MRI scan after my surgery
May 2014, Saturday]: Had my post-surgery MRI scan
this Saturday morning in the NHS UCLH hospital.
Was pleased with their efficiency: no waiting
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
did that help?
Answer: yes! Certainly didn't feel claustrophobic
like I did last year (for the results of that
MRI, see above.
what will be done with the results? Well, my
consultant will receive the report, and I expect
a consultation to discuss it soon.
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.
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
image below shows the cryo ablated (destroyed)
the dark area.
The surgeon says "it looks very
good", so I presume that means he ablated an
"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.
like me, you ask for and get your own
CD copy of your MRI images
[which you have every right to do, free, even on
the NHS], 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
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.
"post-surgery coltation" for more details.
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
whom I talked to at UCLH.
Latest updates follow here - my attempt to keep a
log of tests, procedures and results that are
Most recent results are listed first.
See link below for more explicit details of my
progress, including Dr Thomas' consultation
Seen by Dr Thomas Collins. (I would have liked to
have specified Prof Moore, but since they've
changed their check-in system to paperless, they
can no longer stick a postit on your folder).
He wasn't surprised by my increased PSA (see
I'll ask my GP for another PSA test in September.
If the result is not lower, then I'll try
emailing UCLH to see if they'll give me an
earlier consultation than the one he arranged for
June next year.
I'll get a separate appointment for an MRI in May
2020. It's possible I may be given an earlier one
if my next PSA level hasn't decreased.
I haven't had any recurrence of cancer in my RHS
that was treated, I asked him if it's equally
likely I won't get a recurrence in my LHS. His
comment was that "there's a 1 in 4 chance of
it recurring after treatment".
MSU sample provided.
No results as of 9th July.
Hopefully will have before my consultaion
tomorrow, although I don't think it'll influence
what the surgeon says much.
PSA blood test done; result
This is up from my November 2018 figure of 5.2
A week later, GP refused a re-test within less
than 3 months - "It won't have changed
But they did agree to an MSU (MId- Stream Urine)
queried this with UCLH hospital.
The Clinical Nurse Specialits emailed me back:
"The PSA can still be high at 3 months post
HIFU due to some swelling of the prostate. We
usually just check again at 6 months and if not
down then would consider an MRI at that point. I
think an MSU is a good idea
It's always best not to cycle or have any sexual
activity for 2-3 days before a PSA test
also" (First time I'd heard that!)
Retention re-test: now only
Praise God for that! The threshold figure is
Good that my anxieties about needing a lifelong
catheter are no more!
Finding voiding sometimes a
I contacted the Clinical Nurse Specialists by
email (supplied in their info booklet on
discharge) and asked about it:
"Is it normal to sometimes experience a
little urethral pain when voiding?"
"Yes it is on and off for 6 weeks. If there
is a lot or the urine is smelly take a sample to
the GP for them to test"
At trial without catheter (TWOC) clinic.
Catheter removed, pretty-well painless.
Then: around 3 hours of recording drinking and
Voided volumes good, but retention (post-void
residual, PVR) measured at around 170ml, which is
a bit high. No better after voiding 30 minutes
with nurse, and arranged an informal (no
appointment required) re-visit to her at TWOC
clinic in 2 weeks time (4th June) to re-check
PVR. "Just knock on the door at about
She said HIFU does cause the prostate to inflame
initially more that cryo; in earlier years, some
patients were re-cathetered, but not now.
Concern is too much retention could cause bladder
Hopefully, retention will decrease to an
acceptable level (around 100ml) within the next 2
weeks. It'd be tedious to have to take lifelong
medication, and I don't relish the idea of
observation: I've been passing a small fragment
(presumably of my ablated area) each time I void.
Had HIFU at UCLH
Was seen farly promptly after my 7:30 admission;
whole procedure was finished just before 11am,
after which time I was in recovery then settling
in the ward.
Before the procedue, I asked the surgeon to
ablate only as much as necessary. She said she'd
try to leave the very left side (near my prostate
edge) not ablated.
Most uncomfortable part is now at home, with a
urethral catheter for 7 days.
Time will tell how effective the HIFU has been,
both from a follow-up MRI (in 1 year's time), 3-
monthly PSA tests, and also over the months as to
continence and erectile issues.
Catheter due out on Tuesday 21st May.
enquired via email to a UCLH Uro-Oncology Nurse
Specialist as to why I wouldn't have an MRI a few
weeks after my HIFU, like I did 5 years ago after
my Cryo. (Scroll down a bit to see those MRI
scans and the one titled "18 days after
I was concerned the ablated area would not be
visible in 1 year's time.
They told me: "We
dont routinely do MRI after HIFU like we do
after cryotherapy , we can still see the ablated
area after 1 year".
I assume that either the ablated area won't
shrink or that their definintion of we
can still see the ablated area after 1 year really
means the "black hole" will be visible
or only scar tissue, remains to be seen.
appointment after my catheter removal: 10th July
in clinic for, presumably, a review. I've booked
a PSA test at my GP's for Friday 21st June.
March 2019 Consultation with
Prof Caroline Moore, at Westmoreland Street:
Cancer confirmed at the two points that were
highlighted on the MRI.
I have 5mm posterior of gleason 3+5, 3mm anterior
of gleason 3+5.
here to see the now annotated
here to see the histopathology
way forward: I was given the
option of radical prostatectomy, radiation or
HIFU. I would like to retain my prostate for as
long as possible, so I've chosen to have HIFU.
