Vivian Miles
February 2017
I made a rare visit to my GP during 2009 for a check-up. I knew nothing of prostate cancer, so didn’t mention it. Neither did the GP. This was an opportunity missed.
Your prostate is the size of a lemon; it should be the size of a walnut said my new GP during February 2013. I had mentioned “waterworks” problems. He suggested a PSA blood test. Result: a slightly elevated 5.2. I was referred to urology. (It’s worth mentioning that my GP did post-qualifying training in urology.)
A TRUS biopsy soon followed. Trouble-free. No-one seemed to expect a positive result (positive being generally bad in the medical world.)
Bad news: prostate cancer found in 5 out of 12 samples, Gleason 4+4 = 8. Full staging of the disease required said the consultant. He gave me a PCUK booklet. Bone scan and MRI followed. You’re extremely complicated said another consultant. Suspected spread to lymph nodes. Possible bone mets in one arm. Next day an MRI to a humerus and chest x-ray, both negative. Biopsy of three lymph nodes was recommended. My impression was they would prove negative enabling early curative intent radiotherapy.
Not so, all samples were positive. You will die of prostate cancer unless you’re run over by a bus first. The sky turned black. Why, said the consultant, is it that when I give this news to people I seem to be looking at two blank faces. Treatment would be hormone therapy and localised control radiotherapy. Oncology next stop.
Before meeting the oncologist, I obtained a second opinion from another surgeon. The prostate MRI was unclear because it had been taken after the biopsy, not before.
This meant that the diagnosis was wrong as to the disease’s extent. The recent lymph node dissection ruled out a radical prostatectomy and lymph node removal which would otherwise have been possible: too many holes in the abdomen. Treatment path was the province of an oncologist, but could be IMRT radiotherapy with curative intent to the prostate and lesser treatment to the pelvic lymph glands.
The consultant oncologist outlined the limitations of MRI scans, indicating that radiotherapy would not kill all the cancer cells in my prostate. This meant that I’d have to stay on hormone therapy for the rest of my life. More scans and meetings with other oncologists followed. Eventually curative intent IMRT was agreed with lesser treatment to the lymph node area. I also joined the STAMPEDE trial which included a clear programme for IMRT and a follow-up schedule of consultations over a 5-year period. No more queues in urology!
There was good news in the early stages: PSA dropped from 5.2 to 0.3 after the first hormone injection. A CT scan during August 2013 showed no disease progression since the April MRI. A later scan showed tumour shrinkage. IMRT went well and PSA has remained undetectable since completion in May 2014.
The diagnosis made me re-evaluate my life. I decided to “put something back” and became PCaSO treasurer and became more active in my village. I also joined the Cancer United gym to improve fitness and ward off the possible side effects of long term hormone therapy. All in all, I’ve met many interesting people and feel better than I have done for years.
by Vivian Miles
First published in PCaSO Updates 58
