contained within the
prostate. No evidence of malignancy was
found on the biopsies. Ongoing PSA tests post op have remained at zero. The
catheter was removed at around 3 weeks. Bladder function slowly returned to
normal helped by pelvic floor muscle exercises, which I still do. I wore a pad
for a few weeks then no longer needed it.
Comment:
·
Chris
said most of his referrals were between 58 to 68, with no symptoms. For this
group, usual recovery time to normal activities after laparoscopic surgery was
around six weeks to three months.
·
After
effects varied. Erectile disfunction was variable and largely dependent on
lymph node disturbance or removal (as was the case with me). Bladder leakage
usually responded to physiotherapy - most people fully recovered but a few
needed further help.
·
I
was surprised to learn that at my age some surgeons would not operate. He was
comfortable to do so due to my reasonable fitness levels and good health. He
expected that recovery and problems would take longer and be more difficult. He
was right. Physically I progressed reasonably well but brain fog, memory
problems and fatigue dogged me for some months. This may have been due in part
to anaesthetics - the anaesthetist told me pre-op that some pretty heavy stuff
would be used and there would be after effects, some of which might take a year
or two to wash out of the system - and so they did. I hallucinated off and on
through the first night (at one stage with a group including a man in a suit of
armour and an African chief in full grass kit and headpiece, all standing
around amiably while a grey cat stalked through disdainfully. Cool. There were
diminishing repeats for a few days but I didn’t recover completely for some
time (guess the extended time of the op didn’t help).
Postscript:
Occasionally,
prostate cancer treatment can result in lymphoedema and after a few months my
right leg began to swell and was so diagnosed. There is no cure, but it has
responded well to exercises and a compression stocking, worn daily. It causes
no problems. So, all good. The care, warmth and professionalism of everyone
involved was faultless, we can resume our trips overseas to see our family and
life is great.
Beat the drums about
regular PSA testing!
