route for all men aged 50 or over:
1. Have a PSA blood test at least once
2. If the value is above 4, then repeat every 6 months.
3 If, over 1 to 2 years, the value shows a steady increase, then:
4. Ask for a Prostate MRI scan.
I will admit that
this blog may appear a bit disjointed. However, I
have built it up over several years, from the
time I was originally diagnosed with prostate
cancer in September 2013.
To begin with, it was a shock to hear my
diagnosis, and hence my earlier notes may have
been one way of venting my feelings
during that time.
However, without completely re-writing the whole
blog, I still
hope it will give some helpful details I have
discovered during my experience.
Please note: this blog
includes a summary of what you can find elsewhere
on the web.
My purpose of this blog is to share my personal
experience of my Prostate Cancer investigation,
diagnosis and treatement from
a patients point of view.
It also contains some personal medical
information about myself.
I am happy to share this, because my desire is to
try to raise awareness
of the improved diagnostic
and treatment procedures
for early stage prostate
cancer. This I hope to do through describing my
Note that the MRI I had and
Template Biopsy are available on the NHS (see
discussions later). Most of my treatments were carried out on
Obviously, I am
not a qualified medical practitioner.
I am a patient, describing my
experiences, and commenting on my
observations. I think the legal term is:
I'm "acting entirely in a personal
capacity" (!) Always
consult with a qualified medical
practitioner before making decisions
regarding your own personal treatment.
would advise every man aged 50 or over to have an
annual PSA blood test.
Around 37,000 men in the
UK are diagnosed with prostate cancer each year
It is a medical
statistic that black men are twice as likely to
get prostate cancer than white men.
I am 61 years old (as of
April 2014), and had a significant prostate
cancer tumour, but only knew about it originally
thanks to having 6-monthly PSA blood tests. I had
no other symptoms.
these PSA readings with those up to 2018, click HERE
In 2013, my
cancer tumour was then definitely confirmed using
the technique in the video below (MRI September
then TPM Biopsy October) (and, no: I'm not the
actual patient in the video, but I would have
looked much the same!) Please note
that this Template Biopsy is
now available on the NHS
at UCLH and other NHS hospitals
Warning: contatins some
I had the above TPM Biopsy in
October 2013, under a very short general anaesthetic. As
Emberton explains in the video, it's important that the
patient is very still.
It was probably lots more comfortable than having it
under a regional (local) anaesthetic. My recovery was
about 3 hours, so not much different to recovering from
For those of you interested in
my actual biopsy samples taken, click
here for the histopathology
Below is my
diagnostic MRI scan (September 2013), showing an
"80% 1cc likely tumour" (Red areas on
My TPM Biopsy (as
discussed in the video above) then confirmed it
was localised prostate cancer (12mm Gleason 3+4).
For those of you
interested in my actual biopsy samples taken, click
for the histopathology report sheets.
The treatment technique
I initially chose was Focal Hifu.
This appears to be an excellent treatment, but
IMPORTANT!! My cancer WAS NOT detectable on:
1. Digital (finger) rectal examination
2. Ultrasound scan (rectal)
3. Emberton said that the more common TRUS biopsy
would most likely have not detected my anterior
tumour. See first video
Hence it's essential to
start having an ANNUAL PSA blood test once you
reach age 50. I anticipate I'll do that for the
rest of my life, and so should every man. A blood
test is SO simple!
If you want to skip
straight to my results after my surgery, please click
The video below explains
HIFU, and also mentions Nano Knife:
If you want to
know more details of what happens in the above
video, the Patient Informatioin Sheet below
includes details of HIFU. Please note that this
also includes extra after-test details, which
only apply if it's done as a trial at UCLH. I was
originally going to have it
"off-trial", hence these extra
after-tests wouldn't have applied.
Originally Emberton was going to give me Nano Knife privately at
Princess Grace Hospital. However, since my insurance didn't cover
that hospital, I transferred to UCLH for my cancer treatment.
At that time, Nano Knife was being trialled at UCLH on the NHS,
but I didn't qualify since I also had other residual prostate
cancer, see my diagnostic MRI scan above.
