Andy's Prostate Blog Details
2014-2017

Hopefully helping those recently diagnosed with or concerned they may have early stage prostate cancer


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Post-surgery consultation results Surgery summarised Catheter experience My recovery

MRI scan

PSA readings Why Emberton?

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Hospital referral address Dry climax (orgasm)              

 

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I will admit that this blog may appear a bit disjointed. However, I have built it up over several months, from the time I was originally diagnosed with prostate cancer in September 2013.

To begin with, it was a shock to hear my diagnosis, and hence my earlier notes may have been one way of “venting” my feelings during that time.

However, without completely re-writing the whole blog, I
still hope it will give some helpful details I have discovered during my experience.

Please note:
this blog includes a summary of what you can find elsewhere on the web.
My purpose of this blog is to share my personal experience of my Prostate Cancer investigation, diagnosis and treatement
from a patients point of view.
It also contains some personal medical information about myself.
I am happy to share this, because my desire is to try to raise
awareness of the improved diagnostic and treatment procedures for early stage prostate cancer. This I hope to do through describing my personal experience.

Note that the MRI I had and Template Biopsy are available on the NHS (see discussions later). My final treatment was carried out on the NHS.

Obviously, I am not a qualified medical practitioner.
I am a patient, describing my experiences, and commenting on my observations. I think the legal term is: I'm "acting entirely in a personal capacity" (!)
Always consult with a qualified medical practitioner before making decisions regarding your own personal treatment.

I would advise every man aged 50 or over to have an annual PSA blood test.

Around 37,000 men in the UK are diagnosed with prostate cancer each year

I am 61 years old (as of April 2014), and had a significant prostate cancer tumour, but only knew about it originally thanks to having 6-monthly PSA blood tests. I had no other symptoms.

My PSA readings over the past 6 years have been: (see also comment)

2009

2011

Mar 2012

Jan 2013

June 2013

Jan 2014

2.61

3.94

4.19

4.93

6.2

5.8


In September 2013, my cancer tumour was then definitely confirmed using the technique in the video below (MRI then TPM Biopsy) (and, no: I'm not the actual patient in the video, but I would have looked much the same!)
Please note that this Template Biopsy is now available on the NHS at UCLH and other NHS hospitals

I had the above TPM Biopsy in October 2013, under a very short general anaesthetic. As Emberton explains in the video, it's important that the patient is very still. It was probably lots more comfortable than having it under a local anaesthetic. My recovery was about 3 hours, so not much different to recovering from strong sedation.

For those of you interested in my actual biopsy samples taken, click here for the histopathology report sheets.


Below is my diagnostic MRI scan (September 2013), showing an "80% 1cc likely tumour" (Red areas on drawings)

My TPM Biopsy (as discussed in the video above) then confirmed it was localised prostate cancer (12mm Gleason 3+4).

For those of you interested in my actual biopsy samples taken, click here for the histopathology report sheets.

The treatment technique I initially chose was Focal Hifu.
This appears to be an excellent treatment, but see later.
IMPORTANT!! My cancer WAS NOT detectable on:
1. Digital (finger) rectal examination
2. Ultrasound scan (rectal)
3. Emberton said that the more common TRUS biopsy would most likely have not detected my anterior tumour. See
first video regarding this.

Hence it's essential to start having an ANNUAL PSA blood test once you reach age 50. I anticipate I'll do that for the rest of my life, and so should every man. A blood test is SO simple!

If you want to skip straight to my results after my surgery, please
click here

The video below explains HIFU:


Back to top

If you want to know more details of what happens in the above video, the Patient Informatioin Sheet below includes it. Please note that this also includes extra after-test details, which only apply if it's done as a trial at UCLH. I was originally going to have it "off-trial", hence these extra after-tests wouldn't have applied.

click here For the Ultrasound HIFU trials Patient Information Sheet, click here (these trials have now finished) -
but the study continues.

I transferred to UCLH for my cancer treatment.
(The private hospital was too expensive - my insurance didn't fully cover it!)
Every patient in England has freedom of choice to selelct their preferred hospital
See the
referral contact details below.
I wanted to continue treatment under Emberton.
UCLH was not my local hospital, so I specifically requested to be referred to it.

 

The limitations of HIFU as a focal therapy for my particular type of prostate cancer

Focal therapies, definition: these try to focus on the significant cancer area only, as opposed to a radical prostatectomy. In the latter case, the whole porstate is removed, which can lead to more serious after-effects than focal therapy.

