I had my first routine PSA check back in April 2009 which came back at 4.5. Whilst there were no issues of concern, the only reason I had the PSA test was at the suggestion of my GP who said that I may wish to have one due to my age of 55 years at the time. I was subsequently referred to a Urologist who carried out a digital rectal exam and confirmed that there were no obvious signs of an irregular prostate. None-the-less due to the PSA reading he recommended follow-up PSA tests which were 3.6, 3.9, & 4.0 for the rest of 2009. The urologist was leaning towards my having a biopsy which I was not in favour of, however he was happy to go along with this watchful waiting provided I was monitored by PSA as well as DRE. In early and then late 2010 my PSA readings were 4.1 and 4.0 respectively.

I let the PSA tests slide for a couple of years, meanwhile I had changed my GP. I mentioned my previous PSA readings to the new GP who indicated that I should have another PSA test, which came back in May 2013 at 6.8. I returned to my urologist who strongly recommended a 3T MRI scan, followed by a biopsy if anything positive was found. I agreed to the MRI scan which ultimately showed an area of concern, and followed this up with the biopsy as recommended, given the upward spike in the PSA which could no longer be ignored or put off.

A biopsy was taken in September 2013 and I received the results in early October 2013 showing that 3 out of the 15 core samples taken showed that there were signs of carcinomas in the right anterior mid region (Gleason 3+3), (Gleason 3+4) and (Gleason 3+4).

I was then referred to an Associate Professor Urologist who offered his preferred option of a robotic prostatectomy. The Professor went through all the other more commonly approved treatment options including external beam radiation and brachytherapy etc. However before I committed to any particular form of treatment I was encouraged by the Professor to discuss my situation with a radiologist. After speaking to the radiologist he suggested in my case, against having any form of radiation in preference to the radical prostatectomy which the Professor had also recommended. He reaffirmed that I should not opt for 'watchful waiting'. I then decided to go with the robotic prostatectomy and was booked in to have this operation in late February 2014.

Two weeks prior to my operation I had a meeting with the Professor who indicated that he has just received the latest of the Focal Therapy treatment machines and associated software built by "Visualase". This relatively new form of equipment is able to carry out a Focalised Laser Ablation (FLA) of the affected area of the prostate using constant real time mapping of the prostate under MRI guidance.

The Professor stated that I would be a good candidate to partake in a 5 year clinical trial given my Gleason score being on the "lower end of intermediate". To qualify for the trial the area of carcinoma should largely be specific to a particular area of the prostate which in my biopsy report happened to be the case. After looking quite extensively into this form of focal therapy (the only one with real time mapping and guidance whilst under MRI) I was most impressed with it. For me it was an easy decision due to:- SEE BELOW

I have since had the MRI Focal Laser Ablation carried out late March 2014 and post treatment the Professor said he was pleased with how the procedure went. I will see him to discuss in greater detail in a couple of weeks time, which will then be followed up with an MRI in 3 months and an MRI guided biopsy 3 months following. At that point it will be decided at what frequency further MRI and biopsies will take place i.e. 6 or 12 monthly intervals.

# No General Anesthesetic

# No Surgery or Radiation

# Minimal or No Side Effects

# Negligible Risk of Incontinence

# Negligible Risk of Erectile Dysfunction or Impotence

# No Catheter

Approching 5 year mark since focal laser ablation, having 6 monthly PSA readings, annual MRI scans, and consultation with urologist who is happy with present situation. Whilst PSA has fluctuated and increased slightly overtime, the urologist is confident that the regular MRI scans show no reason for concern at this point.

Friday, 25 July, 2014

Post treatment test by recent MRI discussed with Urologist. He says he was pleased with the findings. and that the area ablated appears to have been successful. Two subsequent PSA tests also show some drop in the levels, however he says not to put too much attention on the PSA results which may fluctuate up or down over time. Rather place more confidence in the MRI and biopsy results. Next MRI guided biopsy on 28/10/2014, then follow up appointment with Urologist

Friday, 31 October, 2014

Post MRI guided Biopsy discussed with Urologist. He says he was pleased with the findings. The area ablated appears to have only signs of scar tissue i.e. no cancer. Other areas of prostate were also tested, which found an indication of a lower grade Gleason 6 specimen of a very small pinhead dimension size, however he says not to be too concerned of such. He has requested two further PSA tests, late December 2014 and late April 2015 approx.

Friday, 1 May, 2015

The PSA results (9 mths and 13 mths post FLA treatment) were discussed with Urologist. He says he was pleased with the findings which appear to be stabilised around 4.0. He also stated that the only area of remaining cancer picked up in the previous MRI guided biopsy) was very small measuring 0.1 mm with a Gleason 6 level. He says not to be concerned of such. He has requested a further MRI scan in early November 2015 followed by a further PSA test.

