Monday, 9 June 2014

Jeffrey Archer does a great job on telling it how it is...

During my annual check-up with my GP Dr Page, among other things I always have a blood test.
This time, when the results came back from the lab, Dr Page phoned to tell me that my PSA level was slightly on the high side at 6.8 ‘What does PSA stand for?’ I asked, ‘and how bad is 6.8?’
‘PSA stands for Prostate Specific Antigen,’ he replied, ‘and 6.8 is fairly normal for someone of your age [I was 73], but it’s heading in the wrong direction, so perhaps you should visit a specialist.’

As my wife Mary and I live in Cambridge, Dr Page made an appointment for me to see Mr Nimish Shah, who is clinical director of the Department of Urology at the city’s Addenbrooke’s Hospital.
The first thing Mr Shah wanted to do was take another blood test so that he could double-check my PSA level. Same result – 6.8 – so I had to face the possibility that I might have prostate cancer.
‘We should conduct an image-guided biopsy,’ announced Mr Shah, ‘and have a proper look at your prostate.’
So I had a short procedure under anaesthetic, during which Mr Shah’s colleague, Christof Kastner, took several tissue samples from my prostate. Later Mr Shah confirmed that I did have prostate cancer.

‘So what do you recommend I should do?’ I asked.
‘You have three choices,’ Mr Shah replied. Option A was what he called active surveillance, and he then produced a chart showing that I had a 90 per cent chance of dying from something other than prostate cancer during the next  15 years, which sounded pretty good to me.
After all, 88 is not too bad an age to finally report to the Almighty.
But Mary, who accompanied me on the consultation, was pointing to a 37 per cent risk of mortality from my particular cancer on the chart, so I had no choice but to listen to what else Mr Shah had to offer.

Choices: Lord Archer was tempted to forgo treatment altogether, but was swayed by his wife
Option B was to have an operation to remove the whole prostate with the cancer, while Option C would mean commencing hormone therapy to shrink the tumour, followed by a seven-week course of radiotherapy.

Prostate cancer kills one man every hour in the UK.
It is the most common cancer in men: one in eight men will be diagnosed with the disease in the UK. The risk is higher for black men, who face a one in four chance of being diagnosed.
Prostate cancer affects almost as many men as breast cancer affects women, yet in the UK in 2013, only £22 million was invested in prostate cancer research compared with £40 million into breast cancer research
If you are over the age of 50 or have a family history of the disease, your risk of developing prostate cancer is also higher than average and you should speak to your GP about your risk.
Join Men United, Prostate Cancer UK’s army  of supporters, to help fund research that will revolutionise how prostate cancer is detected and treated.
Visit the website to sign up for the team and find out how to donate.
Anyone with concerns about prostate cancer or prostate problems can call a Prostate Cancer UK specialist nurse on 0800 074 8383 or visit the website

If I had to do something, the operation seemed preferable to radiotherapy – a short, sharp shock rather than a longer-term experience with repeated hospital visits.
The other major difference between operation or radiotherapy is the effect it may have on your sex life. If you have the operation, you will become infertile.
So if you still want children (not a problem for me at the age of 74), you will have to opt for radiotherapy. You may also become impotent, though with the help of Viagra you can still experience the same sensation.
Mr Shah confirmed that if I wanted to have an operation, he could fit  me in in four weeks’ time.
So did I spend the next few weeks becoming anxious, fearful, even paranoid? Certainly not. After all, I had witnessed my wife going through a far more demanding and stressful experience, when she’d had a cancerous bladder removed three years ago, without a murmur.
She attended a board lunch at the hospital nine days after the operation and was back chairing the board two months later, so I was not going to make a fuss, even if I wanted to.
At 7am on December 17, I checked in at Addenbrooke’s with an overnight bag as instructed, having  been told not to drink any alcohol for at least 24 hours, and that my last meal should be dinner the previous evening.
I am now about to describe what happened during the next six weeks in layman’s language, so this may be the time for the squeamish to turn the page.
After I had stripped down to my pants and donned a hospital gown, I was taken to the operating theatre, where Mr Shah introduced me to his team of six, which included a robot from California called Da Vinci.
Mr Shah next showed me the six places on my stomach where he would make small incisions to allow Da Vinci’s little fingers to enter my abdomen and remove my prostate. He would be operating the robot, he explained.
I did ask, because I’m human, how many times he’d done this before. More than 500 was his reply, which seemed satisfactory.
He then told me that after I’d had an anaesthetic, the operation would take about three hours and when I woke I would feel sore and exhausted, but the job should be done.
Actually the operation took almost four hours because, as Mr Shah later explained, he needed to remove my lymph nodes as well, as there was a concern that the tumour was just about to escape from my prostate and he needed to be sure that the cancer had not spread to other parts of my body.
Although Mr Shah felt the operation had gone well, he couldn’t confirm that all the cancer had been removed and had not spread elsewhere, until all the results came back from the labs, which would take about two weeks.
Now for the details. When you wake up, you find that a long thin plastic tube, which they call a catheter, has been inserted into your penis while the other end is attached to a balloon-like bag that is strapped around your thigh into which the urine drains constantly without you realising it.

