The path I'm taking

Very interesting with obvious parallels to my situation. An increase from one reading to another is statistically unreliable because the test can be affected by so many other factors. I wish my PSA were as low as yours but even with a current PSA of over 7 I still believe AS or WW is the best option at this stage. As you say, one in three men over 50 has PC with the figure rising to 70% over 70 and 80% over 80. This is a very common disease but very few men die of it. Thanks for your post and I wish you all the best.

"very few" I think the statistic this comes from must have as the base figure an estimate of the number of men who have PCa whether diagnosed or undiagnosed. The statistic of using the nember of men diagnosed with PCa of all conditions as base is about 30% die of PCa. However I do not consider either statistic as helpful in assessing the outcome in any individual case.

Hello Robert,

Whilst I fully appreciate that you have specifically addressed David with your post I nonetheless hope you will also permit me to respond,  in order to better understand the background scenario, to your  MRI scan.

1). Two years ago,  did you have symptom(s) that led you seek  investigation,  or was your PSA of 4.6 picked up in a routine general health blood test ?

2). Then more recently when you returned a PSA reading of 6,  had there been any change in symptom(s) ?

3). To see a Specialist in both Australia ( where I am ) and the U.K., referral from a G.P. Is a prerequisite.   Is it the same in Thailand ?

4).  If you were referred then presumably it is because stats-wise 4.6 is already a red flag at age 62,  as is 6 at 64. 

5).  At DRE was the suspicious finding either an area of induration, or an element of mis-shapedness ?  And if so,  what significance was attributed to this ?

6).  Given that lesions under 2mm are not discernable by MRI scans,  are you now in a period of watchful waiting ?   And if your PSA continues to rise at the same velocity,  at what point would you consider having a biopsy ?

And finally, is your current antipathy towards biopsy based on concern about possible side-effects impacting on general health,  or due primarily  to fear of impairment of normal sexual function ?  ( In my case it was about 50/50 ).

Thanks Robert,  fleshing out the rationale for interventionist / non-interventionist decisions made,  greatly assists in a general understanding of the aetiology of conditions affecting the Prostate.

Best wishes,

Dudley 

Music to my ears, Robert. I have asked my GP to refer me for an MRI scan as I do not much fancy a biopsy (see Alfred's story on this thread for just one example). Patient biopsy stories seem much worse than published figures which I suspect downplay the downsides. Anyway, I hope to have an MRI early next year and will take it from there. My PSA is, of course, much higher than yours and I am 9 years younger but I still believe that biopsy is not the way forward. There is an interesting article which can be found by searching 'MRI vs biopsy'. All the best.

Even with hindsight I would have wanted a biopsy when my MRI scan showed two tumours of which one may have broken through the prostate capsule. Pathology was then able to provide the gleason score for each tumour. That in turn enabled the oncologist to recommend agressive treatment and I to want that treatment. The down side was that although I had no infection from the biopsy the antibiotic used gave me a couple of nasty side effects. 

Hello George,

I was wondering ... If either David or Robert find out by other indices that they do have Prostate Cancer ...  Aren't they going to be obliged to have a biopsy anyway,  in order that the aggressiveness and extent of the tumour can be ascertained and a course of treatment formulated ?

Would that be right do you think ?      

Kind Regards

Dudley                    

I have approached this problem from the desire to avoid an invasive and dangerous test until it has been proved to be necessary. Once there is evidence of a tumour the risks of a biopsy fall into place as being less than the risks of treating the tumour unduly lightly ( with fatal consequences ) or with undue severity ( with uneeded risk taking ). Until the Geason scores are superceeded it is difficult to see how the consultant could proceed  at all without a biopsy.

 

Yes Kombi-C,  very well put.  That is The Great Divide:   Between,  those who on the one hand have come to know what an insidious and relentless opponent,  PC is;   And on the other hand those who simply do not want to know,  in the hope that they may be lucky and dodge a bullet.  Not realising that in ducking and weaving they are ensuring that if they are struck,   a fatal result has been increased exponentially.

