Histology (Pathology) Results in Great Result 98% Certain its all gone

After 6 anxious months, sleepless nights, tests, biopsies , major abdominal surgery for prostate removal the news we have been waiting for arrived.

Went and saw Alan Doherty at the Birmingham Prostate Clinic, The Priory. He described the grading of the surgery he does as 1 - 5 with 5 being the best. He put my operation in the context of A Levels - basically the A*. If he could have a * grading , my operation would have been graded 5*. Everything went perfect apart from the blood loss - he has advised me to take iron tablets as I am still anemic . ( Anemia is a condition in which the body does not have enough healthy red blood cells. ). He would also still like me to take some rest in the afternoon - recovery wise I am well ahead of the curve.

The big results though is the histology that has come back from the labs. It totally justifies having had the operation. The cancer was not just on the right side of the prostate but also on the left and it was concentrated also at the Apex. Margins are all clear so he gives this a 98% Cureative factor.

ADENOCARCINOMA, GLEASON 3

+ 3 = 6 PRESENT BILATERALLY;

THE BULK OF THE TUMOUR BEING IN THE RIGHT APEX.

Tumour volume: Approximately 0.7 eu em (about

1.4%).

Apical margin: Negative.

Bladder margin: Negative.

Circumferential margin: Negative.

Perineural invasion: Present.

Vascular/lymphatic invasion: Negative.

Extraprostatic extension: Negative.

Involvement of seminal vesicle(s): Negative.

Premalignant change: Multifocal high-grade prostatic intraepithelial neoplasia.

Other pathology: Nodular hyperplasia, chronic active inflammation.

Pathologic stage (TNM 2010): pT2cNx

Tumour map attached.

Radical Prostatoseminovesiculectomy:

Specimen and organ confined ADENOCARCINOMA,

GLEASON 3 + 3 = 6, pT2cNx. Local excision appears complete.IsabeIle

The above tumour map was given to me by Mr Doherty, it was done by the labs. Basically they carved up the prostate into six slices including the seminal vesicles. The cancer is shown in red. Nice record to have.

PROSTATE:

Radical Prostatectomy specimen weighing 50.9 gms and measuring 37 (Length) x 42 (Width) x 40 (Height) mm, with seminal vesicles up to 21 mm in length. The specimen was cut into six parallel slices and all embedded into seven large blocks.

Mr Doherty wants me to go back in January when I will have a high sensitivity PSA blood test - this is not the same test that is done at the doctors or under the NHS hospitals. The BPC do this test and I will then see him a few days later to go through the results.  I will be tested like this in the future, but its all looking really good.

The only slight concern that I have re this histology report is " Perineural invasion: Present." - looking on the net and on the prostate cancer forums this indicates that the cancer got into the nerve system in the prostate and there may be a chance in the future of a re-occurance of cancer elsewhere in my body as a result. This is a slim chance that would be picked up by regular PSA screening. Its something called PNI. Apparently most doctors ignore it. I dont have to worry about it for now.

Another interesting aspect of this pathology report - I had BPH and had ignored it. All that going to the loo quite often and stinging ... yep I had ignored it - problem with always workign and no time to go to doctors as I was always working away from home ( Other pathology: Nodular hyperplasia, chronic active inflammation. )

One thing this cancer has taught me - I am now going to take a closer look at my health and looking after it.

Now the cancer is  sorted out, the side effects of the oepration have to be sorted. My incontince is being brought under control and he is happy with what I am doing. Things can only get better and the exercise I am doing will help.  My fitness has counted a lot for this, especially the fact that I was doing pelvic exercises before the operation.

The bladder diary that I have kept for the past 5 days shows the improvement.

From an erectile dysfunction point of view he wants me to go on 5mg Cialis per day. This will get the blood flowing and will aid penile recovery. My GP will prescribe these and he will drop him a note.

So, am really chuffed as punch today  - can now see many years ahead.

Told him that I will be climbing Snowdon in December. Must get the fitness going.

Am now signed off from work until near the end of November to recouperate. Will see how I get on by then to judge my return to the hectic work life I had before ther cancer.

So lucky as there are so many who are not as fortunate

The day started as normal, bit boring, emails, radio, TV - but this afternoon I took a walk around the field and was looking back at the house, land and the trees.

Made me think how lucky i have been to have caught this cancer early. Also made me reflect on my life and where it is now. There are so many people in this world who have not been as fortunate, I should be thankful that I am where I am today.

