I have a family history so I have been checked each November. In 2013 I went early, the PSA was 4.2 and my GP suggested waiting 6 weeks as her DRE (digital rectal examination) may have angered the Prostate. In any case, she advised, it may have been an inflammation that would settle.
Late November my PSA was elevated and I was referred to a Urologist in Sydney - Associate Professor Manish Patel. He did a more thorough DRE using 'the American method', different in that I bent over his bench, whereas all my GP examinations were lying sideways. I stress all DRE's do not hurt at all.
He discerned 'softness' on one side, which was hardly conclusive. He suggested an MRI scan, which carries a cost of about $400 in Australia. That produced an image showing a hazy mass occupying 80% of the prostate. A biopsy was booked quickly, I paid extra for a general anaesthetic. Nothing I've read anywhere says that being awake for this is a good idea. The cost was again about an extra $400, as I have hospital insurance in Australia.
The biopsy was fast, I was out for less than an hour, and at midday went home feeling tender. I pissed blood for a few days, and had a reducing blood presence in my ejaculate. This ranged from full blood several days later, to almost zero in three weeks.
Several days after the biopsy Dr. Patel confirmed of the 12 samples removed, 8 were cancerous and it was 7 or 'semi' aggressive. It took me 5 seconds to agree to have the prostate removed. We had to wait 3 weeks as it was Christmas and the operation was on January 10, 2014.
The low point was a bone scan, to rule out any cancer breakouts. This was a nervous wait, it came in clear. Had there been a breakout, I had resolved to die happy and not go out in a blizzard of chemo and radiation. No kidding – I was resolved. I have friends I've buried because of this, and have another one at the time I write in a Hospice. This is a fatal disease if men don't act fast. Don't be lulled by the reports of slow growth, mine was 7 and had I not acted fast I would be facing a very early death.
In the meantime, Dr. Patel introduced me to his support crew. I was booked with a principal Physiotherapist, Sean Mungovan, at his practice at Westmead Private Physiotherapy Services. He is a fairly intense, fit guy in his 30's who hammered the realities of his experience in this field. He did an ultrasound of my pelvic contraction function.
This was the Eldorado moment for me, as I had at least 18 months solid Pilates classes under my belt, and I knew what a pelvic contraction was, despite not bothering too much about it during my Pilates classes. I'd stepped up to four classes a week some months earlier, loving the flexibility and the gentle nature of the exercise. Pilates had already given me the flexibility of a young man, and I felt fit and vital as a consequence.
Earlier on it probably also gave me the confidence to pursue a new girlfriend - Suzanne, who at 47 is awesomely fit but in a lovely feminine way. She isn't a ripped gristle-tripod like some gym girls. I knew that dating her meant being and staying fit (in body and mind) and Pilates was that pass card. Thank goodness! Poor Suzanne – I'd met her in October, and in December was looking down the barrel of uncertainty.
Sean the Physio had me doing a lot of pelvic floor contraction exercises. His first session culminated in giving me a brown shopping bag loaded with incontinence pads, at a net cost of $60. It was a powerful whack on the head, to say 'hey, every man in incontinent after the operation'. He had a plastic anatomy toy on his desk and gave me the whole chapter and the whole verse on what would happen.
I went back and had several exercise sessions, all based on pelvic floor exercises. I was doing them in bed, I was doing them in the car, and I was told to walk 12,000 paces a day. An iPhone APP helped me achieve this.
Although mine was a short treatment period, I listened to Sean and did what he said. It did impact on my work hours. I had time off, and I also had funds devoted to me for treatment. These are essential elements to the outcome I will reveal soon.
On January 10 I checked in, and within an hour was out of it. The operation was performed with a Da Vinci machine. The anesthetist had called a day earlier to negotiate his account – 'around $2000' and the hospital – Macquarie Uni had me in for a pre-op consult earlier. It takes almost 4 hours, it is not a short operation. I had six small incisions, with no external stitches.
Because the cancer was inside the gland, Professor Patel could filet around, and 'preserve' the layer of erectile nerves. He told me they were 'invigorated' and 'active'.
