Prostate targeted biopsy results

Today, about four weeks after the biopsy procedure, I phoned the BRI and got the results which were discussed at yesterday’s multidisciplinary team meeting. I was told that the results were positive and two of the samples (12 in all) showed more aggressive tumours and a greater volume of cancer. My Gleason score has been put up from 6 to 7. I know that this is the addition of two separate scores for what are considered to be the primary and secondary tumours. A score of 7 can be 4+3 or 3+4 where the prognosis is significantly different in each case (the first case being less favourable) and that this will inform the discussion and recommendations of treatment. I was told one of the options would be a radical prostatectomy followed by radiation. I didn’t query this at the time but it might mean there is a risk the newly discovered tumours are either pressing against the prostate surface, the capsule, or even through it. It may still be local, i.e. not metastasis, but it would mean surgery alone might not be enough. I was going to be offered an appointment with the consultant, Mr. Singh, on Thursday 14th July but I will be on holiday in France on that date so it will be pushed back to the following week, probably Thursday 21st. I was assured at the time that a delay of a week would be insignificant but I have emailed and left a phone message this evening asking for more details on the Gleason score and a reassurance I don’t need to cancel my holiday. I will if necessary. This is bad news but I’ve been prepared for the worst ever since I was told the MRI scan showed a cause for concern and a targeted biopsy was needed. Given all the crap that is going on at the moment over the referendum result and the UK leaving the EU I have been as low today as I have ever been. No doubt I will feel better tomorrow and have a weekend in Oxford coming up with my family of 81.


Second biopsy

After seeing Mr Singh last Thursday I have opted for another targeted biopsy. At the moment I have been diagnosed with T1 cancer in roughly the position in the diagram below but, after a reinterpretation of my January MRI scan, there is cause for concern about the possibility of further cancer in the lower, narrowing part of the prostate. Apparently only about 5% of cancers are detected in this area but when they do occur there it can be dangerous as they are nearer the surface and can more easily break out into the surrounding tissues and organs. The biopsy may show nothing of concern, perhaps just some inflammation, but if there is any cancer there, even of the low grade I already have, then it looks like surgery will be strongly advised given the vulnerability of the area. Although this would be bad news as long as the cancer is still contained then the post surgery prognosis should be optimistic. I am expecting and appointment in the next 2 weeks and results should follow in about another week or two so hopefully by the end of May I will know where I am. When surgery was initially discussed last year I was told it could be scheduled in about four weeks or so. If that is the case it may be about the end of June that I have the operation. According to the NHS website it may take several months for my body to fully recover from surgery. The say it is necessary to take it easy for the first couple of weeks after surgery and then a little light exercise such as a short walk every day to improve fitness. I will need to avoid climbing too many stairs, lifting heavy objects or doing manual work for eight weeks after the operation. I will have to ask about cycling but it looks like this would be out for a couple of months. Also my early trips to Oxford and France look would be out, especially if fitted with a catheter. Diagram_showing_T1-3_stages_of_prostate_cancer_CRUK_278.svg

Prostate update

I had my MRI scan on the 28th January but heard nothing for over two weeks. I eventually phoned to see what was going on and heard that the scan had not been seen by the multidisciplinary team yet. A week later I phoned again to be told that there was no change and I would remain on active surveillance. I got a letter to this effect on the 18th February recommending staying on active surveillance and that a blood test would be due in three months, i.e. mid May. So all was well. However, on the 25th March I received another letter saying the MRI scan results had been reviewed and that certain features warrant further discussion and targeted biopsies. This was immediately followed by another letter with an appointment for the 21st April for the procedure when I would be away in Norfolk for a family holiday. I phoned Ian, my contact nurse, to find out what was going on and he explained that their usual expert scan interpreter had been away and someone else had looked at it and said all was well. Since then the main person had returned and reviewed the scan and decided all was not necessarily well. I  don’t know yet whether the first interpretor saw the same thing and thought it insignificant or whether they missed something altogether. Either way this was a bit of a shock. Ian suggested I skipped the discussion with the consultant, Mr. Singh, and we booked an appointment for the biopsy for as soon as I got back from holiday. I opted to have the discussion first as I wanted to be sure another biopsy was really necessary at this time and whether it would be reasonable to continue with blood tests for the moment. So I’ll be seeing Mr. Singh Thursday this week. One of the big problems with prostate cancer is the uncertainty of diagnosis for the sort of low level cancer I have. I can see why some men opt for the surgery regardless and have done with it. If I have the biopsy and the result is that I have surgery this is likely to be in in late May or June. This could well bugger up my arrangements to be on holiday in early July, a second summer wasted.