Every patient in England has freedom of choice to selelct their
See the referral
contact details below.
I wanted to continue treatment under Emberton.
UCLH was not my local hospital, so I specifically requested to be
referred to it.
I originally said
I'd have HIFU at UCLH, but on reflection, considering the
location of my tumour, I decided that Cryotherapy would be
better, since it wouldn't have also ablated my prostate near the
HAPPENS DURING CRYOTHERAPY?
Watch this video made by Galil, the designers of the
machine used on me.
above video appears to show whole
gland therapy, rather than the focal
therapy I had. Emberton says I should end up with only
about 5cc of my prostate ablated, which sounds
"pretty good", should leave around 23cc of my
28cc prostate! Unless, I can come up with a more
the UCLH patient info for Cryotherapy, click here
had the cryo surgery on April 22nd 2014. To read how it
went, - click here
A further brief
discussion of the advantages of these diagnostic
and therapy methods was aired on a BBC Inside
Health radio program in January 2014. See the
appears to offer considerable advantages over
many other forms of focal therapy. It may cause
less localised good-tissue damage, plus offer a
quicker recovery time. Also, the precision with
which it can be used may make it ideal for
destroying very small tumours.
following notes were made early on in the year
2014, during my investigations of my options for
my prostate cancer treatment. [this note added
24th Dec 2014]
2014]: UCLH are undertaking a new
treatment, called IRREVERSIBLE
This may offer slightly more localised
treatment, but is only being offered
to patients with no significant cancer
outside of the anterior (away from the
rectum) side of the prostate. I did
not qualify for this.
22nd April 2014] Cryo went well yesterday . Had
typical post anaesthetic vomiting reaction.
delayed for about 3.5 hours. The reason enables
an insight into the issues that must regularly
face the hospitals.
I had even got as far as lying on the trolley in
the anaesthetic room. Had a cannula inserted.
Then, possibly just in time, before
they started the
anasthetic, I was told Id have to be
wheeled out and wait about 45 minutes.
The ultrasound monitoring machine was still being
used in another
theatre. They needed this machine for me.
I could understand the reason it was being
used for a TPM biopsy (see video for chat about that).
However, after about 90 minutes waiting, I
discovered, by asking, that another patient had
now gone into my theatre, who
presumably didn't need that machine for their
operation (which may have been, therefore, a more
serious operation than mine).
Whilst it was
frustrating, having had myself the TPM biopsy
last year, and knowing whom the other
who was using it at UCLH, it made it easier to
understand and tolerate.
I was discharged from UCLH following morning.
Surgeon was also thinking of
zapping the right lateral (see MRI pic), but I said only do
No pain from cryo instead, just discomfort
now wearing 7-day catheter, to be removed 28th
Wont know initial results until after MRI on
Other side effects- I assume itll take
several months before the extent of the various
possible permanent side-effects can be
determined. Surgeon said possibly only 20%
chance dry climax.
Had visit from district nurse 2 days after
surgery, who helped with a few catheter issues. Surgeon emailed me a few days after
"Hi Andrew - yes spoke with you in
recovery!" [Although I don't remember it -
Amnesia after general].
"Procedure went very well and I'm very happy
with the way it went.
"Yes we use a local anaesthetic [on
perineum] at the end of the procedure.
I agree the catheter causes more discomfort than
the procedure but hopefully will be out soon.
MRI in 2 weeks will give us a good idea about
treatment but I'm confident the [index] lesion
was well treated."
to return to work on 6th May. Surgeon suggests taking it easy: no
cycling for 6 weeks (pity - there's a tube strike
next week!), and "no heavy lifting or
straining" for 4 weeks. Today [1st May] I
bought a box of printer paper. So, asked the PC
World assistant to carry to my car. Then, brought
it up to my flat max. 2 reams at a time.
[22nd May 2014]: Very
pleased to report that my continence and erectile
and ejaculatory functions all appear to be
[29th June 2014]: Ejaculate
does seem to have diminished over the past month.
However, it's difficult to assess it, since it
was never that consistent before
[28th April 2014]
6 days wearing a urethral catheter
uncomfortable, and often painful! The
paracetamols they gave me were a great help,
although they were really intended for any otherpost-surgical pain, which I actually
didn't have. So, a great relief to have the
catheter removed today!