The limitations of HIFU (or perhaps ANY method) as a focal therapy

Since making my choice to have HIFU about 2 weeks ago, I've had second thoughts.

It appears that HIFU,
despite being described as a “focal” therapy, is limited as to how small an area it can treat, if the tumour is not close to the posterior (rectum) side. This applies in my case, because my tumour is an anterior tumour, which means HIFU must reach right across the width of my prostate to get the energy to it, and, to do that, may destroy some good tissue on the way.

My tumour is less than 1cc of my total 28cc prostate volume, i.e., less than 5%. I am thankful to God for directing me, using my GP and Emberton's team, to find out about it
before it became a bigger and more serious tumour.

The consultants at UCLH originally suggested Cryotherapy as a suitable treatment. However, I initially chose HIFU because I liked the idea of
some treatment it would also do to my peripheral (posterior) 3+3 gleason area.

HIFU is shown being used at UCLH on one of 2 prostate patients in a "Curing Cancer" documentary on Channel 4, towards the end of the documentary. The other prostate patient tests as not having cancer. See the links section.

However, because of the reasons mentioned above re. a large area of my prostate being affected, I've now chosen Cryotherapy treatment instead. (I like to call it "the Brass Monkey Treatment"!)

Emberton also agreed that treating the anterior tumour alone, would improve my chances of preserving erections.

The manufacturer's video below gives a vague idea of how Cryo treatment works. This "Galil" kit is what UCLH use.

Note: Cryo gives very similar results to Nano Knife: they are both focal therapies.

[November 2014]: I've recently learnt that the medical term for these sort of therapies is "interventional oncology". There, now you (and I) know!

The above video appears to show whole gland therapy, rather than the focal therapy I'll have. Emberton says I should end up with only about 5cc of my prostate ablated, which sounds "pretty good", should leave around 23cc of my 28cc prostate! Unless, I can come up with a more precise therapy!

For a reasonably detailed article on Cryo by Fuda Hospital, click here

For the UCLH patient info for Cryotherapy, click here

I had the cryo surgery on April 22nd 2014. To read how it went, - click here

Back to top

A further brief discussion of the advantages of these diagnostic and therapy methods was aired on a BBC Inside Health radio program in January 2014. See the video below:

Nano Knife appears to offer considerable advantages over many other forms of focal therapy. It may cause less localised good-tissue damage, plus offer a quicker recovery time. Also, the precision with which it can be used may make it ideal for destroying very small tumours.

The following notes were made early on in the year 2014, during my investigations of my options for my prostate cancer treatment. [this note added 24th Dec 2014]

[March 2014]: UCLH are undertaking a new treatment, called IRREVERSIBLE ELECTROPORATION (‘NANOKNIFE’). This may offer slightly more localised treatment, but is only being offered to patients with no significant cancer outside of the anterior (away from the rectum) side of the prostate. I did not qualify for this.

Also see this summary article re. the UCLH trials.

For the UCLH Patient Trials Info Sheet on Nano, click here

[22 August 2014]: The trials of Nano at UCLH as part of the Promis trials, have now finished -

but the study continues.

To see the Webcast where Prof Emberton answers viewers questions, click here.
Then, search for "Live interview with Professor Emberton"
NanoKnife is mentioned in the video at the 19 minutes slider position.

 

"Dry Climax" Side effect.

Only recently noticed reference this in one of the UCLH Patient information sheets. It says: "50% chance of the side effect of dry climax".
I emailed Emberton about this, "Did it also apply to
focal treatement?" and he said: "It is very hard to predict hence the high rate. I think it is a reasonable estimate given the uncertainty. In most prostate procedures it is 100%. "

So, my question for the sugical team before my Cryo next week will be: "Could this be a temproary side-effect, or permanent?" I suspect the answer will be: "Could be either".

I had the opportunity to ask Manit's consultant about it on April 1st. That was the original date for my Cryo, but it was cancelled because another (probably much less fortunate) patient before had complications in theatre. He told me: "Yes, it's 50:50. It's because semen may no longer be prevented from going into the bladder. You've heard of the "TURPS" procedure? Well, with that, the dry climax side effect is always 100%." Update: see bottom of "Surgery experience" section below.

Surgery experience

[Tuesday 22nd April 2014] Cryo went well yesterday . Had typical post anaesthetic vomiting reaction.