We Patients go on with issues about The Quality of Life and tend to think that cuts and thrusts within the vagaries of Hospital attendances :  tests, scans,  discussions and the like,   Practitioners do not always recognise our concerns.   But I think that is a misconception. 

It very soon became clear ( to me at least )  once treatment had started,  that I had a crossed-wire:-

Whilst I was thinking Quality of Life,  they were thinking :  SURVIVAL.

Kind regards

Dudley

Thankyou for your response Robert.  It is very good of you and I hope you do not feel too put upon.  I am sure followers of David's original post,  and not least in this regard Alfred 5,  will appreciate your contribution.  Good luck with your watching and waiting.

Regards

Dudley

Hi, Robert's situation is very different to ours as an increased size prostate can cause a raise in psa. My husbands psa was raising but with no symptoms and on DRE it all felt normal, which prompted biopsy. 

Hello Alfie,  thankyou for that.   Although it may appear otherwise,  I am conscious of the differences in symptoms between your Husband and Robert.

What I was alluding to is that Robert's Post seems to be at least partly causative of the response by Kombi-Cruiser in which he supports  early intervention over W&W .

Regards

Dudlley

Hi, we were led to believe that smaller prostate cancers do not show up on an MRI, as in our case. Just an update, the Brachy chap did not seem too worried about the psa raise, but he had no notes at all, so he had no idea how much it has gradually increased! Anyway, he said no rush for treatment, but we said we couldn't cope with worrying about whether it is getting worse, worrying about side effects etc and would rather get it over with, we asked to be booked in as soon as possible due to the work on the farm, date booked in less than 4 weeks! So moving on quickly!

 

Yes on both points. The small tumours my urologist called occult tumours. A strange choice of name. The tumours are too small to see on the scan which is not the same as being hidden. Still jargon is jargon. And yes, prostate cancer is worrying and early treatment maximises the achivement of a cure. The risk of side effects is very likely a good trade for peace of mind.

Yes George,  precisely : 'The risk of side-effects is very likely a good trade for peace of mind '.  Ultimately it is,  for all of us.

With respect to them both,  that is what I am having difficulty with in David and Robert's posts:  They both admit that they are in denial and are confident in their decisions ...  and yet they are still perusing Prostate Camcer Sites and Forums !?  

Why ?   If you have decided that you do not want  ( what is, in an imperfect world ) the most definitive diagnostic tool for the disease,  why are you visiting the Forums ?  In the expectation that others  ( predominantly suffering from the disease )  will support your decision ?

It's not going to happen is it ?  You may find one or two people who have also chosen to not have their disease confirmed but that's all.  And  they too are perusing the Forums,  so they can't be all that confident either, can they ?

In my own case and with almost identical precursors to both David and Robert ; having decided I ' didn't want to know ',  I did not do any research,  nor think about it at all .  Yes, yearly over five,  I fronted up for PSA's but totally disregarded the evidence and the recommendations.  And once outside, just got on with my life. It actually took a Doctor getting more than a little irate with me,  for me to do anything pro-active and even then,  my thoughts were ' I don't want to upset him !'. 

And so for a period,  I had complete freedom. ( albeit that I have later and as of now, paid the consequences for that ).

To decide you don't want something and then continue to worry over it is,  as they say in Australia,  a ' no-brainer '.  You're not just having one biopsy,  in your mind you are probably having one every day.  And then there is what I perceive as the danger to other definitely vulnerable Forum users in the extolling of a preference,  as a totally unprovable virtue.

It is a pity that we can't talk about this between us around a table and over a coffee because in print what I have said seems so much harsher than what is intended.  And for that I apologise unreservedly.

 No offence is meant and I hope none will be taken.

Regards

Dudley

Well Dudley as a fellow Australian I must correct you regards the 'no brainer' reference... When given a choice where the answer is blantantly obvious it is referred to as a 'no brainer'...

From what I'm reading this is a situation where a 'no brainer' actually exists yet some participants choose not to accept the 'no brainer' and are somehow hopeful that it's maybe just going to all fix itself...

Unfortunately there are some things that just can't be ignored 'unless' that's part a participants strategy which suggests that a choice has already been made...