Monday, 30 November, 2015

The PSA result (18 mths post FLA treatment) was discussed with Urologist. He says he was a bit concerned that it had risen to 7.0 and has therefore requested a repeat PSA to be taken in a weeks time. He then reviewed and commented on the latest MRI scan which noted a small low volume lesion to the left anterior zone. He was not overly concerned and said that the MRI report may have been overstated. He will therefore ask the analyst to review his findings and report back. The initial lesion treated by FLA remains as scar tissue with no concerns. He has requested a further MRI scan in 6 months followed by a further PSA test.

Friday, 27 May, 2016

The MRI and PSA results (2 years post FLA treatment) were discussed with Urologist. He says he was a bit concerned that PSA had risen to 7.8 and that a possible 2nd lesion has been picked up on the most recent MRI, therefore has suggested that an MRI guided biopsy be undertaken. The area of concern is in the left transition zone anterior sector at mid gland level. The initial lesion treated by FLA remains as scar tissue with no concerns.

Friday, 17 June, 2016

The MRI guided biopsy has confirmed a 2nd small lesion, as suspected and picked up by the recent MRI scan. The area of concern is in the left transition zone anterior sector at mid gland level. It has been graded as a Gleason score 6 (3+3). The initial lesion treated by FLA remains as scar tissue with no concerns. Next course of action is to have another MRI and PSA in 6 months.

Wednesday, 30 November, 2016

The MRI has again confirmed a 2nd small lesion. The initial lesion on the right hand side treated by FLA remains as scar tissue with no concerns. Next course of action is to have a PSA test in 6 months.

Thursday, 29 June, 2017

Urologist indicated that PSA has now risen to 9. A further PSA was taken today for comparison. Next appointment in 6 months time when a further PSA will be taken. Depending on outcome a further MRI guided biopsy may be required. Urologist is mindful that lesion 1 on R/H/S was satisfactorily treated by FLA, and that lesion 2 on L/H/S was very small with a low Gleason score of 6. Therefore he is at this stage happy to wait and monitor.

Monday, 11 December, 2017

Urologist indicated that a PSA taken subsequent to last appointment had risen to 11. However was most pleased to advise that a more recent PSA reading taken a week ago was down to 7.9. Next appointment in May 2018 (4 years post FLA treatment) when a further PSA and MRI will be undertaken. Urologist is confident that lesion 1 on R/H/S was satisfactorily treated and cured by FLA, and that lesion 2 on L/H/S was very small with a low Gleason score of 6 that he does not consider to be a cancer risk. Therefore he is quite happy with progress to date.

Friday, 4 May, 2018

Urologist indicated that the last PSA taken 6 months ago was 7.9. More recently the current PSA is 7.7, consequently he was pleased to advise that the PSA has stabilised. Next appointment mid Nov 2018 (almost 5 years post FLA treatment) when a further PSA will be undertaken. He is of the opinion that following next visit that I may go back to "active surveillance" with regular PSA checks through local GP only.

Monday, 12 November, 2018

Urologist indicated that the previous PSA taken 6 months ago was more favourable. However the more recently the current PSA is at 9.9. Consequently he was a bit, but not overly, concerned at this stage. Next appointment is in 6 months time. This will necessitate a further MRI and PSA results prior to such appointment. Urologist remains confident that lesion 1 on R/H/S was satisfactorily treated and cured by FLA, and that lesion 2 on L/H/S is not a point of special concern at this time. He is of the opinion that should there be a need for further intervention down the track, then Focal Laser Ablation may still a viable option.

Monday, 13 May, 2019

Urologist indicated that the current PSA is now at 14 up again from 9.9 since last time. He was now a bit more concerned, although stating that he does not put a major trust in PSA readings. None the less he has suggested that a general biopsy be undertaken within the next two weeks. He added that there is no change in the MRI result from the previous scan to the present. As we are now approximately at the 5 year mark post FLA treatment.

Wednesday, 12 June, 2019

Urologist has since received results from the recent biopsy. Whilst the L/H/S of prostate was treated by FLA five years ago, the R/H/S of prostate upon more recent biopsy has revealed that there are now a number of Gleason score 7 results affecting that area. The prostate cancer is therefore now considered to be multi-focal and not isolated to one area. However as the more recent cancer evident to the R/H/S of the prostate is not able to be picked up by MRI, it cannot be treated by FLA this time. (ie if it cannot be sighted by MRI it cannot be ablated). Urologist has therefore suggested that there are two choices of treatment open to me:- a) Radical Prostatectomy or b) Radiation. Appointment arranged to see Oncologist in June 2019 re a possible consideration for option b). Follow-up appointment to see Urologist later this month re the other possible option a). When I asked as to a suggested time frame for which I should make a decision, the Urologist said 'soonish'.

