My
MRI scan after my surgery
[10th
May 2014, Saturday]: Had my post-surgery MRI scan
this Saturday morning in the NHS UCLH hospital.
Was pleased with their efficiency: no waiting
around.
Also,
the radiologists were happy about my taking the
one Temazepam 10mg (as a mild sedative) about 20
minutes prior to the scan; they agreed that about
1 hour "hanging around" after the scan
should render me ok to travel on public
transport.
Well,
did that help?
Answer: yes! Certainly didn't feel claustrophobic
like I did last year (for the results of that
MRI, see above.
So,
what will be done with the results? Well, my
consultant will receive the report, and I expect
a consultation to discuss it soon.
You
notice I had the radiologist report for my first MRI. Well, I asked the
radiologist if I could similarly have that, plus
the full CD of all images, after my scan today. I
was told to contact them during the next working
week. There would be a charge to pay.
[13
May] Picked up copy of CD of MRI images
today-there was no charge, since I got them
within 40 days. Was told that the radiologists
don't also give a detailed annotated report as
for my first MRI. I now realise why - this second
MRI merely looks for the ablated
area, so will not report on remaining cancer, I
presume.
The
image below shows the cryo ablated (destroyed)
area-
the dark area.
The surgeon says "it looks very
good", so I presume that means he ablated an
ideal area.
(Remember:
"left" in the image is the right
hand side of my body)
I must say, the area ablated looks much
larger than the red area marked on my first MRI. However, the surgeon did say
that he would target an area a little larger than
that, to be sure all the
index lesion was killed off, plus I guess the
precision of the cryo comes into play.
If,
like me, you ask for and get your own
CD copy of your MRI images
[which you have every right to do, free, even on
the NHS], you may need to download
a MicroDicom viewer to be
able to view the pictures. This is the one I used
for Windows: Click here for the viewer it's free! This
"RadiAnt" version is incredibly good!
it handles both my private pre-op images and
my post-op NHS ones, unlike
the first viewer I downloaded and tried. You can
even measure portions
of the image, in linear and square quantities!
There are even better viewers for Apple Mac. Very
limited choice for Android, don't know about
iphone.
[15th
May]: follow-up appointment to discuss things
with the surgeon arranged for 28th May. PSA
blood test yet to be arranged, but been told will
be around 2-3 months time (update
- see below). Need to note
down questions to ask him.
See
"post-surgery consultation" for more details.
[13
June 2014]: I'd be interested to know what tissue
has replaced the
tumour and good tissue that was ablated. Some
months ago, "scar tissue" was mentioned
by another
surgeon
whom I talked to at UCLH.
|
Latest
updates follow here - my attempt to keep
a log of tests, procedures and results
that are continuing
Most recent results are listed first.
Contact
me
|
|
7th November 2020
Urine leakage
Thankfully, I'm noticing a significant
improvement, for which I praise God.
I now do not wear a pad or any part of one whilst
indoors. I can squat without any leakage, and
when caughing only occasionally slight feeling of
leakage, but no significant soiling of underwear
- not much different to normal after-urinating
dampness.
This
is most
encouraging, and may indicate that, buy next
summer, I'll most likely not need pads at all,
will be back to normal!
Erections
By using my own improvised penis ring (two very
small rubber bands!), I almost get the erections
I did before my surgery. But no spontaneous
erections yet (without stimulation, and no
"early morning boners").
Climax remians good.
27th
August 2020
Hospital telephone consultation
Prostate clinic nurse Karen
from UCLH phoned.
I was able to report my improvements as below.
She reiterated that my PSA of 0.01 meant an
effectively undetectable level, which is very
good.
My leakage - she said that I was doing very well,
particularly considering that I've had two lots
of focal therapy over the years, before my
ultimate radical prostatectomy.
She said that I should continue with squeezy
exercises, it should speed up my probable full
restoring to not needing pads. So I'll try to
increase from my present 1 a day.
I told her also of my recent ED results (see below), which she noted.
My
next UCLH appointment is 26th November, for a
physical consultation with the Andrology team to
have a penis pump demonstrated. The mind boggles!
25th
August 2020
Urine leakage: improved from
a few months ago; very little, some days none at
all. Mostly if I cough or squat then stand up.
Still doing one squeezy exercise per day, but I
feel it now makes no difference - I've plateaued
to no further improvement. From what I've heard,
I may be completely leak-free in about 1 year's
time.
Pads I'm using: Boots
Staydry Men Light Shields
For use around the
home, and occasional short expeditions outside, I
cut each pad in half, and add a bit of
double-sided tape! But for a full day or more
away from home, I wear one whole pad. This is for
my own confidence; the half-pad would still
probably be adequate for me.
