Andy's Prostate Blog Details
2014-2019

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


What's the latest? Click here for my most recent tests and procedures

OR: Select a link below, or just start reading from here for my expericne from 2013 onwards.

Brief introductory summary:
Autumn 2013: PSA 6.2. Cryotherapy spring 2014. PSA then 3.1
Autumn 2018: PSA 5.2. HIFU spring 2019. PSA then - yet to be measured.

Post-surgery consultation results Surgery summarised Catheter experience My recovery

MRI scan

PSA readings Why Emberton?

Useful links
1 update

Hospital referral address                

 

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See also my Home Page

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Recommended route for all men aged 50 or over:
1. Have a PSA blood test
at least once a year.
2. If the value is above 4, then repeat every 6 months.
3 If, over 1 to 2 years, the value shows a steady increase, then:
4. Ask for a Prostate MRI scan.

I will admit that this blog may appear a bit disjointed. However, I have built it up over several years, 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

It is a medical statistic that black men are twice as likely to get prostate cancer than white men.

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 and latest results

2009

2011

Mar 2012

Jan 2013

June 2013

Jan 2014

2.61

3.94

4.19

4.93

6.2

5.8

To compare these PSA readings with those up to 2018, click HERE

In 2013, my cancer tumour was then definitely confirmed using the technique in the video below (MRI September then TPM Biopsy October) (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

Warning: contatins some graphic content

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 regional (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:

Warning: contatins some graphic content


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.

 

WHAT HAPPENS DURING CRYOTHERAPY?

Watch this video made by Galil, the designers of the machine used on me.

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.

 

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.

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, rather than a urologist at my local Croydon Hospital?

[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: see also latest tests and results

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.

 

Found this page helpful? Want to share your experience with me?

 

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 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 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.


**********************************************************************************************************************************************************************
Latest updates follow here - my attempt to keep a log of tests, procedures and results that are continuing
Most recent results are listed first.
****************************************************************************************************************************************************

4th June
Retention re-test: now only 82ml !
Praise God for that! The threshold figure is 100ml.
Good that my anxieties about needing a lifelong catheter are no more!

24 May 2019
Finding voiding sometimes a little painful.
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"

21st May 2019
At trial without catheter (TWOC) clinic.
Catheter removed, pretty-well painless.
Then: around 3 hours of recording drinking and voiding (pee-ing)!
Voided volumes good, but retention (post-void residual, PVR) measured at around 170ml, which is a bit high. No better after voiding 30 minutes later.

Discussed 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 11am".
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 infection.
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 another catheter.

Additional observation: I've been passing a small fragment (presumably of my ablated area) each time I void.

14th May 2019
Had
HIFU at UCLH Cancer Centre
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.

I 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 cryotherapy").
I was concerned the ablated area would not be visible in 1 year's time.
They told me:
"We don’t routinely do MRI after HIFU like we do after cryotherapy , we can still see the ablated area after 1 year".

Now, 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.

Next 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.

20th 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.
Click here to see the now annotated diagrams.
Click here to see the histopathology report.

The 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 rectum.
I understood that if I
did
subsequently need a radical prostatectomy, it may be more difficult to ensure no cancer remained outside of my prostate. Consequently, HIFU is the route I've chosen.

I'm also hoping that this HIFU may mean I won't ever develop significant prostate cancer again, although I accept that this cannot be guaranteed.
The surgeon 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 5mm cancer.

Click HERE for explanation of HIFU
Click
HERE for my now annotated MIRI report.

Friday 22nd February 2019: Template Bipopsy performed on the NHS at McMillan Cancer Centre
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.

Sedation: 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 anaesthetic.
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 wake-up drugs.

Now waiting for follow-up consultation appointment.

Update February 2019
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.

Update 5 December 2018
MRI 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 before.

For a full report from the Medical Imaging team, click here. This will open a new browser window.

Update 9th November 2018 - PSA 5.2ug/L
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. 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:

May 2015

Jan 2016

June 2016

Feb 2017

Oct 2017

Dec 1017

Nov 2018

2.54

3.22

3.7

3.6

4.5

4.0

5.2


My readings prior to my procedure in 2014:

2009

2011

Mar 2012

Jan 2013

June 2013

Jan 2014

2.61

3.94

4.19

4.93

6.2

5.8

IMPORTANT!

This TREND in PSA readings is the IMPORTANT thing to monitor. A SINGLE PSA READING is not sufficient, it can be unreliable.

I've a consultation appointment at Harley Street on Monday 3rd December.

Update 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 see.

Update 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 specimen.

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 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! better still,
check my latest results.

*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.

Update 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!

Update 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.


Update 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."

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!

 

For more details of my experience (some explicit and intimate), click HERE

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.

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. Under the Patient Choice option, you can ask to be referred there even if you do not live in the central London Area.

This is your right, click here
to see my referral letter.

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

Nisma Akhtar 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).
If you are self-funding, you can simply go along and
refer yourself.
Otherwise, check with your insurance first.

Back to top

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

aaaa     bbbbb

For more details of my experience (some explicit and intimate), click HERE

 

Surgical jokes