Thursday, 20 June, 2019

Oncologist provided advise on the option of going down the Radiation path as a means of treating the prostate cancer. She confirmed that my Gleason score was 7 in fact a 3+4, so there is time to consider my options as it was not considered too aggressive, however I will need to select some form of treatment. When questioned further as to the time frame, the Oncologist said weeks to possibly months. In detailing the type of radiation I would be suitable for, the Oncologist said I would receive a high dose external beam radiation over a 4 week period, rather than a low dose of radiation over 6-8 weeks, as in the case of a more advanced cancer spread. She said as my PSA level is now at 14, I would not qualify for Brachytherapy which has a PSA cut off point at 10. Prior to ERBT treatment she said that she would arrange for my Urologist to implant 3 seeds into the prostate as a means of aligning the prostate before each dose of radiation is administered. She also added that he would be asked to apply a gel (Spaceoar) to provide some form of protection to the bowel and the bladder. Some of the side effects with radiation were also discussed, including the likelihood of more frequency in urinating and a possible change in bowel movements, and erectile dysfunction occurring progressively over time. There is likely to be some bleeding in the urine and bowel movements post treatment which should settle down. There could also be some internal burning which should settle down. Additionally there is an increased risk of the radiation treatment itself causing additional cancers to the bowel or bladder, some years down the track which she said may be 3% risk.

Monday, 24 June, 2019

Met with Urologist having decided on the Radical Prostatectomy operation. It is now booked in for early August 2019 using nerve sparing robotic surgery. Expected 2 day stay in hospital. Catheter will remain in place for 1 week to 10 days, which will be removed at the Urologist's rooms on 31st July 2019.

Tuesday, 6 August, 2019

Radical Prostatectomy carried out by Urologist, commenced 8.30am completed 12 noon (3.5 hrs). In his visit the following day Urologist said that the operation went well. He had to remove a part of the sphincter in allowing for a margin, as the cancer had progressed towards it. He said upon removal he held and felt the prostate which felt good, in so far as the cancer appeared to have been contained within the capsule. He mentioned that there was some difficulty in removing the seminal vessels, which required extra time but were eventually and successfully removed. Both sets of nerve bundles were spared during this operation. Discharged from hospital at approx. 2pm Thursday 8th August. Pain level at home being well managed by Panadol at 5-6 hr intervals. Other meds:- anti-inflammatory daily, laxative morning and night, blood thinner injection daily, plus compression socks (to minimise the risk of dvt), and drink 1.5+ litres of water daily. Next meeting with Urologist is in 10 days to have the catheter removed. During this meeting he will also advise the pathology results following the removal of the prostate.

Friday, 16 August, 2019

Post operative meeting with Urologist to have catheter removed. He discussed the pathology report results following dissection of the removed prostate. It found Grade 2 cancer with Gleason 7 (3+4) in both spheres of the prostate. No cancer found in lymph glands. Cancer wholly contained within capsule but within 1mm of external casing. The margin allowed for from the partially removed sphincter did not reveal any cancer. Next meeting in 2 months following further PSA result yet to be undertaken.

Wednesday, 28 August, 2019

After recording liquid intake and the passing of urine, both prior to the operation and subsequent to the catheter removal, and providing these results to the physiotherapist, he was most impressed with them and pleasantly surprised with my continence being well under control. As such he said that I will not require a continence physio follow up visit, unless for some reason I choose to.

Monday, 14 October, 2019

Appointment with Urologist at 10 weeks post prostatectomy operation. He advised the result of the recent 2 month post-op PSA reading, which indicated that there was no longer any traceable sign of prostate cancer. In further discussion I mentioned that I no longer require to wear daily incontinence pads, and that sexual function was improving with the aid of Viagra, presently at the prescribed level of a quarter tablet taken both morning and evening, and the penis pump that he also provided. He was very pleased with these results stating that I had gained the trifecta (no cancer, full continence, and sexual function improving). Therefore the Urologist said that I will no longer be under his direct care, adding that I should simply arrange for a PSA every 12 months through my local GP until age 70 (next 5 years).

At 1 year post prostatectomy, October 2020 my PSA level was 0.1

At 2 years post prostatectomy, October 2021 my PSA level was 0.2

At 3 years post prostatectomy, October 2022 my PSA level was 0.3

In my latest discussion with my GP he suggested that we will monitor the progress of any significant rise in the PSA level, and at this stage there is no need for any immediate concern or any further intervention.

Overall since my robotic surgery to remove the prostate, I am feeling well and remain healthy. There are no signs of any incontinence or leakage, nor is ed is an issue of any concern, having pretty much regained full functionality.

Col's e-mail address is: kealiau AT yahoo.com.au (replace "AT" with "@")