UPDATE - Issue 24 - Winter 2005
The need for a second opinion
Nine years ago, aged 54, I had no concerns when I attended the company sponsored annual medical.
Everything was fine, explained the doctor, except that my PSA reading had risen to 7.0 from a normal of less than 4.0. I was totally naive about these matters but learnt that I probably had the start of a small benign tumour in the prostate. This was quite common in older men but it also indicated the remote chance of cancer. He told me not to worry and referred me to a local Consultant Urologist in Bristol.
| Tony
James, the author of this article, looking fit and well. |
Following ultrasound and biopsy, he explained that a small number of abnormal cells were found; not malignant, probably the start of a benign growth. I agreed to return in six months for repeat tests.
Six months later my PSA had risen to 13.9. Another biopsy revealed more abnormal cells but no cancer. Further tests were set up in four months time. These revealed that my PSA had risen to 14.6. Again, the biopsy revealed no cancer. Would I like to repeat the exercise in six months' time?
I was, by now, extremely concerned. My wife and I had read articles and talked with friends and colleagues, notably one who had suffered prostate cancer, resolved by a prostatectomy.
The time came for the next meeting with the Bristol Consultant (20 months from our first meeting). My PSA reading was 12.9. He said there was no need for ultrasound or biopsy tests and that we should review matters 6 months later. Although my medical training was non-existent I had by this time read much about the prostate and was concerned about the management of my case. I lost confidence in my Consultant and asked for a second opinion. Previous research had highlighted Roger Kirby as a leading expert in the field.
Roger agreed to see me within a week and immediately organised PSA readings and biopsies. I returned a week later to be told that cancer had been found. From all the options available to me, I selected radical prostatectomy, which was carried out a week later at the London Clinic. Unfortunately the tumour had spread to the margins of the prostate so mop up radiotherapy was recommended. A 6-week course was completed at the Cromwell Hospital.
As I was unhappy with the management and assessment of my case in Bristol I asked if it was possible to review the biopsy slides taken in Bristol. Subsequently, two separate reviews were completed and adenocarcinoma was found in slides from all the Bristol biopsy procedures. This was of course totally different to the no cancer results found initially by the Pathologists in Bristol and reported by my Consultant.
'different to the no cancer results found initially'
Seven years after the operation I am fit and well, thanks to Professor Roger Kirby, and my PSA is less than 0.1, which is excellent news.
The initial 20-month period in Bristol of ineffective pathological assessment clearly led to a delayed diagnosis of cancer allowing it to spread unnecessarily. So, in conclusion, I advise anyone to seek a second opinion if his PSA is continuing to rise significantly and corrective action is not being recommended.