Making space and making my decision about prostate cancer treatment

24 January 2020: Today I made my decision about prostate cancer treatment. But first I needed some space.

Making space for good decisions

My December 2019 MRI scan was pretty certain: clinically significant cancer likely in the left peripheral zone of my prostate. Even after I sat with the urologist reviewing the results, I was sure that I would end up being the lucky one. His tone was reassuring. He told me to go on holiday and come back for the biopsy in January. He said in cases like this, sometimes the best option is “watch and wait” but we need the biopsy to find out more before we decide.

The MRI results showed that my prostate is barely enlarged – 32 cc (just over 2 tablespoons) compared to the walnut size typical in a young man. I later find out that this is a big plus in terms of regaining continence after surgery.

Bucket list holiday in China

I am so glad I did go on holiday! I had work scheduled in Beijing in December, and my wife and I took the opportunity to go together and combine that work with the adventure of a lifetime in China – including hiking on the wilder part of the Great Wall in the snow and sleeping overnight in a local village.

We also got to wander blissfully around the streets of Shanghai and Beijing weeks before the Covid-19 pandemic began. We left China literally the day of the first cases (without us ever going to Wuhan).

MRI targeted biopsy

On 16 January 2020, I had an MRI-targeted biopsy. This clever technology is designed to use the MRI scan results to precisely sample the areas highlighted in the scan as at-risk for cancer. Without this, the standard biopsy involved random samples of the prostate.

My experience was surprisingly positive – my journal is filled with appreciation of the medical team, for the support of my family and close friends, and for the joy of waking up alive when the anaesthetic wore off.

Biopsy results: Reality bites

When I get the biopsy results my hopes to emerge cancer-free fly out of the window. My urologist’s tone is very firm and direct: it is time for action. No more watching and waiting. No more holidays abroad. There is definitely cancer in my prostate, and some of it is close to the surface.

The report says it is still confined within the capsule which seems to be the most important thing. They only find cancer on one side of the prostate. The report calls it Stage T1C and that feels like a good distance away from the dreaded Stage 4 Cancer. I start learning fast about Gleason scores – mine is 7 (3+4) which means the majority of samples score 3 out of 5 (where 1 is OK and 5 is most malignant) and some score 4 out of 5.

Prostate cancer treatment options

I have choices and my urologist describes them very clearly. Basically for me, it is either radiation therapy or surgery. Hormone therapy is generally only used in some cases where the cancer has spread beyond the prostate itself.

Both radiation and surgery will have a big impact both on the cancer and on my broader quality of life. It sounds as though radiation leaves urinary continence and sexual function less impaired in the short term but can often end up just as bad in the long term. If I go for surgery, he recommends the laparoscopic robotic assisted type, rather than open surgery. “Your prostate is so deeply buried in your pelvis,” he says, “there is really no space for the surgeon’s fingers to perform open surgery.”

It doesn’t take me long to choose the robotic-assisted laparoscopic surgery. While I don’t generally want to go for “quick fixes,” the option to cut the cancer right out of my body in one go sounds very attractive.

I meet the surgeon that same day. Doctor James Urry is young, positive, amazingly clear in his explanations and I trust him. Later I remember to ask him a few questions, including how many of these operations he has already done. I am satisfied that he is sufficiently experienced and I go back to see him the following week to sign up to have my prostate surgically removed.

Commitment: decision about prostate cancer treatment

So today I’ve decided on Robotic Assisted Laparoscopic Radical Prostatectomy (RALP or RARP for short). When I sign up, I am rather disappointed to find I have to wait a total of 6 weeks for the aftereffects of the biopsy to clear. We schedule surgery for 27 February, 2020.

Postscript:

In case you are thinking that surgery was overkill: the pathology report on my prostate after removal showed it was at Stage 3 – beginning to emerge from the prostate capsule. So not a moment too soon. There is a good chance I have escaped with my life. Without that GP doing a physical examination last November, I would probably be walking around with Stage 4 Cancer right now.