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.

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. 

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.

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.