TURP is useful for diagnosing early stage prostate cancer

URO TODAY: Benign prostatic hyperplasia patients in whom prostate cancer is suspected and who have urination problems, with a previously negative biopsy result, can undergo transurethral resection of the prostate, which treats bladder outlet obstruction and gives early diagnosis of prostate cancer. READ MORE>

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Catheter may be man’s biggest fear – or so you’d think from the number of times the word is searched on the ‘net

PROSTABLOG NZ: What is it about the catheter?

Whenever I look at the viewer statistics for Prostablog, there’s one thing that stands out: “catheter” is the most popular search word people use when they find their way to this site.

It beats everything else by a country mile.

Yesterday, for instance, there were 27 instances of the word being searched – while the next most popular occured seven times.

Today, it’s the same – so far 13 searches on “catheter”, with “Mick Jagger” scoring three (God knows why?) and “brachytherapy and impotence” getting two.

It’s been like this ever since the blog started in April.

I’m not sure I understand how search engines work, but there seems to be a message here: us blokes are very, very worried about getting that damned tube shoved up our tackle.

I can understand why. It was my biggest single fear of the whole radical prostatectomy process.

I needn’t have worried, as it turned out, because the male urology nurse at Wellington Hospital did a brilliant job of removing it. I honestly didn’t feel a thing.

However, two male acquaintances haven’t been so lucky. They both say it was excrutiating. Both had female nurses (is there something significant here? Surely not…) do the removal.

One guy had his taken out just last month and in his words “she just ripped it out.”

How common are such stories? Do they account for the general fear men seem to have about the catheter?

Perhaps someone could write in and enlighten me. All I know is, the term brings a lot of traffic to this blogsite.

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PERSONAL STORY: When prostate rules it’s not OK

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DOMINION POST: In this personal account, a Lower Hutt man recalls the dire effects on his life of an enlarged prostate – and how he finally got it fixed.

When prostate rules it’s not OK

…was too late. I was in trouble again – this time on an island miles from a hospital. I returned in some discomfort to the company and tried to act as if everything was OK. We left soon after. When we got to the cottage I sat on the toilet until I got…read more…

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PROSTATE RESEARCH: Encouraging early results from out-patient incontinence treatment

JUNE 13: URO TODAY: Analysis of a 30-minute, out-patient incontinence treatment called “the AdVance male sling” shows it gives encouraging results, with significant improvement in patient-reported pad use, 24-hour pad test weights, and Valsalva leak point pressure without signs of obstruction. READ MORE>

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PROSTATE RESEARCH: New study adds to knowledge of treatment side effects

JUNE 11: NEW PROSTATE CANCER INFOLINK: There has still only been one large, prospective, comparative study of the side effects of the major types of first-line treatment for localised prostate cancer, but a new, if smaller, study has now added to our knowledge, writes Mike Scott. READ MORE>

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PROSTATE COMPLICATIONS: Study examines remedies for urinary retention

JUNE 7: URO TODAY:  Most men develop urinary retention after external beam radiation therapy (EBRT), after brachytherapy with or without EBRT, and in those who have a combination of EBRT and a radical prostatectomy.  The problem urologists are facing is how to manage the obstructing and radiated prostate, a researcher told a US urology conference in Chicago. READ MORE>

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MY PROSTATE STORY: End of the golden weather (not what you think)

PART 21 of My PC Adventure – see full story HERE>

The headline for this - the penultimate chapter of my prostate story - isn’t what it seems.

It’s not a goodbye, nor a resignation to impending death, nor a signal I’m giving in to the vicissitudes of age.

It’s a metaphor, of course, drawn from a famous NZ play by that name ( The End of the Golden Weather  by Bruce Mason ) which spoke to my boyhood of  ”…the eternal optimism of the child and the harsh certainty of age…”

To quote one tribute to Mason’s 1959 work:

“Golden Weather tells the story of the loss of innocence and of human fallibility…”

The end of my golden weather refers, in part, to the “official”  finish of my recovery from the surgery that took out the prostate cancer, a two-month idyll during which I’ve researched and written about prostate cancer in this forum, which began as a personal blog and has grown to a website with a following around the world.

