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Diagnosis Day. Yay! No.

User
Posted 07 Aug 2022 at 12:29

So, having had my biopsy, and a brief run through of my scans on 25 July, I was back at the hospital on Friday 5 August to get the full run down and discover my fate.


Like the good boy I am, I arrived on time for my 10.40 appointment.  I was eventually seen at 12.00.  Not particularly impressed as I’d already run out of coffee.


In walks Prof X, who heads up the clinic, even though I was hoping to have seen the consultant that did my biopsy.  First off, he asks me about my erections.  What erections, the 150mg daily of Bicalutamide has put paid to those.  Then he asks how I’m peeing.  Better thanks, but not ideal.


“Well,” he declares, “you have a particularly advanced and aggressive form of prostate cancer.  I’m going to put you on the injectable version of your hormone blockers (Decapeptyl) and start you on another type of hormone treatment (Enzalutamide)” and he stresses that it is very expensive.  “Now, I expect you have some questions.”


I mention that I was really rather hoping he’d take me through my scans, so I can better understand my disease, and you know, get the scores on the doors, Gleason etc.


“Oh, I suppose I’d better go and get my laptop then”, he returns with the smallest laptop known to technology, and proceeds to bring up the smallest images of my bone scan.  The disease has already metastasised into my pelvis, spine (right up to my neck), rib cage and collar bones.  I ask about the spread into my lymphs that the consultant mentioned.  “I’ve had a look and I dispute that” is his response.


I ask for my TMN, he says T2 (I think 3) N0 (I think N1) we agree on M1b.  Gleason is 4+5 (9) so grade group 5.


I ask about my prognosis.  He tells me that “things have got better” and “up to 30% of men with this level of cancer live beyond 5 years.”  So, 70% don’t then.  Overall he thinks I’ll mange “probably” 15 years.


“Anyway, I’ll hand you over to one of our specialist nurses, “H” (who I met at my biopsy) and she’ll sort out your appointments etc.”  And off he pops.


H and I have a chat about my post biopsy recovery (numb c*ck and b*alls, very little bleeding).  She’s already got me an appointment for next week to start the Decapeptyl and will refer me to the Enzalutamide clinic to get that sorted.  Meanwhile, my case is being reviewed by the MDT meeting this afternoon, as they need to secure funding for the Enzalutamide, as remember “it is very expensive”.  She’ll call me back with an update later in the afternoon.


She calls me back as promised.  The MDT have overruled the Prof, and feel that given the severity of my disease, chemo is a better option.  I have an appointment in two weeks with Dr H from the Christie to take that forward.  I mention that I wasn’t particularly happy with the Prof’s interpretation of my scans, as it contradicts what he consultant previously told me.  She says she’ll have a look at them and call me back.


She calls me back.  Yes, the disease has entered my seminal vesicles, so T3b, and it is in my lymphs, so N1.  Overall T3bN1M1b.


I’m putting on my best brave soldier face, but in reality, I’ve done nothing but cry since.  Husband is in bits too.


Oh well, onwards and upwards I guess.

User
Posted 08 Aug 2022 at 12:37

Hi,  


Sorry to read about your situation.  My husband was diagnosed in 2015 with Gleason 9 Tb3, he  also had a heart attack last year.How is that for greedy!The surgeon who fitted his stent told him he was a fairly fit man even though he’s got stage four Cancer and he's  had a heart attack He came home the same day the stent was fitted, he took a few days to recover, and was mowing the grass by the next week. Evidently my mowing technique is not exacting enough.  He is a fairly fit 72! even with cancer and a heart attack, but yes, he’s doing ok.We are still managing our small holding, enjoying a good life and he feels good most days. He is now stage four, this was a bit  of a blow, but we have gathered our strength, cried a lot hugged a lot, it’s hard.


His daily drug regime would put a drug dealer to shame, he also takes supplements and follows a diet that helps starve cancer. No sugar, low carb, and some ‘ off label medication’ prescribed by an London oncology clinic, not NHS.


He has no libido, a few aches and pains, gets tired, but he’s 72. 


He is on Prostrap Apalutamide, another expensive one and a raft of other stuff, too many to mention unless your interested. 


Current scores on the doors <0.1   Can’t get much better than that, he is having a zoom with London oncologist on Wednesday.


He has also recently taken up archery, always wanted to try it! Sings and plays his guitar every day, and loves growing  veg.


I hope this helps a bit.


 


Take care.


Leila 


 

Edited by member 08 Aug 2022 at 16:31  | Reason: Not specified

User
Posted 07 Aug 2022 at 12:29

So, having had my biopsy, and a brief run through of my scans on 25 July, I was back at the hospital on Friday 5 August to get the full run down and discover my fate.


