David, 57 - Prostate Brachytherapy

Christmas ’99 was a miserable affair. All the family, except a doughty 80 year-old widowed grandmother, spent at least some time in bed suffering the effects of ‘flu. The Millennium New Year was only marginally better, with most of us snuffling. We decided that the dark days of February should be lightened by a short break in the sun. So it happened that sitting out one day by the pool, Jill said “That mole on your back is growing, you know. You ought to see the doctor about it.”

“If it will stop you going on, I’ll see him when we get back home”, I replied.

Some weeks later, Jill pestered me again about seeing my doctor about the mole and eventually I made a date.

After a brief examination, my GP said, “The mole’s benign, but you’re a bad attender. We don’t see much of you at the surgery so while you’re here, I think we will do some tests - just a normal check up for someone your age – blood pressure, cholesterol, diabetes.  How old are you? Ah, 57. In the US, men around 55 old are routinely screened to check their PSA level. It’s not normal here in UK, but as we have you here, we can take an extra blood sample.”

He explained that the PSA (Prostate Specific Antigen) level in the bloodstream is an indicator of potential prostate gland problems, but I thought nothing more of it, as all my “bits” seemed to be functioning normally and I was a non-smoker, who exercised gently and enjoyed only the occasional beer or glass of wine. In pretty good nick, even if I said so myself.

Knock me down with a feather! About 7 days later, I received a “please come and see me in the next day or so” note from my GP. Intrigued, more than worried, I went in again to be told “Your PSA level is worryingly high at 10. For someone your age, it should be much lower, so I need to examine your prostate. … It seems a little enlarged. There is a possibility that you may have prostate cancer. I think you should see a specialist consultant urologist as soon as possible. As you have private health insurance, here are three names you can call. You could also contact The Prostate Cancer charity as they have a very good advice and support helpline.”

I was devastated. I did not remember the drive home. Jill was at work. Should I tell her yet? A great friend of my mother had recently suffered a painful and long drawn- out death from prostate cancer, but he was over eighty. Was this really my fate at age 57? Should I begin to make arrangements for my demise? How would it affect the family? What about my work? How long have I got?”

I rang the first name on the list. “I’m sorry, but Mr. So-and-So is on holiday for the next three weeks.”

I rang the second name. “Could you come this afternoon at 3pm? We have a cancellation.”

After examination by palpation and by ultrasonic probe and further PSA tests, the consultant advised undertaking a biopsy (taking about an hour as a day patient) to ascertain why the prostate was enlarged and the PSA results were high. This turned out to be rather like having an air rifle shot up your bottom and after four or five “shots”, became somewhat uncomfortable, but hardly painful. My wincing in anticipation of the “shot” began to make the later sampling difficult. The results of the first biopsy were inconclusive so it was decided that I should have a further similar biopsy, but this time under general anaesthetic largely to avoid the discomfort, to relax the patient and enable the sampling to be more effective. These later test results were clear and confirmed the presence of cancerous cells within the prostate. Having caught the disease early, it was thought likely that the cancer was still contained within the prostate and was probably curable.

The recommended treatment choices going forward were:

• watchful waiting – see how the disease develops over time
• surgery to remove the whole prostate gland with its offending cells
• brachytherapy – a relatively new radiotherapy treatment.

I was provided with very helpful information about the disease and its possible treatment options as well as assurance that nothing needed to be done urgently. I was advised to take time to think things over and decide how I wished to be treated. The fact that time was not such a pressing issue was a relief in itself.

After some further discussion and advice on treatment options with my consultant urologist together with a consultant oncologist, I opted for brachytherapy. This involves injection of radioactive iodine seeds (the size of rice grains) around the prostate. An initial planning session was arranged with the oncologist to undertake further ultrasound probing to assess the prostate size and location so that the optimum number and placement of seeds could be determined. Again, this took an hour or so as a day patient, suspended in the “delivery” position familiar to mothers. A date was fixed for the injection procedure and arrangements were made for a short stay in hospital as an in-patient. 

I booked in on a Thursday morning in August 2000 and the “op” was undertaken that afternoon under full anaesthetic. I awoke to find that I was a bit sore and fitted with a catheter. This was removed on the following Saturday morning when it was certain that I was passing urine quite freely, and I was discharged later that day. After spending the Bank Holiday weekend gently at home, I returned to work on the following Tuesday feeling pretty pleased with myself as the soreness abated quite quickly.

The following six months or so were interesting. From having no particular symptoms or problems, I experienced bouts of diarrhoea and urinary incontinence as the treatment progressed. I would feel quite comfortable one moment and then a sudden urgent need to go, which could not be contained. Whilst this was distressing and at times very inconvenient, I learned to cope by using facilities whenever they were available, whether needed or not. Thankfully, these side effects soon passed and subsequently I have returned to normal. My usual work routine was not affected and life went on pretty much as before.

I had regular PSA checks and follow-up consultations with my consultant, initially three-monthly and then later half yearly, to review progress. My PSA level dropped remarkably quickly and its level been around 0.1 over the last few years.

At the last consultation in August 2005, I was signed off and whilst I will continue to monitor things with half-yearly PSA tests, my disease has been declared “cured”, thanks to the initial action of my GP in ordering the first PSA check and the advice, support and treatment provided by the consultant urologist, the consultant oncologist and their supporting teams.