21st August 2020
PSA blood test result from
UCLH: PSA = 0.01 (compare with 0.03 on 15th May)
UCLH intepret that as undetectable. So, praise
God, no indication of any residual prostate
cancer!
21st
August 2020
ED results
Picked up from
the chemist, Sildenafil, (sold under the brand
name Viagra among others) 50mg tablets. These
were requested by UCLH to my GP.
Supposed to improve erections.
Tried one: helped a little, but not a reasonably
firm erection until I used a small rubber band
(as an impromtu penis ring) at my penis base.
Climax seems to have reduced these days.
Don't have a wife, so can't comment re.
"firm enough erection for intercourse"
etc, but my guess is that I might have managed it
28th
May 2020
UCLH Follow-up consultation
with Prostate Cancer Nurse
A couple of extracts from her letters afterwards:
[To Professor
Ralph]: "..........He has
not noted any return of potency. He wishes to be
seen in your clinic and explore treatment options
that is available for him. He also would like to
be shown how to use the vacuum pump for penile
rehabilitation. I will be grateful if you can
offer him an appointment to be seen in your
clinic.
[To
my GP]: "...advised to [perform] [squeezies] a maximum of 5
times/ day instead. As performing a lot of
repetitions may not help build his pelvic floor
muscles." I had stopped altogether, since it
didn't seem to be reducing my 'leaking' any
further.
i'm planning on doing 3 per day.
23rd
May 2020
I've found I can manage with
the light pads.
Also, I use only half a pad, cutting it lenghways
along the fold, then adding my own double-sided
tape on the waterproof side. This may not work
once I get more active if/when I return to work;
I may need a full pad.
Next
consultatioin (presumably by telephone again)
with the clinic nurse on 28th May.
So, what's happend over the
last few months?
Well, my recovery at home has merged into my
being furlouged, because of the national
lockdown.
To help my "mental health", I've found
something to do for the NHS. See
what you think of my efforts!
So what of my recovery? It's been an exceptional
experience!
I've seen the hand of God in this: my cystogram
and catheter removal was originally booked for
more than 3 weeks after my surgery!
Not only did I not want the wear a catheter that
long, but the worsening Covid-19 situation was
steadily shutting down routine hospital
procedures.
However, with the help of the excellent prostate
nursing team, contactable by email, that
appointment was brought forward to 12th March.
MY
PSA as of 15th May: 0.03
ug/L. As far as I am concerned, that means not
measureable!
31st
March 2020: Telephone
consultation with Dr Anthony Ta.
Histology report on my removed prostate:
All good,
praise God! Cancer is well confined to prostate,
not spread to the capsule (thin layer of
connective tissue that covers the prostate). So,
no further treatment required.
Normally assessed as complete cure after results
(probably PSA) clear after 5 years.
Impotence:
Not really tried getting erection at this early
stage. And, being widowed, I'm not to bothered.
To me, the more important issue is continence.
Dr Ta said that ultimately, I'd be eligible for
Viagra, a penis-ring and pump! But, we shall see
if I bother.
Returning
to vigorous exercise:
At the earliest, he said 6 weeks, and even then,
gently ease back into it. My interest is cycling.
"Most of the internal tissues will have
healed by then, and gained their maximum
strength."
"More leakage may occur" - as I
suspected - "because of the greater
abdominal pressure".
But I could simply wear a more absorbant pad to
start with. We shall find out.
Also,
the Anti-embolism stockings:
YES! He said I could stop those now. (it's been
just over 1 month since my surgery)
Follow-up
PSA test at 3 months, then further consultation -
at present, it appears to be booked for Monday
29th June. I might try to get that brought
forward a bit.
31st
March 2020 - general
progress
So how's things progressing?
Well, all glues & stitches off, except one
just above naval, where the glue is mostly loose.
Continence: Much
improved! Needing inly one light pad at night,
and another in the day. ("Light"
corresponds to the 3 drips symbol")
Doubtless mostly a result of my doing plently of Squeezy excersises. Now I
do 5 per day.
It's likely I will return to a reasonably good
level of continence in the next few weeks, and
within a month may need only one light pad per 24
hour period.
Managing more excersise: walking in excess of 3
miles per day. Remember: at the time of writing
this, all of UK is in lockdown due to Covid-19.
So this becomes my one "rationed" walk
per day!
I
will pause here, to give God thanks - that my
surgery was performed, my catheter removed, all
before the Covid-19 UK lockdown.
I
had planned on returning to work yesterday (30th
March), but I'm effectively benefitting from a
very extended period of recouperation!