It was delayed for about 3.5 hours. The reason enables an insight into the issues that must regularly face the hospitals.

I had even got as far as lying on the trolley in the anaesthetic room. Had a cannula inserted.

Then, possibly just in time,
before they started the anasthetic, I was told I’d have to be wheeled out and wait about 45 minutes.

The ultrasound monitoring machine was still being used in
another theatre. They needed this machine for me.

I could understand the reason – it was being used for a TPM biopsy (see
video for chat about that).

However, after about 90 minutes waiting, I discovered, by asking, that another patient had now gone into “my” theatre, who presumably didn't need that machine for their operation (which may have been, therefore, a more serious operation than mine).

Whilst it
was frustrating, having had myself the TPM biopsy last year, and knowing whom the
other surgeon was who was using it at UCLH, it made it easier to understand and tolerate.

I was discharged from UCLH following morning.

Surgeon was also thinking of zapping the right lateral (see MRI pic), but I said only do anterior index.

No pain from cryo – instead, just discomfort now wearing 7-day catheter, to be removed 28th April.
Won’t know initial results until after
MRI on 10th May.

Other side effects- I assume it’ll take several months before the extent of the various possible permanent side-effects can be determined.
Surgeon said possibly only 20% chance dry climax.
Had visit from district nurse 2 days after surgery, who helped with a few catheter issues.

Surgeon emailed me a few days after surgery, said:
"Hi Andrew - yes spoke with you in recovery!" [Although I don't remember it - Amnesia after general].
"Procedure went very well and I'm very happy with the way it went.
"Yes we use a local anaesthetic [on perineum] at the end of the procedure.
I agree the catheter causes more discomfort than the procedure but hopefully will be out soon.
MRI in 2 weeks will give us a good idea about treatment but I'm confident the [index] lesion was well treated."

Hoping to return to work on 6th May. Surgeon suggests taking it easy: no cycling for 6 weeks (pity - there's a tube strike next week!), and "no heavy lifting or straining" for 4 weeks. Today [1st May] I bought a box of printer paper. So, asked the PC World assistant to carry to my car. Then, brought it up to my flat max. 2 reams at a time.

[22nd May]: Very pleased to report that my continence and erectile and ejaculatory functions all appear to be largely unaffected.
[29th June]: Ejaculate does seem to have diminished over the past month. However, it's difficult to assess it, since it was never that consistent
before my surgery.

See also my recovery section, which includes further observations on my ejaculatory symptoms.

Catheter experience

[28th April 2014]
6 days wearing a urethral catheter – uncomfortable, and often painful! The paracetamols they gave me were a great help, although they were really intended for any
other post-surgical pain, which I actually didn't have. So, a great relief to have the catheter removed today!
Yesterday felt like I had a fever (probably my body trying to reject the catheter, but controlled by the antibiotics). (see also
surgeon's comment on the catheter above)
Catheter removed today – far less painful than I thought . The clinic nurses told me to "take a deep breath" twice during the removal. It sounded like I was giving birth! LOL!

Very pleased with initial urine control test results – NO leakage! And 100ml retention was considered ok by nurses, and I think it may improve with time. Pee-ing is quite uncomfortable at the moment, but I know from experience [as after my TPM biopsies] that that will disappear within a few weeks.
And again, a great service from all the staff and nurses at UCLH!

[4th May] Having second thoughts: it may have been my general reaction to the surgery, rather than the catheter alone. Guess maybe part of healing process? Don't feel to terrific today, either. Think my walk of 2.5 miles to Church this morning for exercise may have been a bit ambitious!

Why did I choose Emberton as a urologist?

[3rd May 2014]
Simple answer is, from Google

Retrospetcively, I can see it was an answer to prayer. He is one of the top urologists, and specialises in minimally invasive solutions for prostate cancer.

I have private medical insurance because my company has a group scheme. So, I decided to find a private urologist close to my City office, so as to minimise time off work for consultations. Google flagged Emberton up, since he runs a private clinic in addition to the work he does at UCLH, (see “
useful links” section). Because of his desire to have much of his work in the public domain, it was easy to see the techniques he was using, before my first consultation. Simply googling his name brings up much about his work on the web, including youtube.