(That’s one reason, incidentally, why I have explained “end of the golden weather” – now two of five visitors to this site are from the US. The proportion of Kiwi readers is about one in three).

In this case, “end of the golden weather” also has a literal meaning, since my time at home has been blessed with a remarkable (for Wellington) patch of fine, still weather, an “Indian summer“.

In the last few days, winter has roared in from the Antarctic, bringing snow to the South Island and to hills around Wellington.

Rain hits the windows on the southerly side of the house as I write this, and I know the days of teeshirts and sunhats are over for a while.

Tomorrow, I return to work. Truly, the end of the golden weather, but in fact something well overdue if I am to feel fully restored.

Which is what I want to write about: how do I feel about what’s happened (that classically banal and inappropriate journalistic question)?

Perhaps I should begin with what I don’t feel.

I don’t feel old. At 62, the body and mind are in the kind of shape my parents’ generation, the Depression and war-shaped cohort, associated with their 40s. My mindset accords with that silly epithet, “60 is the new 40″.

I am getting old, of course, but cancer has had no obvious role in that gradual process.

It didn’t turn my beard white, steal the hair from the top of my head, slow up my legs in social soccer games, nor account for loss of memory for people’s names after we’ve just been introduced, nor the keeping to speed limits, and restricting of booze intake to a Heinie a day, and the working day hours to no more than a dozen.

All those things have been creeping up since I was 30.

I don’t feel debilitated. I’m back to the fitness I enjoyed prior to the operation in March, easily able to walk briskly over my personal training challenge, Wellington’s Mt Victoria.

These pictures show the 151 steps I climb on the route to the top, and a view from that top after my first post-surgery ascent, about six weeks after the operation:

As I rather over-excitedly reported in an earlier chapter, my urinal turn-around time is reduced to that of a youngster.

I have no major problems with incontinence – just a little drip of a leak sometimes when I’m tired and forget to brace the pelvic muscle when I laugh or cough.

And the big one – suffice to say, that’s not a problem either, without the use of Cialis or the dreaded injections. Bang goes my excuse to browse in the adult shops for a cheap pump.

I don’t feel apprehensive. I’ve got cancer, but we got it early, it would seem, and it was slow-growing – Gleason grade 6 (I’m now thinking it was there for years before my GP, bless him, encountered it with his digit).

It hadn’t migrated out of the prostate, and prior to the operation my PSA was a mere .77.

I’m a little less sanguine about the “let’s cut the bastard out and be done with it” mindset I had early on, because research tells me there’s never any guarantee that something microscopic didn’t escape into my system during the op, or even during the biopsy. Highly unlikely…but possible.

I expect when my PSA is tested in August I’ll show the required nil level, but I’ve also read data which shows it might rise again after a couple of years. I need to show nil PSA for a decade before I can possible say I’m cured.

But something has changed. Ever so subtly.

It can only be described as an odd sense of betrayal. My body – until now more or less organically sound – has finally let me down in a most shocking way.

Okay, I’ve had marginally elevated cholesterol since 1991, but there is still medical disagreement about what that actually means. And I take a light dosage of blood pressure medication for something that runs in the family.

Neither of these has felt anything other than a mild indication of getting through the years towards maturity.

But cancer! That’s systems failure. That’s involved the first major invasion of my body, leaving a scar (physical and mental), and thoughts – which will no doubt recede – of organic deterioration, of a hurrying of the first steps towards the grave.

Sound morbid?

It does, doesn’t it, but actually it’s not something I’m dwelling on in a neurotic way. It emerges merely as one of the more philosophical after-effects of a mortal event, a reminder that, yes, there is death at the end of the journey, and there’s no way to dodge it.

It doesn’t affect my optimistic view of life in the slightest.

I come from a line of long-livers. My great grand-father died in his baker’s shop in London at the age of 99. My grandfather lived to 84, and my father convinced himself he would go at the same age, so did. On my mother’s side (she lived to 80), there was grandma lasting till 94 and grandfather going to 86. We don’t pop off early in my family.