Was lovely looking at the countryside and the leaves falling from the trees and settling on the ground. Walking around and seeing the tracks made by the badgers. The horses came up to say hello and have some bread I had with me.

I would so miss all of this if I wasnt here.

Bladder Diary

Trying Google docs to see if its any good as an electonic record of the bladder diary. Its interesting as you can now sync your laptop, pc and smartphone using Google Drive so i can access the documents no matter where i am.  Therefore I can update the spreadsheet if i am out ... question now is if it will work or do I stay with paper. Below is a snapshot from the diary.

The biggest problem I think I have is remembering that before I stand up or sit down I must do a strong pelvic contraction. This closes the bladder and ensures no fluid escapes as its only gonna go one way and thats out!  Its early days so this is somethign I must drum into myself.

I suspect coughing and sneezing - as well as the painful effect on the internal surgery - which now seems to be not as bad, will result in accidents. One of the guys on my US support forum reported only this week, a year after his Open RP, that he still wets himself if he laughs too hard, has a head cold or coughs and sneezes - so its something I am gonna have to get used to.  They call this 'Stress Incontinence' so I think I am doing quite well.

What I now need to do is to start to increase my bladder intake and also increase the length of time between toilet visits. The Physio discussed this with me in hospital and the District nurse has given me a leaflet about it. Essentially he described it as going to see a good film at the cinema - say the Godfather. As he said, i dont want to be getting up every hour to use the loo, I need to be able to last the whole length of the movie. So I need to start pushing loo visits to 2 hour, then 2 and half then three hour intervals. This will also help with the evening as I need to be able to reduce the times I get up during the night so I can get a longer time sleeping.

All of this will also help with work, as I drive a lot - 4 to 5 hours somedays travelling south and the same back. Stuck in major traffic jams is a fact of life for me so I need to be able to hold it.  The pelvic exercises are helping with this - so I do them all the time.

Example of bladder sheet:

Sunday - a week since i left hospital - good day

Feeling really up beat today. kept a bladder log for the district nurse saturday and overnightand hardly any problems at all. Managed to wake up during the night twice so there were no accidents.

Also was up early did my exercises and felt good. Exercises to Madonna  on YouTube.
Still lots of internal soreness and a burning underneath berween legs, district nurse said thats where the surgery took place internally , where the prostate was removed. Most men report a burnong sensation there.

Dan said he would drive me to the shops so we went to Sainsburys so I could buy some boxes of Tena for Men pads. They are on special offer 2.49 per box. bargain if they give me confidence to leave the safety of the house.

Went to shops and walked across car park. really slow. chap from work stopped his car to let me cross. didnt see him a i was walking at snails pace.

glad to get back home.

excitement over for the day.

ED and Bilateral Nerve Sparing

Well , one of the side efects of prostate cancer and surgery is erectile dysfunction. Lots have been written about this subject and its one of the prime reasons for getting one of the best surgeons you can who understands and specializes in the techniques to save the nerves.

There is a good article at http://urology.jhu.edu/prostate/erectyle_dyssfunction.php which explains the ins a out and also gives a good picture from the Amercian Medical Association that shows where the nerves are that control erections and you can see these in relation to the prostate that is to be removed. I have included this picture below:

A. Lateral view of the male pelvis illustrating the course and distribution of the left cavernous nerve fiber, as part of the left neurovascular bundle within intrapelvic fascia coverings. The cavernous nerve travels from the pelvicplexus proximally to the penis distally, in close anatomical relationship to the seminal vesicle, prostate, striated urethral sphincter, bladder, and rectum.

B. Anterosuperior oblique view of the same anatomical structures.

C. Anterosuperior oblique view illustrating preservation of the cavernous nervesafter bilateral nerve-sparing prostatectomy and bladder neck anastomosis to theurethral stump. The cavernous nerve fibers are preserved by division and clip-ping of small prostatic nerves alongside the prostate. When non-nerve-sparingsurgery is required for cancer eradication either unilaterally or bilaterally, wide excision of periprostatic soft tissue includes the cavernous nerves en block withthe removed surgical specimen.

Today was a massive day for me as during showering there was definate movement down under - so much so that I encouraged it ( on the basis of research that has said you need to exercise it so that you dont suffer from cell death - cells in the penis do not regenerate as cells in the rest of the body do ).  The result of this encouragement was definate growth - showing that blood was circulating again and also those nerves are starting to work. Often the bruising and battering the nerves take during surgery mean a long recouperation time. You do hear of no life , even after nerve sparing, for up to two years. This exercise resulted in my first ever 'dry orgasm' weird sensation for a bloke - but things are looking up! 