Only down side is I've been laid off work.
16th
March - my
continence
Encouraging. Only needed a nappy the day my
catheter was removed (12th March - see below).
Wore one that night in bed, but it was still dry
in the morining!
Been
doing the Pelvic Floor excersises. The NHS App
(£2.99) is very handy, it does
help you keep track of the excersises. "Squeezy
For Men" Obviously, on a
mobile device, search on your apple store or
google play.
Today,
I'm trying to see if I can manage the day with
just a level 2 pad. Mostly, I leak slightly when
I cough, stand up or blow my nose. Not
leaking other than then, for which I'm thankful.
Hopefully, I'll be fully dry sometime in the
months to come.
Wounds
- glue starting to curl off some ot them. Today,
one was holding on only by one stitch - cut that
with wire cutters (my risk!); all ok, wound
joined with no seeping.
14th
March
So - because of my
decreasing sodium level, went for a walk and
bought 2 jars of anchovies, packets of
hoola-hoops, and salted peanuts. (My normal diet
is to avoid uneccesary salt!)
"I spoke to Andrew over the phone today as
we have converted all our clinics to telephone
calls due to coronavirus.
Andrew had previous HIFU and cryotherapy for his
prostate cancer. He underwent a robotic
prostatectomy on February 27 and I am pleased to
report that he is doing very well. His final
histology revealed a Gleason 3+4 cancer, which
was organ confined and clear margins were
achieved.
From a functional point of view, he is down to
just two small pads a day. He has some day time
leakage with coughing and sneezing, but is almost
dry at night. I expect this will continue to
improve. Unfortunately he has not yet had return
of erectile function, but we will continue to
monitor this for now.
We will speak to him again in around 6-8 weeks
time after a PSA test. He may have this done
locally if he cannot get into UCLH easily."
12th
March 2020
Cystogram was very thourough
- performed at UCLH (been unable to find a better
web link to the details - please let
me know if you do!).
I
was able to see the x-rays of my bladder on the
screen.
They
were checking that the point at which the surgeon
had re-joined my urethra at the neck of my
bladder had healed well. During this time, the
nurse needed to push the catheter further into my
bladder. When it was difficult, she asked if I
minded her pulling back my foreskin! Ok, a bit of
a fun thing to mention for you! I also advised
her to try lubricant, which also helped with
pushing the catheter in.
When they were eventually happy with the cystogram results, they
removed my catheter.
So I sat up on the x-ray bed, and immediately
started to leak!
I was given a nappy and a towel.
Then, spent a few hours in the canteen drinking
coffee and juice so I could prove I could void
(pee) ok.
No problem there - was slowly leaking into the
nappy anyway!
Within a day or so, I only needed incontinence
pads, not nappies. Since locally sourced
incontinence pads are a bit expensive, I've taken
the nurses advice and now use Boots own brand.
Started with the Normal, but see above for
more recent improvements.
27th
February 2020
Praise God! By Monday (24th)
lunchtime, I'd arraged my surgery for Thursday
that week!
And again thankful! I was first on the list.
Recovery: very painful - ended up on a jab of
Morphene (lovely experience!)
Came home next day - most uncomfortable UBER ride
over the speed humps!
Been impressed with how quickly the surgical skin
wounds from the robot stopped being significantly
painful.
Now on the recovery route (as of 7th March)
Have
to give meself daily injections (ouch!).
Pre-loaded syringes of enoxaparin
thromboprolaxis.
Cystogram
(to check for leakage where he's sewn my urethra
back together) and if ok removal of catheter: on
Thursday 12th March.
Will then see if I'm dry (continent) or not.
I
have had a relative staying with me this week and
last, so that's a great help. Been for a few
short walks (about 500m) with them. Also just
about managed to sit through a 1-hour piano
concert on Saturday 7th March. Am using a
pressure relief ring cushion that helps greatly.
Planning
on going over the road to a local Church later
this morning (Sunday 8th March).
Catheter
experience: this is the 3rd catheter I've had to
have, must say is the most comfortable so far!
Possibly different catheter material?
Also, when I asked for a method of securing it at
the top of my thigh, they used a stabiliser.
Gave me much more confidence, particularly as
this time the catheter was in for 2 weeks.
21st
February 2020
Had consultation with Dr
Senthil Nathan. Told him I'd decided on
his surgical option.
Then saw Heather and hugged and
thanked her for her help in all this. Yes, It's
quite an emotional experience!
Dr Nathan said he'd requested a surgical
appointment.
7th
February 2020
Started the day at 9am at Hallam Conference
Centre 44 Hallam Street (just minutes from Great
Portland St London)
A good presentation by Surgeon
Greig Shaw (Their "medical
school").
