It ain't over until it's over ...

The problem with treating prostate cancer is that there are always side effects. For some people, they are severe - lack of control of the bladder; leaking urine; lack of erectile function and so on. Most people suffer some of one or more of these to a greater or lesser extent, depending on their treatment.

Radical prostatectomy, for instance, is quite likely to end up with the severe end of the spectrum ... but not necessarily. We mere mortals who receive the treatment have to simply wait and see.

PSA has fallen!

The great news is that the graph is trending down. The visit to my urologist today also gave me the results of my recent blood test and I had started at the post-operative stage after brachytherapy with a PSA of 6.9. Today, I am proud to announce, it's down to 3.0.

This is wonderful because it means that the little radioactive seeds that have been placed into my prostate are doing their work, killing the cancer and thereby reducing the PSA count. This process will go on for some time yet. Currently I am something over four months on from the op and generally the seeds remain active for around six months.

Normality resuming after brachytherapy?

Here are Gloria and I having a wonderful time - well, similar!

Gloria and I have just returned from a two week holiday on a cruise liner.  It was fabulous and we had a great time, mainly because we both relaxed completely. She did have her laptop with her, but the Internet service was so poor that she really was not able to do much so she had to pay attention to me!

It's hard to tell whether things are getting back to normal because, largely, there's not been a huge change. However, it's easy to be fooled. The changes post-brachytherapy happen very slowly and you barely notice. Yet if those changes had taken place overnight, you would be quite shocked, possibly.

Things feel different during the brachytherapy cycle

It's not so much the operation of having the radioactive seeds inserted into your prostate. It's more about how you feel afterwards and what the "new normal" is all about. The operation itself was no big deal from the end user point of view: go into hospital, get anaesthetised, come round, feel a bit sore, wee through a catheter, bleed a bit, have catheter removed, stop bleeding, manage to wee on one's own, get discharged. Easy. (I'm pretty certain it was quite a big deal from the point of view of those doing the operation though because the little operating theatre was packed!)

Nor was it about the first few weeks, apart from the need to get over the anaesthetic and then to recover from having your bits bashed about a bit. Everything was generally OK, although blood in urine and semen might seem a big deal.

Post-operative visit to the oncologist

When you've had any operation to fix prostate cancer, there are always issues that emerge, whether they are to do with urination, sexual ability or bowel movements. It's all congregated in that one little area. In terms of design, it's not that optimal, really. The poor old urethra - bodily fluids motorway in men - passes right through the prostate so, if you tamper with the prostate, you're going to piss off the urethra.

Hence, one will have post-operative symptoms of soreness when passing water or during ejaculation. Or worse, it might completely block up as the prostate swells in protest, constricting the flow. So, discussing this with your doctor, about seven weeks after the operation, is normally fairly high on the embarrassment scale. Factor in that the doctor is about 23 and female and there's a nice female nurse in attendance, giggling in the corner and you have an idea of why Gloria and I just thought, "Sod it! We'll just tell it as it is."

Six weeks after brachytherapy - exciting!

Actual scan of my pelvis, showing the seed implants quite clearly

The six week mark after you've had brachytherapy is one of those points where you get to see what the surgeon has managed to achieve. In my case, that was a pelvic CT scan followed by a blood test.

Gloria decided that I needed to be driven to the hospital but, this time, she didn't bring her laptop! Apart from the shock of that revelation which, I'm sure you'll agree, either indicates she doesn't have enough to do or, perhaps, she's really taking this seriously. Since she has done from day one, I suspect the latter. It's certainly not the former because she continued to handle emails and chats on her phone - so same difference, really.

Five weeks on from brachytherapy operation - what's the score?

Things have definitely started to warm up in the radioactive response department. Last week, there were the first nigglings of reactions to the seeds embedded in my prostate. How did these manifest themselves? Firstly, most urination sessions begin and end with a little gasp as the urine passes through the inflamed urethra - and sometimes it gets a bit urgent, if you know what I mean! This is perfectly normal and indicates that the seeds are doing their job. This will possibly get a little worse in the next week or so but should then taper off.

