As this thread was so useful to me in the last four months, I feel honour bound to contribute something to it. I hope that it may be a help to others in our predicament, as many of the contributions in this thread have been to me.
At my previous flight medical the AME suggested a digital exam and a PSA test. As it was a few years since I had had one I agreed and he reported a small protrusion on one side. The lab test came back with a PSA of 10. I am a 69 year old presenting fit, and he suggested a visit to a urologist. I agreed and the next week I was again examined this time with an ultrasound and he said that the prostate was mildly larger so recommended a course of antibiotics. I was surprised by this as was my wife comes from a country and profession where the use of antibiotics has almost been banned except for very specific reasons, and never used as a give-it-a go type of intervention. Other aspects of this specialist from my personal point of view led me to find another.
Through medical friends I was directed to a consultant at Guys Hospital in the UK. I flew the required 12 hours to get there and had an interview with this consultant urologist. Within a week I had an MRI, and a transperineal biopsy. The MRI is fine if you can stand being in a tube and clash metal bands (I told the nurse I have heard worse in a Hamburg club) and although I was stressed about the biopsy it was a non event for me. You are under a general anaesthetic, you feel nothing and wake with no chemical hangover. Afterwards you cannot even see where the needles went in. I felt a bit of a fraud for worrying about it.
The result came back as a Gleason 4-3, mostly on one side of the prostate. The surgeon urologist, being a surgeon suggested a robot guided radical prostatectomy but sent me to an onchologist who specialised in radio therapy to the discuss the other options. Together they made me realise that I had to do something, that either procedure would be equivalent in success rate, and that in the end the decision was mine. Gulp.
Somewhere in the thread above, it may be from BoeingBoy, the poster said that the decision becomes an emotional one. To me that was excellent advice. It depends on your character type as to whether you want surgery or modern radio therapy. Three days before my decide day, I was for radio therapy. Then I saw that for me, surgery would be better, but it was a stressful time, and required a lot of shaving mirror discussions.
The next stage was an interesting one for me as I was pointed in the direction of a group of people that I did not know existed, specialist urology nurses, and one very rare character, a consultant urology nurse. I am still in awe of the consummate professionalism of these women, for they were all women. They have the empathy and approachability of a nurse, with the massive knowledge base of a specialist or consultant. They ran me though the pre and post op expectations in a way that a surgeon or onchologist would mostly be unable to provide. They prepared me psychologically for the operation and the post procedure fears of incontinence and impotence that were uppermost in my mind. For the first time in many weeks I started sleeping better. If your system does not have this level of nurses on your pay grade, pay yourself. They are the pastoral care you need at this time.
To help navigate the robotic procedure I had a PSMA PET scan a week before the operation, which uses nuclear medicine to illuminate the CT scan. This gives the surgeon another tool to assist his procedure planning and is not always performed, but was requested by my surgeon. I felt no side effects from the illuminating drug and to me it was like any other CT scan. I know that some people do get claustrophobia in these scans and I feel for them but for me they are no problem.
The consultant urologist who performed my prostatectomy was of a very high level. In the UK there is a web page of their association which even lists the number of procedures they have done, and mine came very near the top. Always a good sign that he is in "landing recency". I came round an hour after a 3 hour procedure feeling tired but under full pain control. (Anaesthetic drug protocols have come on in leaps and bounds in the last ten years, and the reversal drugs are excellent.) Two nights in hospital, although your insurer will try for one, but if there are any complications you are going to need the hospital system around you quickly, so fight for two nights. As my surgeon said, "You'll feel ten years older for a couple of weeks," which was a good description. I went to my AirBnb with a stack of Tena pads and adult diapers and felt a bit the worse for wear. I had five small incisions in my midrif, which itched a bit.
The pain scale is often given out of ten, so you give a subjective assessment of how much pain you feel to let the staff know if you need more pain killers. On nothing more that six Panadol a day I gave it a three for two days then dropped it to a two for a week. I had a catheter in which was removed in hospital after ten days which was a minor nuisance but almost undetectable during the day. Just remember to turn the bottom tap off after you have drained the urine bag. Like landing wheels up, there are those who have done it and those who are going to do it... I was tired and under minor discomfort but nothing as bad as I had expected. Every day I felt a small improvement.
One thing is not mentioned very much in the above thread is the possibility of constipation. You do not want to be straining with the surgery that has gone on near your pelvic floor. So take those laxatives you are given, and more if you need them. There is no reason you should have to suffer from this easily fixed malady.
Now a month on, I find I have no discomfort, I have a big pile of unused Tena pads and diapers and my bladder control is as good as ever. The old fella does not wake me at 0500 as before and will not without drugs or mechanical assistance. These latter were explained to me by the above nurses and sounded like something out of a Hamburg sex club in the 1970s - allegedly. When I have built up some stamina I have been advised to try Viagara as the surgeon managed nerve sparing on one side of the prostate and it may work. As Mrs anxiao has hidden the prescription (Pprune passim) it may be a while before I can report on this...
I have noted that I feel better than I am. I went for a six mile walk today and was told when I got back that I looked dreadful, white as a ghost and ten years older. I felt weak too. So do be careful as you go through convalescence, take it easy and accept that you have taken a big hit. It takes a while. Being in UK with lockdown has helped keep me close to home but having a compromised immune system in a time of a viral pandemic is not good timing. I have got used to the self isolation.
Next is PSA test two months after the op, and then three after that. This is a big worry right now for these will show if they got all the cancer cells out. Fingers and toes are crossed for the results.
Many thanks to all the above contributions, many of which helped me through this time. As Machiavelli said, "Nothing is as bad as it seems..."
Last edited by anxiao; 6th Apr 2020 at 22:25.