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A Prostate Cancer Case Study: Part 1

Jim Flood discovered he had an aggressive form of prostate cancer in 2008. In his series, "You’re Only As Good As Your Last PSA," he details his journey from being diagnosed to receiving treatment to coping with side effects. Read A Prostate Cancer Case Study: Part 2.

Requesting the PSA test

I had first come across prostate cancer years before when I picked up a leaflet at the GP’s surgery. I did not keep it and could never find it again, but what it said about men of a certain age taking the PSA test stuck.

So one day in my 64th year, I went to see my GP to ask for one. To my surprise, she was clearly reluctant. She had 2 main arguments. Firstly, the test is unreliable. It gives false positives and false negatives. In other words, it can be falsely reassuring or falsely alarming.

Secondly, many older men have some sort of prostate problem, not necessarily malign. Because the cancer is slow-growing, most men who die with it do not die of it. It is found at the autopsies of most men over 80.

I asked whether she was in effect saying that ignorance is bliss. Yes, she said. But she gave me a 3-page article to take away and said that if after reading it I still wanted the test, she would arrange it.

Lack of symptoms

What I felt weakened my case was the lack of symptoms. This is another known feature of this particular cancer, and it obviously makes it harder to ask for a test.

However, this is a very common cancer, with more than 10,000 men a year in this country dying of it. And in my experience, ignorance is rarely bliss.1

So 10 months later, I went back to the practice and saw another one of the doctors. Sure, he said, you want the test, you have the test. It came back with a PSA score of 9 – just high enough to trigger the next step, a biopsy.

This too is controversial. The result of the biopsy, where actual samples of the prostate gland are obtained through a procedure not best known for its dignity, was the reason my partner and I were sat before the consultant that morning at the hospital.

Finding the right doctor

Over the years and especially at this time, I relied a great deal on my GP. I am now on my third.

What they may lack in specialist knowledge they more than make up in experience, in their knowledge of me and my assorted conditions, and simply in their availability. They have time for me.

The poor hospital registrars had no time to consult my bulging file; they worked from a script, and I rarely met the same one twice. The hour or 2 we always had to wait was evidence of the pressure they were under.

With my GP, I had a relationship that allowed a dialogue, and even, when it came to medicines, a degree of negotiation. We discussed options outside the script, such as diet. We also shared a sense of humor. It's OK to joke about cancer if you have it; in fact jokes probably have some therapeutic value in themselves, as long as they’re good ones.

Very bad news

It was July 2008.

"Good morning. Do sit down."
We sit.
"Your name is [my full name]?"
"Yes."
"And you live at [our address]?"
"Yes"
Whatever was coming?
"Well, I’m afraid I have some very bad news for you."

We were in a small but crowded room at the local hospital. It was the weekly oncology (cancer) out-patients clinic, and the consultant was giving us the result of the biopsy I had had a few weeks before.

He went on in a similar vein, "Some of them are pussy cats. You have a tiger." I discovered later that these are actually technical terms used to distinguish between more and less aggressive cancers.

Feeling dread

At the time I felt a momentary thrill of pride: I had a tiger in my tank! Dread swiftly followed as he spelled out the detail.

I had an aggressive cancer of the prostate with a Gleason score of 7, the maximum being 9. It had not yet spread further but was close to doing so. Surgery was the answer, and he was a surgeon. He felled me, then offered a hand up.

Getting a second opinion

There was an alternative remedy, radiotherapy, offered by the neighboring health authority, but he was confident that even they would agree that in my case, surgery was the obvious choice. We saw them next. They did not agree.

Naturally, they made the case for their kind of treatment, but I was in such a state of shock that I probably did not give them a fair hearing. The major drawback with radiotherapy, it seemed to us, was that surgery was not possible later if it failed, as surgeons could not operate on irradiated flesh. If two bites of the cherry were needed, surgery had to come first.

Wanting to get rid of it

I was overwhelmed by the urge to get rid of the thing. I felt like I was harboring an alien. The sudden dawning of mortality, possibly imminent mortality, was a huge shock to one who had always had the good fortune of good health.

I was 64 (the song assumed new meaning), and I suppose I was banking on at least another 20 years. I had 3 lads, 2 of them quite young. What would my loss mean for them? It was not a good day at the office.

Now second-guessing

What I should have done (ah, what I should have done) was grasp at the straw that prostate cancer is relatively slow-growing. I should have taken the time to explore other options, especially what is called "watchful waiting," and also to allow the probable after-effects of surgery to sink in.

The after-effects are urinary incontinence and impotence. In my shell-shocked state, I could almost have accepted the loss of a limb as a price worth paying.

Incontinence and impotence have clear meanings, but they are hard to imagine until you actually experience them. And after surgery, unfortunately, there is no cooling-off period. You can’t send the goods back.

Going ahead at full speed

The urge to get the thing out was so strong that I went ahead at full speed. Within 6 weeks the deed – a radical prostatectomy – was done.

The surgeon did not of course guarantee a full cure, but he thought he could give me 5 to 10 years. In order to maximize my chances, he decided to remove as much as he could – what they delight in calling "non-nerve-sparing" surgery. This makes a recovery of potency all but impossible.

In the next part of his series, Jim discusses what happened after the operation.

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