After a couple of postponements I will now be seeing Mr Singh on Wednesday 26th of this month, October, at 11.30 and Dr Owen, the radiotherapist who is conducting the trial I’ve been invited to join, at 4.00 pm on the 3rd November.

Questions for Mr Singh:

What was the result of the tissue tests on the prostate and surrounding margin where the tumour was poking through the capsule? I have been told the stage was confirmed as T3a.

In that area the prostate was stuck to the surrounding tissue. Was this because of the tumour or because of damage done by the targeted biopsies in that area?

The tissue margin tested positive so there are cancer cells present. These are presumably still prostate tissue and cause or contribute to the residual PSA level I have of 0.02. Is that correct?

Could these cells produce tumours and if so how long might that take? I was told that it could take years or not happen at all. Can any of these cells move into the blood stream or lead to tumours in other organs or bones?

General prognosis I was offered is that 50% on PSA monitoring would not develop further cancer. Of the other 50% half would respond successfully to further treatment, radiotherapy e.g. and half would not. I didn’t make a note of these figures so I may have mis-remembered. Are these figures correct?

What do the statistics show in terms of the likely time period before radiotherapy is recommended? are the majority 1 or 2 years or is 3 to 5 more typical? The issue here is that the older a patient gets the more likely the recovery will be affected and suffering from side effects.

If I stay on observation and PSA monitoring how often would this happen and what would trigger concern and a recommendation of further treatment?

Is there any expert nutritional advice available for my condition?

Questions for Dr Owen:

I’ve more time to think about this but would be mostly concerned with the actual procedure and possible side effects, what they could be and how probable. The main ones seem to be incontinence, erectile dysfunction and damage to the bowel. I would need to know how long these tend to last or if they can lead to permanent conditions.

Life is a trial

The meeting with Mr Singh didn’t take place this morning as scheduled. I got a phone call about 9.00 am to tell me it has been cancelled and would have to be rearranged. Given that I had been steeling myself for this and preparing myself for bad news so I wouldn’t be too disappointed if that’s what it turned out to be, this was a considerable let down. However, at 5.00 pm I got a phone call from David, one of the specialist urology nurses offering to go over what would have been discussed at the meeting. First the good news. My PSA level is now 0.02. The bad news is that there was (as he put it) a massive amount of cancer in my prostate and there was evidence of cancer cells right up to the margin of the additional tissue they took around the area where it was poking through the prostate surface. The test of the cancer in the prostate showed it was at stage T3 so at least this is not more aggressive than the biopsy had shown. It was the much greater volume and spread that had surprised them.

He then detailed what this meant. The normal ‘gold standard’ treatment for men in my situation would be to look at the PSA level again in 6 weeks to see if it was going up. Regular monitoring would take place until the level reached 0.2 at which point further treatment, almost certainly radiotherapy, would be recommended. About 50% of men in my condition would have a stable PSA at for many years and never reach the stage when radiotherapy would be required. Of the remaining 50% half would have radiotherapy at some stage and then become stable for the rest of their lives and the other half would continue to develop the cancer to a terminal stage. So normally I would be sent away and seen again in 6 weeks time after a blood test.

