UPDATE - Issue 11 - April 2002
A patient writes
In August 1999 my PSA was checked during a BUPA Health Screen and was found to be slightly high at 4.0ng/ml. After more checks, I was extremely fortunate to be referred to Roger Kirby the following February.
Between February and October 2000, I saw Roger four times and had a rectal prostate examination, four PSA blood tests and three sets of prostate biopsies. By October my PSA had risen to 5.8. The biopsies were only mildly unpleasant. Six samples were taken on each occasion using a needle gun via the rectum. A small thud can be felt as the needle goes in and there are traces of blood in the urine and semen for a week or two afterwards. During the last set of biopsies I was unlucky to have an artery nicked. I bled profusely overnight, eventually collapsing through excessive blood loss and spent three days in hospital on a drip. The biopsies showed high-grade PIN (abnormal cells that may go on to form a cancer) but no direct evidence of cancer. A bone scan showed nothing amiss and an MRI scan was inconclusive. Roger charmed me into having a fourth set of biopsies in early November and this time cancerous cells were detected. I booked in for a radical prostatectomy a week later.
Roger and his team were outstanding. The operation was completely pain free and I was up and walking the following day. When the prostate was examined in the laboratory there was a large amount of cancer, which unfortunately was not confined to the gland and was present in the bladder neck and urethra. I underwent a 30-day course of radiotherapy to mop up any residual cancerous cells.
I regained full continence shortly after the radiotherapy was completed and four PSA checks in the last year have all been unmeasurable at less than 0.1ng/ml so I believe that the cancer has been eradicated. The only residual problem is impotence resulting from the double hit of surgery and radiation. I had expected it so I am not too worried by it. Intercourse is possible using a combination of Viagra and MUSE, but spontaneity is lost.
It took almost fourteen months from being initially aware that something was amiss until cancer was detected. Do I have any regrets? Not really because we had to make sure that it was cancer before taking such a radical step as removal of the prostate. Indeed I consider myself extremely fortunate to have worked for a company providing regular health screening, to have been looked after by excellent medical teams and to have a very supportive wife who has kept me positive throughout. To anyone who is diagnosed with the disease, my advice is to have the operation, have it quickly, get as fit as you can prior to surgery and stay positive. There's an excellent quality of life ahead.
Simon Bott replies
Why so long to diagnose?
This patient's prostate cancer was situated at the front of his prostate (anterior) - furthest away from the biopsy gun. Because of its inaccessibility four biopsy sessions were required before a definitive diagnosis could be made. It was cases like this that led us to look at other patients with similarly placed cancers. Using the Prostate Cancer Database, funded by the Prostate Research Campaign UK, we identified 60 cases with anterior prostate cancers and compared them with 60 cases with their tumours at the back of the prostate (posterior) - the most accessible. Patients with anterior cancers were more likely to have required several biopsy sessions to diagnose their cancer. When cancer was found the biopsy often falsely indicated a small volume of cancer in the prostate.
Multiple biopsy sessions are potentially uncomfortable for the patient and, as he describes, not without complication. Secondly, the surgeon may be misled by the tumour volume estimates from a biopsy of an anterior cancer. As a result of this research, when prostate biopsies are taken in our hospitals the front of the gland is deliberately targeted in an attempt to diagnose these anterior cancers at the first biopsy session.