Like the good boy I am, I arrived on time for my 10.40 appointment.  I was eventually seen at 12.00.  Not particularly impressed as I’d already run out of coffee.


In walks Prof X, who heads up the clinic, even though I was hoping to have seen the consultant that did my biopsy.  First off, he asks me about my erections.  What erections, the 150mg daily of Bicalutamide has put paid to those.  Then he asks how I’m peeing.  Better thanks, but not ideal.


“Well,” he declares, “you have a particularly advanced and aggressive form of prostate cancer.  I’m going to put you on the injectable version of your hormone blockers (Decapeptyl) and start you on another type of hormone treatment (Enzalutamide)” and he stresses that it is very expensive.  “Now, I expect you have some questions.”


I mention that I was really rather hoping he’d take me through my scans, so I can better understand my disease, and you know, get the scores on the doors, Gleason etc.


“Oh, I suppose I’d better go and get my laptop then”, he returns with the smallest laptop known to technology, and proceeds to bring up the smallest images of my bone scan.  The disease has already metastasised into my pelvis, spine (right up to my neck), rib cage and collar bones.  I ask about the spread into my lymphs that the consultant mentioned.  “I’ve had a look and I dispute that” is his response.


I ask for my TMN, he says T2 (I think 3) N0 (I think N1) we agree on M1b.  Gleason is 4+5 (9) so grade group 5.


I ask about my prognosis.  He tells me that “things have got better” and “up to 30% of men with this level of cancer live beyond 5 years.”  So, 70% don’t then.  Overall he thinks I’ll mange “probably” 15 years.


“Anyway, I’ll hand you over to one of our specialist nurses, “H” (who I met at my biopsy) and she’ll sort out your appointments etc.”  And off he pops.


H and I have a chat about my post biopsy recovery (numb c*ck and b*alls, very little bleeding).  She’s already got me an appointment for next week to start the Decapeptyl and will refer me to the Enzalutamide clinic to get that sorted.  Meanwhile, my case is being reviewed by the MDT meeting this afternoon, as they need to secure funding for the Enzalutamide, as remember “it is very expensive”.  She’ll call me back with an update later in the afternoon.


She calls me back as promised.  The MDT have overruled the Prof, and feel that given the severity of my disease, chemo is a better option.  I have an appointment in two weeks with Dr H from the Christie to take that forward.  I mention that I wasn’t particularly happy with the Prof’s interpretation of my scans, as it contradicts what he consultant previously told me.  She says she’ll have a look at them and call me back.


She calls me back.  Yes, the disease has entered my seminal vesicles, so T3b, and it is in my lymphs, so N1.  Overall T3bN1M1b.


I’m putting on my best brave soldier face, but in reality, I’ve done nothing but cry since.  Husband is in bits too.


Oh well, onwards and upwards I guess.

User
Posted 07 Aug 2022 at 13:37
So sorry you join us with an advanced diagnosis. Let's hope your proposed treatment works well for you. Sometimes there is some disagreement between clinicians especially when it relates to interpretation of scans and then treatment. This happened in my case where one leading hospital considered from a Choline Pet scan that my cancer extended to an Iliac lymph node so the top man told me he would not authorise a second HIFU to a small tumour in my Prostate. However, three other hospitals disputed the finding and I paid privately for a 68 Gallium PSMA scan which showed no uptake in the suspect node and the Professor who did my first HIFU administered it again.(with excellent PSA 6 months on). I just use this as an example of how sometimes there can be a different interpretation of scans leading to different treatment plan. In your case it does not seem that the Professor you saw did not come well prepared, probably because most patients just accept what they are told and don't ask searching questions.

Let us know how you respond to treatment which hopefully will be good.
Barry
User
Posted 07 Aug 2022 at 19:54

Though I and probably everyone here would want to know the full diagnosis, as far as the medics are concerned once they see M1 the treatment regime is pretty limited so probably no point in talking through the TN and G.


The Enzo Vs chemo debate is interesting. Prior to the pandemic chemo was the preferred option, but the reduced immune system in a pandemic was considered risky, so Enzo was used. I don't know which is more effective, but you may know Enzo is very expensive.

Dave

User
Posted 08 Aug 2022 at 00:32

Really sorry to read this Icky. 


As you have already been told there is so much that can be done and men are living a long time even with advanced PCa. Also there is continuing research and trials into this disease and so I’m sure new and better treatments will become available too. 


It will be so difficult at the moment but remaining strong and positive is so so important. Keep fit and healthy and always believe that anything is possible….because it is! 


