When I went to get my diagnosis, they kindly offered to record the proceedings for me I case I glazed over. They gave me a CD of it at the end. I made my own recording of my second opinion consultation in Harley Street on my phone. I never listened to either.
I twigged after the DRE and mpMRI where a lump was found that I most likely had cancer, and the Registrar who did my template biopsy confirmed as much in our pre-biopsy consultation.
And so my MDT meeting was something of an anti-climax, as they were telling me what I already knew, but I did have a long list of questions on my iPad which we went through one by one. I have found it in my notes, so here it is if it any use to you:
Anyway, I have a question....or two.....
How much of my abdomen and thorax did the MRI scan? And I presume there are no
metastases showing elsewhere? Did it scan my liver, which has most rudely been referred to by medical professionals as “fatty”!
What’s the difference between template and target biopsy? Which did I have?
Why bother with a TRUS biopsy? How constrained are you financially?
Two friends, both with PCa, who have been down this road before me, one in London and one in South Africa together independently advised me - “don’t be palmed off with a TRUS biopsy”.
So heartfelt thanks to you again for booking me in so quickly for the Transperineal procedure.
My mate in Capetown has seen five top urologists in London and South Africa, two recommended surgery, one radiotherapy and two active surveillance. He has chosen the latter.
The point about TRUS was reinforced by the patient on the post-operative ward opposite me who said he’s got a three times oversized prostate and had a TRUS biopsy in August and then had to wait till January for a Transperineal biopsy where 100 cores were taken. You’ll probably see him when he comes in for his score. He said he may be referred to Cambridge for radical prostatectomy.
What’s in Cambridge?
So how big is my 15mm tumour in proportion to the size of the left lobe of my prostate?
How near is it to the edge of the capsule?
What would have been the difference in your approach to treatment, say five years ago, in 2013, if I had presented to you with a raised PSA of five or six, up from 2.2 in 2010, with a stage 1, 1mm, abnormal lesion?
Did you have 3T resolution scanners five years ago?
Do you use Da Vinci exclusively nowadays for RP? What’s the difference between Da Vinci laparoscopic and Da Vinci open surgery. Which is most appropriate for my lesion?
What are the recovery rates, days of hospital stays, rates of incontinence and impotence for each procedure?
What is nerve sparing?
What is Retzius sparing?
Recovering patients of radical prostatectomy and other hormone and radiological treatments say many Urologists play down the after effects..which can be life changing, but of course, also life saving.
What is HIFU?
What is Nano Knife?
In three years will most prostate surgery be carried out by IRE?
What’s not to like about it?
Is it the Holy Grail of prostate surgery as its purveyors for £18,000 or €13,000 a pop would have one believe?
When will it be offered here on the NHS? How many IRE electrodes would it require to kill my 15mm lesion? They can use up to seven and they cost £400 each.
So, my cancer may have been growing for up to seven years. Or seven months. Or weeks. How accurate is the histological Gleason score estimate as a predictor of future tumour growth? See, I referred to it as a tumour for the first time, rather than an abnormality. In fact, I am going to refer to him as Tommy the Tumour in future.
I see men that who have had RP the whole organ is excised and then once evaluated a different score is given.
What is the prognosis if we do nothing at all? Where are metastases likely to occur next?
Is orchidectomy a certain cure at this stage?
I could be the new Farinelli the castrato. But maybe post-puberty I’m too old. And my voice is not so good unless I have had a lot to drink in a Karaoke bar.
Where can I see your prostate surgery performance results on-line?
Copies of imaging, histology and radiologists reports?