I have had the first of what will be one every three months hormone implants. The drug is Goserelin (Zoladex)which is injected into the abdomen after local anaesthetic. It is in the form of a pellet about 1cm long and 2mm thick and can be felt under the skin. Here is the boring science bit - it is a gonadotrophin releasing hormone super-agonist (GnRH agonist)also known as a lutenizing hormone releasing hormone (LHRH). The effect is to inhibit production of testosterone and estrogen (it is also used in the treatment of advanced breast cancer).
Prostate cancer cells and some breast cancer cells are hormone dependent so when the hormones are eliminated the cancer cells are inhibited.
So how is this making me feel -well pretty good actually. Apart from the dreaded loss of libido (all too evident!)I am feeling OK in myself and have taken a different view on life and the meaning of everything. My wife, family and friends have been very loving and supportive and I have become even more in touch with my feminine side!
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Thursday 22 April 2010
Tuesday 6 April 2010
MRI Scan results
Just got back having had the scan results revealed. Quite good news all things considered. The cancer has been staged as T3a N1.
Basically this means the cancer has spread into surrounding lymph nodes (potentially not good) and is breaking through the capsule of the prostate - known as locally advanced disease. Considering the specialist reckons I have had this for up to 15 years this diagnosis is better than worse case scenario. If the cancer had spread to nearby organs such as the bladder neck,back passage or pelvic wall then it would have been categorised as advanced disease. The scan shows that the cancer has not spread to other parts of the body (metastasised)as far as can be established - (micrometastises cannot be detected but may be there?)
So the next step is an appointment with the radiologist specialist on 13th May. I will undergo a course of daily treatment over several weeks at a Portsmouth Hospital while continuing with the hormone therapy. It is hoped that the hormone therapy will shrink the cancer cells prior to the X-ray treatment.
The blood test for PSA levels came back at 11.1 - down from 47 at initial diagnosis so this shows the hormone treatment is working.
Basically this means the cancer has spread into surrounding lymph nodes (potentially not good) and is breaking through the capsule of the prostate - known as locally advanced disease. Considering the specialist reckons I have had this for up to 15 years this diagnosis is better than worse case scenario. If the cancer had spread to nearby organs such as the bladder neck,back passage or pelvic wall then it would have been categorised as advanced disease. The scan shows that the cancer has not spread to other parts of the body (metastasised)as far as can be established - (micrometastises cannot be detected but may be there?)
So the next step is an appointment with the radiologist specialist on 13th May. I will undergo a course of daily treatment over several weeks at a Portsmouth Hospital while continuing with the hormone therapy. It is hoped that the hormone therapy will shrink the cancer cells prior to the X-ray treatment.
The blood test for PSA levels came back at 11.1 - down from 47 at initial diagnosis so this shows the hormone treatment is working.
Monday 5 April 2010
Hormone treatment - mind and matter!
The treatment I am having so far is called an androgen blockade. This is designed to cut off the production of male sex hormones with the hope of shrinking and slowing the growth and spread of the cancer cells. In the past this was acheived by castration and this still remains a posibility further down the line. The tablets and injections are categorized as chemical castration and the thought of having this treatment is not a happy one for the average male. This is a similar treatment that is offered to some American sex offenders and you cannot avoid being affected both emotionally and physically.
My wife is very understanding over my concerns which typically are far more important to a man than a woman. Her response has been that I have "had a good run". I am grateful that this is true but it is difficult to realise that something you hold dear may have come to an end.
The all too obvious effects of impotency have increased as the days have gone by and the refusal of my "equipment" to perform is not yet in tune with what my mind wants.This may sound like the least I should be worried about given a life threatening condition but the fact is at the moment it is the main thing to occupy my thoughts given the fact I am not in pain and do not yet have a prognosis.
Typical man,thinking about sex six times every hour (Prince Charles quote).
My wife is very understanding over my concerns which typically are far more important to a man than a woman. Her response has been that I have "had a good run". I am grateful that this is true but it is difficult to realise that something you hold dear may have come to an end.
The all too obvious effects of impotency have increased as the days have gone by and the refusal of my "equipment" to perform is not yet in tune with what my mind wants.This may sound like the least I should be worried about given a life threatening condition but the fact is at the moment it is the main thing to occupy my thoughts given the fact I am not in pain and do not yet have a prognosis.
Typical man,thinking about sex six times every hour (Prince Charles quote).
First hormone implant
Its the day after the second MRI scan and a trip to my home doctor for the first hormone injection. This is given in the stomach and was painless. I laid horizontally on the couch,loosened my belt and was given a local pain killing injection. Then the actual implant was injected and I didn't feel a thing. Nor could I feel anything under the skin afterwards.
