UPDATE - Issue 03 - June 1999
Counsellor Questions
Clive Turner has talked to scores of patients and shares some of his experiences
Clive Turner had a radical prostatectomy in 1995. He has counselled scores of patients and himself witnessed an operation. He is well equipped to help people who have had tumours diagnosed to deal with the dilemma of which treatment to have, by whom, and where, and, more significantly, in what state they will emerge. He notes that it is not just the top specialists who are short of time; local GPs are almost never able to give extensive advice and time either. Here is some of the objective, dispassionate and wholly practical advice which he gives.
Is there much on the Internet about prostate cancer? Yes, heaps. Much of it is of US origin. Some is unvalidated and fringe in nature, but you can certainly learn a good deal if you are selective in your reading. A reliable UK web site is www.prostate-cancer.org.uk. Prostate Research Campaign UK which will have its own website by the autumn of this year, has reliable leaflets and other publications available and the address is in this newsletter.
Should I have radiotherapy, surgery or should I 'watch and wait'? That depends upon many factors, including your location, age, results of biopsies, PSA levels and general health. Expert opinions do differ, so get more than one, and weigh them up carefully before making any decision.
If I go for surgery, is the operation painful? Not really because any pain is expertly controlled.
Is there much loss of blood? No.
Do I need to have some of my own blood taken beforehand? No, unless it will buy you peace of mind, but if there are no exceptional circumstances there is no need.
Is there any risk that I will die during the operation? There is always such a risk, but I have yet to hear of an example.
How long will I be in hospital? Normally, some five days, followed by a day and a half for the catheter removal about a week later.
How long should I be off work? Between six and eight weeks is recommended, although reading, telephone calls and stress free activity are all fine.
Can I exercise after the operation? Yes, but listen to the body, it will tell you how much is sensible and when to rest.
Will I suffer any loss of energy? Yes, a marked loss, but it recovers fully after a few weeks.
Will I lose my continence control? Not unless you are very unlucky. Most patients recover control as soon as the catheter is taken away, but yes, it can take up to a few weeks. The good news is that things almost always dry up sooner rather than later.
Is sexual dysfunction a problem? Yes, for nearly everyone, whatever they claim. But some ability, with a dry orgasm can return after about a year or sooner for a few lucky ones. Ejaculation is impossible after prostatectomy. Sexual desire returns but some months after the operation. Erections are not of the quality they were previously. They may be inadequate for penetration.
Are there things I can do to help me in this context? Yes. There are implants (for those who wish to afford them privately); there are penile base injections; there are suction pumps; there are penile suppositories (MUSE) which are expensive, but effective in many instances; and now of course there is Viagra. For those with no medical contra indications, Viagra works well and used with common sense, many patients have reported results little short of amazing with very few side effects of consequence.
Should I tell my family and friends I have, or have had, cancer? It's up to you, but why should there be a need for secrecy or shame, and why not become a disciple for regular check ups, possibly saving someone's life, perhaps one of your own circle?
Will the cancer come back? Well yes this has been known, with any of the treatments, but is less likely after skilled surgery, followed by mop up radiation in some cases, and current success rates are reassuringly high. There are a myriad questions to be asked and answered, but the more you know and understand, the better prepared you will be. And I am convinced the rate of recovery is hastened, whatever the treatment, through a better appreciation of what is involved.
What's the difference between a chimp and a chap? Why are chimps so different from humans? They share 98.5 per cent of the same genes with us humans. As well as the obvious differences of appearance and intelligence, chimps are also far less susceptible to infectious diseases than humans, and rarely get cancer. Scientists are now searching for the genes that make us different from chimps in the hope that they will lead to new treatments for human ailments.