Thank you all for your advice, which I considered and was very helpful. My silence is because I made my decision and am now in recovery mode. In the interests of helping others through the process, I am posting below a blog of the process I went through, from diagnosis to treatment, with more to follow as my adventure unfolds. I hope others following in my footsteps find it helpful, as I have found all the experiences related in this forum. (Doctors names redacted per the requirements of this forum)
Men are told the first symptom of a prostate issue is usually the need to get up several times a night to pee, or difficulty peeing generally. As we all know, peeing is at best imprecise and can be affected by factors such as diverse as the dodgy looking bloke standing in the adjacent urinal, ambient air temperature, someone telling you to hurry up or the amount of beers consumed. Secondarily, and apparently equally inconclusive, is the dreaded finger-up-the-bum test that would reveal an ominous swelling. Fellow men be warned - neither of these were true for me. I was a symptomless 59 year old male who had, quite randomly, decided to see my Doctor for a general health check. He listened as I answered a barrage of questions and diligently noted all my answers. He gave me an EKG - all ticking away nicely. The bum-finger test - fine too. So off I went. Two days later he called and said “Just one thing …, you have an elevated PSA. It’s 6 and it should be no more than about 4.” He suggested we keep an eye on this, and that I should return for another test in a few weeks time to see if it had moved.
“There’s definitely something going on” he began, six weeks later. “Your PSA has jumped to 8.3.” Things went progressively downhill from there, and I had a consultation with a urologist, a CT scan and a biopsy, all in quick succession. The biopsy involved general anesthetic and was painless, but it caused some bruising that made me look as if I had been gored in the balls by a buffalo and I peed pink for a few days, but that was it. The outcome, however, was not good. Not only was my cancer extensive, but aggressive - punching above its weight with 9 out of a possible 10 on the Prostate Shitstorm Scale (otherwise known as the Gleason Scale).
The next critical step was to see if it had spread beyond the prostate or was contained within its walls, so I trotted off to have what I called a Chernobyl Scan (PET scan). Basically they inject you with a radioactive liquid designed to specifically light up only prostate cancer cells (how do they DO this??), then they pop you through a very expensive doughnut a few times and send you off with a slightly ominous warning not to go anywhere near babies and pregnant women for at least seven hours. I zig-zagged off down the street, furtively avoiding prams and woman of child-bearing age.
Thankfully, the results showed that my cancer was contained - the first good news I had had in a few weeks. I needed to lose weight, pronto, so I had started a regime of running every day, a low carb diet and cut right back on drinking. Nothing like an impending surgery to focus the mind,
The decision about which treatment route to take is where the ball comes back and lands firmly in one's lap, because no one will make this decision for you. Every case is, of course, different but usually involves surgery and/or a radiotherapy/hormone treatment combo, so it is important to see both a radiologist and a surgeon. Surgeons generally want to put you under the knife; Radiologists generally don’t. The first Radiologist I saw scored low. He gave me about ten minutes of his time and simply rubber-stamped the surgeons recommended course of action (removal, probably followed by hormone treatment and radiotherapy) without taking the trouble to consider, discuss and inform me of all the nuances. It turns out there are many.
Less than impressed, and always one to take a rubber stamp with a pinch of suspicion, I managed to wrangle a referral to DD, esteemed Professor of Uro-oncology at the famous Royal Marsden Hospital, London. There are few boards he has not chaired, or letters he does not have trailing his name. He is a legend in the profession and his numerous papers and studies have been published worldwide. A nicer and more forthright man you could not hope to meet, but as getting a meeting with the Dalai Lama would be considerably easier, I felt very fortunate to find myself sitting in front of him four days later. “You are lucky” he began, smiling “if not for an unexpected change in my teaching schedule, I would not have been able to see you for weeks”. He listened, looked at all my reports, made copious notes, histological analyses and calculations, asked questions and was in all regards extremely thorough and considered.
