The biopsy results.
So we left the reader in part one just after I had my biopsy and it was quite a few days before I had to go for the results. The results were quite definite which was a good thing as I didn’t want any iffy results. As we know there were 12 samples of the prostate which were analyzed. Seven of these were found to show that the cancer was present and therefore it was enough to give me a score during the test that indicated that something had to be done.
As you may know, one of the treatments of prostate cancer is to watch the person and to watch the test results over time to see if they go up or down and only if there is a significant increase in these results is action taken.
The actions that could be taken are various. In some cases, it can be a case of inserting stents into the prostate to reduce cancer growth drastically. Another option is to use surgery to remove the prostate altogether.
In my case, I had found during one of my hernia operations in Australia that I have a very reduced throat aperture. This makes it very difficult to intubate for them, and I was given a card in Australia to show Surgeons to give them warning that this is for the case. I discussed this with the Doctor who had taken the prostate samples, and as soon as he saw the card, he decided that this was not going to be the way forward.
Is cancer contained?
So the next step was to establish that
The MRI was straight forward in that you attend the department, change into a gown and lay on the machine’s table. The machine then takes you into a tunnel, and the machine makes a solid whirring sound while the MRI (magnetic resonance imaging) is taken. This is absolutely painless, and you just need to be able to lay still while it happens (1 minute). If you get bored as I do rather quickly you can try to count the holes in the ceiling tiles – you know there are rows of them. Despite the fact I went through these machines many times I singularly failed to get a count, usually because the machine moved me – ah well that’s technology for you!
The results of the MRI were available straight away, and this was clear.
The next was a bone scan. A bone scan is a nuclear medicine test. This means that the procedure uses a tiny amount of a radioactive substance, called a tracer. The tracer is injected into a vein, no problem as I am okay with needles. It shows possible cancer in areas where the body has absorbed too much or too little tracer. After the injection, you need to drink water (no panicking please – quite harmless) and then wait for three hours, after which time you attend a machine much like the MRI one and go through the same routine. This is to establish whether there is any cancer in your bones. Again quite painless, just need to keep clear of pregnant women and children after the visit to the hospital due to the nuclear content. The results came through 30 minutes later and much to my relief it was clear.
How did I feel now?
What is interesting about these two tests is how I felt at the time. It interesting because it all happened so quickly that I didn’t have a chance to have any nervousness or worry about what the results would be. Make no mistake, the results could’ve been entirely different in as much that because I waited so long it was quite possible that cancer could have moved out of my prostate and as with my half brother once it starts to get into other parts of your body it is much more difficult to manage and to eradicate. I guess I was in the mindset which says what will be will be. There was no way I was going to be able to change anything; it was merely a case of taking the test and dealing with whatever happened as a result of those tests. If this sounds a little blasé I’m sorry, but that’s the way I am – I had cancer and still have cancer, but how far this had gone was something I just wanted to know.
Going forward from here.
So we are now at the stage of having cleared the big hurdles and having to decide how to go forward.
So we went to see the doctor in charge of the treatment, and he spent a good 90 minutes going through with us what the procedure was and how the American Society NCCN rules for Prostate Cancer were being used to establish where I was on the severity scale. The doctor here was nothing short of amazing. He showed us all of the processes which the NCCN uses and which the hospital here in Cyprus are using as well. We fully understood how he had concluded the severity which illustrates how severe the cancer is within me.
The doctor decided that radiotherapy would be the primary treatment base and that my first step would be to have an injection of Zoladex and after two and a half months go back to carry out a process where they would map and simulate where the prostate exactly is in my body. This would then guide them for radiotherapy treatment.
The injection is a huge needle into the subcutaneous layer (skin to you and me), and it acts as an implant, releasing the drug over the three months. No problem there then, except my wife doesn’t like needles, so we had it done at the hospital. I felt no effects of this until I started having hot flushes (all women may now laugh at this point= thank you). My wife had told me about this in her stage of life, and it is just not possible for a man to fully comprehend what this is like. I can tell you for sure that I now can. You can be just sitting there and perfectly normal watching the telly or having a meal and all of a sudden you get this hot feeling which in my case seem to start somewhere around the stomach. Rapidly moving upwards towards my head and then downwards towards my feet and it’s almost like you’re sitting on a central heating radiator I suppose. Before you sit on it, everything is normal, and then you feel this enormous heat flush going through your body. It doesn’t last very long, but the effect is quite riveting and of course, if it’s the middle of summer and you are really hot wow you begin to boil (not really but you know what I mean).