Went through details of Radical Prostatectomy
using the Da Vinci Robotic machine. Also passed
around a few of the probes used in patients.
Allowed for interactive questions, of which I
provided quite a few!
Then a presentation from two clinical nurse
specialists who dealt with pracical issues such
as catheter and the injections they send you home
with to use to prevent blood clots.
Then onto my consultation with surgeon Dr
Senthil Nathan. Bit blown away with the
details. First time I've spoken to a radical
surgeon for over 5 years!
Then to oncologist Heather for my (now)
second consultation. Because I was still
undecided re Surgery or Radiotherapy she said she
wouldn't give me the first hormone injection as
originally intended. (It would have made surgery
more difficult if I chose that). Instead, I'm
continuing on the (milder) hormone tabs
(Bicalutamide 50mg 1/daily) which are also
halting any growth in my cancer.
I'm seriously considering surgery now - but then,
I seem to change my mind every two days! Good
reason indeed, for me to make this a matter of
prayer. Surgery does sound far more elegant than
the grueling hormone & radiotherapy route,
with it's possible permanent bowel and/or rectal
issues.
But I am very fit, which I figure will be a bonus
for recovery and return of continence if I choose
surgery. Because I've already had HIFU, I'm
kind-of resigned to being impotent after either
treatment I have. But we will have to wait and
see.
This is a very interesting article "Robot-assisted
Radical Prostatectomy After Focal Therapy". One of the
authors, Paul Cathcart, was head-hunted from UCLH
by Guy's and St Thomas's, where my brother had
his Radical. It suggests that the outcome for me,
having had HIFU, would be much the same as if I
had come straight into having a radical.
I have a surgeon consultation this Friday 21st
February in the morning then with Heather in the
afternoon. I'm preparing questions for each of
them to try to clarify things before my decision.
Will update this blog soon, and include my final
decision of this coming Friday 21st.
31st
January 2020 Consultation
with Prof
Heather Payne.
The
focal therapy is over. Now begins hormone and
radiotherapy.
My
hope that my apparently-decreasing PSA (see
below) over recent months, would mean we could
"watchful-wait" and "hope"
the cancer might go away: she said that "the
biopsy trumps the PSA".
This is what I expected to be likely.
Hence, the cancer does need treating, and the
only options at UCLH now are 1. Radical
Prostatectomy (surgery), 2. Radiotherapy
She confirmed the general medical consensus, that
Radiotherapy appears to result
in less likelyhood of lasting problems
afterwards, than does radical prostatectomy.
This
is one of many articles that deal with this
I'd already made up my mind that I'd prefer
radiotherapy.
The downside is that it's several months of
treatment and side-effects, whereas surgerty is
over in one day, although recovery can take
weeks.
Result:
Hormone
Therapy has started now: Heather
prescribed me hormone tablets Bicalutamide 50mg
1/daily.
I'll then return next Friday (7th February) for
my first hormone injection.
I
told Heather, again, of my dissapointment that
hormone therapy won't make me into a soprano (I
sing bass at the moment) (!)
Radiotherapy to start July.
Heather agreed that I've managed to postpone this
moment for 6 years with focal therapy.
But
she would still like me (and I'd also like) to
understand a bit more about surgery.
So my very busy Friday 7th February will have
this programme:
8:45am
group presntation about surgery
12:20am discussion with a surgeon
13:30 first hormone injection with Heather
As
I see it, I could still change my mind and have
Radical Prostatectomy right up to the time before
my Radiotherapy starts probably in July 2020.
Summary
of PSA over recent months
My readings to
date:
9 Nov 2018
|
14
May
2019
|
21 June
2019
|
Sept 2019
|
4 Dec
2019
|
5.2
|
HIFU
|
5.9
|
5.3
|
4.8
|
20th January
I told my MD how God's timing had worked out the
timing of the previous three days, 15th - 17th
January!
I told her about the likely treatment, how it may
involve the 2 hours each working day, during the
later 7-8 weeks. She then spoke to my boss and
the workload planner to summarise how it would
affect my working hours.
Basically, it will probably involve 2 hours off
work for the 7.5 weeks.
But that's why I chose the UCLH hospital all
those 6 years ago - it's conveniently near to my
office
17th
January 2020
Consultation with Prof
Heather Payne
Was told that radical prostatectomy was probably
not ideal, because of the small prostate.
Radiotherapy probably best treatment.
Given details of it - I was told it'd be around
10 months hormone
therapy, with the radiotherapy
starting around 3 months in. The hormone
treatment involves only a montly
injection/implantation of a pellet, pobably done
at my GP clinic.
