Since 2003, I have been having annual Blood Tests to monitor my general health (heart, cholesterol levels, etc.). Included in the regime of Tests was the PSA Test. In January 2007, there was an increase in the PSA reading to 2.7 (still 'inside' the acceptable margins for my age). In March 2008, the PSA reading was 4.5. In August 2008 I had a blood test primarily for another illness, my PSA reading was 5.4.
At that time, my Doctor at the Morphettville Medical Centre Dr Vince Signorelli alerted me to the rising PSA levels and strongly suggested I be referred to an Urologist for further examination. (I recall my immediate reaction back to Dr Signorelli was that "I felt fine, there's nothing wrong with me!!!!") From the list shown to me by my GP, I selected an Urologist that was regionally near to my home.
I was seen by Dr John Miller, Urologist on 23 September 2008. At that consultation, he examined the Data Sheet of the PSA Blood Test Results that I had, he inquired about my general well being including any prevailing medical conditions and he performed a Digital Rectal Examination (DRE). (I state here that there is some discomfort but it is only for a minute or so. In the grand scale of Life matters, it is nothing!)
Dr Miller told me that he couldn't feel any abnormalities on the Prostate during that DRE. (I recall again at that time that I said to Dr Miller that "I felt fine and everything was OK!!") He said that may be true but he would like to be absolutely sure so he recommended without any hesitation that I should undertake a Biopsy to determine the exact status of the Prostate.
On 9 October 2008, I was admitted to Hospital as a Day Surgery Patient. I was given a General Anaesthetic that put me asleep for approximately 50 minutes. The Biopsy was performed by Dr Miller and he used the Transperineal biopsy method. (He selected this method because I had an existing medical condition which ruled out using the more widely used Transrectal biopsy method.).
On 15 October 2008, I, together with my wife, saw Dr Miller at his Consulting Rooms. He stated clearly from the outset that "you have Prostate Cancer!!" (At this point I must stress to anyone reading this is that I believe it is absolutely essential that you take someone along with you to such a consultations/outcome meetings because the other person will hear and understand what is being said to you because you are in a form of Shock and you just don't take in all that is being said to you).
Dr Miller advised that the Biopsy results indicated a Gleason Scale of less than 7 [This is a curious diagnosis, since it is normal to give a definitive Gleason Score. Currently the only Gleason Score lower than 7 for material recovered from a needle biopsy is 3+3=6 - see Gleason Grades] and the rating was T1. [This would have been staged as T1c on most diagnoses - see Staging]
The tumour is located within the prostate gland and is too small to be detected during a rectal examination, but it may be discovered through other diagnostic procedures such as the PSA test. Prostate cancer at this stage generally produces no symptoms.
Dr Miller offered two methods of treatment that I should consider as appropriate:
Brachytherapy Procedure - treatment by inserting 80-120 Radio-active seeds into the Prostate, or a Radical Prostatectomy - Surgery to remove the Prostate in its entirety. (The third method that is often suggested namely External Radiation was not considered/favoured because of my pre-existing medical condition.)
He carefully explained the different methods including the risks associated with each method. He also issued to me a series of pamphlets and brochures that explained the methods in greater detail. He gave me time to consider the options available.
On 10 November 2008 I advised Dr Miller that I would like to try the Brachytherapy Procedure. I explained that I had made that decision based on my Gleason Score (<7) and my T1 Rating. (Upon reflection, I am positive I was probably mentally dreading the thought of Open Surgery Radical Prostatectomy!!) . I was immediately checked in for a Bladder Flow Rate where Urinating Flow Rate of the Bladder is determined and an assessment is made about the physical condition and well-being of the Bladder.
After that Test, Dr Miller's Staff negotiated an Initial appointment with Adelaide Radiotherapy Centre (ARC). The Doctor at ARC went through all the procedures associated with Brachytherapy Procedure. I can also vividly recall he also asked me "point blank" why I did not opt for the Radical Prostatectomy. (I believe the Radiologist was challenging me to see if I had objectively assessed what would be the better treatment option). I said, in my view that the Brachytherapy Procedure appeared to be the less invasive procedure bearing in mind that all evidence at the time suggested that the Cancer was confined to 'within' the Prostate.