However, there was currently being conducted a world wide trial with men in my condition as the subjects. There is some evidence, but inconclusive so far, that overall the outcomes are better (i.e. survival rates in the medium and longer term) if men in my position are given radiotherapy from the outset once they have fully recovered from the surgery, in particular being fully continent. If I volunteer for this I would be randomly assigned to one of two treatment groups, one following the gold standard treatment as described above and the other given radiotherapy as soon as fully recovered from surgery. The issue here is that in practice many men would be given radiotherapy and suffer the consequences of side effects unnecessarily. On the other hand, 50% men who go onto surveillance end up having radiotherapy anyway and would have been better of having it much earlier while they were younger and the disease less advanced. Only time will tell which group will have the better outcomes in terms of 5, 10, 15 and 20 year survival rates. I am interested in joining the trial but will need to think about it more. If I am allocated to the PSA monitoring group, this is what would normally have happened anyway. If I eventually have to have radiotherapy I will probably regret I wasn’t allocated to the radiotherapy group and had it straight away. If I’m allocated to the radiotherapy group I will have 4 solid weeks of daily radiation treatment at St. James Hospital the other side of Leeds and suffer the side effects unbeknown to me entirely unnecessarily. I should have another appointment to discuss this with Mr Singh in the next 2 or 3 weeks and then, if I accept participation in the trial, I will have to see the radiologist Dr. Owen to sign the consent forms. Only then will I be allocated to the observation or radiotherapy group. If I end up in the radiotherapy group I will get the treatment in the New Year. If I’m in the monitored group I could end up having radiotherapy anytime for the New Year and in the years beyond, or perhaps never. Lots to think about.

In the meantime I have recently read a report that says that over 50% of prostate cancers are found to be, after removal, significantly more aggressive than had been determined by the biopsies. David told me, when I brought it up with him as this was the case for me, that this had been well known for some time and that the measuring of biopsy samples was well known to be unreliable and usually erred on the optimistic side. I don’t remember this ever being mentioned to me before and it may have made a difference to me opting to go onto active surveillance when the first biopsy results came through. Although this was my decision I was told afterwards that this had in fact been the recommendation of the interdisciplinary group. Now, with hindsight, this looks to ave been the wrong decision and I should have had my prostate removed last September at the earliest opportunity.

6 week post-op update

It is nearly a month since I last posted and nothing much has happened. I’ve made quite good progress largely through walking although I’ve picked up the pace a bit with racketball.  I started coaching again from Thursday 8th September and returned to doing full Monday and Thursday sessions from Monday the 19th. This was 4 weeks after the operation. I warmed up gently in the gym rather than on court with the other players and did some of the less physically demanding practice routines with them. When it came to playing matches I stayed on the court where we had 4 playing in rotation (so plenty of rest time) and didn’t chase anything, limiting myself to hitting balls that were within a step or two to reach. No twisting and turning and rapid changes of direction. I felt pretty good and knew I was taking it easy as I had no leg aches and pains afterwards, normally a sure sign I had been pushing myself. Last Thursday (29th October) I did the club training evening with our coach, Saeed, and pushed a bit harder. I had done the morning U3A session too with a bit of coaching but had taken it very easy. But by the time Thursday was over my legs were pretty sore so I knew I had been pushing myself round the court a bit harder. The Thursday evening sessions are harder as the players who attend regularly are all pretty good and serious players.

Since the beginning of the month my weight has gone up and stabilised around 12 stone 10 or 11 lbs and, as I write this, I have a bit of a chest and throat cold. This has kept me in doors for the last couple of days but today, a cool but bright and sunny day, I did a 5 mile walk along the canal and am beginning to feel better.

I’m going to see Mr Singh, the consultant, on Thursday this week to hear the results of the tissue tests and the blood test I had done at the BRI Thursday last week. This is when I’ll find out if there is any evidence of cancer in the surrounding tissue and whether I will need radiotherapy or any other further treatment.

The walking cure

On Wednesday 31st August, the day after my catheter and staples were removed, I started a walking regime to help me get as fit as quickly possible. It is now a week later and since then I have met the steps target set me by my Vivofit everyday. While I continue to hit the target the Vivofit increases the step target each day. Last Wednesday this was 7728 and by Tuesday 6th September it had increased to 9347. Over the week I walked 82,912 steps, an average of 11,845 per day, about a 5 mile average. Walking was the only form of exercise that was recommended for the first few weeks with no further instructions other than to “listen to my body”, which I did. Towards the end of the week I started to incorporate a few hills. I’ve been very happy with the way it’s gone and feel significantly better now than I did a week ago. More of the same for another couple of weeks I think although I will not be particularly worried if I don’t meet the targets set every day from now on.