This dose is for 4 weeks and then I am to switch to three montly injections. The initial course of tablets stop in two weeks and are to prevent this injection causing tumor flare. As I understand it the injection causes a temporary spike in testosterone (opposite to what is required) and this can cause the tumor to flare or cause pain in any areas it may have spread into,commonly the bones.
I book one more blood test as it is back to the urologist on 6th April. He will announce the scan results and hopes the blood test will indicate that the hormone treatment so far will have resulted in a PSA score down to single figures.
This dose is for 4 weeks and then I am to switch to three montly injections. The initial course of tablets stop in two weeks and are to prevent this injection causing tumor flare. As I understand it the injection causes a temporary spike in testosterone (opposite to what is required) and this can cause the tumor to flare or cause pain in any areas it may have spread into,commonly the bones.
I book one more blood test as it is back to the urologist on 6th April. He will announce the scan results and hopes the blood test will indicate that the hormone treatment so far will have resulted in a PSA score down to single figures.
The MRI scans
Having started on the hormone therapy the scan appointments come through. Two are ordered. A pelvic scan and a full body scan a week apart. The first is the pelvic scan carried out at St. Mary's Magnetic Resonance Imaging dept. I'm first in at 08.30 so no waiting. Strip off to underpants and don the robe and go through to the MRI suite. Questionaire to make sure I have no metal implants etc and its onto the machine. Having read up on this and been sent a leaflet - nothing to worry about, harmless, no side effects, maybe a bit noisy other than that easy peasy. Well it wasn't that bad as I was not sucked fully into the machine. It was noisy but I was given headphones through which I could occassionally hear classical music when it was not being drowned out by the pneumatic drill like noise of the magnets.
A week on and its the full body scan. This will take longer (up to an hour)and involves imaging the whole body. Over the week I have become increasingly anxious despite my earlier practice. This session was more difficult. As I was moved further into the machine my mouth went dry and a feeling of panic began. With my ankles strapped together and arms pinned down my sides and the curved roof of the machine inches from my face (keep eyes shut throughout)I fought hard to stay still and supress my fear. After all I have been potholing and would be ashamed if I had to press the emergency button that was being gripped increasingly tightly in my left hand.
After 35 minutes I was extracted from the machine and the proceedure was over. Two teas later in the hospital cafe and I was still rattling the cup in the saucer. Strange really as I really thought it would have been easier than that.
A week on and its the full body scan. This will take longer (up to an hour)and involves imaging the whole body. Over the week I have become increasingly anxious despite my earlier practice. This session was more difficult. As I was moved further into the machine my mouth went dry and a feeling of panic began. With my ankles strapped together and arms pinned down my sides and the curved roof of the machine inches from my face (keep eyes shut throughout)I fought hard to stay still and supress my fear. After all I have been potholing and would be ashamed if I had to press the emergency button that was being gripped increasingly tightly in my left hand.
After 35 minutes I was extracted from the machine and the proceedure was over. Two teas later in the hospital cafe and I was still rattling the cup in the saucer. Strange really as I really thought it would have been easier than that.
Biopsy Result and Gleason score
Today its off to St. Marys to get the biopsy results.Sue is coming with me to hear the news as we have decided it is important to share this journey together and I am very grateful for her moral support. I have been hanging on to the idea that the high PSA and lumpy enlarged gland may have been caused by stones or something else.
Hopes dashed. The "Gleason Score" is a high risk 8 out of 10 . This is an analysis of the abnormality of the cells taken from the biopsy and is used to determine the GRADE of the cancer (how aggressive it is). Both sides of the prostate are affected. Information comes thick and fast. Most shocking is that the specialist reckons this means I have had the disease for between 10-15 years. He confirms that it will be no good doing a prostatectomy (surgical removal of the prostate) as this would be shutting the door after the horse has bolted. As I am still young by prostate cancer standards he reckons this must be an inherited disease.
Hormone therapy is to be initiated immediately. I am prescribed tablets to start taking tonight. These are to reduce the male sex hormones -androgen's, including testosterone which the cancer cell "feed" on. I am also given a letter for my doctor to give me a further injection of hormone treatment in two weeks time. It is important that I take the oral tablets for one month and have the injection half way through this period. Something about reducing tumor flare?
I make a follow up appointment in a months time before which I have to have two MRI scans to see how far the cancer may have spread - called the STAGE.
Another booklet is provided "Living With Hormone Therapy" and I realise this whole thing is real.