For details of the radiotherapy click
here.
I asked abou the Proton Beam Therapy - a new
centre opening there later this year.
I was told there's no advantage in protons over
radiotherapy for prostate treatment.
Brachytherapy - they do only whole
gland, and that needs a
solid prostate, which I don't have, after having
had 2 lots of focla therapy.
Heather said her team would discuss me at their
next Friday meeting (24th January), when they
meet with my previous focal team to discuss
patients.
16th
January 2020
How God overrules!
When I told my company the not-so-good news, both
the MD and CEO called me in to his office.
They expressed concern, and offered to help in
any way they could.
15th
January 2020
Consultation - very pleased that I was seen by
Prof Mark Emberton!
But news not good; but honestly probably what I
suspected.
I have low-to-mid grace cancer in the right hand
side, (enhanced area) gleeson 3+4, 6mm. Left hand
side (previously treated area) is clear.
See my latest
MRI scan.
"No further focal therapy is possible. My
prostate is now tiny. The cancer is too near the
sphincter."
"You're making new cancers."
Well, I am an electronics design engineer, but
didn't realise that at the same time, I was
making new cancers also!
He referred me to the radiotherapy team.
Appointment arranged to see Prof
Heather Payne on Friday 17th.
10th
January 2020
PET Scan at UCLH
Nuclear Medicine
Very well organised: was called in slightly
before appointment time.
[18F]PSMA-1007 injection, 1 hour wait in the small
cubicle (I joked on Whatsapp how it
was like being confined to a cell 'cos I was
radioactive!), then a bit over 1 hour later the
scan.
Lovely new
scanner
Took two diazipam sedatives (GP prescribed)
because I'm calustrophobic.
Most uncomfortable part was having my arms above
my head throughout the scan - see the straps at
the grey headrest on the table.
Follow-up
appointment on Wednesday 15th January.
7th
January 2020
Template Biopsy at UCLH
Cancer Centre
Dr Thomas Collins said he'd be sampling more than
just the enhanced
area.
Went very well: arrived prompt for 7.30am. was in
theatre a bit before 9am.
During recovery, more comfortable than after
previous biopsy.
My
observation: my PSA seems to
have slowly decreased over 6 months: 5.9, 5.3,
4.8 (see below). So, it could simply be that it's
doing so slowly.
This may be one indicator that there isn't
significant cancer still in my prostate.The
biopsy above will show more precise detail.
4th
December 2019
Consultatioin with Caroline
Moore
Summary:
My MRI of 6th November "has shown some
enhancement on the right side of the
prostate"
For further details of this consultation
including MRI image
PSA test returned 4.8
click
here
Template biopsy now booked for Tuesday 7th
January 2019
Wholebody
PET scan booked for 10th January 2019
27th
September 2019
PSA test returned 5.3.
Emailed the UCLH Prostate Cancer Clinic Nurses,
told them Dr Thomas had previously said they'd
probably re-MRI if my 5.9 PSA figure hadn't
dropped below 4 by Semptember.
They said they'd review me at their Weekly Monday
Meeting.
I then had an MRI at UCLH on 6th November.
I now have a follow-up appointment arrnaged for
the morning of December 4th at UCLH, Westmoorland
Street.
19th
July 2019
See link below for more explicit details of my
progress, including Dr Thomas' consultation
letter.
click
here
10th
July 2019
MSU
result normal.
Consultation
at UCLH
Seen by Dr Thomas Collins.
He wasn't surprised by my increased PSA (see
below).
I'll ask my GP for another PSA test in September.
If the result is not lower, then I'll try
emailing UCLH to see if they'll give me an
earlier consultation than the one he arranged for
June next year.
I'll get a separate appointment for an MRI in May
2020. It's possible I may be given an earlier one
if my next PSA level hasn't decreased.
Since
I haven't had any recurrence of cancer in my RHS
that was treated, I asked him if it's equally
likely I won't get a recurrence in my LHS. His
comment was that "there's a 1 in 4 chance of
it recurring after treatment".
5th
July 2019
MSU sample provided.
No results as of 9th July.
Hopefully will have before my consultaion
tomorrow, although I don't think it'll influence
what the surgeon says much.
21st
June 2019
PSA blood test done; result
5.9
This is up from my November 2018 figure of 5.2
A week later, GP refused a re-test within less
than 3 months - "It won't have changed
yet".
But they did agree to an MSU (MId- Stream Urine)
test
I
queried this with UCLH hospital.