I’m thankful to God that I found him, because before then, all I knew about was the radical treatments: prostatectomy and radiation, neither of which are necessary for my condition,
unless the patient has a personal desire to have the whole prostate removed. Also, I'd never heard of the TPM biopsy, only the TRUS one. See the
first video on this page, for a discussion about this.

So, why am I now being treated and monitored by his team at UCLH, which is an NHS hospital?

Well, my company medical insurance doesn’t fully cover Princess Grace hospital, which he uses for the treatments. I was happy to pay 1,000 towards the TPM biopsies, but the cryo would have cost me around 4,500, plus more if I needed further surgery because of complications.

Hence, I’m now over to UCLH. It’s a really great hospital. It has a more relaxed atmosphere than what I’ve experienced at some other NHS hospitals. And, the surgical treatment is identical to what you get in the
private hospital. In fact, most of the surgeons operate in both hospitals! The obvious disadvantage is longer waiting time at UCLH. However, to me, that had two advantages:

1. It allowed me more time to study my condition, and consider the various options. True, my final cryo treatment choice is very similar to what he would have done privately within about 10 days. But, for me, there’s a great advantage in understanding more about my condition.

2. It means that I can now pass on my experience here, as an NHS patient. That’s what the majority of you who read this would come in as, should you need to be referred to the UCLH team.

For Emberton's referral details, click here

PSA readings:

Emberton said that, ideally, I should have gone to him for the MRI earlier, when my PSA readings were about 4.

PSA readings can vary, it seems, by as much as nearly 1, in my case. One of my relatives PSA read 4.5, then 6 months later, about 2.5! (It seems unlikely that he has cancer).
Hence, I get the impression that "4.19" could really be "3.8" or "4.6". However, it is the steady increase (from about 2 in 2009 to about 6 now) that is the more meaningful indicator.

PSA readings can be high merely for an infection, not always cancer.

In my case, and for general prostate cancer screening, the important thing seems to be observing the trend over at least 3 or 4 readings, spaced about 6 months apart. This is how my (excellent) GP advised us to monitor my PSA.

Personally, I would have thought it better to give figures rounded up/down to the nearest whole number, without bothering with the decimal place.

Prostate cancer is
slow to develop: you won't suddenly get it "breaking out" and killing you in 6 months! It's easy to think it might, because, sadly, some other cancers can do that. But not prostate.

Please note that it is very easy to have annual or 6-monthly PSA tests. Mine were taken at my very excellent NHS GP surgery (but obviously then sent off to be analysed by the path. lab. at the local hospital). I had them done at the same time as my cholesterol tests (same single blood sample taken, but 2 parameters checked for by the path lab).

You have every right, even under the NHS, to be told your medical test results. My GP happily phoned me up each time, to discuss them.

It will be interesting to see by how much my PSA reading has dropped since my surgery. I'll publish the figure when I've had my next test (I now know this will be in November 2014).

[6 June 2014]: As my GP has just reminded me, PSA can also be an unreliable marker.
It could equally well signal an
enlarged tumour, and not necessarily cancer.

However, I still feel that's erring on the safe side.

All it takes is an MRI to verify if prostate cancer is present.
That's a
test, not treatment. So, it can't be classified as over-treatment.

In my case, I eventually had cryotherapy only becase the initial MRI showed an 80% likely tumour. Hence, over-treatment did not occurr: I needed the treatment.

My recovery

Well, some of my side-effects have been already mentioned in both the surgery and catheter sections.
More of my recovery details will be posted in this section.

[5th May] My first, is my experience of trying to gradually increase my exercise.

Having been told
not to cycle for a month, I decided to try what I considered to be “gentle” exercise over this weekend.

I walked 2 stints of about mile on Saturday. Result: felt ok. So, decided to walk all the way to our church Sunday morning – about 2.5 miles.

Result: felt rather tired. Kind-of
expected that, so got a lift home from a friend.

However, started to feel exhausted during the afternoon. Also, noticed a small amount of blood in my urine, suggesting that slight internal bleeding may have occurred (not had that for about a week, otherwise I’d have assumed it to be a normal side-effect).

The
surgeon did mention that straining is one key thing to avoid: "straining is an increase of your intra-abdominal pressure as when lifting".

So
I’ve learnt by experience that, whilst walking isn’t so strenuous an exercise as cycling, I still need to take it easy in that department.

Just as well I have a bus service that passes my door!

