Lying Prostate or Prostrate?

Last month I telephoned my doctor, asking for a review of my medication – and he agreed. “Let’s undertake a range of blood tests so that we know your current situation,” he suggested. I duly obliged, helped by the skilled phlebotomist who made me feel extremely brave when I hardly flinched after the warning, “Sharp prick!”

With results due a week later, I was somewhat surprised to get a letter just inside that timeframe. ‘We’ve tried to contact you unsuccessfully and need you to contact the doctor. This is a routine matter and not an emergency.’ Thank goodness for that! The routine nature of the requirement was further endorsed when I phoned and the surgery receptionist booked a telephone consultation for five days later. However, the conversation the doctor and I eventually had quickly became considered a little more urgent. “Your PSA blood test is raised to 7.4 and, given it had been at 2.4, that needs to be investigated further.” I wouldn’t have understood what any of this meant except for the fact that around a year before that PSA level had been at over 12! Hence, I had already seen a consultant for prostate cancer in 2015 and had undergone the treatment that says, ‘I’ve carried out a rectal examination of your prostate and it seems enlarged, as expected at your age, otherwise OK – but, with your blood PSA levels as they are, we need to do more.’ More? A CT scan, a urine flow check and a cystoscopy. Cystoscopy? That’s the probe up the penis to look into the bladder and the adjacent prostate gland.

Whenever I’ve described this procedure to a man, there’s a quick crossing of the legs and a sympathetic, ‘Ooh!’ But let me tell you, reader – if you want to know – whilst it wasn’t my most relaxed half-hour, it was OK with local anaesthetic and the distraction of seeing your own bladder and prostate being probed on screen. Yes – there was some sting attached to weeing for a day or two but, that apart, and given the nature of the procedure, not bad at all.

Anyway, that was a year ago and the conclusion then was, no sign of a problem although tablets to improve urine flow would be beneficial. However, now, a return to high PSA levels in just over a year – hmmm, I didn’t feel so confident. The consultation, this time, was fairly short and despite the now expected rectal examination which again happily gave no indication of nodules or other problems, a biopsy was apparently needed. I wasn’t totally relaxed about this, mainly because in talking about possible treatments with the GP, early in the piece, the professional’s view was that biopsies were to be avoided if possible and were a bit uncomfortable. As I considered that most doctors would understate matters of pain, I took that to mean bloody nasty.

Well let me tell you reader, again given the nature of the procedure, the biopsy was fine. A probe up your rectum is not necessarily what you want or expect on a Monday afternoon but, once there, nothing was any more painful than a dental procedure with a local anaesthetic. Injections, remotely but skilfully placed, were like the ones before a dental filling and thereafter the taking of tissue samples was painless even with the accompanying cracking sound of the instrument’s labours.

Once home, all was well provided that you stayed cool about a bit of blood in your urine and poo for a couple of days. The worst part? Waiting for results which the awaited letter suggested would be available via an appointment about three weeks later. As it was, the kind consultant telephoned me early – after I had phoned expressing worry about the feasibility of a transatlantic two month holiday with my wife only ten days after that appointment. Obviously, I was worried that if abnormal cells / nodules, of whatever maturity, were found all of our holiday plans would need to be cancelled with the, hoped for, co-operation and recuperation of funds from our travel insurance company.

When he phoned me back the consultant was brief and to the point, for which I was grateful. “Essentially, we haven’t found anything although one or two cells need further investigation as they may be unusual. This suggests that, if anything at all, there might be pre-cancerous activity which would need treatment. But it’s all reassuring and nothing suggests you need to cancel holidays. Likely treatments, initially, would be monitoring of you and your PSA levels – to investigate why they were, and if they are, staying high.” With profuse thanks from me, we ended the conversation there with a promise from me to still attend the results meeting to discuss in more detail what else might have been found. At the time of writing, this is where I am: relieved, grateful but not complacent or of the view that nothing similar or more developed lies ahead. My bet would be that something will lie ahead – hopefully a number of years ahead – but I’m prepared and confident about the NHS, at that time, doing what it does so brilliantly – providing clinical excellence.

So, why should any of this be useful to anyone else – especially men above the age of 50? Well, I’m not depressingly worried by the investigations and results I’ve got, in fact I’m euphoric that I checked it out when I did. I had no symptoms other than a few additional trips to the toilet overnight and a reduced urine flow. Everything about the treatment I got from the NHS was prompt, efficient, brilliantly skilled and honest. But, if I hadn’t initiated the idea of getting a blood test to check my PSA level, any possible enlargement of my prostate, any possible growth of a malignant tumour or nodule, any dangerous development would have been at a greater maturity, distinctly worse and more difficult to treat. The NHS are brilliant with dealing with this fairly common, and treatable, problem of prostate cancer or other difficulties associated with the prostate – and the embarrassment of any treatment is well worth accepting.

So I’m saying, if you haven’t already, have a conversation with your GP – now – and, between you, decide if anything needs to happen. Is it a good idea to have a PSA blood test? Yes, sometimes it can lie and can give a false positive but that’s surely better than being completely ignorant about the state of your prostate.

So,do it…no…no…do it… this week. It might just save your life!

Oh – and let’s not allow any politician to reduce the effectiveness of the NHS. In fact, let’s make it more effective in all areas. I believe the vast majority would be willing to pay more tax, properly monitored, into a ring-fenced NHS fund – and, if that’s not you, I believe you would once you or your loved ones had received the brilliant sort of treatment that my family have received.

On a lighter note, a tenuously related Christmas joke: Father Christmas went to the doctor the other day and said, “I’ve got a problem. I came down a chimney too fast and got a mince pie stuck up my bum.”

“Oh don’t worry,” said the doctor, “I’ve got some cream for that.”

Boom, boom! Merry Christmas and a happy, healthy New Year.

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