Went to see Mr Alan Doherty, in Birmingham and went through my case with him. Significantly, he had my MRI from the hospital with him and he could explain this. ( Thanks to Dr Parnell at my GP practise for here efficiency ).
Yes there was cancer in the central zone. The biopsy being done before the MRI had also caused some problems there with the clarity of the MRI. He did explain that the clinic would probably have done the MRI before the biopsy as its normal to see the trauma in the prostate caused by the biopsy. ( I have heard and read about this online and through support forums ). But it was still correct for a biopsy to have been done based on my PSA and my family history of my father haveing PCa. ( Prostate Cancer ).
Having gone through the clinical side of things, we discussed myself and my life. 52 years - Young. Healthy - I hillwalk and mountaineer, dont smoke, also we dont want any new children. Water works and erectile functions are fine. So the consultant said - why would I need a prostate? He explained that its only there as part of the reproductive system. So if we can remove it and minimize all the side effects then that would be the goal. So priorities in order would be :
1 Cure the cancer - get it all out
2 Minimise the incontinence issues and use a procedure that helps with this
3 Maintain erectile function - so save the nerves - all of them where possible
4 Leave an option in the even of cancer re-occuring in later life for more treatment
Based on the ability to do all the above, then the discussion centred around
laparoscopic radical prostatectomy
Robotic laparoscopic radical prostatectomy
Open radical prostatectomy
At this point in time I didnt want any radiation - this could come later in life if cancer ever comes back, also if when they operate they find that the cancer had already broken out of the capsule.
Mr Doherty had a fabulous and simple way of describing the cancer in the Prostate. I must admit, I have read 5 books, including the distinguised surgeon Dr Patrick Walsh's Guide to Surviving Prostate Cancer, and the simplicity of Mr Doherty's explanation was amazing. He used a dictaphone ( prostate ), cassette ( cancer ), paperclip ( escaping cancer cells ). With these simple tools he explained to my wife and I the whole procedure for removing the prostate and cancer and the dangers of cancer escaping the capsule. I forgot to ask whether he was ever a scout or scout leader as this improvisation was brilliant.
Of the three surgical options, the Open surgery, though more complex and taking longer gives the best results. This gives the option of proven results with regard to Bilateral Nerve Sparing - key to item 3. Also, the Open procedure has other benefits of the surgeon having more to work with. Mr Doherty has done over 2000 prostatectomies and 400 of these have used the nerve sparing technique and are auditable. http://www.harleystreeturology.com/the_prostate/treatments/nerve-sparing_prostatectomy.php#
Mr Doherty also spoke with my wife and put her mind at ease concerning all of this.
Mr Doherty also described his monitoring of patients and the index-case system. I would be one of the index-case patients who would be monitored as part of his study and results auditing. I had seen this on his website and as an Account Chief Technologist for HP I had been impressed by the use of technology and analytics in the monitoring of patient outcomes. I feel honoured actually to be part of this study by Mr Doherty. http://www.birminghamprostateclinic.co.uk/news/news_2012_09_10.php
I was so uplifted and agreed therefore to move forward , with confidence, with this procedure. As I said to him when he asked me what I wanted - I told him that he was the expert, not me. I would be in his capable hands.
He said his PA will set it all up for October 2012 as he beieved his caseload would be full in september.
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