Prostate cancer
 

Thank you my friend. I have done the same to my friends.
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You have highlighted the problem with PSA test. The reading of 4 is within the upper level for your age. I too was told that my prostate was enlarged by my GP but the MRI SCAN apparently showed it to be normal. As the Urology Specialist explained only a very small proportion of it can be felt.

Prostate cancer
 

Thank you so much my friend. I am by nature a very positive person and not overly worried. I look after myself and trust my body.

Prostate cancer
 

I have just had a letter from the hospital telling me that the prostate biopsies showed nothing abnormal and hence no signs of cancer. That is a relief. I know that this is not a 100% certainty as it relates to the areas of the prostate the biopsies were taken from. But good news anyway.

In a case confirmed to me in the UK, five weeks for a sentinel node biopsy result following a positive diagnosis of aggressive malignant melanoma. That is obscene.

Buster, any progress?

I had robotic surgery over 5 years ago, PSA instantly down to .008 and staying there. But luckily the cancer was completely contained in the capsule and hadn't escaped, so the pros of getting surgery sooner instead of later are quite prominent.

Nerve damage has slowly repaired itself, no need for Cialis or Viagra after the first year. And no wet spots any more! Well, not from me, anyway...

Just heard from another friend who has prostate cancer. This makes nine. If the quoted statistic that one in six men gets it is accurate, I have to wonder about the number I know since I don't know fifty four guys well enough to know their health status.

It keeps me getting PSAs and DREs. :eek:

I am sorry if you did not see my previous post but fortunately the biopsies showed nothing untoward so I am back to 6 monthly PSA tests.
Thank you for your enquiry and I am of course pleased that your treatment has gone so well.

Well, here I am, 18 days after my full radical prostatectomy, and well along the road.

My Urologist was doing routine annual checks and noticed a slight swelling to the right side of the prostate. He said he would monitor and then my GP noticed a slight bounce from 4.0 to 4.8. on the PSA, then it returned to normal (4.0).
Back to see the Urologist and an MRI happened with an indication of 2 areas of concern within the core of the prostate.(Left and right quadrants). 24 point biopsy yielded Gleason:3.4 and 4.0 respectively.

Followed up with Bone Scan and Tissue scan: both clear. The choice became - radio or radical. if radio, later surgery was not possible!

At 73 no question to answer - Radical.. The Urologist recommended going wide to ensure that anything in the Nerve bundles or glands was caught.

Had some complications with Catheter positioning and Pelvic pain, but eventually resolved.

Home for a week now, very little pain at this stage, control over urine and other functions returning to normal.

Results - No encroachment outside of the core, nothing in the semen vesicles, so effectively clear.
I trampled a bit of a rough road but normally it would have been a 6 day stay.

Of one thing I am certain: the PSA score could easily have been missed if I was not being checked for other stuff and even then the Generalist had to recognise it for what it was. The urologist already had an inkling (and told me) so when I was referred for PSA and the blood test was normal, he pursued the MRI for a first look. After that I entered the mainstream diagnosis and medical panel recommendation process.

The best of news overall, Physio starts next week.

Imagegear

Very good news indeed. Great that your urologist was vigilant and kept an eye on things. 4.0 is not usually a particularly concerning level at 73, so full marks to him for being so thorough.

Imagegear,

You've had quite an ordeal but I'm glad you've come out the other side OK.

I know a large number of men with prostate cancer (beyond the one in six statistic we see advertised) but they're all still above ground and doing well after a variety of treatment choices. You will be too.

They all caught it due to an elevated PSA or rate of PSA rise.

Choosing a treatment option seems to be a very difficult process.

Getting a PSA test is critical despite what we read occasionally read in the press saying they aren't needed.

Hang in there.

I saw somewhere that the lifetime number was close to half of all men will get prostate cancer, although the number that require active treatment was quite a bit lower (not sure where I saw that). But few men actually die from it.
My own story has become a bit mixed. I got the seed implant a year ago June, and I'm still not fully over the side effects (thankfully I've not had any noticeable side effects from taking FloMax - which is good because I can readily tell if I forget to take it). The good news is that my PSA is low enough to be nearly unmeasureable and all the signs are that the cancer is gone.