I went to the squash club at Heaton on Thursday 1st September, 11 days after the operation, and had about a 10 minute knock by myself to see how it felt. I didn’t push it at all, just hitting to myself down the side walls in the channels and some figure of 8s at the front to minimise my movement and not damage myself. I felt fine with no twinges. I did the same again on Monday 5th with the same result. I will start going regularly to build on this but it will be a while before I play against an opponent, even socially. Thursday I should be able to return to doing a little coaching as before. My weight has stabilised at around 12 stone 9 or 10, about 6 lbs lighter than when I went in for the operation so my strategy to not put on weight seems to be working so far.

With a view to starting cycling again I have been researching saddles with a cut-out to relive pressure on the perineum. Normal saddles put pressure on this area and can be quite painful for quite a while after a radical prostatectomy as this bears directly on the area where the urethra has been joined up. This gets better over time apparently. I probably won’t ride until I’ve seen Mr Singh and I may need to know if I should delay until after radiotherapy if that is needed.

I have spotted on a couple of occasions a very small blood clot being passed in my urine but have decided not to worry about it. I have 4 weeks before my scheduled appointment with Mr Sing and the BRI (when I will get the histology report and learn if I need radiotherapy) and will mention it then if it continues.

Getting back to normal

On Tuesday 30th September August the catheter and staples removed. The catheter removal I had dealt with before but staple removal was new and I was quite apprehensive about it. The staples are more like the staples you hammer into wood to hold wires in place rather than the office type of staple that go through paper and bend round so the procedure was quick and painless apart from the odd brief sting. Normally staples come out between 10 and 14 days but it made sense to remove them at the same time as the catheter appointment in this case if the surgical wounds are sufficiently healed, which they were.

Then it was just a case of sitting in the waiting room and drinking slowly and steadily two 700 ml jugs of water in order to produce three sufficiently prodigious wees. This involved going to the gents’ toilet and weeing into a bottle with you name on it on a rack – there were 5 men going through this procedure. Every now and then Staff Nurse Sarah (who I thought of as Nurse Catheter) would check the bottles, record volumes and empty them. I managed this without too much difficulty and was allowed to leave at about 11.00 am when Julia picked me up to take me home. I was given a few incontinence pads to take home with me and I was advised to use one straight away before I got of the treatment table as there might be a sudden surge as I stood up. Nothing happened but it was better to be safe than sorry. It is not always as straightforward as this I discovered talking to the other men. Sometimes there is no flow and the bladder just fills up. In these cases a catheter had to be installed again. We were advised to only drink about one small gals of water per 15 minutes as in the past men keen to get away had drunk 2 jugs full straight off in their haste to get away only to find they couldn’t wee and put themselves through some serious pain before a catheter could be replaced.

On arriving home I went for a walk around the local park and felt immediately that I could walk better and in more comfort now the catheter had been removed and felt optimistic about gradually building fitness again although this would be restricted to a walking only programme for a few weeks. I wore the pads for the first two days but didn’t have any leakage problems at all so have pretty well dispensed with them although I’m not fully confident. Most men suffer to some degree or other form incontinence after the operation. For many it is only for a few days, perhaps a couple of weeks. For others it is a constant problem that requires further corrective surgery. It looks like I will be one of the few who don’t suffer at all. If this is the case I think it will be down to two factors, my general level of abdominal fitness through cycling, walking and racketball and the fact that I have been pretty assiduous in doing my pelvic floor exercises for a couple of months before the operation.

My key advice to any man who is going to have this operation is to try to lose a bit of weight and get fitter if necessary but in any case do your pelvic floor exercises. I was instructed to do the exercises as soon as the operation had been done and not wait for the catheter to be removed. While incontinence remains a problem you should do the exercises the recommended 3 times a day. Once continence is achieved this can be cut down to twice a day, for life. Given that you can do these any where at any time, standing up, sitting or lying down, and they only take about 2 minutes there is no excuse. I shall continue with 3 times a day.  I may yet have to have radiotherapy, depending on the histology reports on my prostate and the surrounding tissue removed. This can also produce continence problems as side effect so I want to be in as good nick as possible just in case. I will find out if I will be getting radiotherapy when I see the consultant again on the 6th of October.

