Keith
Martin and Bridget live in London, UK. He was 46 when he was diagnosed on April
1 2010. His initial PSA was 6.5 ng/ml, his Gleason Score was 6 (3+3) and although
he does not give his staging, it seems likely he was staged T2a. His choice of
treatment was Active Surveillance. Here is his story.
I went to the doctor
as part of a general health check and mentioned some urinary issues I was having;
urgent need to go, with little or no warning, that sort of thing. Because my father
had had prostate cancer (treated successfully with hormones) the doctor did a
prostate examination and a PSA blood test. The examination itself wasn't conclusive,
but the PSA score was 6.5 so I was referred to Guys and St Thomas's Hospital in
central London.
I had another PSA test - lower, I think 4 point something
- and a physical prostate examination. Two doctors thought they could feel something,
although not anything much. So I was booked in for an MRI scan and also a Histoscan.
The Histoscan is a new procedure being trialled; it wasn't meant to be a direct
part of decision-making for me, but the results would be used for evaluating the
process itself.
The MRI scan led to a biopsy - an 'enhanced' biopsy, which
involved taking 32 core samples rather than the more normal dozen. And there it
was; minor, small, but revealed. One of the 32 samples was 15% cancerous, with
a Gleason score of 6 (3+3).
The doctors and nurses were very helpful and clear.
The various options were explained to my wife and me. It was made clear that I
had a number of different options available, but that the one they felt was at
the top of their own list, for me, was Active Surveillance - 3-monthly PSA tests,
6-monthly rectal examinations, and another enhanced biopsy in 18-24 months. Because
I have had a Histoscan I would be included in ongoing studies too, although that's
not really for direct treatment information. This is what I have chosen, although
it was again said that I could change my mind at any point and go for a more interventionist
treatment.
I currently have no symptoms I can identify (the urgent need
to pee has passed, maybe a slight bladder infection) and I feel extremely confident
in and comforted by the attitudes of the staff at the hospital. They seem to be
operating at the cutting edge of his field, and - encouragingly - they have said
that thinking is now that there is as much as 50% 'over-treatment' for prostate
cancer. Not that prostate cancer shouldn't be taken seriously, but, apparently,
thinking is moving towards reducing invasive procedures to an extent.
My
next move will be a PSA test at the beginning of November (2010), then another
plus a rectal examination in early 2011. I think my wife feels worse about that
than I do!
I've
been meaning to update my story for a while, but it has been one of the things
that gets put back down to-do lists. Finally, here's how things are as of Jan
2012:
I
have just had another PSA test, and my reading is 2.04 - very respectably low
for my age, and exactly the same as my PSA test last summer. This is in marked
difference to the reading from the previous year, which was a bit over 6. My nurse
is very pleased - and of course my wife and I are delighted too! I won't have
another PSA test until June, when I'll also have another biopsy. I've asked the
staff not to schedule it for the second half of the month as it'll be our 25th
wedding anniversary; it would not be great to be walking gingerly and have unsightly
bruising all around my crotch if we go off to a beach somewhere!
The
biopsy I had in June 2010 was the enhanced kind, with far more core samples taken
than with the normal one. Cancerous cells were found in 15% of one core sample,
and the doctor joked that 'maybe that had also removed the problem'. It would
be remarkable if that really was true, but it is great that the cancer seems to
have backed off so much. My current PSA reading probably wouldn't push a GP into
sending me for more tests if I wasn't already in treatment, and the nurse who
gave me my most recent 'digital examination' said my prostate felt quite small.
My
treatment continues to be the hands-off kind: Active Surveillance. I've been a
vegetarian for around a quarter of a century (ok, the fish-eating kind) but I
haven't gone for any dramatic changes. I eat pumpkin seeds semi-regularly and
I eat tomatoes a fair bit, two things broadly considered to be beneficial to the
prostate. I'm reasonably active now - I took up longboarding (the wheeled kind,
not surfing) last spring and I am thoroughly addicted. I'm fully aware that one
day things could swing back the other way, but the signs for now are all good.
I'm so glad that I didn't make any panicked decisions on invasive treatment! I
had various friends and family telling stories about how people we know had surgery/seeds/hormone
treatments... the side effects aren't as often recounted, and they can be significant.
At
some point in my life I may need to choose an invasive treatment, but anything
with potentially serious, life-changing side effects that can't be undone shouldn't
be rushed into. Next time I'll have the results of a new biopsy as well as my
next PSA test.
Best
wishes to you all - and no rash decisions, ok? :-) Keith !
Keith's
e-mail address is Thatkeith@mac.com
