I've had yearly PSA tests with semi-annual DRE (Digital Rectal Examination) since I was 50. At 55 this was changed to yearly PSA and DRE.
About 2004 I began to experience the urinary symptoms of BPH (Benign Prostate Hyperplasia) or prostate cancer. DRE by GP showed slight enlargement of prostate with normal range PSA in low 3's thus probably BPH.
In 2008 urinary issues deteriorated to the point of urination every 1/2 hr during day, 2-3 at night, occasional pain and never feeling my bladder was fully empty. My annual PSA and DRE were done in March 2008 with PSA 3.8: normal DRE.
After having 2009 PSA test in February prior to DRE in March, my GP called indicating an alarming increase in PSA and to go to lab today for repeat PSA before physical. PSA level on repeat is 4.4 DRE was performed and GP response was - bad news : abnormal - good news : prostate size unchanged and smooth as billiard ball. Appointment arranged with urologist for consult.
Received confirmation for consult with Dr. John Milner the pre-eminent urologist in our city who performs around 150 prostate surgeries a year for June 4 2009. During consult Dr. Milner indicated that with my PSA level 20% chance of cancer. After DRE and confirmation of GP finding indicated odds increased substantially so 12 needle biopsy for September 4 2009. I was given a 20 day supply of Flomax to urinary issues to try with prescription if it appeared to be effective. This did nothing and I did not fill prescription.
Biopsy for September 4 rescheduled for October 4 2009. This one of the drawbacks of dealing with a very busy urologist. Biopsy on October 4 2009 was performed by a resident who was doing all biopsies for the three urologist at this clinic. I was given a sample of Xatral to try for 20 days with prescription to deal with urinary issues. This medication worked immediately. An appointment scheduled for follow-up November 4 2009. Much research on prostate cancer done on internet prior to follow-up to biopsy.
Arrived for biopsy follow-up November 4 2009 and was given a copy of the lab report which showed cancer positive 5 of 12 cores all confined to left lobe. Dr. Milner explained the biopsy report and showed me on a model where the tumor was and probable size. The following is a summary of lab report:
right lobe benign prostatic tissue
left lobe invasive prostatic adenocarcinoma Gleason 4+3 1.5 mm 15% of core: GS 4+3 0.5 mm 3% of core: GS 3+4 1.2 mm 10% of core: GS 4+3 13 mm 90% of core: GS 3+4 6.0 75% of core: GS 7
staging T2b prostate size 40cc PSA 5.85
After the biopsy I had done considerable research on prostate cancer and had been given pamphlets on BPH to study. So on the biopsy review I was not completely ignorant and therefore was not surprised that biopsy results were positive for PCa Dr. Milner explained in detail the treatment options available for me how they are performed and probable side effects.
Dr. Milner had stated that with no treatment at all prostate cancer will take about 10 years from onset to cause illness. Since my symptoms started about 5 years ago I probably had 5 years before illness set in so my wife and I both agreed that treatment was necessary and that surgery was the only option for the following reasons.
- This could be a one time treatment no more PCa.
- Overall 90% success rate with a very experienced surgeon.
- Ultimate biopsy, no doubts about staging, grading and capsular escape.
Since we have no Da Vinci robots here Dr. Milner indicated he could refer me to Edmonton to have robotic surgery or to and Oncologist for radiation. We did not wish to travel to Edmonton so RRP (Retropubic Radical Prostatectomy) is our choice.
I had a consult with another urologist at The Manitoba Cancer Clinic and he agreed with our decision and that Dr. Milner is the best there is at RRP. All three urologist and my GP agree there is no real evidence of capsular escape and surgery should have a good outcome.
RRP surgery scheduled for Mar 12 2010.
I had RRP (Retropubic Radical Prostatectomy) surgery performed on March 12 2010 and was in hospital for five days and went home with catheter. The catheter caused bladder spasms which were quite unpleasant but handled nicely with Tylenol. I suppose my bladder hadn't been filled for more than 4 years and that may have added to the discomfort.
I had the usual incontinence for about three weeks then continence while sleeping and sitting with slight leakage when standing and walking. After a month mainly stress incontinence and now after three months total continence with no pads. I did Kegels initially however this became more sporadic as my condition improved.
The catheter and staples were removed on May 29 and the bladder spasms disappeared immediately. Dr. Milner gave me my pathology report indicating that I had extracapsular extensions on the left side and indicated although the path report wasn't very good not to panic until PSA test results in a month. As he indicated from now on PSA reading are pretty much all you have to worry about. What we are looking for is a reading of .02 ng/ml which is undetectable.
I took the report home and read it and was somewhat shocked.
Gleason Score: Primary Pattern: 4, Secondary Pattern: 3
Tumor present in the left apex and all prostatic lobes. Moderate to high volume.
Extraprostatic extension: Focally identified in left posterior lobe.
Perineural Invasion: Extensively identified.
Lymphovascular Invasion: Not identified.
Surgical Margins: The surgical margin is clear in the areas of extraprostatic extension in the left posterior lobe. However, positive intraprostatic surgical margins in the left and right posterior lobes.
Seminal Vesicles: Negative for tumor
Later: Regional lymph Nodes: no evidence of malignancy in left or right pelvic lymph nodes. Pathological TNM Stage: pT3an0 Comment: The specimen demonstrates extensive intraprostatic positive surgical margins involving posterior lobes bilaterally. This finding is associated with a significant risk of PSA recurrence.
I had an appointment on April 29 2010 to obtain first post surgery PSA reading which was .02ng/ml thus undetectable for cancer or prostate cells. Dr. Milner indicated that although the tumor staging is T3 there is still a 60% chance that I will remain PSA recurrent free for 5 years. He also indicated that even if recurrence occurs in less than 5 years pelvic radiation would begin probably when PSA reaches 0.10 ng/ml. If the recurrence occurs later than 5 years then he would recommend letting the PSA climb to around 5.0ng/ml then begin hormone therapy.
Since the PSA reading at present is undetectable he would like to see a PSA reading in six months. I have a scheduled check up with my GP and will get a PSA reading in July just for my own curiosity.
I had blood drawn on July 29 2010 for second post-op PSA reading and the result was an undetectable PSA level. Next reading will be at the end of October.
Saw my urologist yesterday for 6 month PSA results and happy to say reading is less than 0.02. I've been turned over to primary care with PSA tests on a yearly basis. Everything else is also normal except I still have ED which is slowly improving.
Just got my six month PSA reading and it came back at .01 ng/ml so I'm still a survivor: next test in six months.
I had my 2 year PSA test done at the end of 2011 with a result of less than 0.01 so cancer free for another 6 months.
I had my semi-annual PSA test in June with undetectable result. ED hasn't changed.
I had my PSA test in July with undetectable result next test is in December.
I had two PSA tests this year as usual no detectable PSA. This will become yearly test after next year.
I had two PSA test in June and December with no detection. I will now only have one yearly test since this is now 5 years since treatment with no detectable PSA.
I do one PSA test annually and it always has been undetectable since surgery.
Terry's e-mail address is: tsfee AT shaw.ca (replace "AT" with "@")