Next test: Prostate MRI on
10th May. Hospital agreed to prescribe me Diazepam for that, because I found the MRI I had last year (for my original diagnosis at Nuada Medical Imaging centre) rather claustrophobic. That may have been because that was an older machine than they'll use for me at UCLH, which is relatively new. Maybe that's an advantage of having an MRI on the NHS at UCLH, rather than privately at Nuada Medical. I'll let you know what I thought, after my MRI on 10th May.

[6th May]: Waited about 90 minutes at the UCLH Parmacey, and received.......one Temazepam 10mg! (Kind-of a mild Valium pill). Could certainly help me suffer less stress from claustrophobia during the MRI, although the surgeon suggests that the imaging folks may get a little uneasy about my taking it. Oh well, I'll see how things go on the 10th.

Why was I told not to cycle for a month? Well, in the
Cryo Patient Info Sheet, I read in section 12, (page 12), "For the first 6 weeks after cryotherapy you should not lift anything heavier than a full kettle.". So, I emailed the surgeon, and he translated that into the recommendations I've written above. Actually: not to cycle the 9.5 miles to work for 6 weeks, and not to cycle the 3.5 miles from London Bridge station for 4 weeks.

[7th May] Been back at work 2 days. Coping quite well - my job is electronic repairs, so it's light work - kind-of like repairing mobile phones (but the very old "brick" type!)
But I'm avoiding lifting heavy boxes containing 40 of those units.

Have to admit to mildly panicking on Tuesday (my first day back), worried I might suffer ill-effects from the exertion of the journey (on public transport), and then at work itself. But I didn't, so I'm thankful for that.

Still find it painfull pee-ing, but have emailed the surgeon about that. [16th May]: has certainly improved now.

[16th May]: Also, as the surgeon said a week ago, slight blood in urine has more-or-less ceased.

[22nd May]: Very pleased to report that my continence and erectile and ejaculatory functions all appear to be unaffected, except if I try to hold myself to "busting for the loo", when I find I might leak slighty, something that I could control ok before. See the consultation for comment on this.

See the consultation also for other recovery updates.

[30 May]: Tried cyling for the first time since my surgery (nearly 6 weeks!). Felt really good, again to have the fresh air on my face, and breath it more deeply than when I'm merely walking.

Intending now to take the folding bike on the train, and try cycling to work the 2 miles from London Bridge station to the office, untill I feel up to cycling the full 9.5 miles all the way to work.

[13 June 2014]: for the last 3 days, been doing my full commute (9.5 miles) on my full-size bike (It went in for a re-build during the same time I had my surgery! I wore it out with around 20,000 miles commuting!). I was fed up with squeezing on and off trains with my folding bike! This is despite the surgeon suggesting it should be next week that I start. So, am I irresponsible? I don't think so, for the following reason:

I was very fit before my surgery, so probably I had recovered a bit quicker than I otherwise would have.

I should mention that I'm not fully back up to the fitness I had before: find myself having to change into lower gears sooner, but doesn't affect my commute time noticeably. And, thankfully: such great summer weather to "welcome" me back to my commute to work in the city!

[17th June 2014]: Now seem to be back to my former fitness level. Cycling in the same gears I used to.

[19th July 2014]: Ejaculation volume, and "dry climax" symptom.
Initially, soon after my surgery, my ejaculation volume appeared similar to my pre-op volume.
However, now, nearly 3 months on, it seems to have diminished to a few drips.
Difficult to say if this is reduced seminal fluid production, or my ejaculate going into my bladder.
My impression is the former, since I am not seeing any cloudy effect in my urine after ejaculation, as should be the case if my ejaculate were "going the wrong way" into my bladder.

Although it's difficult to determine: my volume of premature seminal fluid ("pre-cum") apperas similar to my pre-op amount, so maybe it is the fact that I'm simply not ejaculating like I used to.

Will be interested to see the result of my next MRI that I'll have in November.

Update July 2016: Sometimes it seems I manage some ejaculation after normal masturbation. But not as much as previously. However, after visual sexual stimulation in additon, I often find I manage more ejaculation. But difficult to say if this is as much as before my operation.

[22 August 2014]: Ejaculation now down to nothing. This is then followed by slight oozing.

Asked Emberton by email, (My erections are still normal).

His reply:
"Ejaculation is always diminished after focal treatment - it goes
completely in all the other therapies.

About 50% of men manage to preserve some ejacualtion but this depends on
what needs treating.

It will not return. All men are warned of this.

