Tuesday, 1 March 2011

Sorry, so much technical stuff on here right now and not much fun! But as it's Prostate Cancer awareness month starting today, I thought it appropriate. This is a very interesting view on PSA levels after surgery, from a great guy called John on the forum.......(What do you think Paul?)


After my radical prostate operation (in April 2005), my PSA remained negligible for almost two years, but in the summer of 2007 began to rise.

The figures were:

1st March 2007 0.01
4th September 2007 0.03
29 November 2007 0.04
14 March 2008 0.07
19 June 2008 0.06
1st December 2008 0.10
3rd June 2009 0.20
10 December 2009 0.30
13 April 2010 0.32
26 October 2010 0.51

In September 2007, the hospital urologist who was then in charge of my case – a gloomy and rather negative fellow – threw a wobbly when he saw the rise from 0.01 to 0.03 and referred me to the radiology department. The head of radiology was quite clear – she thought it highly premature to intervene at that stage (she said amongst other things that she would prefer to have a physical target to aim at, and it was too early to have such a target).

Then for a brief while, I saw another of the hospital’s urologists (I privately called him Laughing Jack) who took a far sunnier view of the situation, and who cheerfully observed that “after all, we’re dealing in extremely tiny figures” – his conclusion was to let things be for the time being. “Lets leave it until we have a figure that we can really get our teeth into!”, he declared jovially.

But in March 2008, Dr Gloomy came back, said the situation was extremely serious, and that drastic remedial action was required immediately. There ensued a brief, incandescent, but inconclusive row between Gloomy and the head of radiology.

At that point, I got fed up, and decided to go private. I booked in as a private patient with one of the senior urologists who had assisted at my op, and I have had several hour-long sessions with him. He is impressed by the slowness (so far) of the rise in the PSA, and thinks that radiotherapy would be both premature and risky – risky in that it could inadvertently cause damage to my already fragile waterworks. He counsels hormone therapy, but is reluctant to recommend any course of treatment, hormone or otherwise, until the PSA passes the 1.0 mark.

Meanwhile, I feel fit and happy. Perhaps I’m living in a fool’s paradise, but I have established a very good rapport with the “private” urologist (we happen to get on very well together) and I’m quite willing, so far, to go along with what he recommends. My next PSA reading will be in three weeks’ time.

What does all this show? It certainly shows that there isn’t always agreement amongst urologists – even when the said urologists are close colleagues belonging to the same surgical team. In short, I have had to deal with Dr Gloomy, Dr Laughing Jack, a senior radiologist who has her own strongly-held view from which she won’t budge, and my present urologist. The tale also shows, to my mind, the importance of finding a urologist (or oncologist, or radiologist or whatever) who you can trust, and whose advice you respect.

As for PSA readings being unreliable - who knows? But in my case, I feel that they have shown a consistent and predictable picture. It's not the PSA totals that have been the problem, but the differing interpretations that have been put on them. But then that's life, I suppose.

Best wishes to all,

John

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