Hi all, an update on were l am heading as the thread has been bumped and general info on procedures for anyone that may be interested, but remember l’m not a doctor.
I talked to the specialists in Melbourne a few weeks after my starting this thread, the “Australian Prostate Center” is a world leader in treatment so l am led to believe, they host the largest International Conference on prostate cancer and also hold the largest specimen bank for testing in the world.
Radiologist.
I first talked to the Radiologist for about 40 minutes (all phone consults for free). I was initial going to head down the path of seeded radiation (there are 3 types of radiation depending on how far the cancer has got, seeded for earliest stages, thru to using it when there are no other options available (i.e. very late cancer)) as it seemed to have the lest side effects with very little bed rest. Limiting factor was the $20K, the radiologist said that was conservative and it was more like AU$25K. He was confident that l would pass the governments strict requirements to get on the public purse, so there would be no cost to me. In more than 10 years he had only put forward 4 people for the public purse and all 4 had had it done. He does lots of private patients/insurance companies who pay the $25K, but to be eligible for the public procedure you need to have at least a 10 year life expectancy after the operation and have good urine flow, because after radiation you can’t do a “Turp’s” (where they bore out the urethra tube you pee through that goes via the prostate, hence having a urinary issue caused by the tumor pressing against the urinary tract is a symptom of prostate cancer) operation to correct poor urinary flow.
He finished by saying, next l’m going to speak to the surgeon, who will say you are better off to get it cut out, the radiologist agreed that seeded radiation treatment had lost it’s main advantages over the last 10 years as robotic surgery had advanced. Now the 2 main side effects (erectile dysfunction and incontinence) from surgery were at about the same percentage as seeded radiation, but without the possible side effects from using radiation, which can show up some years down the track i.e. cancer of the bowel/bladder.
Surgeon.
The surgeon was keen to cut the prostate out, as it would be an easy operation due to it being very early stage cancer. He confirmed that robotic surgery had improved immensely and side effects weren’t as common as open surgery and possible better than seeded radiation, with no following side effects like radiation could have.
Active Surveillance.
Well if you are going to get prostate cancer active surveillance is the best outcome for as long as it is an option. Just follow your PSA results and if they takeoff, confirmation biopsy and then some sort of treatment to follow.
I couldn’t find any data on the internet re time frame for stepping up the treatment. Both the radiologist and the surgeon agreed that the data shows within 2 years 25% of patients will need some sort of procedure, 50% in 5 years.
My biopsy done in Tasmania was using a new technique called “precision needle”, l was going to be the first patient in Tasmania to have this, but due to Covid restrictions l had to wait 2 weeks and someone else was the guiney pig. The day Covid hit here, the surgeon that comes from Melbourne to do a MRI image guided biopsy phoned to say they weren’t coming to Tas until all restrictions are lifted, hence the “precision needle biopsy”. l initial thought what the Melbourne surgeon was going to do was MRI image guided, but he is one of only 2 in Australia that does the biopsy while you are in the MRI machine, not from an image from when they did the MRI to see if you may have cancer. Under MRI he is able to guide a biopsy needle thru the center of the tumor.
If the biopsy from the center of the tumor is to the same level as the other needle results (gleason 3) he was confident that with my long history of PSA results showing the slow progress of the cancer, he felt it was likely that my time on active surveillance could be counted in many years (sounds good to me l can tell ya).
But currently Melbourne has had Australia’s largest outbreak of Covid so l can’t/won’t go there until it is safe to do so, my MRI biopsy isn’t that urgent as a recent PSA test has shown my 4.8 reading before the biopsy has come back to 4.3, possible due to aggravation from digital examination’s (if you get my drift).
The consensus seems to be no one wants to do anything nasty to you until your PSA is >=10 (public purse seeded radiation is limited to <10) unless there is other indication that the cancer has got aggressive. The surgeon also agreed to do the biopsy free of charge.
Conclusion.
l had a long and interesting phone conversation with the Melbourne psychologist (last of the 3 specilists) to confirm or deny that l’m a nuttier, came back l’m in a good mental place (mostly) for having prostate cancer. I believe it is due that l always thought it was going to happen so wasn’t a shock at all, apart from the$20k bill and haven’t thought it was going to kill me.
l am now just waiting for my trip to Melbourne for the biopsy (hoping it comes back gleason3) and then just be waiting on each 3 monthly PSA test result.
Active surveillance has benefits in the sense that you aren’t living with some of the possible side effects from any procedures i.e. erectile dysfunction (well any that is caused by surgery anyway) and the bigger one to me, incontinence, while you are just watching, so
a) You may die of something else before needing to do anything for the cancer.
b) Their maybe better methods to deal with the cancer in the future.
I’m told some people don’t like having the thought that they have a living/ growing tumor in their body and don’t wish to go on active surveillance so they get the prostate removed, l’m currently comfortable with active surveillance and will do it until something happens to change my view.
Re why does prostate cancer happen. There seems to be no definitive answer to be found, l eat reasonable healthy, very few processed foods and grow veggies and stay active.
Even when l worked underground and night shift l had good vit D, so in my case l don’t think that was an answer. Drinking coupés amounts of alcohol could be an answer though, both my dad and l like a drink.
Regards Kevin