We discussed at length the pros and cons of each treatment option. Surgery was certainly a good option as I could possibly get the entire cancer removed before it spread. Additionally, the results were measurable via PSA and, if it turned out I had traces that recurred down the line, they could be effectively treated with radiotherapy. The side effects of surgery were more extreme and trickier to manage (extended incontinence, probably; sex, probably not), but overall the treatment process was faster.
Hormone/Radiotherapy was also a good option. Treatments were now highly advanced and of pinpoint accuracy, the side effects were somewhat less aggressive and more manageable (with more likelihood of some sex) and the success rate high, even for cases like mine. The PSA level would no longer be a viable indicator of being clear and if it did not work, and surgery would be off the table as a back-up. Treatment was lengthy, possibly as long as two years.
Eventually, he said that in my case, he would very slightly err on the side of surgery, because I had the chance to get it all out in one fell swoop. So, ninety minutes of his valuable time later, I got up to leave. As I opened the door he said “Just one more thing - you should look at it like this: In your case, it's like trying to decide between buying a Mercedes or a BMW. There is no bad decision, they are just different, and it comes down to which you feel suits you better.”
Nothing about this is easy, and all of it is deadly serious, but even in the darkly ominous process of discovery and treatment, there are glimmers of light and, occasionally, even humour. Another positive - I had lost about 30lbs (2 stone) as a result of my exercise and diet, which pleased Dearly Beloved no-end, and friends looked at me as if I had just produced a large rabbit from my hat.
I spoke at length to my wise GP, to expert radiologists at Cornell (for an American opinion) and also to a past patient of my surgeon’s, whose case was similar to mine and who opted for surgery. I heard all the first-hand details, and sex (or lack of it) and incontinence both featured prominently. Having had many years of extensive rogering under my belt, the prospect of having that little avenue of pleasure denied me was, on balance, not one that especially concerned me at age 60. I vacillated wildly for about 36 hours, before deciding on surgery and, having made the decision, I was able to relax and go with the flow, all doubt assuaged.
I spent the week girding my loins (literally) and having vast quantities of blood and swabs taken in preparation for admission, lest I be unknowing host to some dreaded lurgy. A kindly and knowledgeable male nurse talked me through the experience step by step, from admission to full recovery. This was both comforting and alarming in equal degrees. Comforting because I knew what to expect; alarming because what I was now expecting initially involved being tilted, head-down at a 45 degree angle as six incisions are made in my abdomen, which is then pumped full of Co2 to push my intestines out of the way to get me ready for an encounter with the robotic equivalent of the six-armed Hindu Goddess Durga, but more on that later.
On admission to hospital, my surgeon came to see me. xxxxx is regarded as one of the top urological surgeons in the UK, and absolutely the gold standard when it comes to the Radical Robotic Prostatectomy (RRP) I was about to have. Normally a serious and reserved man, today he was positively bouncing with excitement, his face lit up with a huge smile and his bushy eyebrows twitching like furry antenna. He breezily ran through all the possible complications, including bad-Robot scenario, which would result in an immediate switch to conventional open-surgery. I shot him a look of mild hysteria, hoping the robot was more Apple than Microsoft. “Don’t worry” he said “it will all be quite all-right” as he patted me encouragingly on the leg. “I will see you after surgery to tell you all about it - but you won't remember a thing I say.”. He beamed at me again and scurried excitedly away. “Extraordinary”, I said to Dearly Beloved, “I have never seen him like that before”. “This is the bit he loves doing more than anything else” she replied, sagely.
A nurse walked me down the corridor to what looked like the bridge of the Heart of Gold spaceship from the Hitchhikers Guide to The Galaxy. Bright blue light saturated the entranceway to the “Hybrid Theatre” as the glass doors swooshed open in a way Douglas Adams would have particularly admired and I was ushered into the prep room, the floor of which had been painted an especially improbable shade of neon green. I was busy pondering the reason for this alarming color choice, as the delightfully charming and chatty lady anesthetist talked me through the epidural and other things she was going to …
Five hours later, I awoke to find myself mysteriously back in the hospital room I started in, the only immediately noticeable difference being that my tongue no longer appeared to be attached to my brain and I had an annoyingly urgent but unfulfillable need to blow a massive fart. Tubes connected me to several machines that went beep and Dearly Beloved hovered about, trying to get me to drink some liquid. or other.