Fatigue is probably the bigger thing for me - not because I have not been sleeping. People have told me that they are up two or three times in the night to wee. Not me - maybe once, possibly, but most nights, not at all. Yet, nonetheless I feel that my stamina is less and activity tires me more easily. Looking this up on Google, it seems that no one really knows why radiation causes fatigue. It could be that healthy cells are being destroyed as well as the cancerous ones and so the body is fighting to restore those.

A summary of what happens up to and after brachytherapy for prostate cancer

This blog is now getting quite lengthy so I think a quick overview - a helicopter snapshot - might be in order. Those of you avid followers (in your thousands, well quite a few anyway) will already know the background and how I was fortunate to be blood-tested and came up with an elevated PSA result.

In the Prostate Cancer Begins Like This article, I covered off that part of my story and how Gloria, ever supportive, came with me to many of my appointments. The key thing here is the #dontfearthefinger hashtag because, quite frankly, if that's all that stands between you and a debilitating cancer, it's an easy check.

Four weeks on from brachytherapy

I'm not one to make a fuss, as Gloria will tell you, but it was as though the gods said, after last week's post, "Oh, no side-effects huh? We'll soon sort him out!" So, sure enough, come Friday and Saturday, although not bad, there was some evidence of the effect of radiation on my prostate. How did it manifest itself?

First of all, urination became a bit more extended, let us say. To the extent that I have taken to bringing my iPad into the loo with me (that should ensure no one else uses it then!) in order to browse Twitter, write my life story or simply read the news. Moreover, bowel movements have become noticeably looser - not runny, mind you, but less firm, shall we say? And they've become more frequent so, for the time being, the excellent Holland and Barrett prunes are staying in their packet.

Three weeks after the brachytherapy operation

Gloria preparing to test me.

Gloria is threatening to buy a Geiger Counter or, more properly (she's a stickler for accuracy, this one), a Geiger–Müller Counter. Why this extravagant purchase? Simply because she doesn't believe that I am radioactive at all and that the operation was a huge hoax, probably conducted by the same people who faked the Moon landings.

The reason for this doubt is that after three weeks of waiting for symptoms to kick in ... I'm still waiting. Perhaps I'm weeing a bit slower? If that's the extent of it, then I'm doing well. I should be experiencing more restriction of urine flow as my prostate swells from the radioactivity. I should also potentially have negative side-effects relating to my sexual capacity and I could also have some disturbance of my bowel function.

Two weeks on from Brachytherapy - how am I doing?

It's been a bizarre couple of weeks. Gloria took the week after my operation working from home, with the expectation that I would be too feak and weeble to look after myself. As mentioned previously, I was a bit groggy from the anaesthetic and sore from the needles, but that was it.

The second week has found me hale and hearty, with a good appetite, keen to go on long walks, no fatigue. I had one night when I was up twice in the night - too much water the evening before, methinks! Waterworks are a little slower and I'm giving them time - seem to be spending a lot of time on Twitter, on the loo. That stratagem seems to work OK and I've not been caught short. Mind you, the beach side walks are peppered with public loos so there's unlikely to be a problem round here.

Brachytherapy. One week on.

It's exactly one week since I had my brachytherapy implants of Iodine-125 radioactive seeds and I have to say that I don't feel a lot different at the moment. This may of course be the lull before the storm and Gloria is watching my every move intently, analysing me for any possible sign of outcome.
"Have you found any seeds yet?"
"Nope."
"Not even when you wee?"
"No."
"Let's look at your bruises ..." There follows an embarrassing lying on the bed with legs in the air while Gloria peers at my scrotum area with intense interest. "I can't believe you heal so quickly."
"Me neither."
"What about your poos?"
"Gloria!"
"Well, I'm just being caring. You know ... like I'm supposed to."
"Yeah, well that's lovely. Thank you. I'm all fine. I'll tell you when I'm not."
"I'm sure you will!"

Radioactive condoms?

Gloria's dedication to my comfort and pleasure knows no bounds and therefore, on a shopping expedition to Tesco, she decided to wander the condom aisle, looking for (in her words) "radioactive condoms".