Absolute madness either way in my opinion...

I came to this forum in the hope of gaining input from those in a somewhat similar situation as me... Participants that are open minded and in search of answers and not merely seeking justification for a decision already made... I didn't think that when I came here I would find participants that would show so much resistance to input from those willingly enough to voluntarily contribute...

Yes we are all individuals and are all responsible for making decisions that affect us as individuals but please remember just one thing...

Prostate Cancer does not descriminate on an individual level and this is the very reason that no two participants are ever going to be the same, have the same experiences or have the same overall result...

Be thankful you have lots of choices... I'm running out fast!

 

Thanks for that Kombi.  I agree with what you say and how you have said it. My literary skills just aren't up to the need for concise expression sometimes ( see George for that ! ) and even now I do not think our wave-lengths are quite matching up;   because you seem to be aligning me with the ' in denials'.  

So I think,  '. time to turn it in '.

Admittedly up to 2014 I had been one for roughly five to eight years. ( more a total avoider actually ).  But I was trying to convey : Not Now ;  and that it had been a  mistake. That was what I have been trying to get across.

 Never mind that though.  I am more conscious that you have been fighting a serious rear-guard battle for quite a while now and I have considerable respect and admiration for your Stoicism ;  I view you as a Senior Statesman in these matters and accordingly,  the better equipped to evaluate them.

So for my part and because I am pretty sure I have said all that I could ever think of to say on this particular topic I am now going to retire from the discussion.

Hopefully the exchanges will have proven insightful and helpful to those who have followed it. That was the intention.  And not to put any one particular person on the spot,  just because I consider their approach to be,  ultimately,   self-defeating.

I wish you all possible comforts,  support and peace of mind.

Kindest regards

Dudley

 

Dudley old mate I thank you for the input and I hope that many will ultimately benefit from the experiences you have so kindly shared...

Hi Alfie,  Good News indeed ! 

If you can overlook the fact that they appear to have either,  two sets of notes for your Husband or none at all,  then you seem set fair for some reassuring curative action within two weeks either side of Christmas,  although I dare say you would prefer after.

Anyway My Dear.  my very best wishes to you and your Family for a favourable outcome.

 I am now retiring from discussions on this  Forum, although I will still follow the posts/comments with interest.   My reason is that I have said all I can think of to say about the investigate and treat / don't investigate or treat Debate.  Although as you will see,  if you read all the posts under this thread,   I did get a clip on the ear from Robert to send me on my way.  

But no matter,  if I have been of any help to you it is more than worth it.

You mentioned starting a new discussion  subsequent to the brachytherapy  procedure / convalescence and I will be most interested to learn both of your combined perspectives and experiences,  and the hoped for eventual diagnostic outcome,  of ever-reducing PSA levels.

With my best wishes for a Merry Christmas and a Happy New Year.

Dudley

 

Dear Kombi,

Mate,  despite all you've got going on,  I sincerely hope that there will be,  over the Holiday Period and Beyond,  many and long windows of pain-free peace and calm and not a little,  Joy and Happiness.

Best wishes Kombi.  May The Lord make His Grace to shine upon you and may He keep you both now and forever,  in His sight.

Dudley  

( And I know without asking,  that George joins me in sending you Best Wishes )

 

Dear Combi,

Yes, indeed. Dudley knows me very well. 

George

Well....things are not moving after all. Brachy due tomorrow, consultant phoned tonight to say due to lack in nhs funding the brachy tomorrow is very unlikely to go ahead. The consultant said he will call after his meeting which is at 9am tomorrow. But most likely cancelled!

Oh. Wow.  They are turning this into a roller-coaster for you both,  aren't they ?   As your Husband would need to prep before the op if it were going ahead ... It seems it is not going to happen doesn't it? 

Would I be right in assuming that this is the same Brachytherapist who a few months back was seemingly confusing the issue by saying there is no immediate urgency ?  Well I guess we can conject as to where he might have been coming from !  I believe any Health Service in the World with adequate funding,  would be acting on Gleason 3 + 3.

