Prostate Cancer
Sports has never really been my thing. I have to force myself to do it and a muscular body will never be mine. Still, I try to keep it up, because I know how important it is. With that same mindset, I regularly have my blood tested.
As early as 2009, my PSA was first measured with a PSA value of 1.0.
In the years that followed, we saw a slow increase. Nothing serious according to my GP, just keep monitoring it calmly.
But in October 2022, there was a clear increase to a PSA of 5.14.
Below are some reports from my urologist.
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10 11 2022
Dear colleague,
On November 10, 2022, I saw your patient in consultation due to a PSA of 5.14 ng/ml.
The PSA evolution is 1.09 in 2012, 1.78 in 2015, 2.64 in 2018, 3.13 in February 2020 and 5.14 in October 2022.
He has no urinary complaints.
There is no family history of prostate cancer.
On rectal examination, I palpate a symmetrical, non-suspicious prostate of approximately 35 g.
A transrectal ultrasound shows a prostate of 32 ml with a small hypoechoic area on the right periphery. Prostate calcifications. The PSA density is 0.16, which is relatively suspicious.
CONCLUSION: Slow PSA increase. Increase of almost 2 points in the last 3 years. Next PSA check within 6 months. If further PSA increase, an MRI of the prostate will be requested.
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11 04 2023
Dear colleague,
On April 11, 2023, I saw your patient in consultation after performing an MRI of the prostate.
The prostate MRI shows no clearly suspicious areas according to our radiologist. I think I may see a suspicious area on the right apical mid-prostate ventrally.
This is communicated to the patient.
A wait-and-see approach is recommended with PSA check within 6 months. With further increase, prostate biopsies under transrectal ultrasound guidance can be taken from this area.
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In early 2024, I had my blood checked, not specifically for the PSA value, but rather to better monitor other blood values, resulting in a PSA of 4.76. Lower, so reason to be content, but at a check several months later, it unexpectedly rose to 6.62.
This increase meant I suddenly found myself in a whirlwind. By the way, I had just gotten married.
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06 05 2024
Dear colleague,
On May 6, 2024, I saw your patient in consultation due to a PSA increase to 6.62 ng/ml.
The PSA was 4.76 ng/ml in January 2024.
An MRI of the prostate showed, in my opinion, possibly a suspicious image on the right next to the transition zone ventrally.
On rectal examination, I palpate a symmetrical, non-suspicious prostate of approximately 25 g.
A transrectal ultrasound shows a prostate of 26 ml with a hypoechoic area at the location of the previous MRI.
The PSA density is 0.25, which is relatively suspicious.
CONCLUSION: Elevated PSA that warrants prostate biopsies. This was scheduled for May 13, 2024 under antibiotic coverage.
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22 05 2024
Dear colleague,
On May 21, 2024, I saw your patient in consultation to discuss the biopsy results of his prostate.
The pathology shows a Gleason score 7 (4+3) in both the left and right prostate lobe. Nearly all biopsies are infiltrated by tumor.
CONCLUSION: Gleason score 7 (4+3) prostate cancer occurring bilaterally in a relatively small prostate. Despite the low PSA, staging is still performed by means of a CT abdomen and a total bone scan. Given the patient’s age, I think he would be better off choosing a radical prostatectomy. This will be discussed at the MOC on May 31, 2024.
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03 06 2024
Dear colleague,
On May 30, 2024, I saw your patient in consultation to discuss the staging of his Gleason score 7 prostate cancer.
A total bone scan cannot demonstrate bone metastases.
A CT abdomen cannot demonstrate lymph node enlargement.
CONCLUSION: cT2b N0M0 Gleason score 7 prostate cancer. A radical prostatectomy was proposed as first choice. The alternative is external radiotherapy. This will be discussed at the MOC on May 31, 2024.
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07 08 2024
Your patient was hospitalized in the Urology department from August 7, 2024 to August 9, 2024.
Reason for admission: cT2 prostate cancer Gleason score 7.
On August 7, 2024, under general anesthesia, a smooth bilateral nerve-sparing radical prostatectomy is performed via a median lower abdominal incision. No lymphadenectomy given the low PSA. Blood loss was 400 ml. Bladder neck-sparing surgery. Very long urethra can be spared. Bilateral nerve-sparing prostatectomy. At the level of the left prostate base, there is a somewhat firmer area around the prostate. Still nerve-sparing there. Hemostasis. Drain. Anastomosis that is watertight at the end of the procedure. Closure of the abdominal wall in layers.
The postoperative course was uncomplicated so that the patient can leave the hospital in good general condition on August 9, 2024 with a leg bag.
The pathology shows a pT2 prostate cancer Gleason score 7 with negative resection margins.
CONCLUSION: Radical prostatectomy bilateral nerve-sparing for pT2b NxMx Gleason score 7 prostate cancer. Follow-up on August 13, 2024 after performing a cystography.
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07 11 2024
Dear colleague,
On November 7, 2024, I saw your patient in consultation 3 months after his radical prostatectomy.
The PSA is 0.12 ng/ml.
The pathology nevertheless showed negative resection margins.
No lymphadenectomy was performed.
He uses intracavernous injections 1.5 ml Papaverine Prostin mixture with success.
CONCLUSION: PSA too high 3 months postoperatively. Next PSA within 2 months. If the PSA continues to rise, external radiotherapy to the prostate bed will be proposed.
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This means there is still cancer activity somewhere. After my honeymoon, another test follows, but the expectation is the same. Then a new treatment awaits: first hormones, then thirty days of radiation.
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Before the operation, three major problems loomed: incontinence, no longer being able to get erections, and problems with climaxing. At 64, I didn’t find any of these prospects attractive. But there was no choice – it had to happen.
Now, three months after the operation, there is good and bad news. All that purchased supply of incontinence materials turned out to be largely unnecessary. I do have problems sometimes, but minimal. The pelvic floor muscle exercises that were recommended, I never really did. I can exercise again, box and run, though I don’t. I’m back at work and feel healthy.
The bad news: erections and orgasms remain absent. Of the three feared consequences where incontinence was the most feared, that turns out to be the least serious. But the other two are starting to weigh psychologically after three months. The internet tells me that climaxing without an erection should be possible. For erections there are two options: have a lot of patience, or injections in the penis.
Indeed, injections in your penis… we tried it. You literally have to inject a certain amount of a Papaverine Prostin mixture into your penis, with a real needle. We started with three injections of 0.7 ml, then 1 ml, and finally 1.5 ml. At that last dose, the erection was finally sufficient for penetration. Too bad the side effects, or rather the after-effects, are very annoying. The feeling was strange and remained present for up to two hours afterwards.
There was a third alternative, a vacuum pump. Despite never having considered it before, I did get one. As strange as it sounds, in hindsight I should have done that immediately. It all seems a bit weird, mainly mechanical, but it’s not too bad. The pump sucks away the air, allowing the penis to swell. With a ring you hold the blood for an erection. It’s not perfect, but as soon as the ring is removed, everything is over – no unpleasant aftertaste like with the injections.
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So it will be an exciting spring, both for the further cancer treatment and for the possible (?) recovery of my sexual functions. But the most important thing is that the cancer gets under control – that’s what we need to focus on first.