Hopes dashed. The "Gleason Score" is a high risk 8 out of 10 . This is an analysis of the abnormality of the cells taken from the biopsy and is used to determine the GRADE of the cancer (how aggressive it is). Both sides of the prostate are affected. Information comes thick and fast. Most shocking is that the specialist reckons this means I have had the disease for between 10-15 years. He confirms that it will be no good doing a prostatectomy (surgical removal of the prostate) as this would be shutting the door after the horse has bolted. As I am still young by prostate cancer standards he reckons this must be an inherited disease.
Hormone therapy is to be initiated immediately. I am prescribed tablets to start taking tonight. These are to reduce the male sex hormones -androgen's, including testosterone which the cancer cell "feed" on. I am also given a letter for my doctor to give me a further injection of hormone treatment in two weeks time. It is important that I take the oral tablets for one month and have the injection half way through this period. Something about reducing tumor flare?
I make a follow up appointment in a months time before which I have to have two MRI scans to see how far the cancer may have spread - called the STAGE.
Another booklet is provided "Living With Hormone Therapy" and I realise this whole thing is real.
The biopsy procedure
Not been looking forward to today very much after reading up on this on the Internet. I have taken my first antibiotic tablet before setting off for the hospital. The antibiotics are to counter any infection caused by the biopsy as it involves taking samples via the back passage which is of course a "dirty" area.
A urine sample and blood pressure test are taken first. Blood pressure was ridiculously high something like 185/95 and the nurse had to check if it was OK to do the procedure. I am sure this was simply a mixture of Fear and White Coat Syndrome - I must admit I was pretty wound up.
Ushered in for the procedure where I was introduced to the McMillan nurse who was to be my point of contact from now on and the doctor who got me to sign a disclaimer for the operation.
"Keep your shoes on but drop your trousers and underpants and lay on the couch facing the wall" was the firm but kindly order from the nurse- an impossible operation when it came to attempting to preserve my modesty - but I was soon in position for the doctor to do his initial - you guessed it -digital rectal examination - a piece of cake!
The procedure adopted is called a trans rectal ultrasound biopsy. This involves the insertion of a hollow ultrasound probe through which needles are fired from a special "gun" through the rectum wall. The probe provides a "picture" of the prostate and helps direct the needles.
An initial local anaesthetic is given up the bum and the noise of the needle gun is demonstrated- similar to a staple gun. The samples are then taken from different parts of the prostate - in my case 10 shots. A warning is given before each needle is fired, mainly I think so that the noise does not make you jump. The anaesthetic worked quite well and I felt a momentary prick each time. However the mental tension seemed to mount as I counted up to 10 and I was VERY GLAD when it was done. A quick check to see if any blood was emerging from my penis (no) and advice re coming back if any bleeding or excessive pain. Then off for a cup of tea and 15 minute wind down and final blood pressure test 150/85 (down a bit!). Off home for a few gin and limes to wind down!
A urine sample and blood pressure test are taken first. Blood pressure was ridiculously high something like 185/95 and the nurse had to check if it was OK to do the procedure. I am sure this was simply a mixture of Fear and White Coat Syndrome - I must admit I was pretty wound up.
Ushered in for the procedure where I was introduced to the McMillan nurse who was to be my point of contact from now on and the doctor who got me to sign a disclaimer for the operation.
"Keep your shoes on but drop your trousers and underpants and lay on the couch facing the wall" was the firm but kindly order from the nurse- an impossible operation when it came to attempting to preserve my modesty - but I was soon in position for the doctor to do his initial - you guessed it -digital rectal examination - a piece of cake!
The procedure adopted is called a trans rectal ultrasound biopsy. This involves the insertion of a hollow ultrasound probe through which needles are fired from a special "gun" through the rectum wall. The probe provides a "picture" of the prostate and helps direct the needles.
An initial local anaesthetic is given up the bum and the noise of the needle gun is demonstrated- similar to a staple gun. The samples are then taken from different parts of the prostate - in my case 10 shots. A warning is given before each needle is fired, mainly I think so that the noise does not make you jump. The anaesthetic worked quite well and I felt a momentary prick each time. However the mental tension seemed to mount as I counted up to 10 and I was VERY GLAD when it was done. A quick check to see if any blood was emerging from my penis (no) and advice re coming back if any bleeding or excessive pain. Then off for a cup of tea and 15 minute wind down and final blood pressure test 150/85 (down a bit!). Off home for a few gin and limes to wind down!
1st visit to specialist
Two weeks in and I am visiting the urologist at Ryde clinic. He also wants to perform a DRE (digital rectal examination)This is very quick, about 5 seconds and he confirms my doctors findings and views the lumpy prostate with suspicion.(I am starting to get used to these DREs!!!)
The PSA test is 47. Apparently a man of my age (62) should have a PSA level of between 2 & 4. The urologist declares that he is 99% certain I have cancer and books me in for a prostate biopsy at St. Marys Hospital, Newport.