You are probably ejaculating but it is expelled backward into the bladder.

[my observation: this is also known as the "dry climax" effect]

It does not affect the climax or orgasm."

My questinon: "Why did ejaculation diminish steadily over about 4 months, rather than straight away, after the cryo?"

His answer: "Hard to know exactly. This is the time over which the contraction of the scarring and therefore contraction occurs. That is probably the dominant reason."

Based on that last comment, it will be interesting to see if the ablated area has shrunk, on my next MRI scan, which is booked for 17th November 2014, follow-up consultation with Emberton on 10th December 2014.

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My MRI scan after my surgery

[10th May 2014, Saturday]: Had my post-surgery MRI scan this Saturday morning in the NHS UCLH hospital. Was pleased with their efficiency: no waiting around.

Also, the radiologists were happy about my taking the one Temazepam 10mg (as a mild sedative) about 20 minutes prior to the scan; they agreed that about 1 hour "hanging around" after the scan should render me ok to travel on public transport.

Well, did that help? Answer: yes! Certainly didn't feel claustrophobic like I did last year (for the results of that MRI, see above.

So, what will be done with the results? Well, my consultant will receive the report, and I expect a consultation to discuss it soon.

You notice I had the radiologist report for my first MRI. Well, I asked the radiologist if I could similarly have that, plus the full CD of all images, after my scan today. I was told to contact them during the next working week. There would be a charge to pay.

[13 May] Picked up copy of CD of MRI images today-there was no charge, since I got them within 40 days. Was told that the radiologists don't also give a detailed annotated report as for my first MRI. I now realise why - this second MRI merely looks for the ablated area, so will not report on remaining cancer, I presume.

The image below shows the cryo ablated (destroyed) area-
the
dark area. The
surgeon says "it looks very good", so I presume that means he ablated an ideal area.

(Remember: "left" in the image is the right hand side of my body)
I must say, the area ablated looks
much larger than the red area marked on my
first MRI. However, the surgeon did say that he would target an area a little larger than that, to be sure all the index lesion was killed off, plus I guess the precision of the cryo comes into play.

If, like me, you get your own CD copy of your MRI images, you may need to download a MicroDicom viewer to be able to view the pictures. This is the one I used for Windows: Click here for the viewer it's free! This "RadiAnt" version is incredibly good! it handles both my private pre-op images and my post-op NHS ones, unlike the first viewer I downloaded and tried. You can even measure portions of the image, in linear and square quantities! There are even better viewers for Apple Mac. Very limited choice for Android, don't know about iphone.

[15th May]: follow-up appointment to discuss things with the surgeon arranged for 28th May. PSA blood test yet to be arranged, but been told will be around 2-3 months time (update - see below). Need to note down questions to ask him.

See "post-surgery consultation" for more details.

[13 June 2014]: I'd be interested to know what tissue has replaced the tumour and good tissue that was ablated. Some months ago, "scar tissue" was mentioned by another surgeon whom I talked to at UCLH.

Update February 2017: PSA 3.6ug/L. This indicates that the cryotherapy is remaining effective - the cancer tumour appears to have been effectively destroyed, with no evidence of recurrence.

Update July 2016: Dry Climax (orgasm) - click here

Update June 2016: PSA 3.7 ug/L

Update January 2016: PSA 3.22ug/l. Prostate volume 23cc

Hospital consultation at
UCLH Westmoreland Street*: My cancer is now stable, no evidence of any significant prostate cancer,
Recommendation: Remote Surveillance. Get 6 monthly PSA test done at my GP. If it goes above 4, then also do Mid-Stream-Urine test, to check for an infection that may be giving the higher reading. No need for another MRI provided PSA remains below 4, see above.
[My understanding]: Repeat PSA 3 months later. If still above 4, then go back to the hospital for advice.
Note: a 6 monthly PSA test should be mandatory for every man aged 50+, see my notes at the beginning of this blog.
I've put 3 MRI images taken in November 2015. Compare these with my earlier ones below. Whilst not commenting specifically on these,
the consultant said that the overall MRI had not revealed any significant (observable) prostate cancer.
[My observation]: I'm at
no more risk from prostate cancer than any other man my age.

*This is the new loacation of the Urology department (as of the date of writing this). It is no longer in the Cancer Centre in Huntley Street.

PSA result, May 2015: 2.54. This is a slight reduction from 3.1 measured in November 2014.
So, it's a trend in the right direction.