Yesterday felt like I had a fever (probably my
body trying to reject the catheter, but
controlled by the antibiotics). (see also surgeon's
on the catheter above)
Catheter removed today far less painful
than I thought . The clinic nurses told me to
"take a deep breath" twice during the
removal. It sounded like I was giving birth! LOL!
Very pleased with initial urine control test
results NO leakage! And 100ml retention
was considered ok by nurses, and I think it may
improve with time. Pee-ing is quite uncomfortable
at the moment, but I know from experience [as
after my TPM biopsies] that that will disappear
within a few weeks.
And again, a great service from all the staff and
nurses at UCLH!
May] Having second thoughts: it may have been my
general reaction to the surgery, rather than the
catheter alone. Guess maybe part of healing
process? Don't feel to terrific today, either.
Think my walk of 2.5 miles to Church this morning
for exercise may have been a bit ambitious!
Why did I choose Emberton as
a urologist, rather than a urologist at my local
[3rd May 2014]
Simple answer is, from Google
Retrospetcively, I can see it was an answer to
prayer. He is one of the top urologists, and
specialises in minimally invasive solutions for
I have private medical insurance because my
company has a group scheme. So, I decided to find
a private urologist close to my City office, so
as to minimise time off work for consultations.
Google flagged Emberton up, since he runs a
private clinic in addition to the work he does at
UCLH, (see useful links section). Because of
his desire to have much of his work in the public
domain, it was easy to see the techniques he was
my first consultation. Simply googling his name
brings up much about his work on the web,
Im thankful to God that I found him,
because before then, all I knew about was the
radical treatments: prostatectomy and radiation,
neither of which are necessary for my condition, unless
the patient has a personal desire to have the
whole prostate removed. Also, I'd never heard
of the TPM biopsy, only the
TRUS one. See the
on this page, for a discussion about this.
So, why am I now being treated and monitored by
his team at UCLH, which is an NHS hospital?
Well, my company medical insurance doesnt
fully cover Princess Grace hospital, which he
uses for the treatments. I was happy to pay
£1,000 towards the TPM biopsies, but Nano Knife
would have cost me around £4,500, plus more if I
needed further surgery because of complications.
Hence, Im now over to UCLH. Its a
really great hospital. It has a more relaxed
atmosphere than what Ive experienced at
some other NHS hospitals. And, the surgical
treatment is identical to what you get in the private
hospital. In fact, most of the surgeons operate
hospitals! The obvious disadvantage is longer
waiting time at UCLH. However, to me, that had
1. It allowed me more time to study my condition,
and consider the various options. True, my final
cryo treatment choice is very similar to what he
would have done privately within about 10 days.
But, for me, theres a great advantage in
understanding more about my condition.
2. It means that I can now pass on my experience
here, as an NHS patient. Thats what the
majority of you who read this would come in as,
should you need to be referred to the UCLH team.
Emberton said that,
ideally, I should have gone to him for the MRI earlier,
when my PSA readings were about 4.
PSA readings can
vary, it seems, by as much as nearly 1, in my
case. One of my relatives PSA read 4.5, then 6
months later, about 2.5! (It seems unlikely that
he has cancer).
Hence, I get the impression that "4.19"
could really be "3.8" or
"4.6". However, it is the steady
increase (from about 2 in 2009 to about 6 now)
that is the more meaningful indicator.
PSA readings can be high merely for an infection,
not always cancer.
case, and for general
prostate cancer screening, the important thing
seems to be observing the trend
over at least 3 or 4 readings, spaced about 6
months apart. This is how my (excellent) GP
advised us to monitor my PSA.
Personally, I would
have thought it better to give figures rounded
up/down to the nearest whole number, without
bothering with the decimal place.
Prostate cancer is slow to
develop: you won't suddenly get it "breaking
out" and killing you in 6 months! It's easy
to think it
might, because, sadly, some other cancers can
do that. But not prostate.
that it is very easy
to have annual or 6-monthly PSA tests. Mine were
taken at my very excellent NHS GP surgery (but
obviously then sent off to be analysed by the
path. lab. at the local hospital). I had them
done at the same time as my cholesterol tests
(same single blood sample taken, but 2 parameters
checked for by the path lab).
