In April 2022, my prostate was removed in a radical prostatectomy. Radical meaning that more than my prostate was removed. The procedure was performed by open surgery at a public hospital in Dublin.
Initially, I had planned for robotic surgery where a surgeon collaborates with a da Vinci Xi cobot. A cobot is a collaborative robot that cooperatively assists its human operator.
However, due to the diffuse nature of my cancer, it was decided that open surgery was the best option for me.
My journey started in September 2021 when my GP sent me for a PSA test after I complained of a low flow during urination. The result came back with a PSA of 60 ng/ml. The UCL for PSA is generally regarded as 4 ng/ml. He arranged to send me to a urologist.
The urologist met with me in October 2021 and advised me that I would need a repeat PSA, an MRI, CT scan, bone scan and a prostate biopsy. The biopsy was performed in December 2021 and returned a Gleason 8 score, indicating that some cells looked aberrant and that the cancer could proliferate. The MRI revealed a PI-RADS 5, indicating that the tumour was probably malignant.
Before deciding that surgical removal of my prostate was the best option for me, I went for a PSMA PET CT scan to determine if cancer had spread out of my prostate.
Where there prostate cells outside of my prostate?
The answer was yes. The 68Ga PSMA PET CT scan revealed cancerous prostate cells in a lymph node close to my prostate. Open surgery became my best option, with its ability to create a clear margin around the prostate and lymph node hot spot identified in the PSMA scan.
Obtaining the PSMA scan proved problematic, and I eventually elected to self-fund it by paying for the scan at a private clinic in the UK. Fortunately, later, I could claim back some of this expense from my health insurer.
The PSMA PET CT scan indicated that cancer had spread to one lymph node outside my prostate. My PSMA PET CT staging was determined as T2N1M0. (T(Tumor)2:The tumour is inside the prostate. It is large enough to be felt on examination, N(Node)1:The cancer has spread to one lymph node, M(Metastasis)0:The cancer has not spread.)
It was not on my strategic plan for 2022 to have prostate cancer, nor was it on my risk assessment horizon. My 2022 strategic plan focused on expanding my training business, not cancer treatments and mystifying health care and insurance administrative processes. It was as if time had caught up with me. I had failed to value my time in the past and either dissipated it away or sold it cheaply to achieve other organisations’ objectives. Now it was clear how I must spend my time.
I will keep you updated on my progress. Prostate cancer is the most widespread cancer diagnosed in men resulting in considerable illness and death.
CT Computerised Tomography
GP General Practitioner
68Ga Positron emitting isotope of Gallium, t1/2= 67.71 minutes
MRI Magnetic Resonance Imaging
PET Positron Emission Tomography
PI-RAD Prostate Imaging Reporting and Data System (From MRI analysis)
PSA Prostate Specific Antigen
PSMA Prostate-Specific Membrane Antigen
UCL Upper Control Limit
UK United Kingdom
Glossary of terms.
Bone scan A type of nuclear imaging of the bones
Cobot A robot that cooperatively assists its human operator.
Gleason Prostate cancer biopsy grading scheme.
Mena, E., Lindenberg, L. and Choyke, P., 2022, January. The Impact of PSMA PET/CT Imaging in Prostate Cancer Radiation Treatment. In Seminars in Nuclear Medicine. WB Saunders.