Age expectation is a tricky calculation, incidentally. One of the interesting things in Michael Dattoli’s new prostate cancer book (reviewed recently on this blogsite) is a reminder that average longevity calculated at birth (about 78 for male Kiwis) is way shorter than that enjoyed by someone at 60 and beyond.

This chart from the Dattoli book shows what I mean:

This is important in the debate about population-based prostate screening. One of the arguments against it (and against surgical treatment after about 75) is the thesis that because many tumours are slow-growing, something else will getya before the prostate.

As age expectation rises significantly once you’ve reached 60 (compared with what you started out with, when accidents and other factors are probably much more influential), so presumably does the point at which “watchful waiting” should apply.

My life expectation in terms of surviving prostate cancer is also being extended as we speak by the massive effort by scientists and doctors – in the US especially – to achieve breakthroughs in testing, diagnosis and treatment.

Any time soon they’re going to find a quick, non-invasive method of helping the medics know how bad the cancer is and how (or if) it should be treated.

This is undoubtedly an effect of the great surge into old age of my generation, the baby boomers, with our more positive attitude to aging and our demands (and wherewithal to pay) for better medical options.

So. How am I feeling?

Bloody good, bloody lucky, bloody optimistic.

Even so, I will be taking a few precautions.

The number of red meat meals will be dropped from four or five a week to one or two, the already fat-free diet will be applied even more rigorously, the brisk walks will be taken even more regularly, stress at work will be avoided (hah!), sunsets and scenery will be noted more diligently, the regular evening hit of red wine will be replaced with pomegranate juice (which looks exactly the same in a wine glass and, amazingly, tastes like a slightly sweet version of a Central Otago pinot noir)…but the single daily can of that nectar of life, the Heineken (no, they’re not paying me a cent), will continue.

This weekend we had a pleasant visit from my journalist colleague, Barry Young, who also happens to be president of the NZ Prostate Cancer Foundation.

Barry is 10 years free of prostate cancer after his prostatectomy, his PSA is nil, he can enjoy a good glass or three of red wine, and he tucked into seconds of lamb shanks (grown on the open fields of the Canterbury Plains, no doubt).

I’d be tempted to say us journos have an extra gene that bodes well when we get prostate cancer, but I know that’s not true (witness the death of the legendary Frank Haden a couple of years ago).

But our sense of outrage might help. It comes from our journalism-driven suspicion that there are people in positions of medical power who – with their dogmatic opposition to the promotion of prostate testing - are deciding the fate of a lot of men in this country.

This comment in no way applies to the medics who have treated me – surgeon Rodney Studd and the team at Wellington Hospital, Bob Hale at the urology department, the nurse-manager of the rehab clinic, and to GP Rob McIlroy.

Thanks to them, I feel confident of a long life. I don’t care about speaking too soon - I’m just not suspicious about tempting fate.

NEXT (some time away): PSA - wherefore art thou?

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OUR PROSTATE STORY: A wife’s side of the tale

PART 18 of My (Our) PC Adventure:  see the full story HERE>

By LIN TUCKER

A few of weeks before Christmas, 2008, a very worried Jim told me that our GP had found some roughness when performing a digital examination of his prostate.

He’s the family worrier, so I went into reassurance mode with comforting words such as “found something early”, “stats in your favour”.

I must internalise worry, because no alarm bells rang: maybe it’s the two years of nursing training I did, so I understand the odds are usually in the patient’s favour.

Besides, Jim has had regular checks and his PSA reading was never high. Well, that’s what we thought then.

Fast forward to Christmas Eve: my niece from Canada has arrived to spend Christmas with us. Jim says he still hasn’t heard about his biopsy test results. I say “no news is probably good news. However, if you’re concerned, why don’t you call the surgery.”

He calls, and the nurse says yes, the results are back, but you will need the doctor to interpret them. A small tingle replaces the former insouciance I have been feeling.

