Radical prostatectomy (to treat prostate cancer)
In January 2012, Michael, 61, a teacher from Brentwood had a radical prostatectomy to treat prostate cancer at Spire Hartswood Hospital in Brentwood, Essex.
Diagnosis
In Spring of 2011 Michael visited his GP to discuss an unrelated health issue and mentioned to his GP that he was having trouble passing urine. On looking over Michael’s medical history and taking into account his age and the symptoms he was describing, his GP sent him for blood tests at his local NHS hospital. Michael explains what happened next
“I wasn’t concerned as I knew that a PSA (Prostate Specific Antigen) test was quite standard and I had previously had one years earlier. This time the test results came back slightly high so my GP referred me to see a consultant urologist and I went for an appointment to see Mr Sandy Gujral a few weeks later. At the appointment Mr Gujral suggested that I have a few more investigations.”
Mr Gujral sent Michael for another PSA test to confirm the high levels were correct and for urine flow tests. The investigation showed the Michael’s bladder was not emptying and that he was struggling to pass urine effectively. Michael went back for a follow up appointment to see what the next steps were.
“Mr Gujral told me that he wanted to do further investigations which would entail a camera going into my penis so he could look at my bladder and take a biopsy of the prostate through the back passage using an ultrasound probe. This wasn’t what I wanted to hear but I knew it needed to be done. The camera and biopsy procedures were not painful as local anaesthetic gel was given, but it was uncomfortable. The biopsy results revealed no cancer at this point. Mr Gujral advised that I had a operation called a TURP (Transurethral Resection Prostate) to improve my urine flow rate and I went ahead.”
Cancer
Mr Gujral performed the TURP to remove the blockage caused by Michael’s enlarged prostate so that he could urinate more easily. Unfortunately the chips taken from the surgery revealed prostate cancer.
“I knew that my PSA was high but the biopsy had not shown anything malignant so I was shocked. Literally my jaw dropped. I wasn’t worried that I’d die from it, instead I was thinking about all the inconvenience that would be caused by having treatment, how would it affect my work? What options of treatment did I have?”
Michael had a follow up appointment with Mr Gujral and a cancer nurse specialist, Angela, who discussed with him the treatment options and any questions he had.
“Angela was very helpful and a comfort to me. I was already minded towards cutting it out when I spoke to her.” Michael considered his options and decided he wanted to have a prostatectomy to surgically remove the cancer.
Treatment
“I booked my surgery to take place in January and I used my health insurance to pay for it all.”
Michael had his radical prostatectomy at Spire Hartswood Hospital in January 2012 and four days after his operation, Michael was discharged with a catheter and went home to rest.
“I was well looked after during my stay. I could tell that they made an effort with the food and the nursing staff were very sweet and caring. They did everything with a smile.
“Some people may be concerned about going home with a catheter but I went to the opera a week after my operation and took a few lessons at school the following week. It is not uncomfortable and you adapt to it.”
Recovery
Michael had his catheter removed ten to twelve days after his operation.
“This was a bit more tricky as once the catheter is removed you literally have no control for a couple of hours and I have to use pads whilst I regain control of my bladder. Once I felt I had some control, my clips were removed and I had seen Mr Gujral I went home.
“It’s early days yet. I am due to have follow up blood tests in a couple of weeks and am hopeful that the incontinence improves as time goes by. I am a keen runner and also swim and have always kept myself fit and I know that long term incontinence is less likely if you are generally fit and active.”
Michael will continue to have regular PSA blood tests and follow ups to monitor his recovery.
“It was caught early, I was treated quickly and am recovering well so I’m hopeful that I can soon put this episode behind me and move on.
“Had I not mentioned it to my GP, then I don’t know when or even if my cancer would have been discovered and I could be looking at a very different future. If any man reading this has symptoms or concerns then see your GP.”
The surgeon's view - Mr Sandy Gujral
Lower Urinary Tract Symptoms (LUTS) are very common as men grow older. These include poor urine flow, hesitancy, intermittency and may also be related to frequency, urgency and having to pass urine several times at night. In the vast majority of men these will be due to the prostate enlarging and causing obstruction to urine flow.
There are many treatments including reassurance to the patient, medical drugs such as alpha blockers and five alpha reductase inhibitors and subsequently surgical treatments such as laser prostatectomy or TURP.
In a small proportion of men prostate cancer will be diagnosed. Most often this will be following a blood test from the GP called PSA (Prostate Specific Antigen). This was the scenario with Michael. Subsequent investigations include imaging of the prostate with MRI and biopsy using an ultrasound probe through the rectum. Several new tools are also being used and developed including urinary markers such as PCA3, which is available at Hartswood Hospital.
Once a diagnosis is made of prostate cancer (which may need more than one set of biopsies as in Michael’s case) the patient is informed about this. Important considerations include the grade (‘severity’) of the cancer and the stage. Staging is the process to assess whether the cancer cells are limited to the prostate gland alone or have spread locally or into the blood supply and further into the body’s organs.
Treatment options depend on the grade and stage. If the cancer is located within the prostate alone, then cure is possible. Curative options include surgery or radiotherapy. In less severe cases a process called ‘Active Surveillance’ can be used where patients are carefully monitored on a three monthly basis.
Newer technologies such as focal HIFU (High Intensity Focussed Ultrasound) are also available at Spire Hartswood Hospital. Surgical options, as in Michael’s case, are highly effective curative options. The main surgical techniques are open radical prostatectomy, where a very small incision is made in the lower abdomen; keyhole (laparoscopic) surgery, where five tiny cuts are made to remove the prostate; and robotic surgery.
Hartswood Hospital has facilities to undertake both open and keyhole surgery using a robotic arm. As in Michael’s case, the benefits of surgery at Hartswood Hospital include the highly effective post-operative care in a very clean and safe environment.