[the following notes added on 24 November 2014]
18-day and 7-month MRI and PSA comparison - see image below.

Explanation: my prostate is roughly outlined in RED.
The original location of the tumour is roughly outlined in YELLOW on the 18-days image.
The ablated area is outlined in GREEN on the 18-days image.

These results show:

The ablated area has shrunk to (I presume) no volume at all.
My prostate volume has reduced by 5cc, which is pretty close to the 5cc volume that Emberton estimated would be ablated.
My PSA has rougly HALVED. The present PSA of 3.1 is within the range expected for a man of my age (61 years) who does not have significant prostate cancer.

My conclusion: Success! Cancer treated*.
Side effect: reduced ejaculation.
Future plan for tests, surveillance: to be discussed on 10th December with Emberton.
Watch this space!

*The significant anterior tumour has been treated. I am not experienced enough to recognise any remaining lower-grade cancer by looking at the MRI image.

[10th December 2014]: Had follow-up consultation with Emberton.
He said that it was "all good!"
See below for his dictated letter which gives a precise statement of his observations.

He said that there was scar tissue, outlined in the 2nd image above in BLUE. I guess this is the left-over bit of the ablated area, see the 1st image above, outlined in GREEN.

He did not make any comments about any further cancer being visible, probably because my PSA now of about 3 does not suggest there IS any significant cancer. Remember: all men my age will have some very low-grade prostate cancer, but it will probably never grow fast enough to catch up with them as they age.
There is even talk of
not considering low grade prostate cancer as cancer,
see this link.

The future: I am to organise 6-monthly PSA tests throgh my GP. If my PSA goes above 4, then I am to contact Emberton again.

He has arranged another MRI scan for me in 1 years' time (November 2015).

Note that the 6-monthly PSA tests are what I was having for several years before my diagnosis of cancer.
As I say at the beginning of this blog, it's very advisable for
all men over 50 years old, to start having 6-montly PSA tests and continue them for the rest of their lives.

A graph of my PSA is shown below. (The best graph I could make; my PSA probably dropped much faster than the slope shows, from a figure of about 6 before my cryotherapy, to a figure of about 3, soon after my cryotherapy that I had in April 2014).

My PSA steadily climbed over the years, until it reached about 6.
Then, the cryotherapy knocked it down to about 3 again.
If it climbes again above 4, then I'll have further tests. If necessary, repeat treatment will be given.
However, it may well be that any remaining low-grade cancer will never develop in my lifetime to cause any trouble,
see this link.

This report above is the very latest update to this blog. Apologies again for it all being a bit disjointed! I'll get round to re-writing the whole page someday!


[January 2015]: Just received my copy of Emberton's consultation letter.

"....he has done fantastically well with almost no toxicity. The only thing he has noticed is a change in the quality of the ejaculate, which we would expect, treating in the anterior component. His PSA is now steady at 3.1 g/l and the MRI shows no residual disease on the late [24 November 2014] scan. We would recommend PSA's on a six monthly basis and look forward to seeing him in December 2015, with an MRI beforehand."

[February 2015]: Regarding "...a change in the quality of the ejaculate" mentioned above: as mentioned elsewhere, my ejaculation diminished to zero about 4 months after my cryotherapy. However, a very little ejaculate does appear after orgasm.
Emberton is probably familiar with this process in some patients, hence he would classify this as
"diminished ejaculaion", and not "zero".
My erections and sexual desire remain good and unaltered.

Read more about my ejaculations here

 

Post-surgery (and post MRI) consultation on 28 May 2014

Surgeon had already said the post-surgery MRI (one picture I sent him) looked good. This was an initial MRI scan, only 2 weeks after my surgery. The one in November will give a better idea of the status of any remaining cancer.

Since then, he'd had an opportunity to look at the whole set of post-surgery MRI images.
He said that these preliminary images suggested that the significant cancer had been destroyed (ablated).

Unlike Prof. Emberton, he couldn't bring up my MRI images on his consulting room computer.
So: before my next MRI, need to see if I can find a DICOM viewer for Android.....(!)
[13 June 2014]:
found a DICOM app for android! "Simply DICOM" it's called. Can see clearly the ablated area. Wish I'd had this for my consultation 3 weeks ago! I'd have been ahead of the surgeon!
So from now on, we can discuss my MRI pics using my phone!