I am prescribed some tablets to help me wee a bit easier and also some antibiotics to start taking the morning of the biopsy.
He informs me that around 150 men on the Isle of Wight are diagnosed each year and that I will probably have the biopsy next week as waiting lists are amongst the shortest in the UK for this proceedure here on the Island. I am given a booklet- Prostate Cancer for Newly Diagnosed Men - just about official now then.
The PSA test is 47. Apparently a man of my age (62) should have a PSA level of between 2 & 4. The urologist declares that he is 99% certain I have cancer and books me in for a prostate biopsy at St. Marys Hospital, Newport.
I am prescribed some tablets to help me wee a bit easier and also some antibiotics to start taking the morning of the biopsy.
He informs me that around 150 men on the Isle of Wight are diagnosed each year and that I will probably have the biopsy next week as waiting lists are amongst the shortest in the UK for this proceedure here on the Island. I am given a booklet- Prostate Cancer for Newly Diagnosed Men - just about official now then.
Bllod test and PSA
Back to my local health centre for the blood test taken by a nurse and sent off for analysis specifically to establish the PSA level.
I have had to wait a week from the DRA (digital rectal examination) as that procedure can elevate PSA levels when the prostate is palpitated by a finger.
PSA stands for Prostate Specific Antigen and the presence of this can be established by the blood test. This PSA level can be an indicator of cancer but is not the definitive test as it could indicate the more common BPH -benign prostate hypertrophy- an enlarged prostate that causes urination problems etc. but is not life threatening.
I am seeing the specialist urologist next for the PSA results and a more expert opinion.
I have had to wait a week from the DRA (digital rectal examination) as that procedure can elevate PSA levels when the prostate is palpitated by a finger.
PSA stands for Prostate Specific Antigen and the presence of this can be established by the blood test. This PSA level can be an indicator of cancer but is not the definitive test as it could indicate the more common BPH -benign prostate hypertrophy- an enlarged prostate that causes urination problems etc. but is not life threatening.
I am seeing the specialist urologist next for the PSA results and a more expert opinion.
Initial visit to GP
Here we go - "I think I may have a prostate problem doc?" A quick run through the symtoms and then the bit I was dreading. "OK I need to carry out a digital rectal examination". I don't know why this should be such a big deal, I suppose it may be that men on balance do not have anything like as many of this type of examination as ladies have to go through?.
Funnily enough now I am committed and likely to get some answers it doesn't seem so bad. I lie on the couch pull my trouser down a bit and face the wall away from the doc. who instructs me to pull my legs up, knees under my chin. The examination lasts a few seconds and at first I think I have disgraced myself by pooing on the couch but it was just the sensation of the finger being withdrawn.
I am informed that the prostate is hard and knobbly and the doctor is obviously worried about it. He makes an appointment for me to see a urologist and arranges for a blood test in a week.My urine is also analysed on the spot and although it shows a few blood cells it is not enough for the doctor to be worried on that score.
Funnily enough now I am committed and likely to get some answers it doesn't seem so bad. I lie on the couch pull my trouser down a bit and face the wall away from the doc. who instructs me to pull my legs up, knees under my chin. The examination lasts a few seconds and at first I think I have disgraced myself by pooing on the couch but it was just the sensation of the finger being withdrawn.
I am informed that the prostate is hard and knobbly and the doctor is obviously worried about it. He makes an appointment for me to see a urologist and arranges for a blood test in a week.My urine is also analysed on the spot and although it shows a few blood cells it is not enough for the doctor to be worried on that score.
First signs of trouble
Men are often reluctant to admit to a medical problem and will often make any excuse to avoid a doctor - I am in that category. However a couple of months of at first barely noticed problems with weeing led me to look up the symptoms on the internet.
Prostate trouble seemed to be a possibility. I certainly had some of the problems. Weeing had become a prolonged process and I was dribbling at the end. It wasn't painful and I wasn't having to get up in the night but I gradually realised something was "not quite right".
My thoughts went back to my early schooldays and peeing competitions in the boys toilets - who could get get their stream the highest up the wall. I realised that I had no control of the flow - it just came out at the one rate. Having discussed this with my wife a visit to the dreaded doctor was next.
Prostate trouble seemed to be a possibility. I certainly had some of the problems. Weeing had become a prolonged process and I was dribbling at the end. It wasn't painful and I wasn't having to get up in the night but I gradually realised something was "not quite right".
My thoughts went back to my early schooldays and peeing competitions in the boys toilets - who could get get their stream the highest up the wall. I realised that I had no control of the flow - it just came out at the one rate. Having discussed this with my wife a visit to the dreaded doctor was next.
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