The Clinical Nurse Specialits emailed me back:
"The PSA can still be high at 3 months post
HIFU due to some swelling of the prostate. We
usually just check again at 6 months and if not
down then would consider an MRI at that point. I
think an MSU is a good idea
It's always best not to cycle or have any sexual
activity for 2-3 days before a PSA test
also" (First time I'd heard that!)
4th
June 2019
Retention re-test: now only
82ml !
Praise God for that! The threshold figure is
100ml.
Good that my anxieties about needing a lifelong
catheter are no more!
24
May 2019
Finding voiding sometimes a
little painful.
I contacted the Clinical Nurse Specialists by
email (supplied in their info booklet on
discharge) and asked about it:
"Is it normal to sometimes experience a
little urethral pain when voiding?"
"Yes it is on and off for 6 weeks. If there
is a lot or the urine is smelly take a sample to
the GP for them to test"
21st
May 2019
At trial without catheter (TWOC) clinic.
Catheter removed, pretty-well painless.
Then: around 3 hours of recording drinking and
voiding (pee-ing)!
Voided volumes good, but retention (post-void
residual, PVR) measured at around 170ml, which is
a bit high. No better after voiding 30 minutes
later.
Discussed
with nurse, and arranged an informal (no
appointment required) re-visit to her at TWOC
clinic in 2 weeks time (4th June) to re-check
PVR. "Just knock on the door at about
11am".
She said HIFU does cause the prostate to inflame
initially more that cryo; in earlier years, some
patients were re-cathetered, but not now.
Concern is too much retention could cause bladder
infection.
Hopefully, retention will decrease to an
acceptable level (around 100ml) within the next 2
weeks. It'd be tedious to have to take lifelong
medication, and I don't relish the idea of
another catheter.
Additional
observation: I've been passing a small fragment
(presumably of my ablated area) each time I void.
14th
May 2019
Had HIFU at UCLH
Cancer Centre
Was seen farly promptly after my 7:30 admission;
whole procedure was finished just before 11am,
after which time I was in recovery then settling
in the ward.
Before the procedue, I asked the surgeon to
ablate only as much as necessary. She said she'd
try to leave the very left side (near my prostate
edge) not ablated.
Most uncomfortable part is now at home, with a
urethral catheter for 7 days.
Time will tell how effective the HIFU has been,
both from a follow-up MRI (in 1 year's time), 3-
monthly PSA tests, and also over the months as to
continence and erectile issues.
Catheter due out on Tuesday 21st May.
I
enquired via email to a UCLH Uro-Oncology Nurse
Specialist as to why I wouldn't have an MRI a few
weeks after my HIFU, like I did 5 years ago after
my Cryo. (Scroll down a bit to see those MRI
scans and the one titled "18 days after
cryotherapy").
I was concerned the ablated area would not be
visible in 1 year's time.
They told me: "We
dont routinely do MRI after HIFU like we do
after cryotherapy , we can still see the ablated
area after 1 year".
Now,
I assume that either the ablated area won't
shrink or that their definintion of we
can still see the ablated area after 1 year really
means the "black hole" will be visible
or only scar tissue, remains to be seen.
Next
appointment after my catheter removal: 10th July
in clinic for, presumably, a review. I've booked
a PSA test at my GP's for Friday 21st June.
20th
March 2019 Consultation with
Prof Caroline Moore, at Westmoreland Street:
Cancer confirmed at the two points that were
highlighted on the MRI.
I have 5mm posterior of gleason 3+5, 3mm anterior
of gleason 3+5.
Click
here to see the now annotated
diagrams.
Click
here to see the histopathology
report.
The
way forward: I was given the
option of radical prostatectomy, radiation or
HIFU. I would like to retain my prostate for as
long as possible, so I've chosen to have HIFU.
Waiting confirmation of surgery date.
I asked about Cryotherapy again; I was told, as I
suspected, that Cryo could not be done in the
posterior area, since it's too close to my
rectum.
Caroline did mention that if I did subsequently need
a radical
prostatectomy, it may be more difficult to ensure
no cancer remained outside of my prostate.
However, HIFU is the route I've chosen.
I'm
also hoping that this HIFU may mean I won't ever
develop significant prostate cancer again,
although I accept that this cannot be guaranteed.
Caroline said that I would have a left
hemi-ablation, in other words (I assume) the left
of my porstate will be destroyed. This should
destroy both my anterior 3mm and the posterior
5mm cancer.
Click
HERE for explanation of
HIFU
Click HERE for my now
annotated MIRI report.
Friday
22nd February 2019: Template
Bipopsy performed by Dr Thomas Collins on the NHS at McMillan
Cancer Centre
This is a really nice, fairly new building.
I was told after recovery that 8 samples were
taken (this requires verification at the
follow-up consultation, I might have heard wrong
in the ward).