The ablated area is the dark area.

He also said that it was originally significant, and did not fit into the category of being able to be left untreated for surveillance.

"Anyone", he said (meaning "any" urologist), "would have taken action". This is because the maximum cancer core length was 12mm, a significant size.

The ablated area extended significantly below where the anterior tumour had been (see annotated sketch - original tumour outlined in red).

Commenting on this, he said:
"The ice-ball (produced by the cryotherapy) would have done that". Basically, that's the best precision that could be achieved.
But an advantage may be that it may have also partially destroyed the peripheral 3 + 3 cancer on the right hand side, (marked as a green area). Even though I had asked him not to, the cryo could not be controlled precisely enough not to destroy that.
I must admit I was in two minds as to whether I should have asked him
not to destroy that 3 + 3 also; well, maybe it's happened now!

My second post - op MRI scan and first post-op PSA blood test to be done in November.

Regarding slight leakage when "busting" for the loo: he said that should improve with time.

The surgeon said that I am now over the main, initial recovery period.

Please see the section above for my latest results.

 

Hopefully, I'll be updating you with how I get on over the coming months and years!

 

Help Treat Prostate Cancer

Useful Links

To see the Webcast where Prof Emberton answers viewers questions, click here.
Then, search for "Live interview with Professor Emberton"
NanoKnife is mentioned in the video at the 19 minutes slider position.

Curing Cancer documentary Channel 4 programme featuring UCLH
Sorry about the ads, but Ch 4 won't let you view it with adblock running!

Program details

click here

Prostate anatomy drawings:

click here

For the Nano Knife trials info sheet,

Please note: as of August 2014, these Nano trials at UCLH have finished, but the study continues.

    

For more info on the UCLH Cancer Centre,

click here

For more about HIFU,

click here

For the ORCHID "fighting male cancer" website,

click here

For Mark Emberton's NHS details at UCLH,
(See also
below)

click here.

For the Pelican Cancer Foundation,

click here

A wealth of research information!
Features UCLH and HIFU, etc.
click here

For the "HealingWell" forum site,

click here

For London Cancer website,

click here

For the UCLH patient info sheet for Cryotherapy,

click here
   

 

The NHS UCLH Urology referral address is:

You need to be referred by your GP

This is your right, click here

Recently changed:
Upper Ground Floor, Outpatients,
University College Hospital at
Westmoreland Street
16 - 18 Westmoreland Street
London W1G 8PH

Sohia Mekoma is PA for Emberton and his team:
Telephone 020 3447 9194
or 020 3447 9485 (main dept)

Emberton's Private Harley Street referral address - click on the link on the right
Note: if you're thinking of having private treatment under Emberton, check that your insurance covers the imaging place and the hospital that Emberton uses.
I opted out of private treatment after my TPM Biopsy, and had my final cryo done on the NHS,
as I explain above.
Also, for a private consultation with Emberton, you don't have to be referred by your GP (as you do for NHS UCLH).
You can simply go along and
refer yourself.

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Help Treat Prostate Cancer

Got any comments? Contact me using the button on the right:

 

Press articles

Different!

Shows the advantage of early diagnosis. This man had no symptoms of Prostate Cancer

Mr Bartram said he [only] discovered he had early-stage cancer when he visited a doctor about his injuries.

See Royal couturier David Emanuel's Mail online article
"Andrew Lloyd Webber's honesty about prostate cancer saved my life"

Note: thankfully, because my cancer was diagnosed early, I didn't need my prostate removed.

Read about the late Bob Monkhouse campaign

Not sure how to interpret this BBC article! Perhaps it reflects the fact that many men still aren't benefitting from the greater accuracy of the MRI & TPM Biopsy test, or that even that can't predict how aggressive the cancer is.
I admit that it appears uncertain how quickly my anterior tumour would grow, if it were left alone.
But see
consultation above.
Pity it doesn't even
mention focal therapy!

BBC Health:
Prostate cancer tests miss severity in half of cases

 

Focal therapy is an amazing treatment.
However, it can still only cure my body until it will
die anyway.
But praise God: I'm assured of eternal life because I believe in the atoning work done by Jesus Christ, when he died for my sin, and rose again!
You too can have this same eternal assurance, if you believe!

Free Bible app!

        
iphone         android

Prefer a Free printed bible?
https://www.gideons.org.uk/enquiry/Bible request

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Surgical jokes