Prostate cancer and excercise

There was a news item on the BBC Today programme Thursday last week on some research being done on any possible connection with exercise and the speed of development of prostate cancer in men that have been diagnosed with a Gleason score of 6 or 7 and on active surveillance. This is the PANTERA study. Details of the study and how to volunteer to be a subject can be found on the Cancer Research website. I fit the criteria to join the trial on every count except I already exercise beyond the maximum specified in advance of the study, more than 90 minutes per week of moderate intensity exercise. However, I was sufficiently interested to contact the lead researcher, Liam Bourke, by email. I asked if there if there is any information on the exercise regime required of the supervised group and whether they will be given any advice on nutrition. I was also interested in the conduct of the trial, in particular how if at all the ‘self-help’ group will be monitored for any level of activity they may decide to adopt in the light of the information pack you will be giving them and what that information pack consists of.

Dr. Bourke’s reply contained details of the exercise regime: Participants will be asked to attend two group-based supervised exercise sessions a week, comprising up to 45 minutes of aerobic exercise. Exercise intensity will be 65% to 85% of age predicted maximum heart rate or 12 to 17 on the Borg rating of perceived exertion scale, in episodes of 20-30 minutes of continuous exercise for the first 8 weeks, progressing up to 45 minutes per session thereafter. Gym based aerobic exercise training will be conducted using standard ergometers e.g. stationary cycles, rowing ergometers or treadmills. In addition, men are required to undertake self-directed two exercise episodes of up to 30 minutes per week, using an exercise log book and heart rate monitor to objectively record independent exercise behaviour and support adherence and compliance. They won’t be providing any nutrition interventions. The care pack for subjects in the group not undertaking regular supervised sessions is the standard Macmillan move more information pack, available free from McMillan Cancer Support. This comparison group’s exercise behaviour will be checked via standard questionnaires and any change in fitness by sub-maximal treadmill testing.
I have now joined the gym at my squash club and aim to replicate the 2 supervised sessions a week 20-30 minutes for 8 weeks and thereafter building to 45 minutes. I will not do the additional unsupervised sessions of 30 minutes per week as I think I will already be doing enough with cycling, walking and racketball!

Prostate cancer update

I’ve decided to put any posts related to my condition here rather than were they are up until now in my cycling blog which from now on I will restrict to more directly related issues. This blog will be rather more eclectic and will cover a much bigger range of topics but still including stuff on health and lifestyle. Where it seems to be appropriate I will cross-post between the two blogs or at least refer to and summarise posts on the other blog. The two posts specifically about prostate cancer on the cycling blog are Prostate Cancer posted 15th August 2014 and Active surveillance posted 29th August. One thing I forgot to mention in the last post is that, on making a firm decision to opt for the active surveillance programme I was informed by Dr. Owen that this had been the interdisciplinary group’s recommendation. This is the first time I had heard this and I must say it gave me some confidence in my decision. I guess that was the point f not letting me know earlier  – let the patient make their own mind up since there was no sure-fire way of making the right one anyway.

Having opted for the AS regime this involves a 3 monthly PSA blood test, and initial MRI scan 3 months after going on the programme and, if necessary, further biopsies if changes in the prostate and tumours warrant them. I had a blood test early December 2015 which gave a result of 8 – a little higher than the last one, 7.9, but quite a lot lower than the highest taken while I was in hospital with the ruptured kidney of round 9. So the latest test may mean something or nothing – the usual problem with PSA tests. The initial MRI scan due at the same time (part of the AS protocol I was told) never happened but after chasing this up I have it booked for 28th January. I understand from others on this programme that test time is a particularly stressful period as you dread being told the tumour is on the move and surgery, etc. is now necessary. I can feel the tension mounting already even though the scan is 3 weeks away, in fact the day before my 70th birthday.

Rectum? It certainly didn't do them any good. (Thanks to several Carry On films for this)

Ouch! An ultrasound probe is inserted into the rectum to show where the tumor is. Then a needle is inserted through the rectum into the prostate to remove tissue. Apparently 1 in 10 men find the biopsies process too painful to tolerate so it is abandoned and rearranged under a general antithetic. I was one of the 9 out of 10 lucky ones.