Will be reporting in these results as well as the continence progress to Mr Donerty and his team when I see them next week.

Getting to grips with Incontinence - day 3 since catheter removal

It has been three days since I had my catheter removed. Its been a learning curve. When you have the catheter in you drink loads and dont worry about urinating, in fact , you consciously relax all your muscles because you want to expel the fluid to help with the healing process. Also you dont want to squeeze as you feel it may damage the internal stitches that the surgeon has done reconnecting your bladder to your uretha.

Tuesday evening when I got back from the hospital I wet myself getting out of the car. I had forgotten something the physio in the hospital had told me that will become so important in my life. When getting up or down out of seats, bending or stretching, I must remember to do a big pelvic muscle contraction to prevent leakage. This may well have stopped the leakage I had coming home from hospital.

Thursday 18th was the day I started my physio exercises and I did them well. However, I did hurt. I stopped taking any pain relief when I got up in the morning as I wanted to be able to feel any tweek or twinge so that I didnt push myself to hard. I didnt want drugs masking any pain as this might cause more damage.

After the exercises in the morning I went for a walk from my house to the road , about 1/4 a mile - this was hard as the ground was potholed and bumpy. I could feel lots of soreness inside me, also the bumpyness of walking made me stop a few times and it also gave me a urinary urge.

Am suffering from annoying dribbles. Its ok being at home and also if I wear a pad, but need to combat this.

Tried to drink more Thursday  but my mind is consciously telling me not to in-case I wet myself. Must stop this and get back to a fluid regime.

A lady from the Office of National Statistics called in the afternoon on thursday and interviewed me for nearly 2 hours. This length of time talking got me really tired and I was glad for her to go. 

The internal soreness got worse into the evening and also I developed a headache. i never get headaches. Decided I needed some paracetamol. Took some at dinner time and then at bedtime ( midnight ). Bit of an accident before bedtime, snoozed on the settee .. major error .. woke up wetting myself !! Dam ! 

Time for bed.

Restless nights sleep - up three times to go to the toilet - in the end I was up early again. Did pelvic exercises in bed to kill some time. Must keep doing them to cure this wetting problem.

Big day in Birmingham TWOC - Do not Fart in Public !!

TWOC - Trial Without Catheter.

When I went into theatre for the Open Radical Prostatectomy the operation didnt just involve removing a prostate, but also involved the removal of a section of the uretha. The uretha has to be re-attached to the bladder so to help with the healing and to ensure you can pass water they put a catheter into your bladder through your penis.  This has to be removed at some point so you can urinate again and learn to do it under control. The start of potty training for adult men -:) . Today was the big day.

Went to the Priory and checked into the ward - this time Bournville room 3 . Was looked after during the day by some great staff nurses.

Stage 1 - anti-biotics so I dont get any infection when the catheter is removed. An hour later , lie down on the bed and the removal takes place. Trick they dont tell you that I found out on the internet, take a deep breath and when she starts pulling it out , breath out - it relaxes you and you dont feel a thing.

The next three to four hours involved me drinking fluid, weeing  and after each wee pushing a buzzer, nurse would come in , take the bottle away for measuring and they would then scan my bladder to see what was left in. After three scans they were totally happy that I was voiding my bladder. In fact they would have been happy with less than 200ml left in, but I was managing to expel urine and only leave 21 ml in there.

Brilliant - everyone happy  so I could go home.
They redressed my surgery wound for me. Also I was given a bag of bottles, some incontinence pads and some aweful paper panties !! Plus a seat pad that I could use at home. Time to leave - got my discharge papers .. then a quick trip to the loo ... and into the car for trip home.

Got back to Telford and I had no accidents. Trip into Tesco to buy some more Mens Tens Pads, a waterproof sheet for my side of the bed .. incase of evening accidents .. then to the KFC for a celebration take home meal.

Still everything ok .. drive home.

We pulled into the driveway, now our drive is down a long bumpy private lane .. obviously this must have caught me by suprise. We pulled in to the drive and it happened ... car stopped , I swung out of the car and straightened up ( a Golf TDI GT is low to the ground ), when I straightened up I couldnt stop it -- I farted !!!! Woops - never fart without control or never fart unless you are in the loo ... I pissed my self !!!!!

It wouldnt stop, I couldnt stop it.  I was out of control !! The pad I had put on to leave hospital wasnt in the right position - pants wet . OMG!! 

Thank god this did not happen in Tesco - I would have been mortified.

I suppose this is going to happen again until I am potty trained -:)