Kerry Bell’s story

Synopsis
PSA of 5.3 in May 2005 indicated that a biopsy should be undertaken. Biopsy showed presence of cancer (Gleason 7). Bone scan and MRI indicated confinement within the prostate. Underwent a radical prostatectomy in August 2005. Recovery was without complications and I was able to enjoy a one-month skiing holiday five months after the operation. PSA is monitored on a 6-monthly cycle and continues to be less than 0.04. Current health is excellent and I enjoy a very active life which includes work as a ski patroller and volunteer officer in the ACT State Emergency Service.

Moral of the Story
Nerve sparing radical prostatectomy performed by skilled surgeons on relatively healthy males can have excellent results. Seeking a second opinion can be valuable to either validate the proposed treatment option and to provide exposure to separate and possibly different views on treatment. Don’t be afraid to ask questions of your urologist and to seek a second opinion, possibly in another location, to ensure you are exposed to the best skills and the best knowledge of prostate cancer treatment available. Your local Prostate Cancer Support Group is a great source of information and of personal experience and discussions with members can provide a great deal of information and reassurance for both you and your partner.

Full Story
I was diagnosed with prostate cancer in May 2005. At the time I was a pretty fit 68 year old, a regular skier, cyclist and in-line skater, supplemented by 2-3 gym workouts a week. I had experienced no symptoms at all, and it was only a routine blood test on a regular visit to my local (Canberra) GP which showed a slightly elevated PSA at 5.3. Retesting showed a slightly higher reading at 5.6 and I was referred to an urologist who recommended a biopsy.

After a bit of delay, due mainly to my misunderstanding about possible side effects, the biopsy was conducted and the tissue sent for pathology. By this time my wife and I had undertaken a reasonable amount of research on prostate cancer, and I had some concern about the biopsy, but I elected to have the procedure in the surgery. Much to my surprise, the procedure was quick and relatively painless, with little or no bleeding or discomfort either at the time or subsequently. I did discover later however that the urologist took fewer biopsy cores than some of his colleagues routinely take.

Several days later the urologist called me at work (as opposed to a face to face consultation) and informed me that the pathology report showed the presence of cancer (Gleason 8) and advised me to have a bone scan and MRI undertaken at the earliest possible opportunity. These tests were undertaken several days later and showed no involvement outside the prostate to our great relief. We then met with the urologist to discuss treatment options.

The options were presented as either surgery or external beam radiation, the latter to be preceded by some months of hormone therapy. The urologist advised that we needed to decide on the preferred treatment option within several weeks. Because we had a number of unanswered questions, and also because we felt that the matter was too serious to rush into a decision, we decided to seek a second opinion.

We decided to seek out well credentialled consultants in Sydney and enlisted the help of my daughter, a health professional in that city. Through her we quickly obtained appointments with a leading urologist and a radiation oncologist, both of whom were extremely helpful in outlining the treatment options and the benefits and problems associated with each. We also had the pathology reassessed in Sydney, producing a slightly lower result at Gleason 7. After consideration we opted for surgery and a radical prostatectomy was performed by Dr David Eisinger on 5 August 2005.

Dr Eisinger operates at two private hospitals in Sydney, the Mater Private and Strathfield Private. While I would have preferred the former as I knew it, and it was close to the home of one of my daughters, we selected Strathfield because of an earlier vacancy and because the surgeon did not want to wait. (I had been trying to get him to delay until the end of the ski season!)

Strathfield provided excellent clinical care commencing with pre-operative consultation, continual reinforcement throughout the hospital stay and regular postoperative follow up. I can’t stress enough how good this clinical support was, how efficient the entire nursing and support staff were, and how much it helped in my achieving a speedy recovery.

I checked into hospital the night before surgery. The wait seemed interminable, having been prepped the night before and with nothing to eat all day, by the time I went to theatre at around 2.30pm it seemed to have been a very long day already! My poor wife who had been there all day had chosen that time to go and get something to eat, and had to rush back to the hospital after throwing her mainly uneaten lunch away! The surgery itself was relatively uneventful albeit quite long; just under 6 hours, which I understand is fairly standard, at least for Dr Eisinger.

The recovery phase also went well, although much to my surprise I was awake most of the night immediately after the surgery, feeling very dry with ice blocks doing little to alleviate the thirst. Luckily the pain was reasonable and I was able to manage with modest pain relief, which was good as I found that the medication used in the PCA (fentanyl) left me groggy for quite some time. The physiotherapist had me sitting in a beside chair some 18 hours after the surgery and within 36 hours I had my first assisted slow walk down the corridor.

From then on progress was steady and by day four I was back on solid food and walking slowly but steadily. One of my lasting memories of my stay in hospital is the sight of a number of patients, mainly older males, perambulating up and down the hospital corridor resplendent in knee-length white support hose (to prevent DVT) and clutching the ubiquitous urine collection bag! On some occasions, the sight was enhanced by the absence of dressing gowns and hospital gowns which failed to meet at the rear. Surely a sight that not even one’s own mother could appreciate!

By day four Dr Eisinger advised that the pathology results confirmed the surgery had been successful. I could have been discharged at that stage had I lived in Sydney, but was advised to wait a further few days, so the catheter could be removed following a cystogram to prove the satisfactory rejoining of the urethra to the bladder. This was done, the catheter was removed, and I left hospital a week after the surgery.

I had been a bit in trepidation of the removal of the catheter, however it proved uneventful and then the problems of dealing with incontinence commenced. Although I was aware of the high incidence of incontinence post operation, I had not appreciated that this meant initially, at least in my case, little or no bladder sensation or warning of impending urination. While this complete lack of sensation only lasted several days, I found it difficult to deal with, and the loss of control to be both humiliating and embarrassing.

Luckily the worst of the problems were taken care of by using incontinence pads, and bladder function and sensation gradually improved, much to my relief. By 7 weeks post-operation I was virtually dry, resorting only occasionally to small pads, primarily for insurance purposes! At a post-operative consultation at this time, Dr Eisinger told me I could recommence all physical activity and that he would not need to see me again unless the routine tests showed a raised PSA.

My first blood test, approximately three months post-operation resulted in a virtually undetectable PSA of 0.04, confirming the expectations of my medical team. By this time, I was completely dry, not needing pads for even such activities as roller blading or cycling, and with pads restricted to insurance, primarily for social occasions. Five months after the surgery my wife and I spent a month skiing in the US where I had the opportunity to really test out both my fitness and the surgery, both of which passed with flying colours!

Subsequent follow-up blood tests have repeated the earlier result and these are now restricted to 6-monthly tests, although I still feel that sense of nervous anticipation every time the results arrive. (Incidentally, the pathology service I use in Canberra is remarkably efficient with the blood test results normally arriving within 24 hours. If only all reports could be so rapid!)

Now more than five years post–op my health is excellent, and my wife and I continue to ski both overseas and in Australia where I work as volunteer ski patroller at Perisher Blue. We have just returned from another ski trip to the US in January this year and are deep into plans for another extended visit in 2012. I also am a volunteer with the ACT State Emergency Service which keeps me occupied during the storm and flood season particularly this year!


Kerry Bell

December 24 2010

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