Some time later, the doctor hasn’t called back, so Jim phones him and is told that the tests show cancer cells present, but the situation is not considered so urgent that it couldn’t have waited until after Xmas. An appointment will be made for him to see a urologist.

The cancer word is a bit scary, although Christmas and a vacation with an old nursing friend are enough to keep my mind from dwelling too long on any worst-case scenarios.

Jim doesn’t follow the accepted male ideology that you ignore symptoms; he is not shy about getting medical advice and for this I’m grateful. It means that as a partner I’m fully informed about the options, as – being a journalist – he will have done exhaustive research.

Knowledge is powerful as a tool for my peace of mind. If I can rationalise, I can cope.

I took him to the hospital for the biopsy prior to Xmas. Although the procedure is not entirely pleasant, Jim didn’t find it too much of an ordeal. But after the effects of the biopsy, which was quite invasive, he needed a bit of looking after.

Jim made another visit to the urologist just after New Year and returned with material to read and view, and a request to discuss it with me and make a decision about treatment.

At the end of January, I go with him for the treatment consultation. The urologist is young enough to be up-to-date, but old enough to have some gravitas, which is very comforting.
 
We’re informed that three of the 12 samples have shown cancer. On the positive side the cancer is not of an aggressive nature. 

The urologist mentions “margins”, where the cancer cells might have migrated to the surface of the prostate and affected other tissue. Not quite so straight-forward after all.

On balance, though, things are more favourable than not; I tend to concentrate on the positive.

Right from the beginning, Jim is keen on having a radical prostatectomy rather than brachytherapy. I’m a little worried that he’s making the decision on a cost basis, but the literature seems to lean that way. The urologist says he is a good candidate for surgery.

Jim can have the operation done at the public hospital by the same urologist, so we wait for a date. Hospital surgery waiting lists vary and Jim is hoping it will work out during his between journalism courses, a break when he can have plenty of recovery time.

His wish is granted – March 25, the day before his students graduate – oh well. 

By now we’re in early March and I’m given the “realignment” news at work. I’m numb: another team has also been disestablished. Work is a flurry of shock, questions, and a couple of weeks’ consultation period.

The following weekend, we’re off to New Plymouth to enjoy the wedding of Jim’s niece, Jaclyn. It should be a wonderful weekend catching up with his nephew’s newish son, family and friends and getting our minds off the pending surgery and redundancy.

The operation itself doesn’t worry me unduly. However, the risks of anaesthetic are very real and I’m feeling some disquiet, while trying not to show it.

The wedding day is wonderful, perfect even. The weather shines, the venue is fabulous, the bride’s mother and father behave well (their rift is still somewhat raw). Tensions are non-existent. Jacs is marrying an Australian and he has plenty of family and friends for support. The speeches are hilarious and heartfelt. The bride’s sister, Philly, makes a very warm and loving speech to her big sister. We leave at 11pm and they’re all dancing up a storm.

Next morning, we’re sleeping in when we’re woken with a message that Rob is trying to get hold of us: some accident…Philly’s seriously ill in hospital. We get to the hospital and find she is in an induced coma and they have called a helicopter to take her to Wellington, but they need to carry out emergency intervention!

We try to console each other, joined now in a wave of horror equal to the joy of the day before. It is all surreal. We take Rob’s wife home and keep busy with household chores, when we’re called to say the outcome is not good. We rush back to the hospital.

I stay outside minding the young ones, who are moving quickly into shock, recalling the morning’s events of hearing screams, Philly on the floor of the unit, having apparently fallen from the balcony above.

About 2pm, she is pronounced dead and we go back to Rob’s to prepare for the coming funeral in four days. The Aussies and guests silently file back to what was going to be a post-wedding friendly international cricket match. Instead, the wake starts.

The family tensions buried for the wedding quickly resurface under the stress. The estranged fiancé and his family are also in the mix; it’s not pretty. Eventually, we farewell the yellow coffin.

Due to the funeral, Jim has to change his pre-op check date, hoping he will not lose his place in the operation queue. I am hoping for this, too, as I don’t think I can stand any more waiting to get his situation resolved.