This is much less than in 2013, where 24
samples were taken. On that occasion,
there was a clearly defined, very likely tumour
visible on the MRI.
But this year (2019), I assume only 8 were taken
because there was not a very likely tumour
visible on the MRI.
Sedation:
Before my biopsy, I was concerned when I was told
by the anaesthetist that I would not be having a
general anaesthetic, but instead deep sedation. I
was worried I'd be aware of what was going on
during the biopsies.
I needn't have worried: I was "out"
just as if I'd had a genereal anaesthetic. As
with a general anaesthetic, the next thing I
knew, I was waking up in recovery.
The main difference is that you breath yourself,
and don't require ventilation as with a general
anaesthetic.
This deep sedation is probably more suitable for
very short procedures such as this biopsy.
Another interesting detail is that, when I told
the anaethetist I vomited after my last general
anaesthetic (a common recovery effect), he said
he'd give me anti-nausea medication as part of my
wake-up drugs.
Now
waiting for follow-up consultation appointment.
Update
February 2019
Because of forecast of heavy snow, managed to
re-arrange UCLH consultation for 1st February as
a phone consultation at the same date & time.
Apparently they do that often - many of their
patients live far away.
The consultant, Clement
Orczyk, Said he would request a
Template Biopsy for me. I subsequently had a
pre-assessment on 6th February.
Update
5 December 2018
MRI
results are indicative of possibly
significant cancer, but will only be sure if I
have a biopsy. Professor Caroline Moore at Londn
Urology Associates has written to my GP, asking
him to refer me back to her team at UCLH NHS
hospital for a Template Biopsy.
She did say we could monitor my PSA on a
4-monthly frequency, but because the pattern of
steady increase in PSA is in keeping with that
leading up to my previous diagnosis, I've elected
for a biopsy.
Also, regarding the supposedly higer PSA value
threshold for someone my age (65), Caroline said
that does not apply
to someone like me, who has had prostate cancer
before.
For
a full report from the Medical Imaging team, click
here. This will open a new
browser window.
Update
9th November 2018 - PSA
5.2ug/L
GP said to re-test in January, since for my age,
65, the threshold is supposedly 5.0, not 4.
However, I expressed concern that the steady
increase over the past few years is in keeping
with the values I had leading up to my diagnosis
in 2013. Hence he agreed to refer me back to the
urology team. I've chosen to start, as I did in
2013/2014, with the private clinic at Harley Street. My insurance will
fully cover the consultations and MRI (if I have
one). If I need further tests/treatment that they
will only do at Princess Grace Hospital, then
because that hospital isn't covered by my
insurers, I'll probably ask to be referred back
to the team on the NHS, at UCLH.
COMPARISON OF PSA
TREND TO DATE with PRE-SURGERY TREND
My readings to
date:
May 2015
|
Jan 2016
|
June 2016
|
Feb 2017
|
Oct 2017
|
Dec 1017
|
Nov 2018
|
2.54
|
3.22
|
3.7
|
3.6
|
4.5
|
4.0
|
5.2
|
My readings prior to my procedure in 2014:
2009
|
2011
|
Mar 2012
|
Jan 2013
|
June 2013
|
Jan 2014
|
2.61
|
3.94
|
4.19
|
4.93
|
6.2
|
5.8
|
IMPORTANT!
This
TREND in PSA readings is the IMPORTANT thing to
monitor. A SINGLE PSA READING is not sufficient,
it can be unreliable.
I've
a consultation appointment at Harley Street on
Monday 3rd December.
Update
4th December 2017 - PSA
4.0ug/L This is considered as "normal"
on my GP report, "no action needed". My
conclusion: although it's good that I don't need
to take any action, the trend over the last 2
years is upwards. It may be that this will be the
last time it will be 4.0ug/L or less. We will
see.
Update
13th October 2017 - PSA
4.5ug/L This is slightly above the ideal
threshold of 4.0. However, based my "Hospital
consultation at UCLH" about 1 year ago,
(see below) and chatting to my GP, I'll have a
repeat PSA in a few months time. And soon I'll
provide a Mid-Stream-Urine specimen.
Update
February 2017: PSA 3.6ug/L.
This indicates that the cryotherapy is remaining
effective - the cancer tumour appears to have
been effectively destroyed, with no evidence of
recurrence.
Update
June 2016: PSA 3.7 ug/L
Update
January 2016: PSA 3.22ug/l.
