UPDATE - Issue 20 - Winter 2004
Messages Correct - Facts Somewhat Adrift
Nigel Offen, an experienced surgeon, was correctly diagnosed with prostate cancer (almost as an afterthought) following a consultation for something quite different.
Here, is his story.
Some of you will have read an article in the Daily Mail Health Supplement last November about my experience of being diagnosed and treated. I must say, firstly, how surprised I was to find so many Daily Mail readers amongst my friends and acquaintances! I was also pleased that the reaction was unanimously positive, particularly from women.
Many of you will, I am sure, have been puzzled by the sequence of events that was described and I am grateful for the opportunity to set the record straight. Firstly, my career in surgery was as a general surgeon, with an interest in disease of the large bowel and breast - urologist indeed!
any urinary symptoms in my age group, have a PSA
I went to see my GP, following an annual eye test, when signs of raised blood pressure were detected. I mentioned my urinary symptoms, almost in passing, but my GP, despite not finding any abnormality in his examination, nevertheless arranged an immediate PSA test. What followed was an instant referral to a surgeon, preceded by biopsy, MRI scan, and bone scan. So when we met, I was given a precise diagnosis of locally advanced disease and advised that treatment with conformal radiotherapy, preceded by supportive drug therapy in the form of Casodex, was the best option. That same day I was offered and accepted a meeting with a fellow victim in the profession, which I found extremely helpful and by the end of the day, I was in much better shape than might have been expected.
I saw the radiotherapist after a month of drug therapy that produced a gratifyingly sharp drop in my PS. It was decided that treatment should commence after a further month of Casodex therapy
By that time I was aware of a little tenderness in the nipple area. Being aware that a short course of low dose radiotherapy to the breast area could prevent breast development, I raised the question of such treatment.
| Nigel Offen, dressed for surgery |
At this stage I was advised that my long term drug therapy should be changed to Zoladex. This follows advice from the Committee on Safety of Medicines that there was an increased risk of heart complications if Casodex is used for prolonged periods. I went away to consider the options. I much preferred the side effects of Casodex, in particular the possible maintenance of potency, (maybe supported by Viagra), which seemed to be very unlikely with Zoladex, as this is essentially a medical castration. I asked to see the evidence on which the advice was based. A week to get it, a week to evaluate it, and I came to the conclusion that the increased risk of heart disease was minimal if indeed a risk at all. My choice was to stick with Casodex, with which the radiotherapist agreed.
However, a month had gone by; the breast development had increased so concurrent radiotherapy to the breast area commenced. Only four treatments were needed and that has stopped it but not, I would emphasise, removed that which had already occurred.
The outcome so far is good. I am working again. I get a bit frustrated by the tiredness, but that is a choice that I find acceptable, and the opening PSA of 44 has fallen to 0.4 with a vast improvement in the urinary symptoms.
Having set the facts straight in a slightly abbreviated fashion, I would emphasise that the messages that I wanted to come over were very definitely there in the Daily Mail article. I did offer to check the copy for factual accuracy before it was submitted, although I knew it would be journalistic heresy to allow that.
The messages then; any urinary symptoms in my age group: have a PSA, and if there is any demur, don't take 'No' for an answer. Patients need to have understandable information to hand that allows them to make choices that include quality of life, as well as longevity, in their decision making.
consider quality of life as well as longevity
Lastly, my father had prostate cancer, and I have two sons. Nobody suggested that I should give them any advice. I have told them to start having two yearly PSA tests from the age of forty. I understand that there is currently a trial of doing PSA tests on the sons of patients in progress. Heredity being a significant cause of the disease currently identified, that would seem to me to be science trying to prove the perfectly bloody obvious. To me common sense is preferable.