You have every
right, even under the NHS,
to be told your medical test results. My GP
happily phoned me up each time, to discuss them.
It will be
interesting to see by how much my PSA reading has
dropped since my surgery. I'll publish the figure
when I've had my next test (I now know this will
be in November 2014).
[6 June 2014]: As
my GP has just reminded me, PSA can also be an unreliable
It could equally well signal an enlarged
prostate, and not
this page helpful? Want to share your
experience with me?
MRI scan after my surgery
May 2014, Saturday]: Had my post-surgery MRI scan
this Saturday morning in the NHS UCLH hospital.
Was pleased with their efficiency: no waiting
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
did that help?
Answer: yes! Certainly didn't feel claustrophobic
like I did last year (for the results of that
MRI, see above.
what will be done with the results? Well, my
consultant will receive the report, and I expect
a consultation to discuss it soon.
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.
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
image below shows the cryo ablated (destroyed)
the dark area.
The surgeon says "it looks very
good", so I presume that means he ablated an
"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 surgeondid 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.
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
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.
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
whom I talked to at UCLH.
updates follow here - my attempt to keep
a log of tests, procedures and results
that are continuing
Most recent results are listed first.
21st June 2021 Update re. erections and
Sildenafil: I now find the 50mg tablets are
adequate to give me a pretty firm erection, which
would probably be good enough for intercourse.
So, if I re-marry, I'll let you know!
June 2021 My progress so far.
Had teleconsultation with Andrology Registrar
regarding my erectile disfunction.
I was able to report that Sildenafil 100mg gave
me good erections. Also reported the cyanopsia (blue tint to
colours) that I get in my vision for a few hours
with the Sildenafil. He said that's not a
problem, so long as it doesn't persist
only get erections by doing physical stimulation.
Was told that might never improve, due to having
had only one nerve spared (see below). He both
nerves would have needed to have been spared to
make that a small possibility.
he did emphasise the importance of getting
erections reguarly (not necessarily every day),
to prevent penis shortening.
And he mentioned something I'd not thought about
- for younger men, miltiple nightime spontaneous
erections are normal, which maintains penis
length. This diminishes with age, and has
dissapeared altogether in my case.
said either use Sildenafil or the pump to obtain
an erection, for the above reasons. But it's
likely, I think, that using my constriction
device (see below) may be a third method;
however, my personal thought is that this merely maintains
erections; it doesn't of
itself increase the blood flow, like Sildenafil
or the pump does.
now discharged me back to my GP, saying I can
always ask to be re-referred back to him in the
future, if the need arises.
March 2021 Teleconsultation with
prostate clinic nurse.
Was pleased to be able to report slight
improvements all round.
Very slight improvement in continence: still
hardly need to wear a pad.
Caughing can cause very slight leakage if I don't
think to do a squeeze beforehand, but even then
only a small amount, much like just after shaking
after a pee.
Also after cycling; as I suspected, the hospital
today confirmed that would be because I've just
been sitting with my perineun on the saddle.
Short-term effect on my lower sphincer.
using pump has made a slight improvement (bear in
mind that I could already achieve a reasonable
non-rigid erection before having it, see notes
earlier), but still no firm erections without a
Have now fashioned my own one, based on an item
for sale online, see below. Made using part of a
drawstring from an old pair of swim shorts, and a
Using this, and without the pump, I can achieve a
fairly firm erection. But no spontaneous
erections; still need to use physical
stimulation. Obviously no ejaculation. Orgasm and
climax remains very good. (To reiterate: they
spared one of my nerves during surgery -
"unilateral nerve sparing")
comment from hospital is that I'm doing very
well, considering I also had HIFU in 2019.
Both continence and ED likely to further improve
January 2021 So, how have I been getting
on with the pump?
First, I'll mention a few tips.
they supply: I figured it'd run out after around
20 uses. Then I'd need to order it free (I'm over
60) on prescription again.