That same operation day I walked up-stairs in hospital. The hospital physio put a giant TICK on my chart and I didn't see her again.
The one big discomfort was the gas. They inflate your gut, and it is very uncomfortable when you stand and walk, but in your shoulders! Like being hung on a hook from each shoulder. Lying back down fixes it. Knowing helps too!
I was released within 48 hours. The pain was only Panadol threshold! Just six days after the operation I was unwired from the post-op hardware (a catheter, with a bag strapped to my leg) and I am NOT incontinent. Far from it - all the mental prep work the physios have done was wasted, as I was operating entirely normally! When the catheter came out (yes, you have this just after the op, it is not the end of the world and it does not hurt) the nurse whacked a pad in my under pants and said ' every man in incontinent after this'. I was NOT.
Next day Dr. Patel called to advise the pathology showed ALL the cancer was contained in the removed gland, and there were no breakouts. I did a mental cartwheel.
Now I hope and expect to regain great erectile function fairly quickly too given my profile. Not boasting, just sayin..... these two are the sleeping bogies of Prostate Cancer, but they don't NEED to be! Just days after, I had sensations, and now a few weeks on, I am 35 – 40% there. Which is very encouraging.
A year of Pilates really helped. Please do consider this form of exercise; with its focus on core and pelvic contraction. Most men think it is girly, but once I started, I fast got back to how I felt as a young man! Many guys tell me it cures aches, pains and sore backs too.
I went to work on day 5 (after the op) for a few hours. On day 6, I did my usual journalistic work from my kitchen table. And I've been down to the pub every day for a beer or three as well. No more daytime sleeps.
I had the robotic removal in a private hospital. Don't wait for the public system to schedule you with a specialist down the track that does the old fashioned full operation - you'll be munted.
I got this monster (Gleason 7, Stage 2) just BEFORE it went berserk. It came on FAST, within 12 months of my previous clear PSA and DRE.
So that's it. I am active, have taken up swimming and expect to re-start Pilates around week 6 from surgery. I'm the luckiest guy alive. Total out of pocket costs are about 10 grand Australian. Just pay for it. Borrow the bucks if need be.
It is now 16 months since my operation.
I had zero incontinence, and gained some sensations within the first month. My girlfriend dumped me and frankly I didn't blame her. Pre-op, I had good libido and kept her very happy. Post op, I was clearly a different man.
Around five weeks post op I experienced my first 'dry' orgasm, which elated me. The erectile function recovery was slow but linear.
At week 8 I was confident enough to start dating again, and found the revelation that I had my Prostate removed opened up interesting discussions with women, some of whom confiding their stories about men who could not perform.
I dated around a bit and then four months post op entered a relationship that has blossomed into a sustaining and loving partnership that is now 12 months in. She accepted that my erection was a work in progress, and together we have progressed where today I would rank myself as 'fully recovered'.
There are differences though, it's like I've been re-wired and re-plumbed. The libido is lower, but at least the ability to obtain an 'unassisted' erection has returned.
My girlfriend appreciates the 'dry' orgasm.
Overall, my Prostate cancer experience was life changing. I feel I was fairly casual about my relationships prior - not unfaithful - and I just hit the 'next' button whenever something didn't work out. Now I deeply value my relationship, probably because she has been with me through the journey.
Finally I am really happy that I've saved one friend through my testimony, and helped some other men. Those I have spoken to all say that as they were diagnosed early, everything has been far less arduous than they feared.
It is now 22 months since the operation.
I have regained 100% erectile function, although the libido is reduced.
I feel I have benefited from this whole journey as I am not inconvenienced in any way, I will not ever have this cancer again, and I re-evaluated my life following surgery.
It is 2 years and 10 months since the removal.
At about the 24 month point I recognised I had 100% erection, although the libido is suppressed. I have zero incontinence.
I have a great life, a new wife who is (I am sure) completely satisfied.
So there is life after this, men!
Julius's e-mail address is: firstname.lastname@example.org