 
Peter
Walton lives in Victoria, Australia. He was 59 when he was diagnosed on November
5, 2005. His initial PSA was 8.1 ng/ml and his initial Gleason Score was 3+3=6.
Although he does not state his staging, it seems from what he says that it was
T1c. The treatment he decided on was Radical Prostatectomy. Here is his story:
I
was first alerted to the possibility of a prostate problem back in 2003 when my
(new) doctor enquired as to when I had last had a prostate check. I guessed that
it was at least 10 years prior, so I was soon up on the table undergoing that
digital rectal examination that all us squeamish men dread. The verdict was that
the prostate was enlarged but otherwise felt ok. However a PSA test was scheduled
with a 4.1 ng/ml result. Evidently with was not considered good for a 57 year
old so I was packed off to see a Urologist.
Another finger test: ?feels
ok but we should do a biopsy?. I was a bit shocked and left in a bit of a daze.
In the following days I did a lot of research and, perhaps with a touch of denial,
decided that I was not ready to be subjected to a biopsy and its possible side
effects. My reading suggested that the PSA test was useful but far from foolproof
and as a result too many unnecessary biopsies were performed. This was quite a
stressful time with restless three-in-the-morning anxiety. I decided on another
PSA a few months down the track. Result 3.6 ng/ml , not great but below the magic
4.00 ng/ml. Over the next two years my PSA results bounced around before taking
a couple of swift leaps to 6.00 ng/ml then 8.10 ng/ml. I also had the Free PSA
results reported as a cross check. Watchful waiting time was over.
During
this period a small cancer had been detected in a kidney which I had removed via
keyhole surgery. The surgeon did a brilliant job which saw me out of hospital
in 48 hours and back running within a week. The same urologist was now consulted
about the PSA. This time there was no avoiding the biopsy, about which I had heard
some horror stories. So in November 2005 in fear and trepidation I had a biopsy;
ten samples take. Under a local anaesthetic the procedure was only slightly uncomfortable.
I was not surprised at the results, two of the ten samples were positive with
a Gleeson score 3+3=6 . The good news was that this is low grade, detected early.
Prior
to biopsy I was told of possible side effects including blood in the urine and/or
semen and possible bowel infection. I read some useful literature so that I understood
what was involved. My first pass of urine had a small amount of blood, but blood
in the semen was a different story. Perhaps there was semen in the blood, it would
be hard to know. I certainly wasn't prepared for the amount of blood. From a practical
point of view use condoms until the blood has disappeared and perhaps it is a
good idea to warn your wife/partner. I wish I had been warned of the possible
quantity of blood.
Back to the main story. I was faced with some decisions.
I absolutely did not want surgery. A very good friend of mine had been one of
the first men in Australia to have brachytherapy. He had a great outcome. That
was what I wanted. But the gods had decided to thwart that idea. My prostate was
way too big, >70cc. If I really wanted brachytherapy I would have to go on to
hormone treatment for at least nine months to shrink the prostate to a size that
would make the therapy a practical proposition. Very frustrating. I didn't fancy
the side effects of hormone treatment, primarily the loss of sex drive, as my
wife and I still enjoy a very active sex life.
The urologist suggested
another meeting with my wife present and other members of the family if required.
This is very important. The consistent advice that I received from friends that
I consulted who had been through all this was: "be open, talk about it, the
worst thing I did was keep it to myself ". It was sound advice that helped
greatly.
So the decision really made itself. I knew I had a good surgeon.
I discussed with him his approach, the likely outcomes and asked a lot of questions.
I talked to two good friends, the one who had brachytherapy and one who had a
radical prostatectomy. Both had enjoyed good outcomes and were able to describe
their experiences. I had been reading a lot of material from web sites, but decided
that there is a point where you can simply confuse yourself. One disappointment
was that I couldn't have keyhole surgery due to the scar tissue from the previous
operation. I confirmed my decision with the surgeon, (stressing /nerve sparing),
and we set a date two weeks later. That allowed enough time for me to have a CT
scan, give two units of blood for use in the operation and practice my pelvic
floor muscle exercises. I didn't see any reason to delay. I wanted to remove the
problem, remove the anxiety and start my recovery.
December
21 2005
The
operation went as planned. The next morning, after the drain tube and monitoring
cables had been removed, I was able to shower, shave and walk, albeit cautiously.