On 29 January 2009, I was admitted to Calvary Hospital as a Day Surgery Patient so that the Brachytherapy Procedure "Volume Test" could be conducted. I think I was under General Anaesthetic for approximately 90 minutes. In the Recovery Room afterwards, I was advised by Dr Miller that the Brachytherapy Procedure option was not available/suitable to me because my Pubic Bone partly shrouded the 'direct line access" to the Prostate that the Radiologist need to properly insert the Radio-Active Seeds into the whole of the Prostate. My only option available to me now was a Radical Prostatectomy.
I attended Dr Miller's Consulting Room on 31 January 2009 where he fully discussed the outcomes of the Brachytherapy Procedure Volume Test. He then proceeded to discuss the procedure for undertaking Radical Prostatectomy. He fully explained the risks and the scope of the Radical Prostatectomy. These procedures included Laparoscopic Prostatectomy where surgery is undertaken using robots. Also offered was the Radical Prostatectomy procedure (Open Surgery).
Dr Miller advised he specialises in Open Surgery and he fully explained why he preferred this method. I elected to proceed with the Open Surgery. (I did this because of my confidence in Dr Miller's capability and his honest and frank manner in all his discussions and actions he has had with me throughout. (For me, this enabled me to have the greatest confidence and respect for Dr Miller's ability as a Surgeon.)
I made a commitment to Dr Miller that I would endeavour to get as 'physically fit' as possible prior to the operation (the exact date was not known at that time other than it would be approximately April/May 2009). So in 10 weeks or so from 31 January 2009 to 21 April 2009, I lost 11 kg of weight and I rode a pushbike for a minimum of 20 minutes a day. (I missed a total of 4 days riding that bike in that period.) On 4 March 2009, I had my PSA checked as a component of my usual annual Blood Tests - the reading was 5.2. The date of 21 April 2009 was set by Dr Miller during a visit on 17 March 2009.
The Radical Prostatectomy Operation and thereafter
On 21 April 2009, I presented at Ashford Hospital in South Australia at 1.00PM. I had been fasting since 8.00AM that day. At 6.40 pm, after a brief talk with Dr Miller, I entered the Operating Theatre. My wife told me that Dr Miller rang her at approximately 11.00pm to advise her that he had completed the surgery and that I would not likely be conscious until the next day. I woke up in High Dependency Unit at Ashford Hospital at about 5.30 am on 22 April 2009. Tubes everywhere!!!! Two drain tubes immediately above the incision area, a Catheter, and a series of tubes in the neck region for administering pain relief drugs if needed. Additional tubes were still in the arm and wrist regions too.
High Dependency Unit
I was monitored very closely throughout the 22 April 2009. (I can recall being sent for an X-Ray early in the day of the 22nd to ensure that the series of tubes in my neck were correctly positioned.) The Nurses were constantly seeking feedback from me about pain, discomfort, etc. I was in pretty good shape I thought because I didn't feel much!! The Nurses assigned to High Dependency Unit when I was there are of the highest calibre and skills. I cannot express how highly I regard their care and attention. I was in High Dependency Unit until late in the afternoon of Thursday 23 April 2009 where they decided that I was recuperating enough to be transferred to Mitcham Ward.
I was again getting wonderful attention and care from the Nurses on Mitcham Ward. On Friday 24 April 2009, I was able to have a shower in my en-suite. I was able to sit down on a suitable chair and just run warm water over all of the body. It was just so refreshing! (I still had my Catheter and the other tubes attached to me and this took a little time to get used to as I shuffled from the bed to the en-suite.) Late on that Friday I was 'requested' by the Hospital's Physiotherapist to try to do some walking about the Room/Ward. I wasn't doing that I can tell you!!
I was slowly showing interest in small quantities of food - namely small serves of steamed vegetables as a follow up to initial ice-cream and yoghurt!! In the 4 day period (Tuesday 22nd - Friday 25th) after I awoke from the operation, Dr Miller and the Hospital took great care and interest in ensuring the Bowels were beginning to work again. I was given a proprietary laxative and stool softener to ensure that there would be NIL constipation after the Bowel 'woke up". The need for this is to ensure that any bowel movement does not create any unnecessary strain on the abdomen. As the days proceeded in Mitcham Ward, many of the systems put in place during and a result of the surgery (tubes, medicines, etc) were being withdrawn.