Will look out for your updates, and we wish you well with your response to treatments. Take care


 


 

User
Posted 09 Aug 2022 at 14:58
HI, sorry to hear about your sistuation and the way the Prof engaged with you, sounded to me as if he didnt really know a lot about you in detail. Just to say Elaline is so right and I have been encuraged by her positive comments as well. My 80 year old husband was diagnosed with advanced Prostate cancer in May this year. It was such a shock for both of us, however with the hep of the people in this wonderful forum I have managed to stay positive. My husband however has always been very stoic and I was the one who needed emotional support which I got from this forum. So hubby had his first chemotherapy treamment 2 weeks ago and so far apart from the metallic taste in his mouth he is not too bad. He is comletely pain free, quite active and has managed to continue playing tennis.

He will be on the Decapeptyl injection every 6 months for the rest of his life, and long may this continue. I have also had wonderful telephone support from the specialist nurses at Prostate Cancer Uk. The Clinical Specialist Nurse where hubby is being treated is also very good. We have booked a holiday at the end of September for a UK cruise for 9 days.

My husband who knows I am getting support from the forum had begun to show interest in the responses and it has made him feel a lot more positive about his journey with this uninited guest!
User
Posted 21 Aug 2022 at 00:21

Well not a great prognosis, but Que sera sera. I agree with your reasoning on chemo. I have a female friend with long red hair, and to some extent it defines her. She had breast cancer, caught early and easily treated, but chemo was offered as a belt and braces adjuvant treatment and she refused. 7 years later all seems fine, so she kept her beautiful hair and lives happily ever after. With what years you have left you may as well be the best version of you.


PARP trial might be interesting, you need some idea of the potential side effects, remember a drug is in a trial because it has not been proved to do more good than harm. I have a slight inclination to say always get involved in a trial if you can, not for yourself but for future generations. 

Dave

User
Posted 21 Aug 2022 at 03:30

Hi Dave.


As you say, que sera sera. I can't do nowt about it, just make the most of it.


To be honest, we spent last night, and a fair part of today getting blind drunk!


I haven't even googled whatever PARP is, but I'll consider it if found suitable. As you say, it's not necessarily about us, now, but for future generations.


Icky / Ian

User
Posted 22 Aug 2022 at 02:54

Getting drunk is always a good place to start. I doubt it can cure cancer but if someone will fund a trial I shall volunteer.

Dave

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User
Posted 07 Aug 2022 at 13:37
So sorry you join us with an advanced diagnosis. Let's hope your proposed treatment works well for you. Sometimes there is some disagreement between clinicians especially when it relates to interpretation of scans and then treatment. This happened in my case where one leading hospital considered from a Choline Pet scan that my cancer extended to an Iliac lymph node so the top man told me he would not authorise a second HIFU to a small tumour in my Prostate. However, three other hospitals disputed the finding and I paid privately for a 68 Gallium PSMA scan which showed no uptake in the suspect node and the Professor who did my first HIFU administered it again.(with excellent PSA 6 months on). I just use this as an example of how sometimes there can be a different interpretation of scans leading to different treatment plan. In your case it does not seem that the Professor you saw did not come well prepared, probably because most patients just accept what they are told and don't ask searching questions.

Let us know how you respond to treatment which hopefully will be good.
Barry
User
Posted 07 Aug 2022 at 19:54

Though I and probably everyone here would want to know the full diagnosis, as far as the medics are concerned once they see M1 the treatment regime is pretty limited so probably no point in talking through the TN and G.


The Enzo Vs chemo debate is interesting. Prior to the pandemic chemo was the preferred option, but the reduced immune system in a pandemic was considered risky, so Enzo was used. I don't know which is more effective, but you may know Enzo is very expensive.

Dave

User
Posted 08 Aug 2022 at 00:32

Really sorry to read this Icky. 


As you have already been told there is so much that can be done and men are living a long time even with advanced PCa. Also there is continuing research and trials into this disease and so I’m sure new and better treatments will become available too. 


It will be so difficult at the moment but remaining strong and positive is so so important. Keep fit and healthy and always believe that anything is possible….because it is! 


Will look out for your updates, and we wish you well with your response to treatments. Take care


 


 

User
Posted 08 Aug 2022 at 12:37

Hi,  


Sorry to read about your situation.  My husband was diagnosed in 2015 with Gleason 9 Tb3, he  also had a heart attack last year.How is that for greedy!The surgeon who fitted his stent told him he was a fairly fit man even though he’s got stage four Cancer and he's  had a heart attack He came home the same day the stent was fitted, he took a few days to recover, and was mowing the grass by the next week. Evidently my mowing technique is not exacting enough.  He is a fairly fit 72! even with cancer and a heart attack, but yes, he’s doing ok.We are still managing our small holding, enjoying a good life and he feels good most days. He is now stage four, this was a bit  of a blow, but we have gathered our strength, cried a lot hugged a lot, it’s hard.