I occasional hear of a Feminist that's claiming that if men got breast cancer, there would be a cure in short order. Prostate cancer is proof positive that those Feminists that claim that are clueless.

Sadly men can get Breast cancer. Met someone with just that during one of my cycles a few months ago.

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..."

Thanks anxiao. What a fascinating and eloquent summation of your experience, and may you "become airborne ;) on your 0500 departure" again soon.

Re the dreaded decision between surgery or radiation, I will always remember Boeing Boy's quote: "The sword or the death ray".

It sounds like you were (and still are) in excellent hands.

Fingers crossed, for all of us, that the @#$%^& doesn't come back.

Anxiao. I'm glad I was able to help and I'm glad my analogy between the Sword and Ray proved valuable to Capn Bloggs too. It's good to read of your journey and I hope your recovery continues. Interestingly I have a close friend who went through Pca at the same time as me and he chose the Sword. His experience has been very close to yours including the recovery and functional issues.

For me I'm two years down the road with PSA's around 0.36. No problems to report although probably as much age related I function best with recreational pharmaceutical assistance. Frequency is still more than I would like by day but I sleep well. Flying has continued by developing a deep meaningful relationship with a lot of 380ml Lucozade bottles (other beverages are available, but check the width of the bottle neck ;))

(Update July 20. Lowest ever PSA score at 0.31 so now discharged from Urology with just the Radio Oncologist to see next January. )

BB, we glider pilots use external catheters, a bit of tubing and bags or bottles. Saves fumbling in the cockpit.

I like these: https://www.urodry.com/products/geewhiz.html

There's a wide variety available. Stay away from the ones with adhesive (think ripping off a bandage) and and the flimsy ones.

For more info, search "glider pilot relief".

A quick précis of my dealings with prostate cancer....... diagnosed 10 years ago with a Gleason score of 2:2 & a max PSA of 6... 3 options available ..removal, radiotherapy or brachytherapy.... opted for low dose brachytherapy at Royal Marsden Chelsea...... PSA dropped to .5 .... but now gone up to 6 ... had PET/CT Scans a few years ago & told treatment has failed, when I had brachytherapy was informed removal after treatment was not really an option but time moves on & now can be achieved....... face to face chat coming up in September to discuss what happens next which could be just anti testosterone injections or removal which could well involve removal of bladder at same time which obviously I don’t particularly want or maybe cryotherapy & my question is has anyone had or know someone who has had this option plus or minus problems with it?

As an aside it was amazing the amount of people who never were tested for their PSA reading & all I will say is please get checked it may save your life!!

It's astonishing that some doctors talk of the morbidity that the PSA check can cause and deem it a reason not to do the checks. I've always thought that was a bizarre bit of logic. Let's not put red warning lights in aircraft in case we upset the crew with false warnings.

I've not heard of low dose brachytherapy, though yours was a low Gleason. I'm sorry to hear of your bad news.

Mine was 4 - 3, the bad way round, and right on the borderline for the procedure. Given the choice again, I'd go with the same procedure. The only side-effect I had was 'Bowl-hurry'. 1 in 500 chance was stated, though I felt at the time it was a figure plucked out of the air. All it meant was the signal that I wanted to go did not give me much notice. I watched my wife and daughter ride the London Eye from the embankment, there was no way that I could be trapped in a place like that. Commuting to Texas meant a full Picolax procedure 36 hours before flying.

When I was diagnosed aged 57 I encouraged work colleagues/ friends to have a PSA test ... some did some didn’t..... a couple who went to different doctors were told “ have you any symptoms “ .. no ... “ well don’t worry about having test done” ...... one work colleague/friend who eventually got tested had prostate removed at aged 52 & friend aged late 60’s had radiotherapy both now ok.

Low dose brachytherapy is the standard one with permanent seeds implanted 66 in my case but you can have a brachytherapy boost which involves radiotherapy & hormone treatment combined with the brachytherapy.

I don’t take it as bad news Loose rivets more as the case of another river to cross & I think it’s all about staying positive.

If anybody else reading this feels like they need to read up on forms of treatment etc etc the website to go to is www.prostatecancer.org ..... no offence to our colleagues across the pond but I was told don’t read about prostate cancer on American websites as you may think you won’t make it!