Yesterday, Wednesday, I went on a fairly hilly walk of about 2.5 miles and am feeling stronger every day. I will be building up the walking over the next 3 weeks before I have a short easy bike ride, probably only 10 minutes or so somewhere flat, to see how that goes. I’ve had to withdraw from two racketball tournaments in both of which I was lying 2nd in my group. However, the 2016 Yorkshire Racketball Championships are to be held on November 26th and 27th and I hope I may be able to play in this, in the over 60 group.

The first week

I was pretty uncomfortable when I got home and found it hard to stand from sitting or twisting in any way. This got better every day and by the end of the week apart from the odd twinge as long as I took it easy and slowly I became a lot more mobile. On the Tuesday I just took a few steps round the house but spent most of my time lying down and watching La Vuelta and Hong Kong squash on Eurosport. Wednesday I had a very slow walk around Greengates Park, about 15 minutes, with Julia but since then I have been doing two walks a day of between 20 minutes and 40 minutes, definitely getting a bit stronger and a little quicker each day.

I was surprised when I got home and weighted myself the next morning that I had gone up form about 13 stone 2 lb before the operation to 13 stone 10 lbs on my return 2 days later. I wondered if they had left some instruments in me. My tummy was quite bloated but for the best part of the operation day, Sunday, I hadn’t eaten of drunk. The next day, however, Wednesday 24th, I weighed in at 13 stone 3 lb which made a bit more sense. I had already decided to go on a low carb diet when I got back without sacrificing protein intake as I was concerned about putting on weight and losing muscle over the weeks of relative inactivity to come. I had also been advised to eat small amounts more frequently and avoid large meals so as not to overload my stomach. Constipation and straining were a concern, hence also the laxatives I was given as part of the discharge pack. By the end of the first week, Saturday 27th, I was down to 12 stone 10 lb.

One concern that is worth recording is that my wee remained bloody (rose, not claret) until Thursday evening, 4 days after surgery. The notes given as part of the discharge pack stated that this should clear within 24 hours and if not phone the hospital. This I eventually did Thursday morning where I was told not to worry about it too much if it was only pink but let them know if it continued for more than another couple of days. Needless to say since Friday 26th it has been clear a a bell. The other problem I had was quite a pronounced ache across my shoulders and occasionally at the top of my chest. This passed after a couple of days and when I mentioned this I was told it may be due to the gas they pump into my abdomen to make space for the operation which is generally dispersed within my body and has been known to cause some temporary chest and shoulder pain. So, so far so good.

Immediate post op and discharge

I finally went down to the theatre about 2.00 pm on Sunday 21st August and woke up in bed round about 7.00 pm that evening is some discomfort. Julia was there and apparently we had a conversation but I remember very little about it. She reports that I said I thought something had gone wrong with the operation as I had oxygen tubes up my nose and I don’t remember any one else coming back form the theatre with these. I also had a little more pain than I expected. She left after 30 minutes as I had fallen back to sleep. I was awake at midnight as I had to have some pain killers, a combination of paracetamol and Tramadol (officially a class A drug) and injection of Tynzoparin, a blood thinner. I had the first of these at midnight Saturday and I must have one every 24 hours for 28 days after the operation. These are to help avoid DVTs during a prolonged period of relative inactivity. By now a rather confused and near unintelligible man had been put in the bed next to mine and spent the next few hours calling for his wife. He thought he was in bed at home and that his wife was downstairs. He quietened down in the early hours and I eventually got off to sleep again.