Of course the dreaded catheter was still in place so I had to carry a bag with
me. It wasn't that embarrassing. Going to the toilet was difficult and painful
in the first couple of days, but a couple of suppositories got things working,
but it was still uncomfortable while the catheter was in.
I was in hospital
a total of three days and left with the catheter in place with a leg bag and a
larger bag for night time. It was a nuisance and a bit uncomfortable but nothing
more. The catheter was removed a week after the operation. I wore a pad for the
first day but found that I didn't need it. Perhaps all the work that I had put
in on pelvic floor muscle exercises had paid off or was it the surgeon's skill,
my fitness level, good luck or a combination of all of these. Very occasionally
I lose a drop but this is rare and does not warrant wearing a pad. I have to get
up once during the night but I suspect that need will disappear once everything
has healed up. During the day I urinate less than pre-op despite drinking water
all day long.
The pathology confirmed that the cancer was Gleeson score
6 and completely confined to the prostate. Good news.
9
January 2006
It is less than three weeks since the operation as
I write this. I am back at work full time and I have been back at the gym for
the last week, (upper body work only of course), have done a lot of walking but
haven't started running yet as I feel as if I have a groin strain on the right
side and I don't want to take a risk. There is of course some bruising and minor
discomfort and no doubt a few weeks of healing to go. I might be overly optimistic
hoping for the return of erections at this early stage, but there are other ways
of loving, (and there are promising signs!).
As you can see from all the
case studies available, there are lots of different experiences. I believe that
you can help yourself somewhat by keeping fit, enjoying a balanced diet, being
open and discussing the issues with your partner, family and friends. Then you
have to have a very good, very experienced urologist/surgeon that you trust and
can talk to. Remember, you are not alone.
It
is now four months since my operation. I had a blood test, CT Scan and chest Xray
last week and then a consultation with my surgeon. All the results were good with
no PSA trace and clear scans and Xray. I have had no incontinence problems at
all since the day that the catheter was removed, (a week after the operation).
Erections are a problem with only partial firming rather than an erection. Levitra
has been prescribed, (expensive little tablets!), I have tried one which provided
significant improvement but hardly impressive! There were some side effects: a
mild headache and some stomach impact which is hard to describe but resulted in
slight pain when when eating. I am not sure if these effects will prove to be
a problem. Otherwise recovery has been great and its good to know that everything
is clear. It
is just over six months since I had the operation and I am in very good shape.
Erections still need improvement but the Levitra has helped considerably with
penetrative intercourse being possible on accasions. I have found that the side
effects from the Levitra are only minor if I eat before I take the tablet and
drink lots of water. In my case if I have had more than a small glass of wine
beforehand then the tablet is wasted! But generally I think that my own erections
are improving as time passes. The surgeon said it could take a year. I am starting
to believe him! Just
before Christmas was the first anniversary my operation. My X-rays were clear
and PSA undetectable. As recorded earlier I have not had any incontinence problems
and my fitness and general health is great. However, normal erections have not
yet returned and I am starting to wonder whether they will. This has had a bigger
mental impact on me than I probably liked to admit as I was so confident that
I would recover fully. Sure I sometimes get "useful" erections without
the help of a tablet, but these would hardly give a stallion a fright! I am not
keen to take tablets regularly as for me the side effects are uncomfortable. I
have road tested Levitra, Viagra and Cialis; the later suits me the best with
the least side effects, but each person's experience could well be different.
I
guess I just have to come to grips with the change in my lifestyle and be thankful
that everything else is good. I
am about to reach the second anniversary of my surgery so it seemed a good time
to update my story. My X-rays were all clear a couple of months ago and PSA was
undetectable. Sexual function is pretty good, perhaps not quite at pre-operation
level as far as maintaining an erection is concerned but with a little occasional
help from Cialis I am very happy. I have been able to almost cut out Cialis only
using a low dose tablet occasionally. On
reflection, and discussion with my wife, the mental impact of the change in sexual
function, (or fear of change), was probably greater than I realised. I think that
it would have been very helpful if I had been offered some counselling from a
suitably experienced psychologist. Consider this if you are concerned about post-op
sexual function. Otherwise
life is good and it is great to have a clean sheet.
|
