I've just found that a friend has been examined by his doctor and consultant, and is now going for a biopsy next week. I want to write to him here because so many other men will be in his position right now, wondering what the next few months will hold, and this letter may benefit them...
Dear friend,
At this stage you don't know if you have prostate cancer but you've researched it to death, so you know a hell of a lot more than you did a few months back. But it's information overload and you're worrying yourself to death over things that probably won't turn out anywhere as near as bad as you're thinking right now. You may even be told that you don't have prostate cancer, only one in ten enlarged prostates turn out to be cancer!
A guy in the states said, "You shouldn't look at a diagnosis of prostate cancer as a visit from the grim reaper, more a long slow waltz with the angel of death". I liked that, because when I was first diagnosed, I just thought I was going to die, yet 4 years later, hey man I'm still kickin! Winning the battle in your mind is critical at this stage, and not imagining the worse, but staying focused on today. Your mind will try and play out dozens of different scenarios on the information you already have, but why bother, you know nothing yet!
There is a urine test that will tell you if you have prostate cancer, but I'm afraid it won't tell you what gleason grade you have; that's why the biopsy. I would describe this as 'uncomfortable', but you do get a local anaesthetic and antibiotics before you leave to prevent infection. You will have usually 12 needle samples taken, and these are guided by the nurse on an ultra sound scan, so that they can go for areas that look suspicious. The whole thing takes around 20 minutes and I have to confess, it's not as bad as the dentist!
Take a nice big cushion for the seat of the car and whatever you do, don't drive yourself back! They will tell you that there may be a bit of blood in your urine. Ha ha, everyone is probably different but I had blood in everything, yes, everything, but that's perfectly normal and takes a few days to go away.
The result, 8 days or so later will tell you what grade cancer you have if they find any, but it is possible that if they don't find any, that cancer is still there but may be in an awkward place to biopsy. If you need a second biopsy it will be a 'saturation biopsy' under general anaesthetic, but that doesn't often happen.
At this stage, if no cancer is found then that's still an excellent sign, because if there is any, it's going to be very small. You may even be put on what they call 'watchful waiting', where they just keep an eye on you for years ahead with 6 monthly PSA's.
If you are told you have prostate cancer, Gleason 6 is the dream ticket at this point. Very early stage, unlikely to have travelled to anywhere else in the body, my brother Paul had this. I had Gleason 7 (3+4), a little more nasty but as it was contained, only a 5% chance of recurrence for me now. Gleason 8 to 10 is more likely to travel, but if caught early is completely treatable with surgery.
The next stage is an MRI, but that's not possible for around 6 weeks after the biopsy as they need to give the prostate a chance to heal. During this time you will also be booked in for a bone scan (that's routine), just to make sure the cancer hasn't metastasised, but if you've already been told the cancer is localised, it's rare that a bone scan will show anything going on. Only after the biopsy, bone scan and MRI will your MDT meeting take place, where all specialists involved will get together to offer you 'best advice' on the way forward. At that stage, there are several paths open to you, from surgery to radiotherapy, radioactive implants to alternative medicines, but the choice is left to you. I'm happy to help you if needed, but it may not even come to that, because today is 'today' and officially, you're still all clear until told otherwise.
Having said all this, know that I am only a Skype away if you need to talk and take it one day at a time. Good luck with the biopsy, treat yourself to a nice drink that night and I'll toast to your long and healthy future.
Best wishes always
Daniel
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