So, as an alternative to the lubircant, I made up
a strong hand-soap/water solution. Whilst runnier
than the lubricant, it is sufficient to make a
seal. They claim other lubricants (like you can
get online) will damage the rubber rings etc. But
I reckon that soapy water is ok, since that's how
they suggest you clean the pump tube.
As they mention in the instructions, shaving
pubic hair around the base of your penis helps
achieve a vacuum seal. I use a "personal
grooming shaver" - there's loads out
there to choose from.
Well, in my case, over the months since my
surgery in February 2020, I've been trying to
occasionally get an erection. So, since I've
likely already been rehabilitating my penis, this
pump hasn't made a lot of difference. But I've
not been able to achieve as hard an erection
without it before, but I do need to use their
tension device (ring) to maintain that erectioin.
My overal opinion When used to get and
maintain an erection, it's not as comfortable as
Maybe I'm still using too small (tight) a tension
device (see video). I get an unpleasant pinch
I've yet to try one of the larger tension devices
that came with the pump.
Since I don't have a wife, I can't comment if I
get an erection suitable for
insertion/penetration. However, from my
experience when my late wife was alive, I think I
could manage insertion with a less hard erection
- using a looser, less effective tension device.
But obviously, this will depend on individual
beneficial secondary effect:
Improved flow: This does
seem to have improved since using the pump! In
fact, my flow when voiding is better than it was
before my surgery!
Also, I think (difficult to tell: may be due to
just being more relaxed) it helps me to not get
up so often in the night. I was typically getting
up for the bathroom twice until about a month ago
- now it's normally only once a night.
Important observation I still do
not get a spontaneous
erection. I can
"work-up" a reasonable, but not
"hard", erection, without the pump, but
using my improvised "rubber-band" ring.
If I do this just prior to using the pump, find I
obviously get a hard erection (in the pump)
It takes a lot longer
for me to "work up" an erection without
the pump, than it did before my surgery. I guess
this is because there's no spontaneous erection
Will spontaneious erections ever return? From what I've read/heard,
maybe in a few years time.
But, I'll keep you posted!
November 2020 Andrology appointment at
Purpose: to try/learn how to use a penis pump.
instructed and supervised by the clinician. Yes,
really on myself. Yes, he firmly locked the door
and checked the window blind beforehand!
Basically, it was how you see in the video below:
it effective? Very! Obtained a pretty firm
erection, which I've been unable to do even when
using my own improvised penis rings.
main purpose for me at present, is to rehabilitate
my penis, reather than only using it for
getting/holding an erectioin.
I bring it home? No, it was his demo version. But
he was able to see what size rings I needed.
was effectively a clinician-representative for
the iMEDicare Ltd company. He gave me a list to
give my GP of all the relevant items, the idea is
that my GP will then write me an NHS prescription
Thankfully, I'm noticing a significant
improvement, for which I praise God.
Most days, 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 a
slight feeling of leakage, but no significant
soiling of underwear - not much different to
normal pre-surgery after-urination dampness. I'd
like to see if I leak at all in a pad next ime
I'm outdoors for a significant lenghth of time,
before I'm confident enough to not wear a pad
encouraging, and may indicate that, buy next
summer, I'll most likely not need pads at all,
and will be back to normal!
update 20th November: squatting and leakage: I do
get some leakage if I perform squeezy exercises
whilst squatting with my lower back against my
sofa; kind-of half sliding off. This only happens
during the fast squeezes. It's effectivey
sqeezing and relaxing every second, and the quick
relaxes are probably close to relaxing when
pee-ing. Will discuss on Thursday 3rd December
during my hospital teleconsultation.
update 20th November: I have managed to take
short outdoor walks without
any pad, and normally have not leaked.
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.
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
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.
next UCLH appointment is 26th November, for a
physical consultation with the Andrology team to
have a penis pump demonstrated. The mind boggles!
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
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
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
May 2020 UCLH Follow-up consultation
with Prostate Cancer Nurse
A couple of extracts from her letters afterwards:
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
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
i'm planning on doing 3 per day.
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.
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
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
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
However, with the help of the excellent prostate
nursing team, contactable by email, that
appointment was brought forward to 12th March.