Dr Miller called every day that I was in Hospital to check my progress and well being. On the morning of Sunday 26 April 2009, he said to me that the operation was successful. He also told me that he had to expand the area of the operation because he found that the Cancer was more aggressive than expected and he spent additional time ensuring that he has removed it all from all surrounding tissue. Dr Miller was very, very, very confident that I was "Prostate Cancer free." Oh what a relief!! After he had spoken to me, he said I could go home!! I still had the Catheter in place.
Hospital in the Home (HITH)
For the period 27 April 2009 to 3 May 2009, I was visited daily by the Nurses assigned to Ashford Hospital's "Hospital in the Home" System. These Nurses are the "on road" part of Mitcham Ward. Their role included ensuring that I was able to manage my Catheter, my medicines were being correctly applied and that I was coping and recuperating in a proper and safe manner. In hindsight, their most wonderful and endearing asset as Nurses was their capacity to steer a person (me) who has just had major surgery with significant outcomes through a roller-coaster series of emotions!!! We men are aware of women experiencing post-natal "blues" - rest assured it happens to men too as we try to grapple with our own differing emotions!!! I have no hesitation in saying, "Thank you Nurses."
Catheter and Incontinence
On Monday 4 May 2009, I was re-admitted to Mitcham Ward as programmed so that the Catheter could be removed. The removal of the Catheter took but a few seconds. The next 3-4 hours was spent ensuring that the Bladder was functioning properly and in particular, the Bladder could hold an acceptable volume of Urine and that it was able to be passed in a proper time frame. I wasn't going anywhere until Dr Miller was satisfied.
I kept a Log of the period 4 May 2009 to 19 May 2009 when I was due to see Dr Miller. Looking over the Log I kept, it reveals that I had little control over what was happening during the daytime. Nearly every time I moved, there was an uncontrolled 'squirt'. I was waking up 2-3 times during the night with varying experiences but generally, I was able to control what was occurring at night.
What was good though was that the "brain" was waking me up so I would go to the toilet. There were instances where I didn't wake up in time and I had to change the pads but that was at a minimum. I used two pads - an absorbent pad embedded in a throw-away set of underpants (Depend Underwear) and an absorbent pad (Hartmann Molimed) which I placed as an additional safeguard. At the visit on 19 May to Dr Miller, he recommended that I see a Physiotherapist that specialises in Pelvic Floor Muscle exercises. [commonly known as Kegels ]
On 1 June 2009, I had a first meeting (of several) with Mrs Virginia Gill, a Physiotherapist. She was able to tell me what exercises I needed to undertake to try and get back Control. Over the next several weeks I was getting better at Control and I next changed the layers of Pads to use the adhesive "Molimed for Men". On 6 August 2009, I did away with the Pads 'cold turkey'. I was getting annoyed at the rubbing action of the pad on the Penis and so I decided to give them away!! I have had a few little mishaps since then but the amount of leakage is almost negligible in the scale of things. Only once in that whole time did I have a small showing on my clothes.
Dr Miller advised from the outset and continually reminded me that there can be varying degrees of Erectile Dysfunction after Radical Prostatectomy. Aside from the Prostate being removed in its entirety, there are other organs, nerves and tissue that is removed or affected temporarily and/or permanently during and after this surgery.
Dr Miller offered Cialis 5mg tablets as a means to try and obtain an erection. [See Use It Or Lose It for a view on appropriate therapy] I do not get an erection as such but the foreskin does become sensitised after stimulation. My wife and I both accept that erectile function will not occur with me in the foreseeable future. Life is too precious to be hung up about such matters!!
It was a period of 28 weeks from confirmation that I had Prostate Cancer until my operation. In that time I thought that I would be able to be treated by using Brachytherapy Procedure. I found out I was not able to use that method and about 16-18 weeks went by. I have said to Dr Miller that perhaps it would have been better for me if I had just elected to go straight to Radical Prostatectomy from the outset. (I think in hindsight it's perhaps being 'scared' of major surgery!)