I hadn’t eaten or drunk since 7.00 am before the operation. I had been given a mouth care pack back on the ward, basically a small amount of water and sponge ‘lollipops’ to moisten my lips and mouth, so by 7.15 am on the Monday I was looking forward to water, a cup of tea and some breakfast. During the operation and over night I had been on a hydration drip. I had to, and will continue until the catheter is removed, drink 2 litres of water a day to keep every thing flushing through. No fresh fruit on offer so a small portion of orange juice and a bowl of fruit and fibre cereal. Julia had brought me some fruit and a Sunday news paper the night before,placed on the seat beside the bed, but I couldn’t see these and hadn’t remembered. I was still quite sore and it was hard to change position in the bed without pain.

The doctors’ ward round took place about 9.00 am. I didn’t see Mr Singh, the surgeon who had carried out the procedure, but another surgeon who apparently assisted him. He told me that the tumour had been quite a lot bigger than expected and had poked out of the wall of the prostate a little more too. This meant they had to take a wider ‘clear margin’ in addition to the prostate on the side with the cancer than planned. There had been some discussion of whether they should remove the lymph glands in the circumstances but decided against it and stick to the original plan for surgery. Another complicating factor was that the prostate in that are had ‘stuck’ to the surrounding tissue. They don’t know yet if this was because of the penetration of the tumour or because of damage done by the targeted biopsies taken from the same area. All the material is sent of to the laboratory to grade the cancer in the prostate and to see if any cells had escaped into the surrounding tissue. I was warned that this increased the chance of needing addition radiotherapy but the results would be back in time for the consultation meeting 6 weeks after the operation. In the meantime we must just wait and hope for the best.

Later that morning Mr. Singh came to see how I was getting on and I told him what I had been told. He seemed slightly surprised. He confirmed what had been said but seemed slightly more relaxed about it. His assistant turned up at that point and seemed nervous that I’d now been told something different. I am assure him I hadn’t.

All that remained now was to get onto my feet and walk a few paces when I felt able and, all being well, got through the discharge procedure so Julia could come to pick me up and take me home. I had a couple of short and very slow walks down the ward corridor and by lunch time I was given the all clear to go home. Unlike last time I was on the ward after my bike accident, April 2015, I was to be discharged from a special unit in ward 19, the other end of the hospital, too far to walk but I would be picked up and taken there in a wheelchair. I found getting dressed and packing very painful and after a while went to the nurses’ station to request the pain killers I had, as is my normal practice, turned down in the morning. I handle low levels of aches and pains pretty well and have always preferred not to take drugs if not necessary as there is always the possibility of side effects some of which can be long lasting and damaging. However, I didn’t think I could get through discharge and then home by car without some help. They gave me another 2 paracetamol and 2 Tramadol and within 20 minutes or so I was feeling better. The nurse taking me to the dischareg unit came for me at that point and finished my packing and put my socks on for me, put my shoes on and tied my laces. The first time anyone had done this for me since my mother over 60 years ago!

TynzoparinThere was a slight hiccup and delay as my prescription for take home pain killers was wrong and had to go to another doctor to be altered. The discharge procedure took nearly 3 hours in all (it only took 1 hour on the ward last time) but went fairly smoothly. Most of the time was waiting for the prescription to made up by the pharmacist. I was given a packet of paracetamol and of Tramadol and two packs of Movicol, a mild laxative and stool softener. They were keen that I didn’t strain while going to the toilet especially as lack of activity could cause a degree of constipation. I was also given a pack of 28 preloaded disposable hypodermic needles for the self administered Tynzoparin injections. These could be done by a visiting district nurse but I had watched the first two given me by nurses and decided I would start of by trying to do it myself.

Then I was ready to go. I had phoned Julia a little earlier and I walked to the entrance with the nurse carrying my bags and medication so that Julia could just pull up and I could get straight in. She was there, it was about 4.20 pm by now, and I had an uncomfortable ride to Greengates in the beginnings of the rush hour traffic. However, it was good to be home and after a light dinner all that remained was to stay awake until midnight to give myself the my first injection.Although quite fearful about this it was OK and I’m sure I’ll get used to it. In fact you are given a 2 hour window either side of the 24 hour period so I did it at 10.30 and continued to do it at 10.00 pm, our normal bedtime, give or take. The next morning, Tuesday, we would plan my recovery programme – particularly exercise and diet.