PSA as of 15th May: 0.03
ug/L. As far as I am concerned, that means not
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.
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.
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
"More leakage may occur" - as I
suspected - "because of the greater
But I could simply wear a more absorbant pad to
start with. We shall find out.
the Anti-embolism stockings:
YES! He said I could stop those now. (it's been
just over 1 month since my surgery)
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.
March 2020 - general
So how's things progressing?
Well, all glues & stitches off, except one
just above naval, where the glue is mostly loose.
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
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
will pause here, to give God thanks - that my
surgery was performed, my catheter removed, all
before the Covid-19 UK lockdown.
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.
March - my
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!
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
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.
- 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.
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
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."
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!).
was able to see the x-rays of my bladder on the
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
No problem there - was slowly leaking into the
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.
February 2020 Praise God! By Monday (24th)
lunchtime, I'd arraged my surgery for Thursday
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
Now on the recovery route (as of 7th March)
to give meself daily injections (ouch!).
Pre-loaded syringes of enoxaparin
(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.
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.
on going over the road to a local Church later
this morning (Sunday 8th March).
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.
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
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
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
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
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.
focal therapy is over. Now begins hormone and
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.
I'd already made up my mind that I'd prefer
The downside is that it's several months of
treatment and side-effects, whereas surgerty is
over in one day, although recovery can take
Therapy has started now: Heather
prescribed me hormone tablets Bicalutamide 50mg
I'll then return next Friday (7th February) for
my first hormone injection.
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.
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
group presntation about surgery
12:20am discussion with a surgeon
13:30 first hormone injection with Heather
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.
of PSA over recent months
My readings to
9 Nov 2018
I told my MD how God's timing had worked out the
timing of the previous three days, 15th - 17th
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
Consultation with Prof
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
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
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.
Consultation - very pleased that I was seen by
Prof Mark Emberton!
But news not good; but honestly probably what I
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
"No further focal therapy is possible. My
prostate is now tiny. The cancer is too near the
"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.
PET Scan at UCLH
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
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.
appointment on Wednesday 15th January.
January 2020 Template Biopsy at UCLH
Dr Thomas Collins said he'd be sampling more than
just the enhanced
Went very well: arrived prompt for 7.30am. was in
theatre a bit before 9am.
During recovery, more comfortable than after
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.
December 2019 Consultatioin with Caroline
My MRI of 6th November "has shown some
enhancement on the right side of the
For further details of this consultation
including MRI image
PSA test returned 4.8
Template biopsy now booked for Tuesday 7th
PET scan booked for 10th January 2019
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
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
See link below for more explicit details of my
progress, including Dr Thomas' consultation
July 2019 MSU
result normal. Consultation
Seen by Dr Thomas Collins.
He wasn't surprised by my increased PSA (see
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.
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".
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.
June 2019 PSA blood test done; result
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
But they did agree to an MSU (MId- Stream Urine)
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!)
June 2019 Retention re-test: now only
Praise God for that! The threshold figure is
Good that my anxieties about needing a lifelong
catheter are no more!
May 2019 Finding voiding sometimes a
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"
At trial without catheter (TWOC) clinic.
Catheter removed, pretty-well painless.
Then: around 3 hours of recording drinking and
Voided volumes good, but retention (post-void
residual, PVR) measured at around 170ml, which is
a bit high. No better after voiding 30 minutes
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
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
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
observation: I've been passing a small fragment
(presumably of my ablated area) each time I void.
Had HIFU at UCLH
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.
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
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".
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.
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.
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+4, 3mm anterior
of gleason 3+4. Click
here to see the now annotated
here to see the histopathology
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
Caroline did mention that if I didsubsequently need
prostatectomy, it may be more difficult to ensure
no cancer remained outside of my prostate.
However, HIFU is the route I've chosen.
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
HERE for explanation of
Click HERE for my now
annotated MIRI report.
22nd February 2019: Template
Bipopsy performed by Dr Thomas Collins on the NHS at McMillan
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.
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
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
waiting for follow-up consultation appointment.
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.