The da Vinci Surgical System is a robot made by the American company Intuitive Surgical. It is “designed to facilitate complex surgery using a minimally invasive approach” (more commonly known as the five-small-holes-instead-of-one-bloody-big-one approach). It is controlled by Mr. xxxxx from a console the other side of the room, into which sticks his head and enters the 4K, 3D world of my abdomen. Manipulating five interchangeably weaponized robotic arms with astounding accuracy, he then pretty much plays a video game with my prostate as the enemy. The system costs about US$2 million and is probably the most fun a surgeon can have with his clothes on. Here is a video of it stitching a grape skin back together.
The feeling of having been minimally invaded by a robot with six arms is a curious one. There are six small plasters covering the holes around my navel and I am conscious of a vague sense that deep rummaging has occurred in places that have never before experienced a deep rummage. Movement is not easy and, taking a look under the sheets, I see a tube has been deliberately placed where one should never normally consider putting any sort of tube - especially one of such startling girth. Clearly, this entire procedure involves a lot of firsts for me, I thought, as I vigorously pumped the machine labeled “press here for intravenous heroin”
RECOVERY - Phase One
Recovery was more about discomfort than pain and involved - at least initially - hot-and-cold running drugs with a street price close to the healthcare budget of a small African nation, farting volumes of Co2, a nice little present from the Conran Shop, farting more Co2 and several quite good creme brûlées, artistically arranged inside a hollowed out half-orange in an attempt to win some obscure award for hospital catering excellence. Dearly Beloved, in between considerate ministrations, marched me up and down steps and along corridors until my body promised not to be sore anymore as long as she would just stop. By day three I was pretty mobile and ready to go home. They say two days in hospital is fine for an RRP. They are wrong - you really benefit from that extra night.
Now I am home in Battersea, which is nice, getting used to living with Mr. Catheter. Thankfully no real pain, but plenty of discomfort, as my bowels, bladder, willy and lower abdomen try and come to terms with their robotic assault. Mr. Catheter and I have been for a walk by the river and by all accounts seem to be well on the way to recovery - notwithstanding the occasional very sudden and sharp reminder that he is there. Walking involves adopting the posture of an octogenarian man with a very bitey ferret down his trousers, which happens to be asleep but could wake up at any moment and, on waking, would likely to be both hungry and agitated. The importance of walking in a way that would not disturb said ferret cannot be sufficiently emphasized. Of course, walking in public places carries with it enhanced risks, such as the need to suddenly avoid reckless skateboarders and bicyclists or deal with being greeted by a young and bouncy golden retriever who has decided you might just possibly have a ferret in your crotch that requires urgent investigation and to whom the concept of asking permission is entirely foreign. This is an extremely bad scenario so one must carry bear-spray and be on Def-Con One at all times. Other than that, all good.
So as I in equal measures take it easy, indulge in the occasional snooze, get some work done and walk gently along the riverbank and park with kind friends, Dearly Beloved disappears for hours-on-end to a succession of missions, interspersed with lunches and knee-polishing appointments. She returns to our nest like a magpie bearing the sparkly-spoils of London - a rather nice fish-pie from the fishmonger in Bute Street, a dressing gown I needed, some delicious cheese from a Marylebone Road cheesemonger, a spare catheter bag. Life, one could argue, is relatively normal.
I cannot help but be struck by my good fortune. Were it not for my random medical check-up back in April, I would be still wandering around, feeling perfectly fit and blissfully unaware that deep inside me a virulent cancer was exploding out of my nether regions. For heaven's sake get a blood test, gents. Every year.
To be continued ….