A personal story
My own experience of the perils of this unseen little gland – ’13 grams of danger’, as one specialist put it – is instructive, because it is fairly typical of what happens.
I had been ordered to have the usual battery of tests that most doctors like to see every year or so. My PSA had been comfortably around 2 or 3 for years. When I saw my GP, this was the exchange:
- GP: Everything’s good, though your PSA is a bit high.
- Me: What’s the PSA?
- GP: A measure of what’s going on in your prostate.
- Me: What’s ‘high’?
- GP: 4.4.
- Me: Is that bad?
- GP: Anything above 4 we watch carefully. It could be an infection. Let’s do some more tests early next year, to see how it’s going.
Next year, it was higher again.
- GP: I’m afraid this is not good. You should see a urologist.
And so off to the specialist. He performed the digital exam – the famous finger up the bottom. The gland was enlarged. Beyond that he was not prepared to guess.
- Specialist: Is there any history of prostate cancer in your family?
- Me: My father.
- Specialist: How serious?
- Me: He died … after it spread.
- Specialist: Then we need to do a biopsy to see what’s happening.
The local guy wanted to do the old through the rectum probe. By then I’d started doing serious research on what could be done and I realised that procedure carried a high risk of infection. I needed the latest and the best. And so, with remarkable swiftness, off to the big city to see a surgeon specialising in the latest technique, a trans perineal biopsy.
An Associate Professor of surgery in Melbourne performed the biopsy. The biopsy came back with a Gleeson score of 7.
- Surgeon: This tumour is a serious concern. We can wait, but I would urge you to take action without delay. It’s a reasonably aggressive one. It could spread. Time is critical.
- Me: If we go ahead, what will you do?
- Surgeon: Remove the whole prostate, using a new robotic technique [the ‘da Vinci’ method], which is much more accurate, and try to spare as many of the nerves around the gland as possible. That’s to minimise the worst effects and try to preserve erectile and urinary function.
- Me: When should we do it?
- Surgeon: I would suggest within weeks.
And thus, on a bright Autumn day in 2015, I was wheeled into the operating theatre in a big Melbourne hospital. In the corner was a massive white machine – like something out of Star Trek. There were more technicians and nurses than I could count.
The surgeon asked how I felt. The anaesthetist smiled and said, “You may feel a little sleepy…”
When I woke up, there was almost no pain. But there were six puncture marks on my belly – the sutures covered up where the machine had gone into me. There was a catheter secured to the inside of my leg. And I was now without a prostate.
Immediate effects? A tenderness in the perineum (the smooth skin between anus and scrotum). Not surprising. The little nut shaped gland that used to live in there, just above the bottom, had been cut out, the urethra sutured and restitched to the bladder. The body was seriously discomforted. Sitting was difficult. We were driving up country for a holiday a couple of days after my discharge, and those country roads were murder. Also a lack of control of urination – for the time being. Pads were necessary for some weeks. And as for sex … on hold for the time.
Within weeks, those effects had largely abated, and everything had settled down. It was time to wait and see if all was well. The key test was still the PSA. If it remained ‘undetectable’, all was well. The ‘prostate specific androgen’ it measures can only come from the prostate – and I had no prostate. If the reading went up, there was a chance that some tumour cells had escaped.
We can fast forward to 2018, three plus years on. The PSA, tested every three months, had decided to go up to 0.8, and then to 1.2. This is not a problem in normal guys with a prostate – in fact they can be happy with such a number. But in a prostate free zone, the number is too high.
This time I saw a radiation specialist, recommended by the surgeon. And he arranged a second line of treatment, this time EBRT (radiation). The procedure was to take place over five weeks, in the lead up to Christmas. The place: Peter MacCallum Hospital, Australia’s number one cancer treatment centre.
The worst thing about the procedure was not the little tattoos they marked on me – to give reference marks for the rays – a ‘grid’ on the belly you mind say. The worst thing was not the noise – though that was scary at first – a bit like the sound made by Dr Frankenstein’s machine when he brings his monster to life. The worst thing was having to manage the bladder to within plus or minus 50 ml of 200 for each treatment. This meant ingesting water from a little plastic cup, topping up the bladder to get it half full. Any less and the bladder was not sufficiently protected against the rays. Any more and your eyes were bulging with the effort of keeping it in.
The technicians and staff – fantastic. The procedure itself – painless. And after five weeks of this, the cells where the prostate had been, and few areas of lymph gland nearby, had been irradiated to the point that (in theory) those sleeper cells were terminated.
And so, more surveillance. Every three months. Then every six months. And then every year. And … cross fingers … no recurrence.
The key is to do something, preferably when the tumour is still inside the prostate. Cancer can be a silent killer, but if removed before it has spread, a man has excellent chances for a full recovery and a good life ahead.