Away from the funeral-wedding, we start to prepare mentally and physically for the operation. When we go to town he walks home to Hataitai over Mt Victoria to get fit. I’m unable to concentrate much at work. 

Jim and I head for Wellington Hospital at 6.45am on Wednesday, March 25. He has a bag packed with PJs, clothes and toilet gear. We spend an hour or so in a small room with no windows where he changes into the sexy nightgown, socks and hat. No need for the contents of the bag – I take it home. Nobody gives clear instructions that you will spend the small time in hospital in their gear and won’t need clothes until you are discharged. 

A number of staff come in with their various checklists and tick off all the boxes, some for a second or third time. Part of me is glad they are being so careful and another part is just screaming “get on with it”.

We are then escorted up to pre-op, where he is put in a bed. More checks and a visit from the surgeon. I’m relieved when he promises to call me after the op, which should take three to four hours.

I wave Jim through the doors and set off home. We live only about five minutes away, and there’s no point hanging around the corridors.

I had intended to go into work, but there’s no point: my mind is mush. I go home and wait. About noon, one of Jim’s work colleagues calls. I tell her no news yet.

At 12:25pm, the urologist calls…relief, all went well and looks good. I figure that is code for no obvious signs of marginal cancer cells…hope I’m right. I let out my breath.

I have Jim’s cellphone, so I text all and sundry, call close family, and head back to the hospital about 3pm. It’s going to cost a fortune in parking fees.

He’s sitting up in bed looking morphine-sleepy. I don’t stay long, leave money for a morning paper, his cellphone with all the incoming well-wishing messages. It was good to touch him and know he’s okay

Next day, I come back at about 10am when visiting starts. He’s had a reasonable night, aside from bringing up the jelly he tried for dinner. We visit until lunch, then I leave. I go back to tuck him in late afternoon.

That night wasn’t quite so good, bit of pain. Next day it’s up and showering, the drain having been removed. He may come home tomorrow.

Yes, after the night from hell (including him wrenching the catheter tube out and wetting the bed thoroughly), having been moved from the “must-be-watched-closely cubicle” across from the nurses station to one around the corner, he is happy to be coming home.

Eventually we’re allowed to take him, and his spares home. I drive carefully, but Newtown roads are not in good shape. You would think streets and roads around a major hospital would be smooth.

At home, Jim is doing well and the first night we attach the extra catheter bag for the night and all goes smoothly.

We are lulled into a sense of false security. The next night, the valve joining the bags doesn’t work, so I’m changing a wet bed at about 3am. The following night I get to change it twice. Finally we get it right.

He gets the catheter out after six days. This process is very interesting, as this is a teaching hospital and I learn a lot. I take JT home with his “pad”. I’ve purchased a “dry sheet” for any accidents: I’m too old to be changing beds in the early hours of the morning. I sleep patchily as it is.

At work on Friday I get a call from JT at 3pm. He sounds in severe pain: “Come home, please. I need to go to A & E.” I make the fastest trip home. On the way to the hospital, he tells me how he came to be in that state. Feeling chipper he found that he was getting some penile action, so he tested it to the point of orgasm, which caused muscle spasm of the acute variety.

Oh no, I thought. I hope this doesn’t put his recovery back at all.

ED do their thing with so much pain relief an elephant would be downed. Then he’s finally able to pee and the pain stops. He can go home.

But this is not to be the last of his tribulation. That night he has trouble peeing and at 3am I get the car out of the garage (why do all these things happen at this hour) for another trip to hospital. Sorry darling, but I’m just so tired.

But then he passes a massive clot. Much relief, more mess, but the pain is over, and recovery resumes. 

Eventually, the blood in the urine passes, and normality (whatever that is) returns. 

Each day I come home, JT looks and seems to feel better. I am so enjoying his recovery. So far, so good.

NEXT: Spreading the news.

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MY PROSTATE STORY: Two out of three ain’t bad

PART 15 of My PC Adventure (read full story HERE> )

“It’s good news…” the surgeon begins.