I'm extremely grateful that I was looked after by a highly committed, highly competent and a very focussed Urologist. I also received care and attention at Ashford Hospital's High Dependency Unit, Mitcham Ward and "HITH" of the highest order. I could not have asked for better attention from the Nursing Staff I also believe that I may have been in a more difficult situation now if my GP had not insisted in mid 2008 that I be referred to an Urologist when the elevated PSA was evident. And I received and was given tremendous support from my wife and children - they were very supportive when I experienced some low periods after the Surgery.
My 4 post-operative PSA readings so far have been <0.04, <0.04, <0.05 and <0.04 respectively. I am on a schedule of 3-monthly checks with Dr Miller. This may be reviewed after the 12 month period from the date of the operation.
I hope my experiences are able to assist someone in the future.
Michael J McInerney
12 January 2010
UPDATE 6 April 2010.
I visited my Urologist 6 April 2010 for my 3-monthly check-up and any development/trend discussion.
My PSA Blood Test undertaken on 31 March 2010 returned <0.04 result.
I discussed with Dr Miller a matter that I could not fathom re the 'discrepancy in understanding 'between the methodologies used for obtaining the Biopsy Tests of 9 October 2008 results and the 'failed' Brachytherapy Volume Test of 29 January 2009 (Pubic Bone 'shrouded' part of the Prostate and therefore Brachytherapy Procedure was not a consideration in my case.)
He advised, using a model on his desk to illustrate how the Transperineal Biopsy was conducted and on a particular 'plane and angle' of inserting the Biopsy Needles and the different 'plane and angle of the ultra sound probe' for the Volume Test.
A case of a "X Axis" and a "Y Axis" would be a best way of visualising how the two probes were undertaken.
I told him I continue to have NIL Erectile Function but I do have a strong sensation at the Foreskin Region of the Penis.
He asked if I wanted to consider Injections and I said to Dr Miller that my wife and I accept matters as they are at the present. No Erectile Function but alive and with a PSA number of almost NIL value.
He has now recommended that I see him again in 6-months.
Update 5 October 2010 PSA Blood Test for Specialist was undertaken on 23 September for 6-monthly visit on 5 October 2010. Met with Dr John Miller at his Rooms, 116 Partridge Street Glenelg, South Australia at 0900 Hrs. He informed me that the PSA Blood Test result shows a PSA Value of less than 0.04 and as expected.
I discussed my progress regarding my health and well-being and in particular my continuing "being free from any uncontrolled or unfathomable Incontinence issues." I also discussed my continuing Erectile Dysfunction and that the current situation poses no problems for me (and my wife) and I am not worried about it. My wife is not concerned.
I also informed Dr Miller that I had made contact with friends and this Website. He said awareness amongst Males of Prostate issues was important. He said that he will see me again in six months and if any urology issue should arise, I am free to contact him immediately.
Next meeting scheduled for 5 April 2011.
Had scheduled meeting with Dr John Miller on 5 April 2011. He had the results of the last blood test of 26 April 2011. Blood Test PSA Level was <0.03.
He asked about my general well-being including non-Erectile Function since my last visit of October 2010 and talked about future. I said the issue was not a priority in any sense for me He said he was satisfied that all matters associated with my post Radical Prostatectomy are now finalised and I was no longer required to see him. He offered that should any aspect change relating to my future scheduled GP-initiated PSA Tests, I was to seek to see him forthwith.
After being released from Urologist Dr John Miller care in April 2011, I am being continually monitored (every six months)by my GP Dr Vince Signoriello of Morphettville Medical Centre, Anzac Highway, Glenelg.
My last (October 2011) PSA Reading is <0.03.
Last visit to GP for 6 monthly renewal of prescritions and associated blood tests - PSA is 0
Latest blood test 13 April 2013 reveals PSA at 0.03 or for purposes of this forum - 0.
21 April 2013 represents 4 years since Radical Prostatectomy was undertaken.
Visited my GP for the pending 5th anniversary of the Radical Prostatectomy (April 21 2009). Full range of tests for general health were ordered and results obtained. PSA shown on the Results Form is "<0.01" or ZERO.
Blood Test result obtained today 21 April 2015 - 6th Anniversary of Radical Prostatectomy. PSA is less than 0.03
Blood Test PSA results obtained 19 April 2016 - <0.03
21 April 2016 represents 7 year anniversary of Radical Prostatectomy.
General health is fine.
Michael's e-mail address is: firstname.lastname@example.org