In April 2017, I was diagnosed with incurable kidney cancer and given a poor prognosis of just months. Following surgery, radiotherapy, and chemo, I was delighted to be discharged in September 23. I was told there was now little chance the cancer would return. However, due to a lab mistake, one of my last blood tests was analysed for psa instead of kidney function. My psa was 13.1. I now have an urgent referral for investigation.
Despite the previous cancer diagnosis and treatment, I am fit, healthy, highly mentally alert, and young for my age at 77.5. I am not on any medication. I can nip comfortably up numerous flights of stairs and frequently do. I have a good bmi, don't smoke or drink etc. I would say my biological age is much lower than my chronological age.
I had a nephro ureterectomy. I now only have one kidney and am classified as Stage 3b CKD due to reduced kidney function in the remaining kidney, post-nephrectomy. This does not impinge on my life, and I have a normal diet and existence.
I had HOLEP 11 years ago in 2012. In 2018 my psa was 1.49. In July 23 it was 13.1, two months later in September 23 it is 13.37. Does the previous HOLEP make this latter psa more significant, even if my prostate appears to have regrown over the past 11 years?
Following the inadvertent psa, the oncologist referred to (what was) my final ct with contrast in August 2023. I was told they saw “heterogeneity enhancement of prostate similar to the ct” from the previous year. They also said that if it was PCa it appeared to be contained within the prostate.
I also had my annual cystoscopy in August 2023, in which my bladder was clear. Due to a declining flow and a little hesitancy, at the last few annual cystoscopies, I have asked how my prostate was looking. They said it is growing and you need a redo.
I don’t get up more than once in the night, and it is usually after about 6 hours, and I could hold it longer if I choose. I have no urgency or discomfort. I don’t fret about toilets when out and about. Personal dipstick tests show no blood, and all the other parameters are normal.
The oncologist said that despite me being a “fit man” surgery would not be offered, and very briefly hinted at the possibility of VMat IMRT with a few months of HT. Now what to do?
I know it is early days in the process, but want to be as prepared as I can be. I absolutely don’t want to skew the suggestions and want to leave all options open, but considering my age and medical history Is WW or AS ‘the’ viable option? I also want to be around for my wife as long as possible, and that is a prime consideration.
Having researched all the different options from private focal HIFU to robotic prostatectomy, I ended up at RT, which having read some personal experiences believe it could potentially significantly impact my QOL. The same goes for HT. I have an even greater antipathy towards the latter considering what it could do to my QOL. Is RT viable without HT? Could it, would it give more years, or is it just months?
I know there is a considerable waiting list at my hospital. I don’t want to have HT given as a holding option for months. There is mpMRi at the hospital so I also don’t want to be directly pushed towards a TRUS biopsy as an alternative. In fact, I worry about multiple biopsies generally in terms of potential infection, prostatitis, and sepsis. Also, could the ‘genie be let out of the bottle’? I think they only do transrectal biopsies. I could use savings for an mpMRI and trans perineal biopsies. Should I opt for the latter?
Apologies for the longish first post. I welcome advice because I have been going around in circles and getting quite anxious over the whole matter.
Jonal