The thing is this; when you've had brachytherapy for prostate cancer you have dozens of radioactive "seeds" inserted into the prostate. As you know, (well you do now) the prostate delivers the fluid in which sperm float and so, if you have sex ... when you have sex ... the fluid may possibly contain one or more of these seeds. It's not something that a lady of Gloria's delicate sensibilities wants floating up into her personal areas, not least because it could in theory do her damage.

Night on the ward

My sleep may have started at 9:30pm, but it was soon disturbed by the goings-on on the ward. Considering there were only three others in the room, they all had their own particular way of ensuring my sleep was broken. It has to be said at this point, however, that I had my own way too as I snore like a moose when asleep (certainly not when I'm awake though).

It was the music that got to me first. The opening four notes of Magic Roundabout: da-da-da-da ... da would normally follow. What's that? Oh, it's some instrumentation saying that it needs checking. The guy next to me was constantly monitored with drains in his leg and he was the most musical of all. He also had Mungo Jerry's In the Summertime which I think was the blood pressure monitor because we all had that set of notes at various times in the night.

The day of the brachytherapy operation

The morning dawned bright and clear and I was up with the lark ... well, with the alarm, actually that Gloria had set for six-thirty. I needed to be up quickly because my last chance to eat was before seven-thirty and I didn't want to faint with hunger before going down for the op at either 1pm or 3pm.

Gloria brought me tea and toast in bed - what a treat! Then we were up and about, getting some cereal down us before getting showered and putting the last things into the overnight bag. Then, the best part - a micro enema. Gloria had asked if she could administer it - absolutely not! It was a little tube of stuff with a long spout that had to be inserted right up your bum and then squeezed - and keep squeezing as you pull it out. Did that and then sat on the loo and waited. It didn't take long ... about five minutes and all of a sudden my back passage was clear and sparkly. Then it was time for a shower.

And then the oxygen test

It had all started innocently enough while I was having my pre-op and the nurse was checking off the list of ailments that may impede my survival of anaesthetic. The "sleep apnoea" box was ticked by me because someone once said I might have that - mainly because I snore a lot!

"Oh, yes!" pipes up Gloria, "I think he has sleep apnoea," and the nurse looked concerned.
"Look," says I, "the tests were inconclusive and I'm not symptomatic."

The pre-op before brachytherapy

It was a very cold day as Gloria and I emerged from the car into the multi-storey car park and shivered. We'd taken three quarters of an hour to cross town to the hospital and now, nearly at the top of the parking building, we had to find our way to the radiology and oncology department which was in the basement.

Once there though - Gloria with her computer bag, of course - we settled down for a short wait before a briefing from an enthusiastic young nurse. She wanted to talk all about our sex life, how well I wee and poo and a raft of other conversation items that would never grace a refined dinner table. Totally unfazed, she confidently reassured us about how most problems can be solved and that the operation is all about success. Indeed, the negatives seemed mostly to be about weeing or ejaculating radioactive seeds and the appropriate responses thereto.

Filling the forms before brachytherapy

One thing you get very used to when you begin discussing anything to do with prostate cancer is the level of intimacy that you have to reveal. Nurses and doctors will listen, expressionless, as you discuss the workings of your erections, flow of urine, how well and often you defecate, the importance and extent of your sex life and any manner of other things.

I guess though, when you've had someone shove their finger up your bum or been probed about with MRI or with an ultrasound scanner, there's not much left to reveal about your physical self, other than what you actually do with your body when you're not sprawled on the examination table.

First consultation with the clinical oncologist

With all the results in, I was swiftly given an appointment to attend the oncology clinic at the local hospital. It all starts to feel very real at this point as they confirm with you your treatment decisions and make the necessary arrangements.

Once again, Gloria came with me (she's a brick) and still didn't bring her laptop. You know it's serious when she's paying attention like that! The waiting room was light and airy and there was a low buzz of activity as people wandered in and out, some carrying folders, others looking important. We waited with a few other folk - a lot of old men, unsurprisingly - and pondered the fact that cancer patients can get free parking. One wonders why particularly that group is singled out for that privilege.