Whether you can take comfort from this potential delay Alfie by assuming it will not be detrimental to your Husband's survival and also ,  will allow him to get through the calving season as per normal providing he is not in too much pain,  is purely subjective on your joint behalfs.

Budgets in the U K used to run April / April.  So I guess you'd be looking for reassurance that you'd be amongst the first cabs off the ranks in the next Financial Year ?

Dare I say Happy New Year ?

Regards

Dudley

 

Alfred, I am sorry. That is very chilling news.

Alfie,  my longer reply is being moderated.   Don't know why.  I seem to "8"8"8"@

remember ... Isn't he the chap who,  a few months ago,  said that you could watch and wait ?  So if there is any silver lining in this,  perhaps he continues to consider that no harm will be done ?  Emotionally though it must be tough for you.

Please continue to have Faith.  I am firmly of the belief that the P C will still be caught early and that ultimately the results of treatment will be good for you all.

Best wishes

Dudley

Just had a very long night. He did suggest last time to wait, but as psa is 4.9 we decided not to leave it, though I noticed on the consultants report the Psa says 3.7 for some reason the last psa result was not sent from gp to hospital. My other half is complaining about constant pain down there that worries me. Poor man has to do his enema this morning just Incase he is called in. He has gone out at 5.30am to do an hour on the farm, 7am breakfast then enema all just incase. Let's hope they say yes, though the consultant wouldn't have called unless he was doubtful!

It would be most galling to have to wait longer for the brachytherapy because the Hospital does not have the latest PSA figure which shows an increased velocity.   Especially in view of your Husband experiencing  continuing pain.

I think if I recall accurately,  that the first time you saw the Brachy ...  ( I won't use his full title because I think that is why my first post has been held over ) ... He was initially looking at notes that were not your Husbands in any case.

So all in all,  the profession seems to be not exactly covering itself in glory at the moment.   Of course we are talking solely Admin issues here and I would expect all to be fine Clinically,  so try to not worry on that score.

My feeling is that in having your Husband prep,  they are disposed to try to proceed,  if the List runs through well.  

It would not hurt however if you were able to phone in your Husband's last PSA result ( If it's not now too late ) to ensure they know all they need to know.

Hoping that the procedure will go ahead and be all that is intended.

Best wishes

Dudley

Hi Alfie,

Well,  you haven't been online to say " It didn't happen ",  so I guess it has !?... and you are now,  as I would have expected,  way too busy to be on the 'puter.

So when you do ultimately click on,  I just wanted this message of good will to be sitting there for you all.  

I hope you will all as a Family be managing O.K. and that your Husband is not in too much discomfort.

Best wishes,

Dudley

 

Hello Dudley, thanks for asking. Yes got the call at 9.50am saying to come, we needed to leave at 10am Not sure if you are in the UK? I think not, it is all over our news that nearly all operations have been canelled due to too much strain on nhs. 

He has had it done, his main problem was from the catheter after the procedure, apparently it is much bigger than a normal catheter incase the seeds pass out, he said it felt like "the old chap" had been snapped in a mousetrap, he had a fan blowing on it!. He felt better when they removed it, came home the next morning, he is a little sore underneath today, but we have walked round all the cattle as he cannot stay inside, he has now gone off in his car visiting people, so at least he will only be exercising his jaw! No bladder problems yet, only up once in the night. But I know with brachy it can take a while for side effects to kick in, peaking at week 6. So just have to hope it won't be too bad. Thanks again for asking. Take care.

Hello Alfie,

Good news!  It's great to think that the PC is already under attack and if expectations are realized,  then it will be wiped out.  And with it,  the pain.

I'm not surprised that your Husband is already experiencing warmth in that area.  ( It's the same with EBRT although with that method, it takes a little longer to accumulate ).  A strange and perhaps somewhat disconcerting experience initially,  but liveable with.  

Being a Farmer he will get plenty of exercise and together with increased hydration these are probably the very best ways to lessen the side-effects.

I hope it all goes well for you both from hereon in.  And don't forget to give yourself a well earned pat on the back.

Regards

Dudley

 

Hello Kombi,

G'day Mate.  How are you ?

Regards

Dudley