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Andy's Prostate Blog Details
2014-2019

Some more details that may be of concern to men with, or suspecting they have, early-stage prostate cancer.

 

This page contains a summary of my experience, plus some more intimage and explicit details.


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Dry climax (orgasm) My recovery

Useful links
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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.

The videos below discuss precision biopsy and Hifu treatment.

Warning: contatins some graphic content



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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

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"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.

 

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.

 

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

 

 

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

 

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. 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.

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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!

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Surgical jokes