So these hot flushes are the only thing that happened at this stage.
After the 2 ½ months had gone by I went back to the hospital and we had then another MRI, to map precisely where my prostate is so that when the radiotherapy machine was used it would be targeted accurately and another PSA test to see what was happening. When the mapping was done, the attendants drew several marks on my body around my prostate area so that the radiotherapy machine could be lined up okay.
The main treatment regime.
So we then start the main treatment which is the radiotherapy. Initially we thought that there would be 33 sessions of this where each course is a visit to the hospital each day (more about that in a minute), but eventually, it turned out to be 44 sessions over a five day week which meant essentially nine weeks of treatment. I have to say up front that the team in the hospital who were with me on these 44 sessions were marvelous. They made me feel at ease, and apart from one or two small occasions, everything ran like clockwork so that my treatment was usually over by between 9.30 and 10 o’clock every morning.
The daily routine.
So what happened? I live about an hour’s drive from the hospital, so that meant up with the lark has taken the dogs out and set off at the hospital around 7.30. You can imagine of course all sorts of things happen. The main highway between the nearest town to me and the hospital was due to be resurfaced, and of course, it started on my first day of these journeys to the hospital. There were many people on the local forum casting doom and gloom on this resurfacing exercise because of the disruption. I was so fortunate that it didn’t disrupt my journeys at all and the trips became if you like fairly routine after a while.
So I arrived at the hospital and went into the waiting room, and did something on my iPad until you were called. When you were called (Mr. Philip your turn) then I had to go to the bathroom to relieve myself, and 5 cups of water then followed this within a 15-minute time frame. Once this was complete, I was then called into the radiotherapy area where I took all my clothes off except for my underpants (clean ones of course) and then put on a gown. I then waited to be called to the machine itself, took off the dress, and two attendants would guide me to lay down on the table in a particular position with my knees slightly raised and my underpants moved down just above the line of what should not be seen. The attendants then left the room which was closed, and the treatment began.
On the machine.
You can imagine this machine therapy would be ingrained in your mind after 44 sessions. Until the day I die I will always remember the sound which the machine makes. Initially, the device has a laser scope which comes up to your right-hand side and “looks” at your body to understand if it has the right situation of your prostate, (remember the marks on my body after the MRI). If it does, then it continues with the treatment which was effectively seven high energy beams in different positions. If you can imagine the gantry which delivers the beams is moving around you in a circular movement from underneath you round to your left side, above and then over to your right side, as you lay there. You have to stay still, but the whole treatment only takes about fifteen minutes. If the laser does not recognize the position of your prostate, then the attendants return and move you until all is well. And the noise of the machine is what I’m thinking about each time I remember.
Of course, you lay there each time, and the great thing was that on the ceiling was a large, beautiful picture of a tree (well small tree actually) with loads of blossom on it. I counted all sorts of things on that picture to distract me and make sure I stayed still.
One amusing incident was one day I turned up, and I was on the table the machine started the scope and then stopped. The door opened and in came one of the attendants and very apologetically said to me “Mr. Rickman there is too much gas in your rectum for us to do it.” I, therefore, had to pay another visit to the bathroom to reduce the amount of gas in my rectum. This became a Family joke called G I T R (gas in the rectum) whenever one has flatulence. The radiotherapy course gave me no problems at all. I never felt anything from the treatment, and the 44 sessions seem to fly by after the first 10. Then of course came the obligatory PSA test, and another injection.
The PSA test came back at 0.077 which of course compared to my original 10.45 was brilliant.
This wasn’t the end of the treatment story, though – for the next two years, I have to have the injections every three months.
In part 3 I will bring you up to date on where I am now, the side effects and some thoughts. See you then.
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