Waiting confirmation of surgery date.
I asked about Cryotherapy again; I was told, as I
suspected, that Cryo could not be done in the
posterior area, since it's too close to my
Caroline did mention that if I did subsequently need a radical
prostatectomy, it may be more difficult to ensure
no cancer remained outside of my prostate.
However, HIFU is the route I've chosen.
also hoping that this HIFU may mean I won't ever
develop significant prostate cancer again,
although I accept that this cannot be guaranteed.
Caroline said that I would have a left
hemi-ablation, in other words (I assume) the left
of my porstate will be destroyed. This should
destroy both my anterior 3mm and the posterior
HERE for explanation of
Click HERE for my now
annotated MIRI report.
22nd February 2019: Template
Bipopsy performed by Dr Thomas Collins on the NHS at McMillan
This is a really nice, fairly new building.
I was told after recovery that 8 samples were
taken (this requires verification at the
follow-up consultation, I might have heard wrong
in the ward).
This is much less than in 2013, where 24
samples were taken. On that occasion,
there was a clearly defined, very likely tumour
visible on the MRI.
But this year (2019), I assume only 8 were taken
because there was not a very likely tumour
visible on the MRI.
Before my biopsy, I was concerned when I was told
by the anaesthetist that I would not be having a
general anaesthetic, but instead deep sedation. I
was worried I'd be aware of what was going on
during the biopsies.
I needn't have worried: I was "out"
just as if I'd had a genereal anaesthetic. As
with a general anaesthetic, the next thing I
knew, I was waking up in recovery.
The main difference is that you breath yourself,
and don't require ventilation as with a general
This deep sedation is probably more suitable for
very short procedures such as this biopsy.
Another interesting detail is that, when I told
the anaethetist I vomited after my last general
anaesthetic (a common recovery effect), he said
he'd give me anti-nausea medication as part of my
waiting for follow-up consultation appointment.
Because of forecast of heavy snow, managed to
re-arrange UCLH consultation for 1st February as
a phone consultation at the same date & time.
Apparently they do that often - many of their
patients live far away.
The consultant, Clement
Orczyk, Said he would request a
Template Biopsy for me. I subsequently had a
pre-assessment on 6th February.
5 December 2018
results are indicative of possibly
significant cancer, but will only be sure if I
have a biopsy. Professor Caroline Moore at Londn
Urology Associates has written to my GP, asking
him to refer me back to her team at UCLH NHS
hospital for a Template Biopsy.
She did say we could monitor my PSA on a
4-monthly frequency, but because the pattern of
steady increase in PSA is in keeping with that
leading up to my previous diagnosis, I've elected
for a biopsy.
Also, regarding the supposedly higer PSA value
threshold for someone my age (65), Caroline said
that does not apply
to someone like me, who has had prostate cancer
a full report from the Medical Imaging team, click
here. This will open a new
9th November 2018 - PSA
GP said to re-test in January, since for my age,
65, the threshold is supposedly 5.0, not 4.
However, I expressed concern that the steady
increase over the past few years is in keeping
with the values I had leading up to my diagnosis
in 2013. Hence he agreed to refer me back to the
urology team. I've chosen to start, as I did in
2013/2014, with the private clinic at Harley Street. My insurance will
fully cover the consultations and MRI (if I have
one). If I need further tests/treatment that they
will only do at Princess Grace Hospital, then
because that hospital isn't covered by my
insurers, I'll probably ask to be referred back
to the team on the NHS, at UCLH.
COMPARISON OF PSA
TREND TO DATE with PRE-SURGERY TREND
My readings to date:
My readings prior to my procedure in 2014:
TREND in PSA readings is the IMPORTANT thing to
monitor. A SINGLE PSA READING is not sufficient,
it can be unreliable.
a consultation appointment at Harley Street on
Monday 3rd December.
4th December 2017 - PSA
4.0ug/L This is considered as "normal"
on my GP report, "no action needed". My
conclusion: although it's good that I don't need
to take any action, the trend over the last 2
years is upwards. It may be that this will be the
last time it will be 4.0ug/L or less. We will
13th October 2017 - PSA
4.5ug/L This is slightly above the ideal
threshold of 4.0. However, based my "Hospital consultation at UCLH" about 1
year ago, (see below) and chatting to my GP, I'll
have a repeat PSA in a few months time. And soon
I'll provide a Mid-Stream-Urine
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
June 2016: PSA 3.7 ug/L
January 2016: PSA 3.22ug/l.
Prostate volume 23cc
Hospital consultation at UCLH Westmoreland
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
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
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
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
So, it's a trend in the right direction.
following notes added on 24 November 2014]
18-day and 7-month MRI and PSA comparison - see
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
ablated area has shrunk to (I presume) no volume
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
conclusion: Success! Cancer treated*.
Side effect: reduced ejaculation.
Future plan for tests, surveillance: to be
discussed on 10th December with Emberton.
Watch this space! better still, check
my latest results.
significant anterior tumour has been treated. I
am not experienced enough to recognise any
remaining lower-grade cancer by looking at the
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.
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.
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
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.
arranged another MRI scan for me in 1 years' time
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
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
steadily climbed over the years, until it reached
Then, the cryotherapy knocked it down to about 3
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
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!
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
ejaculaion", and not "zero".
My erections and sexual desire remain good and
Update January 2015:
Just received my copy of Emberton's consultation
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 µg/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