After that, his words are a blur.

When you’re a cancer patient and you’re taking a phone call from the doctor about your test results, you’re not really going to hear much beyond that wonderful opening line.

It’s a Monday morning, 12 days after my radical prostatectomy, and surgeon Rodney Studd is relaying details of the lab analysis of the cancerous prostate he’s removed:

• The cancerous cells weren’t near the margins of the organ (which meant they weren’t touching anything else and thereby spreading);
• They were non-aggressive – a lowly 6/10 on the Gleason scale.

That’s two out of three, he says. Good news, indeed.

Erm…the third thing?

Ah yes, the PSA blood test I need to have a few months after the operation when there has been time for everything to settle down.

If that shows negative, I’m good to go (although I will need to be monitored in future to make sure nothing in there is changing).

It’s time to celebrate, even though his call follows a tense weekend as the after effects of my little accident the previous Friday begin to subside.

Blood and clots cleared quite quickly and my urine is clear again, but it’s hard to rid my head of the thought I’ve done some permanent damage.

Rod’s call certainly helps. I need to spread the news.

Lots of phone calls and text messages later, I’m exhausted and sleeping. When Lin gets in from work with a bottle of Bollinger, I can manage half a glass before dozing off. Some party.

The week plays out anxiously.

By Wednesday, blood drops have returned to the urine. However, it’s oldish looking blood and it’s watery, so perhaps my system is just clearing itself out. Lin consults Dr Google, who tells her this is a natural occurrence.

I want to call someone, but it’s Easter.

I try to get myself moving about more. My first proper walk is all of 100 metres down to the bus stop and back, and it goes okay, duck-shuffle though it is.

Next day I go up the street to the other bus stop, twice the distance away, and in my enthusiasm start to walk quite quickly, forgetting I’m supposedly an invalid.

Then I hang out the washing. I sit at the computer and hammer out a blog. The bleeding gets a bit worse.

Have I overdone it? Hell, I wish I knew.

On Tuesday, I shoot an email off to Rod with a still picture attached showing the colour of my urine.

I leave a message for Wellington Hospital urology nurse Bob Hale.

Bob gets back first. No problem. It’ll happen for a while. Don’t worry.

Rod emails back and says the same thing, and compliments me on the strong urine flow in the picture, which he says I must have taken one-handed.

I relax a bit. As they predicted, the blood gradually disappears, and is gone altogether by the weekend.

After 18 days, my scar has healed beautifully and the only sensitivity I have is from the gens, which are still slightly swollen.

I use a horseshoe pillow on the computer seat to give a bit of clearance.

Then another problem arises – the dreaded incontinence.

So far, this hadn’t been an issue. But, mysteriously, when the blood disappeared, I suddenly found I was having trouble holding it back whenever I climbed up from the sofa or a chair or out of bed.

Right – get back to the pelvic floor exercises, which I hadn’t been able to do for a while because of the raw feeling in my groin.

The feelings of leaking slightly last just a few days. Then, everything seems to be back under control.

I sleep six or seven hours without having to get up to pee. This is helped by taking my blood pressure pill – a diuretic (piss-inducing) – in the mornings.

I try my first can of Heineken. Nectar. But just one a night.

The walks get longer.

The autumn weather has been superb for Wellington, calm, sunny, warm, perfect for perambulations around the block. I shed the slippers for proper shoes. I’m even trying hills (small ones – Mt Vic will have to wait).

I wish we had a dog. I feel like an old perv on the prowl. I start carrying my camera on my shoulder, which at least makes me think I’m walking slowly with obvious purpose.

Here’s one of the results – a beautiful day down at nearby Evans Bay. It’s nice to have time to look at things properly.

I’m on the mend. For sure.

NEXT: Sorting out the other thing.

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MEDICAL ADVICE: Having prostate cancer test an individual choice

CONNECTICUT POST HEALTH: Q: What should someone like me do when it comes to the prostate cancer test? Please help me make a decision.  For the answer, READ MORE>

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