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
a full report from the Medical Imaging team, click
here. This will open a new
9th November 2018 - PSA
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
My readings prior to my procedure in 2014:
TREND in PSA readings is the IMPORTANT thing to
monitor. A SINGLE PSA READING is not sufficient,
it can be unreliable.
a consultation appointment at Harley Street on
Monday 3rd December.
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
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.
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
June 2016: PSA 3.7 ug/L
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 everyman 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)
[My observation]: I'm at no
more risk from prostate cancer than any other man
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
So, it's a trend in the right direction.
following notes added on 24 November 2014]
18-day and 7-month MRI and PSA comparison - see
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
ablated area has shrunk to (I presume) no volume
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
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.
significant anterior tumour has been treated. I
am not experienced enough to recognise any
remaining lower-grade cancer by looking at the
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.
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.
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
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.
has arranged another MRI scan for me in 1 years'
time (November 2015).
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
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
PSA steadily climbed over the years, until it
reached about 6.
Then, the cryotherapy knocked it down to about 3
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
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!
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
ejaculaion", and not "zero".
My erections and sexual desire remain good and
Update January 2015:
Just received my copy of Emberton's consultation
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
(and post MRI) consultation on 28 May 2014
Surgeon had already
said the post-surgery MRI
(one picture I sent him) looked good. This was an
scan, only 2½ weeks after my surgery. The one in
November will give a better idea of the status of
any remaining cancer.
then, he'd had an opportunity to look at the
whole set of post-surgery MRI images.
He said that these preliminary images suggested
that the significant cancer had been destroyed
Prof. Emberton, he couldn't bring up my MRI
images on his consulting room computer.
So: before my next MRI, need to see if I can find
a DICOM viewer for Android.....(!)
[13 June 2014]: found
a DICOM app for android! "Simply DICOM"
it's called. Can see clearly the ablated area.
Wish I'd had this for my consultation 3 weeks
ago! I'd have been ahead of the surgeon!
So from now on, we can discuss my MRI pics using
ablated area is the dark area.
also said that it was originally
significant, and did not fit into the category of
being able to be left untreated for surveillance.
he said (meaning "any" urologist),
"would have taken action". This is
because the maximum cancer core length was 12mm,
a significant size.
ablated area extended significantly below where
the anterior tumour had been (see annotated
sketch - original tumour outlined in red).
on this, he said:
"The ice-ball (produced by the cryotherapy)
would have done that". Basically, that's the
best precision that could be achieved. But an
advantage may be that it may have also partially
destroyed the peripheral 3 + 3 cancer on the
right hand side, (marked as a green area). Even
though I had asked him not to,
the cryo could not be controlled precisely enough
not to destroy that.
I must admit I was in two minds as to whether I
should have asked him not to
destroy that 3 + 3 also; well, maybe it's happened
second post - op MRI scan and first post-op PSA
blood test to be done in November.
slight leakage when "busting" for the
loo: he said that should improve with time.
surgeon said that I am now
over the main, initial recovery period.
Hopefully, I'll be updating you with
how I get on over the coming months and years!
For more details of my experience
(some explicit and intimate), click
see the Webcast where Prof Emberton answers
viewers questions, click
Then, search for "Live interview with
NanoKnife is mentioned in the video at the 19
minutes slider position.
if you're thinking of having private treatment
under Emberton, check that your insurance covers
the hospital that Emberton uses.
I opted out of private treatment after my TPM
Biopsy, and had my final cryo done on the NHS, as
I explain above.
for a private consultation with Emberton, you don't
have to be referred by your GP (as you do for NHS UCLH).
If you are self-funding, you can simply go along
and refer yourself.
Otherwise, check with your insurance first.
sure how to interpret this BBC article! Perhaps
it reflects the fact that many men still aren't
benefitting from the greater accuracy of the MRI
& TPM Biopsy test, or that even that
can't predict how aggressive the cancer is.
I admit that it appears uncertain how quickly my
anterior tumour would grow, if it were left
alone. But see consultation above.
Pity it doesn't even mention
Focal therapy is an amazing
However, it can still only cure my body until it will die
anyway. But praise
God: I'm assured of eternal
life because I believe in the
atoning work done by Jesus Christ, when he died for my
sin, and rose again! You
too can have this same eternal
assurance, if you believe!