Guest post: Prostate cancer treatment affected by prior cancer and COVID

By Pramod Daya, Founder and CEO, Mindspring Computing

Here’s the story of how my prostate cancer treatment options were affected by prior cancer experience. I’m a business leader and founder of Mindspring Computing. My prostate cancer story started as a sidenote in my life.

When I visited my excellent GP, Dr Anna Frost, in February of 2020, she mentioned that we had not done a PSA test for a while. Good idea, I thought. I did not know too much about it, nor was I overly concerned.

PSA test and digital examination

The test came back with a level of 4.15 – apparently just slightly over the threshold. My GP recommended a visit to the urologist. She recommended the helpful and pleasant Dr Govender, who had treated me ably and kindly when I had kidney stones a few years earlier.

He did the initial digital examination. In this case digital is not the opposite of analogue, unfortunately – it means finger-up-the-bum! He felt some hardening in my prostate and suggested an MRI scan.

MRI challenges

I’m very claustrophobic, and couldn’t handle the idea of being in a tunnel while the machine hammered away. So I asked for that process to be done under conscious sedation. After some poking around to insert a needle for the sedative, I successfully entered la-la land. Next thing I knew, my partner was driving me home.

The report from the radiologists and Dr Govender was not welcome….. there was definitely cancer, and it had to be treated. I needed a biopsy to determine the scale and scope to determine the course of treatment.

Next step: Biopsy

The game was on… not my first rodeo, as I’d had lymphatic cancer some 20 years before. That was dealt with quite efficiently, and my confidence in allopathic medicine remained high. I was confident that this was going to be another routine round of procedures and treatments.

The biopsy was again done under general anaesthetic: doze off under general, wake up and get driven home. The post operative recovery was not so pleasant – lots of blood in the urine, and pain for a week.

Cancer treatment options

My cancer was determined to be Type 2C. It was contained in the capsule of my prostate, which was a good sign. It had been detected early enough to reduce the chances of it spreading into adjacent areas. My urologist recommended brachytherapy – his speciality. Brachytherapy is the implantation of small titanium coated radioactive pellets into the prostrate to shrink it over a period of several months. It seemed like the less invasive and risky option, compared to surgery to remove the prostate.

The side effects of brachytherapy were not great – inflammation of the bowel, which is near to the prostate – possible secondary cancer risks – and impotence developing within a couple of years. However, not much chance of incontinence, which seemed like a highly desirable outcome.

Impact of previous radiotherapy

My partner joined me in the consultation with the urologist. She mentioned in passing that I had had radiotherapy for the previous cancer. I had omitted to mention this as it seemed like a distant memory with no long term side effects.

I was surprised, then, that my options for prostate cancer treatment were affected by my prior cancer. My previous cancer treatment turned out to be a deciding factor. Dr Govender immediately changed the thinking around brachytherapy – and proposed that I consider surgery instead. We walked straight over to his colleague’s adjacent room, and spent a hasty 10 minutes discussing surgery.

Preparing for radical prostatectomy – COVID intervenes

The operation date was booked, six weeks in advance, and the waiting settled in. I had no discomfort, or pain, or worry – this seemed like a routine procedure with minimal side effects.

Photo by Fusion Medical Animation on Unsplash

A week before the due date, I was feeling sick – and went to have the pre-operation COVID test – to find that I’d managed to get COVID. Another six week delay, while dealing with the anxiety around getting COVID – and spent 18 days in bed recovering from that dreadful ailment.

Another COVID test – still positive, so another 6 week delay.

A third COVID test, pronounced all clear, and given 2 days notice that the surgery was about to proceed. Being laid low with COVID meant that I had not had much opportunity to practice the Kegel exercises; and foolishly, had decided that YouTube videos were enough preparation. Big mistake.

First days after surgery

The operation proceeded successfully, nerve sparing on both sides, no cancer in the nerves, so there was a hope of retaining erectile function, and some sensation. Woke up in hospital with a drain bag attached to my side, a pipe leading into my abdomen, and a catheter draining into a bag on the side of the bed. The painkillers kept misery under control. Less then 24 hours after going into theatre, I was discharged with a leg bag for the catheter strapped to my leg. So far, apart from the prior cancer and my apparently-light brush with COVID, this was a lot like Mish’s experience.

On the way out of the hospital I visited the pharmacy to get urine absorption pads in preparation for the catheter being removed. Little did I know what lay ahead … to be continued.