Men's things - XV

When the not-so-obvious is ignored

When I was about 7 or 8 years old, my parents took me to the lawn tennis club to take lessons and learn how to play tennis. My mother was naturally trim and still in the child-bearing age range and even though my father had golf clubs, he was more inclined to play tennis and never on the golf course less than half a mile from where we lived in Rayfield, Jos.

I was not that good at tennis for a reason no one discovered until I was in my 30s. I could not hit the tennis balls because I could not track the distance and the speed of the ball. I had a lazy right eye, an astigmatism where the eye at rest wandered off the right depriving me of stereo vision.

That is why I ended up not properly learning to drive for my ability to judge distance and speed was impaired. I could compensate for it as a pedestrian, but not with impatient drivers behind me if I drove a car.

However, the sad part of knowing this truth was that something could have been done to correct the problem in my childhood; like wearing a patch over the good eye and forcing the lazy eye to align and focus. By the time I found out, my brain had already made up for the handicap, it would have been nigh on impossible to retrain my brain for the new vision of having astigmatism dealt with.

There is a correction for astigmatism in my lenses, but it does not perfect the entrenched issues with the condition. It is something you live with, and it is benign that it is not a concern to be bothered about.

Even knowledgeable doctors are not God

50 years on, I find myself ensuring that my concerns are addressed, all perspectives considered, and every option explained to satisfactory detail in my engagement with the medical profession to ensure that my expected outcomes are at the forefront of any conversation.

I respect the standard of expertise and wealth of knowledge that defines this group of professionals but for all they know, they are not gods, their word is not law in and of itself while every diagnostic and therapeutic path cannot be valid without my engagement and understanding.

The prime admonition that grounds everyone involved is encapsulated in this saying, “It is my body first before it is your Guinea pig.” By all means, I should never feel under pressure, duress, or deception in making choices. Whatever course I take with regard to the options before me is ultimately my decision, having been adequately informed by the experts.

I have learnt that I cannot be shy about asking questions and fundamentally there are no stupid questions, you find the form of words to pose your concern, and you have every latitude to ask follow-up questions until you have been satisfactorily answered.

I understand that doctors or consultants might feel challenged, they should welcome the challenge and be up to the task of confidently and convincingly defending their thinking, assertions, and procedures. It makes them better at understanding and addressing patient needs. Anything short of that, demands review.

Better safe now than sorry later

As medical procedures engender risk and can usually be irreversible, they do not run as projects that you can redefine if certain requirements are not met, you want to be sure that all issues are adequately and fully addressed before you submit yourself to treatment.

On the prostate cancer track of treatment of which I have now made the decision to opt for radical radiotherapy and much of the process of my thinking is addressed in the earlier series of Men’s things blogs, I have one question based on cancer risk groups which I have not found in any of the medical notes.

After I called the Macmillan Urology Specialist Nurse assigned to me at the Christie Hospital to tell her that I would elect for radical radiotherapy treatment, I decided I should seek support from Prostate Cancer UK to see if I could speak to a volunteer who had undergone radiotherapy without the prerequisite of hormone treatment.

You need to be quite knowledgeable about your condition with the articulation of your understanding of what you have been told about your diagnosis.

A progression of tests and results

My route to treatment was a progressive set of checks and tests going back to February and the highlights I would present again below:

PSA: Prostate Specific Antigen; this is a blood test that if the reading is high might suggest the presence of prostate cancer, but other factors might lead to a high PSA reading and that informs the next stage of investigation.

DRE: Digital Rectal Examination; when your PSA reads above certain nanograms per millilitre (ng/ml) in your age group, your doctor will use their judgement and discretion to digitally feel your prostate through your rectum to determine if it is enlarged or unsmooth among any other unusual or abnormal indicators. An enlarged prostate would suggest a referral for more analysis.

mpMRI: multiparametric Magnetic Resonance Imaging scan for prostate cancer. This is an MRI scan taken of your prostate with contrast. This means a dye solution is fed into your veins to accentuate the blood vessels and the prostate gland to determine the condition, size, and possible presence of cancer lesions. The most important score from the mpMRI scan is the Likert or PI-RADS (Prostate Imaging – Reporting and Data System) score with a range of 1 to 5.

A score of 3 or more would most likely lead to conducting a biopsy of your prostate gland. This would indicate the likelihood of cancer and the only way to determine this is to conduct a histopathology examination of cells extracted from your prostate.

The reading from the MRI scan would give an indication of the prostate cancer stage represented by a T score and better detailed in the TNM reference later in the blog.

UGTBP: Ultrasound-guided transperineal biopsy of the prostate is a procedure to extract biopsies of the prostate gland for examination. An ultrasound probe is inserted in the rectum and a biopsy needle which operates like a staple gun is inserted through the perineum under local anaesthetic. The injections can be painful and uncomfortable, but you should be awake to react.

While it is possible to have this under general anaesthesia, you lose the facility and ability to react, and some damage might ensue. After the biopsy, you are likely to have blood in your urine and semen for weeks. This procedure is the more favoured of biopsies as opposed to the transrectal one which could introduce complications and infection.

The result of the biopsy if positive will set in motion, an entry in the National Cancer Registry and a referral to a cancer specialist hospital.

The most important information from this histopathology examination is the Gleason score and Grade Group.

Making sense of it all

The investigations and tests above will inform the medical personnel conclusively if you have prostate cancer and begin the determination of the course of treatment to take.

The consultant who conducted the biopsy made two assertions in his medical notes without engaging me, this was besides the fact that the information was mismanaged by the NHS trust that I knew what was to be diagnosed a week before I met with the consultant.

His advice was in these words, “He will need active treatment,” and that meant out of three possible options for treatment, active surveillance, a radical prostatectomy, and radical radiotherapy of the prostate, the first was off the table before I was engaged.

Having opted for radiotherapy and found I did not qualify for brachytherapy because of my high I-PSS score, the external beam presented a more comfortable treatment plan over the uncertainties of surgery and the complications that might result.

A welcome intervention from another angle

That was until I sought support from Prostate Cancer UK and the nurse having been given some indicators from the diagnosis wondered why I was not being considered for active surveillance.

CPG: Cambridge Prognostic Group system; this allows the doctor to assess your cancer risk group and suggest the best treatment track for the cancer. The indices use values and logical operators of AND/OR to provide an assessment.

• the Grade Group or Gleason score [7 (3 + 4) Grade Group 2]
• prostate-specific antigen (PSA) level [4.0 ng/ml]
• tumour, node, metastasis (TNM) staging [Contained within the prostate – T2]

From the 5 CPG groups, the elements landed in CPG 2 and the Prostate Cancer UK nurse vehemently suggested I ask some questions as to why active surveillance and watchful waiting was not one of the treatment options on the table.

A radiotherapy planning CT (computer tomography) scan is scheduled; I have since called the Christie Macmillan Urology Specialist Nurse service to ask for an appointment to discuss this option in detail.

This is to address all the questions before we start anything and to give me both the understanding and conviction that I am following the course of treatment for the best outcomes.

In researching this blog, I came upon this piece of tabulated information I have from the onset, sought, to help me choose the best treatment in terms of the options, the long-term situation, and the consequences of whatever treatment option you choose.

Choosing the best treatment based on different studies. [Adapted from CRUK (Click to enlarge)]

Men's Things Blogs

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Blog - Men's things - VII

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Blog - Men's things - IX

Blog - Men's things - X

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Blog - Men's things - XII

Blog - Men's things - XIII

Blog - Men's things - XIV