Testing urine flow and prepping your prostate

The thing about your prostate is that it wraps itself around the urethra down which your wee comes from the bladder, before exiting to the outside world via the penis. When all's well, then all is indeed well. However, as you get older, the prostate grows and, as it grows, it can compress the urethra, making you urination more difficult.

For this reason, you'll find that you dribble rather than gush, you may sometimes find it hard to finish a wee and you can also experience "urgency" where you actually find it hard to restrain a wee from coming (usually when you are in sight of a toilet, is my experience!).

Five things to know about Prostate Cancer

In a blog like this, while I wait for something to happen (first consultant appointment next week), you the reader need something to keep you going so here are five top things that I've learned about the prostate and its associated cancer.

1. What is the prostate?

It's a little gland, typically about the size of a walnut, that sits around the urethra (the tube down which your wee comes from the bladder), above and behind your testicles. This means that if it swells, your flow of urine is restricted. So, one of the symptoms of prostate cancer for example is difficulty passing water - although it might just be that your prostate has grown, because the little blighter will do that all through your life (just like your ears). What's it for, I hear you cry. It makes the fluid in which your sperm are transmitted, through the urethra, when you come. If you have the prostate removed, you'll have a dry orgasm whenever you have sex. In other words, you still get the good bit, but without the mess.

When the waiting ends ... and you're told the results of your biopsy

I'd been told that the results from the biopsy would take a while and so I was quite surprised to receive an appointment to see the consultant a week later. Gloria and I both put a positive spin on it which went something like this:

"They probably just want to go through the result and tell us that it needs monitoring;"
"It's going to be an all-clear - I can't have prostate cancer because I feel so great;"
"If it is prostate cancer, then it's been caught early and if treatment is needed, they'll get on with it quickly."

What's next? Trans-rectal, ultrasound-guided biopsy

Fate sometimes, conspires, doesn't it? I was away on business for the next few days so didn't receive the urgent first-class posted letter that had dropped through my door, only a couple of days after the MRI scan. Not having received it, I was a bit gob-smacked to get a phone call from a lady wanting to confirm my appointment for a biopsy.

"Er, what biopsy?"
"You've not had the letter?"
"Nope, I'm in Birmingham at a conference."
"Your MRI results are showing a shadow on the prostate and Mr Smith (name changed) has decided you need to have a biopsy."
"I see."

MRI scan of the prostate

It's all so easy. Once you are in the highly efficient mincing machine that is the NHS, (sorry if you're reading this in the USA, folks - you've missed a trick) then you get dealt with, if you are "fast-tracked" as a priority. Within a couple of days of the consultant's reluctant signing me on for a scan, I was walking through the doors of the MRI suite at my local hospital.

Normally, for an MRI, you zoom in head-first, headphones on to deaden the din that is clanking and thunking around you. However, for a scan of the prostate, you're whizzed in feet first. Oh, let's not forget the prep ...

Visiting the urology department specialist

The invitation to visit the Urology department at my local hospital was fast-tracked. When the NHS fast-track it usually means that someone phones and tells you to get your arse over there double-quick. This was no different, although it was a letter, actually. And the appointment was a couple of days later. Yeah, no need to fret. Prostate cancer is not a fast-growing one, but nonetheless, they still had their skates on.

I went and found the Urology department, taking along my trusty minder (who shall be named Gloria, to protect the innocent). The waiting room was jam-packed with blokes of a certain age - most, to be fair, older than me. Or they looked it. Gloria and I looked at each other and she said, "Get used to this, mate."

Prostate cancer begins like this ...

You know that feeling of impending doom that comes when the sun is shining the most brightly? Well I didn't have that at all. Not a jot. My whole thing was a doctor visit to check out some irregular heartbeat which vanished straight after he put me on a 24-hour ECG and told me I would live for ever.

If it had stopped there then I'd be none the wiser and none of this would be happening ... yet. But, no. What occurred was that he said, bright and perky like, "I think we'll just take some blood tests, though. Just as a precaution." Yup - no problem. I have visions of perhaps there being thyroid issues, blood sugar levels, who knows what ... "Oh, and I'll tick the PSA one while we're at it - man of your age ... etc, etc."