Countdown to the operation

After the information I was given by phone reported in the last two posts, I had a meeting with my consultant on the 21st July. The additional tumours detected by the MRI scan and following targeted biopsies show a significant volume of more aggressive cancer that is pressing against the prostate surface and there is some evidence that cancer may have begun to poke through into the surrounding tissue. Active surveillance is no longer an option and, for reasons described in earlier posts, surgery seems to best choice as it leaves radiotherapy as a possible plan B. If the tests of the surrounding tissue that will be removed along with the prostate are all clear radiotherapy may not be needed but will be used as a backup if cancer cells are found outside the prostate. I have opted for the surgery. I was told that the provisional date for the operation is Wednesday 24th August but might be earlier as they have begun to do weekend surgery to help clear a back log of operations.

After this meeting Julia and I were invited to a seminar on the 4th August with other men due to have the operation over the next few weeks to meet with the surgeons, radiologists and physios to have the operation explained in more detail, what the side effects are and how these are treated. Mr Singh, who will be my surgeon, was very enthusiastic about the semi-robotic procedure that the BRI are now very experienced with and the much better rates of recovery obtained. We were shown one of the arms that are inserted through a small 2 cm incision with the surgical implements and how they worked to get round corners and into the restricted areas that in the past have made prostate removal such a tricky business. The operation involves 5 small ‘keyhole’ incisions for the surgical instruments and the camera. A slightly larger incision is necessary for the removal of the prostate. They will be taking some additional tissue from around the prostate where the tumour is poking through and tests will show whether any cancer cells have leaked out. If so I will need 4 weeks of radiotherapy in due course when I have recovered sufficiently from the operation but all being well this won’t be necessary. However, I’m not optimistic about this and so far my intuition to fear the worst has proven to be correct. I hope I’m wrong this time. On the whole the seminar was positive. A patient who had the operation a couple of months before spoke about his experience and I found this to be encouraging. He had a Gleason score of 9, so a higher risk than my score of 7. He is currently waiting to see if he will need radiotherapy but has had little problem with incontinence. The other highlight of the seminar was the talk about Viagra and the vacuum pump and there use to try and rehabilitate erections. These can take up to a year to return and for some men it never does. I depends on how easy it was to get erections before the operation and how much nerve damage is sustained. The Viagra and pump are to help keep the blood vessels in the penis fully functional so that all is well if and when the nerves get their act together sometime in the future. The pump produces an erection that deflates as soon as the pump lets in air again but apparently it can be sustained for a while with the use of a rubber ring that acts like a tourniquet. This looks quite painful so I don’t think I’ll bother! The combination of the Viagra (3 to 7 a week for 10 days or so I think) and the daily use of the vacuum pump is just to keep things ticking over and to prevent your member withering on the vine,so to speak. The other rather disconcerting aspect of the operation is the necessity to self-administer injections into the fat of your tummy with a blood thinning agent. I think this is for about 10 days and is to minimise the development of possibly life threatening blood clots. Our man said he had no trouble with these and the needles used were about as thin as you can get. We’ll see.

Anyway, I have just learnt that my operation is now confirmed for Sunday 21st August, three days time, and I will be going into Ward 14 of the Bradford Royal Infirmary 2.00pm Saturday afternoon.

Update: Saturday 20th August, 12.00. Just been told there won’t be a bed ready for me at 2.00 pm and so I’ve been asked to come in for 6.00 pm. It’s still OK to eat as usual before then as they will be ‘starving me on the ward’.

