I was monitoring twitter the other day and spotted the following article Perineural Invasion On Prostate Biopsy: Does It Mean that I Have Advanced Prostate Cancer?
In simple terms this describes how the cancer invades the spaces around a nerve and can use these nerves that are inside the prostate as channels to escape the capsule and invade other part of the body.
"Since having PNI on final pathology clearly and negatively affects prognosis its presences should influence the treatment decisions."
As I didn't know I had PNI at biopsy it wasn't detected , it couldn't impact my decision to have surgery. But not detected was just that they didn't hit the sampling area. It makes sense though to assume that I was a higher risk and need to ensure that I keep up the monitoring each year. Based on this article I would fall into a category that could have a recurrence within the next 3 years. ( John Hopkins study ).
Finally this quote sums it up " Perineural invasion (PNI) on biopsy is a very significant and needs to be treated as such, despite Gleason grading and PSA scores. It can indicate high risk prostate cancer, even in men with who otherwise we would consider to be low risk. "
Saturday, 20 April 2013
6 Month Post Open Radical Prostatectomy and things going well
I had my 6 month check up with Mr Doherty at the Birmingham Prostate Clinic last week and all things are looking good.
Everything has healed up well. I am in total control of my continence and as part of Mr D's study ( I am one of his index cases ), I have a green flag for continence. Put it this way I haven't had an accident with wetting at all, even with sneezing in the past 3 months. Last weekend I had to renew an outdoor emergency first aid course and we did mock scenarios on the hill that involved all kinds of stretches and bodily shapes and I had no problems with leaking.
Only thing I have been warned of is the danger of hernia's which is common post operation, especially with putting on weight - so I need to lose a stone or two. More walking needed.
Erectile dysfunction is still there and I am to carry on taking the 5mg Cialis daily for the next 6 months until I see him again. The MUSE I am giving a miss for a while as they may have caused a UTI - my fault , tricky to administer. Had a one of dose of antibiotics from the GP's to clear the UTI. Quite common apparently with prostate cancer patients post operation, especially post using the catheter. It may well have not been the MUSE but the catheter as I had burning of and on for months.
Mr D has written to the GP and the GP has ordered an Osbon EreCaid Esteem VED. They don't come in cheap, I think they are nearly £300 but these are medical grade devices. This has to be used a couple of times a day to prevent atrophy and fibrosis which is sets in could be permanent. Lots of guys use these so its part of the therapy. Had a bit of a laugh with some mates when I told them about using this - most guys ( non prostate cancer )who play around with such devices buy cheap non med versions to try and increase size - bit of a con but there is a whole industry out there. From an ED perspective there is some life so the nerves are starting to recover. Mr D believes between 6 and 12 months is a key period for recovery. I have read several medical journals that put it between 12 and 18 months - we will see.
A worrying aspect of the meeting with Mr D was the issue of PSA values. 3 months ago I was < 0.1. My next ultra sensitive test will be at 12 months post op. I said I would expect to have a result of <0.1 again. He said not to worry if there was a slight increase. I questioned this and he said that in nerve sparing surgery quite often as the nerves start recovering this can cause a spike in PSA. If this happens then I would be retested and if it doesn't go down then we would see what other treatment might be needed. Humm .. got me thinking about biochemical recurrence again.
Everything has healed up well. I am in total control of my continence and as part of Mr D's study ( I am one of his index cases ), I have a green flag for continence. Put it this way I haven't had an accident with wetting at all, even with sneezing in the past 3 months. Last weekend I had to renew an outdoor emergency first aid course and we did mock scenarios on the hill that involved all kinds of stretches and bodily shapes and I had no problems with leaking.
Only thing I have been warned of is the danger of hernia's which is common post operation, especially with putting on weight - so I need to lose a stone or two. More walking needed.
Erectile dysfunction is still there and I am to carry on taking the 5mg Cialis daily for the next 6 months until I see him again. The MUSE I am giving a miss for a while as they may have caused a UTI - my fault , tricky to administer. Had a one of dose of antibiotics from the GP's to clear the UTI. Quite common apparently with prostate cancer patients post operation, especially post using the catheter. It may well have not been the MUSE but the catheter as I had burning of and on for months.
Mr D has written to the GP and the GP has ordered an Osbon EreCaid Esteem VED. They don't come in cheap, I think they are nearly £300 but these are medical grade devices. This has to be used a couple of times a day to prevent atrophy and fibrosis which is sets in could be permanent. Lots of guys use these so its part of the therapy. Had a bit of a laugh with some mates when I told them about using this - most guys ( non prostate cancer )who play around with such devices buy cheap non med versions to try and increase size - bit of a con but there is a whole industry out there. From an ED perspective there is some life so the nerves are starting to recover. Mr D believes between 6 and 12 months is a key period for recovery. I have read several medical journals that put it between 12 and 18 months - we will see.
A worrying aspect of the meeting with Mr D was the issue of PSA values. 3 months ago I was < 0.1. My next ultra sensitive test will be at 12 months post op. I said I would expect to have a result of <0.1 again. He said not to worry if there was a slight increase. I questioned this and he said that in nerve sparing surgery quite often as the nerves start recovering this can cause a spike in PSA. If this happens then I would be retested and if it doesn't go down then we would see what other treatment might be needed. Humm .. got me thinking about biochemical recurrence again.
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