Back in health: After an arduous recovery, Lord Archer is back on his feet and in the garden of his Cambridgeshire house once more.
Once the bag is full, you release a little tap at the bottom to allow the urine to drain into a bucket or the loo so that you can begin the whole process again: unpleasant, but you get used to it.
The one time you have to be sure the bag is empty is just before you go to bed, because if the bag is full and you want to pee, it has nowhere to go, which is extremely painful. But I’m jumping ahead of myself.
You spend only one night in hospital, maximum two, because they want you out of bed and walking as quickly as possible, and not just because they need the bed for the next patient.
However, you are not allowed to go home until you can prove to the ward sister that you can walk up and down the long corridor outside the ward 20 times, a distance of about a quarter of a mile – not that easy with the tube and bag as your companions.
I just about managed it, so Mary was called for, and I was allowed to go home. The next seven days were the worst, despite the fact that Mr Shah had described what to expect in graphic detail.
This is the period when the tube and bag remain in place, and have to be drained every two to three hours, while at the same time you’re expected to increase your walking, so that by the end of the week, you ought to be covering about a mile.
During the week, you don’t feel like eating but you have to drink lots of water, which only helps to  fill up the bag and adds to your discomfort.
You also don’t feel like washing or shaving, but Mary insisted that I had a shower so she sprayed me down, and I must admit that I felt a lot better afterwards.
On the seventh day, I returned to Addenbrooke’s to have my tube and bag removed, and I was more than ready to get rid of those unwelcome attachments.
I had imagined that the pulling of the tube out of my penis would be painful, but not so: once the little balloon that had kept it in place was deflated, it just slid out in the expert hands of the nurse, and moments later, the bag and tube were dropped unceremoniously into a hospital bin, and I breathed a sigh of relief, convinced life was about to return to normal.
Not quite yet! For a week I had been peeing happily away, like a child, not giving a great deal of thought to it, so the brain and body had already accommodated themselves to a new routine, which they were quite happy to continue without consulting me.
For the next seven days, you become a baby again and need to wear a large nappy to make sure that if you can’t get to the loo in time you won’t water the carpet and everything else on the way.
And just like a child, you have to learn to control yourself. For this you need another specialist, a physiotherapist, who will teach you to do exercises to strengthen your pelvic floor – a part of my anatomy I didn’t know existed until then.
You do ten firm uplifts, holding the new position for ten seconds, before relaxing. This should be done three times a day, so that by the end of the week you can replace your nappy with a large triangular pad that fits neatly into your pants.
You will find by the second week that you no longer pee uncontrollably, though you do leak from time to time.
This improves fairly rapidly as long as you go on doing your pelvic-floor exercises, while the triangular pads get smaller and smaller, until you are able to dispose of them completely and return to normal attire.
After that, just the occasional leak when you least expect it – which is embarrassing if you’re at a restaurant or the theatre.
So how do I feel now, some six months later? Well, I would advise any man over the age of 50 to visit his GP and find out what his PSA level is.
I have asked several of my friends in that age group this question and, with one exception, none of them had a clue.
Two out of three of you will discover that your PSA is nearly zero, or so low (less than four) that it’s not a warning sign.
But if you’re in the other smaller group of one in three with a raised level, you ought to make a decision – that is, if you want to add another ten years to your life. So get on with it.
Two weeks after my operation Mr Shah wrote to tell me the interim results from the lab were encouraging.
Four weeks later he sent me the full findings, but I was only interested in the bottom line. My PSA was 0.02, virtually undetectable!
Thank you, Mr Shah, and thanks to all of you who work in the NHS. But thanks are not enough.
I have joined Men United and am proud to support Prostate Cancer UK, because if I die before the age of 88, the diagnosis won’t be prostate cancer.

Committed: Mary Archer helped her husband through his ordeal
In sickness and in health – that’s what it says in the marriage contract, and that’s what it feels like when your husband or partner is diagnosed with prostate cancer.
If your man is anything like Jeffrey, he won’t be good at getting regular medical check-ups or admitting he may have a health problem.
That’s why, when I heard that Jeffrey’s PSA level was slightly higher than it should be for a man of his age, I encouraged him to have a thorough check-up.
I was very glad I did, because the MRI scan and biopsy that he then had showed quite a bit of cancer in his prostate, though fortunately it didn’t seem to have spread.
Something needed to be done, but what? This is a key point in the cancer journey where a family member can be really helpful, by going with the patient to discuss treatment options with the specialist.
Jeffrey had little hesitation in opting for surgery, and a couple of weeks later he had a robot-assisted radical prostatectomy.
The surgeon had told us what to expect after this surgery and that was very helpful. Jeffrey did not like the catheter he had in for a week afterwards,and I was able to help with catheter care and practical issues of washing and taking regular medication and exercise.
Then, when the catheter came out, he didn’t like the poor continence he suffered for the next few days any better. I was very sympathetic about that as I had had a similar experience three years ago, after my operation for bladder cancer.
I’m fine now, and that helped Jeffrey believe he would be fine too.
So my advice to any woman finding herself in the same situation as I was last autumn, with her man facing a diagnosis of prostate cancer, is to stay connected for the journey. It’s much easier to travel the road together.

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