Prostate volume 23cc
Hospital consultation at UCLH Westmoreland
Street*: My cancer is now stable,
no evidence of any significant prostate cancer,
Recommendation: Remote Surveillance. Get 6
monthly PSA test done at my GP. If it goes above
4, then also do Mid-Stream-Urine test, to check
for an infection that may be giving the higher
reading. No need for another MRI provided PSA
remains below 4, see above.
[My understanding]: Repeat PSA 3 months later. If
still above 4, then go back to the hospital for
advice.
Note: a 6 monthly PSA test
should be mandatory for every
man aged 50+, see my notes
at the beginning of this blog.
I've put 3 MRI images taken in November 2015.
Compare these with my earlier ones below. Whilst
not commenting specifically on these, the
consultant said that the overall MRI
had not revealed any significant (observable)
prostate cancer.
[My observation]: I'm at no
more risk from prostate cancer than any other man
my age.
*This
is the new loacation of the Urology department
(as of the date of writing this). It is no longer
in the Cancer Centre in Huntley Street.
PSA result, May 2015: 2.54.
This is a slight reduction from 3.1 measured in
November 2014.
So, it's a trend in the right direction.
[the
following notes added on 24 November 2014]
18-day and 7-month MRI and PSA comparison - see
image below.
Explanation:
my prostate is roughly outlined in RED.
The original location of the tumour is roughly
outlined in YELLOW on the 18-days image.
The ablated area is outlined in GREEN on the
18-days image.
These
results show:
The
ablated area has shrunk to (I presume) no volume
at all.
My prostate volume has reduced by 5cc, which is
pretty close to the 5cc volume that Emberton
estimated would be ablated.
My PSA has rougly HALVED. The present PSA of 3.1
is within the range expected for a man of my age
(61 years) who does not have significant prostate
cancer.
My
conclusion: Success! Cancer treated*.
Side effect: reduced ejaculation.
Future plan for tests, surveillance: to be
discussed on 10th December with Emberton.
Watch this space! better still, check
my latest results.
*The
significant anterior tumour has been treated. I
am not experienced enough to recognise any
remaining lower-grade cancer by looking at the
MRI image.
Update
10th December 2014: Had
follow-up consultation with Emberton.
He said that it was "all good!" See below for his dictated
letter which gives a precise
statement of his observations.
He
said that there was scar tissue, outlined in the
2nd image above in BLUE. I guess this is the
left-over bit of the ablated area, see the 1st
image above, outlined in GREEN.
He
did not make any comments about any further
cancer being visible, probably because my PSA now
of about 3 does not suggest there IS any
significant cancer. Remember: all men my age will
have some very low-grade prostate cancer, but it
will probably never grow fast enough to catch up
with them as they age.
There is even talk of not
considering low grade
prostate cancer as cancer, see
this link.
The
future: I am to organise 6-monthly PSA tests
throgh my GP. If my PSA goes above 4, then I am
to contact Emberton again.
He
has arranged another MRI scan for me in 1 years'
time (November 2015).
Note
that the 6-monthly PSA tests are what I was
having for several years before
my diagnosis of cancer.
As I say at the beginning of this blog, it's very
advisable for all men
over 50 years old, to start having 6-montly PSA
tests and continue them for the rest of their
lives.
A
graph of my PSA is shown below. (The best graph I
could make; my PSA probably dropped much faster
than the slope shows, from a figure of about 6
before my cryotherapy, to a figure of about 3,
soon after my cryotherapy that I had in April
2014).
My
PSA steadily climbed over the years, until it
reached about 6.
Then, the cryotherapy knocked it down to about 3
again.
If it climbes again above 4, then I'll have
further tests. If necessary, repeat treatment
will be given.
However, it may well be that any remaining
low-grade cancer will never develop in my
lifetime to cause any trouble, see
this link.
This
report above is the very latest update to this
blog. Apologies again for it all being a bit
disjointed! I'll get round to re-writing the
whole page someday!
Update
February 2015: Regarding
"...a change in the quality of the
ejaculate" mentioned above: as mentioned
elsewhere, my ejaculation diminished to zero
about 4 months after my cryotherapy. However, a
very little ejaculate does appear after orgasm.
Emberton is probably familiar with this process
in some patients, hence he would classify this as
"diminished
ejaculaion", and not "zero".
My erections and sexual desire remain good and
unaltered.
Update January 2015:
Just received my copy of Emberton's consultation
letter.
"....he
has done fantastically well with almost no
toxicity. The only thing he has noticed is a
change in the quality of the ejaculate, which we
would expect, treating in the anterior component.
His PSA is now steady at 3.1 µg/l and the MRI
shows no residual disease on the
late [24 November 2014] scan. We would
recommend PSA's on a six monthly basis and look
forward to seeing him in December 2015, with an
MRI beforehand."
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