Prostate cancer: part 1
I’m going to do this in several parts, as it will get quite long I fear.
Some time towards the end of 2005 I was having to go for a wee 4-5 times during the night. I’m not sure exactly when I noticed it, but I was certainly fine earlier in the year when we went to Italy for 3 weeks.
My previous checkup had been in April 2003, done by Dr Louise Gardiner.
In February 2006 I finally got off my backside and went to see Dr Salie Greengarten for a checkup. He requested a PSA (Prostate Specific Antigen) blood test, which produced a result of 6.1 ng/ml; normal for my age was more like 3.5. So he did a physical examination, felt some abnormalities, and referred me to a urologist in Chatswood (Dr Philip Bergersen). He had a feel for himself, and arranged to do a biopsy the next week at the SAN in Warringah. In those days that was no fun, as it involved firing a hollow needle through the rectum into the prostate to get tissue samples – 12 or 13 times. Now they use MRI. The biopsy produced a Gleason score of 9 (4+5). That’s nearly as bad as it gets, poorly defined cells that spread. I also had a CT scan and a whole-body bone scan, but they were negative.
During this time Tante Rese and Ulrich were based at our place but didn’t know what was going on. After the biopsy I was due to go back to Bergersen I think on a Tuesday in early March. Ulrich and Tante Rese had driven off to Dorrigo up behind Coffs Harbour, for Ulrich to see some old locomotive. That’s when she had a heart attack and finished up dying in the Coffs Harbour hospital late on the Sunday night. Ulrich called us, desperate of course, and I booked a plane ticket to get up there by 8.30 next morning. We arranged to get her back to Sydney and I had to get back too!
Bergersen wasn’t really able to tell me anything that sounded positive. He explained how serious it was and sent me off to decide what treatment I wanted, after saying there was no established way to handle such a case.
Karin came with me on the next visit as I was struggling to take it all in. After hearing that if I was 75 I would be put on watchful waiting (the exact words were “sent away and told not to start reading ‘War and Peace’”), we decided to seek a second opinion.
So Salie arranged for me to see a second urologist (Phillip Stricker, who just happened to be the urology king in Sydney - and still is), who sent me on to radiation and medical oncologists (Dr Raj Jagavkar and Dr David Dalley). They all recommended surgery, to be followed by adjuvant treatment based on the results. While waiting for the surgery I was given hormone treatment, a 3.6mg Zoladex implant with daily Casodex for a month, with the aim of putting the brakes on the tumour. These drugs are anti-androgens, meaning they stop the production of testosterone. It’s often called hormone therapy. The last PSA result before surgery was 0.16.
Stricker also sent me for an endo-rectal MRI (which I had to pay for myself), to assist him in his preparation for the operation.
In the meantime, we had been to WA as Tania was living there that year. It was a good trip, we went up to Lancelin for a bit with Dad, Mary and Marco, and down to Yallingup to Peter and Cathy’s place
I had open surgery at St Vincent’s Private Hospital at the end of May 2006. Pathology results were:
• Gleason 9 (4+5)
• Tumour extent unifocal
• Focal capsular penetration but all margins clear of carcinoma
• Left seminal vesicle involved
• No lymph nodes involved
PSA 6 weeks after surgery was <0.01, but I had hormone therapy before the operation so we didn’t know how meaningful that was.
The recommendation from the team was that radiotherapy should be held in reserve, but that I should proceed with chemotherapy and hormone therapy.
Docetaxel would have been the preferred chemo drug, but it was not available to me on the PBS in 2006. I was given 4 cycles of ‘MC’ (Mitozantrone and Cyclophosphamide), with 3 weeks between each cycle. At the end of this the PSA was 0.05.
Immediately on completion of chemo, I was started on 3-monthly Zoladex implants. PSA dropped straight away to <0.01. I was kept on Zoladex for 2 years (8 implants), until late 2008.
There’s a bit going on with the body after a radical prostatectomy. The main thing is incontinence. Some people don’t have much of a problem, but it took me a while to beat it. I was fine by the end of the year though, and forgot about it for many years, until it came back after I had radiotherapy.
Every time I saw Salie for a Zoladex, he said that no matter what happens I was with the A-team of professionals and couldn’t get better care.