Locally advanced prostate cancer T3a

This morning I had a a phone call in reply to the questions I emailed yesterday evening. David and Ian do get back very quickly which is excellent. The email asked a couple of questions that arose when I had given a bit more thought to yesterday’s conversation and a bit of research I did subsequently. The biopsies discovered additional more aggressive cancers and I had now been given a Gleason score of 7 (previously 6). The total score is made up by the addition of the individual scores for the grades of cancer. 3 is the lowest grade for slow developing cancer so the best grad to have that indicates cancer is 6. A score of 7 indicates that there is some cancer present of the next higher grade, 4, which indicates more aggressive and fast growing. The score of 7 can be a 3-4 or a 4-3 where the first score is for the most common grade. Mine turns out to be a 3-4 and, as the prognosis for this is better than for a 4-3, this constitutes good news!

2406-how-prostate-cancer-is-diagnosed-t3a_250x229However, I was also told at what stage my cancer had developed too, T3a. This is not good news as it is now deemed to be a ‘locally advanced’ prostate cancer. T3a means that the cancer has broken through the capsule of the prostate but there is no evidence of it having yet spread to the seminal vesicles, lymph nodes, bones or other adjacent organs. Ian on the phone this morning said that the tumour is ‘pressing on the surface’ which implies it hasn’t broken through yet. What this means thou is that remaining on active surveillance is no longer an option and some treatment is necessary. I am seeing the consultant on the 21st July when we get back from France and the recommendation is highly likely to be surgery, a radical prostatectomy. Whether I will need radiation treatment as well after the surgery will depend on what they find and subsequent pathology tests. Ian said they may go ‘a bit wider’ on the right side where the tumour is pressing and that this might lead to a bit more nerve damage. I assume this might have consequences for my rate of recovery form the normal side effects; incontinence and erectile dysfunction so it is something I will need to ask about..

According to this leaflet from Prostate Cancer UK surgery is not normal offered to men with advanced local cancer.

 “A small number of men with locally advanced prostate cancer may be offered surgery (radical prostatectomy). This isn’t very common and is usually only offered as part of a clinical trial”.

Locally advanced prostate cancer

I assume that this is because once the cancer is through the capsule then surgery can no longer offer a cure and other treatments would be necessary anyway. Ian was talking this morning as if surgery was going to be recommended. If this is the case I can only assume they are confident that the tumour is still contained albeit pressing on the surface and so surgery is a good option with the chance of complete cure. The fact that he said they may need to go a bit wider where the tumour is pressing suggests they are not 100% confident as is the suggestion they may still recommend radiation treatment, depending on what they find while they’re in there.

All the Prostate Cancer UK fact sheets and tool kits are available to download from here:

Prostate targeted biopsy results

Today, about four weeks after the biopsy procedure, I phoned the BRI and got the results which were discussed at yesterday’s multidisciplinary team meeting. I was told that the results were positive and two of the samples (12 in all) showed more aggressive tumours and a greater volume of cancer. My Gleason score has been put up from 6 to 7. I know that this is the addition of two separate scores for what are considered to be the primary and secondary tumours. A score of 7 can be 4+3 or 3+4 where the prognosis is significantly different in each case (the first case being less favourable) and that this will inform the discussion and recommendations of treatment. I was told one of the options would be a radical prostatectomy followed by radiation. I didn’t query this at the time but it might mean there is a risk the newly discovered tumours are either pressing against the prostate surface, the capsule, or even through it. It may still be local, i.e. not metastasis, but it would mean surgery alone might not be enough. I was going to be offered an appointment with the consultant, Mr. Singh, on Thursday 14th July but I will be on holiday in France on that date so it will be pushed back to the following week, probably Thursday 21st. I was assured at the time that a delay of a week would be insignificant but I have emailed and left a phone message this evening asking for more details on the Gleason score and a reassurance I don’t need to cancel my holiday. I will if necessary. This is bad news but I’ve been prepared for the worst ever since I was told the MRI scan showed a cause for concern and a targeted biopsy was needed. Given all the crap that is going on at the moment over the referendum result and the UK leaving the EU I have been as low today as I have ever been. No doubt I will feel better tomorrow and have a weekend in Oxford coming up with my family of 81.