His daily drug regime would put a drug dealer to shame, he also takes supplements and follows a diet that helps starve cancer. No sugar, low carb, and some ‘ off label medication’ prescribed by an London oncology clinic, not NHS.


He has no libido, a few aches and pains, gets tired, but he’s 72. 


He is on Prostrap Apalutamide, another expensive one and a raft of other stuff, too many to mention unless your interested. 


Current scores on the doors <0.1   Can’t get much better than that, he is having a zoom with London oncologist on Wednesday.


He has also recently taken up archery, always wanted to try it! Sings and plays his guitar every day, and loves growing  veg.


I hope this helps a bit.


 


Take care.


Leila 


 

Edited by member 08 Aug 2022 at 16:31  | Reason: Not specified

User
Posted 09 Aug 2022 at 14:58
HI, sorry to hear about your sistuation and the way the Prof engaged with you, sounded to me as if he didnt really know a lot about you in detail. Just to say Elaline is so right and I have been encuraged by her positive comments as well. My 80 year old husband was diagnosed with advanced Prostate cancer in May this year. It was such a shock for both of us, however with the hep of the people in this wonderful forum I have managed to stay positive. My husband however has always been very stoic and I was the one who needed emotional support which I got from this forum. So hubby had his first chemotherapy treamment 2 weeks ago and so far apart from the metallic taste in his mouth he is not too bad. He is comletely pain free, quite active and has managed to continue playing tennis.

He will be on the Decapeptyl injection every 6 months for the rest of his life, and long may this continue. I have also had wonderful telephone support from the specialist nurses at Prostate Cancer Uk. The Clinical Specialist Nurse where hubby is being treated is also very good. We have booked a holiday at the end of September for a UK cruise for 9 days.

My husband who knows I am getting support from the forum had begun to show interest in the responses and it has made him feel a lot more positive about his journey with this uninited guest!
User
Posted 20 Aug 2022 at 21:19

Update:


Despite being told 2 weeks ago that the MDT recommended the only way for me was chemo, I finally saw my oncologist (Dr H) yesterday. Husband was able to come along too, which was really great.


Dr H apologised, and said that he wasn't at that meeting as he was on leave. However, I'm now his patient, and he will be supervising my treatment going forward. He also asked us how blunt he could be in telling us things, which was refreshing. I told him to go for it.


So. My options are:


Chemo is still on the table.


Enzalutamide is too.


There's a possibility I might qualify in for a PARP trial he's leading, but that's subject to all the relevant tests etc.


The three of us had a frank and open conversation about my options, and after a bit of deliberation, Husband and me agreed Enzo is my best bet. I can't afford to loose my hair and beard as they define my identity. I'd end up looking like a boiled egg with some features scribbled on with a sharpie!


Next up. Prognosis. 


The "average" life expectancy of men with my level of cancer is 3-4 years, upper range 10.


Bummer. That's not only the retirement plans out of the window, but even the possibilty of retirement itself.


Husband is taking things really badly. Me, well, it's my fate I guess.


Enjoy your weekend. Be nice, be kind and love a lot.


Icky xx

Edited by member 20 Aug 2022 at 21:22  | Reason: Not specified

User
Posted 21 Aug 2022 at 00:21

Well not a great prognosis, but Que sera sera. I agree with your reasoning on chemo. I have a female friend with long red hair, and to some extent it defines her. She had breast cancer, caught early and easily treated, but chemo was offered as a belt and braces adjuvant treatment and she refused. 7 years later all seems fine, so she kept her beautiful hair and lives happily ever after. With what years you have left you may as well be the best version of you.


PARP trial might be interesting, you need some idea of the potential side effects, remember a drug is in a trial because it has not been proved to do more good than harm. I have a slight inclination to say always get involved in a trial if you can, not for yourself but for future generations. 

Dave

User
Posted 21 Aug 2022 at 03:30

Hi Dave.


As you say, que sera sera. I can't do nowt about it, just make the most of it.


To be honest, we spent last night, and a fair part of today getting blind drunk!


I haven't even googled whatever PARP is, but I'll consider it if found suitable. As you say, it's not necessarily about us, now, but for future generations.


Icky / Ian

User
Posted 22 Aug 2022 at 02:54

Getting drunk is always a good place to start. I doubt it can cure cancer but if someone will fund a trial I shall volunteer.

Dave

User
Posted 22 Aug 2022 at 09:29

Hi Dave 


If you hear about such a trial, then give me a shout, as I'm in too! 😊

 
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