Part 2 – Waiting and Watching

As a urology outpatient, the local system uses nurse specialists as a first point of contact. Having someone who is a dedicated specialist seems to work very well, especially as there are many practical questions to be answered, and the process is a little more patient-centred, rather than the treatment-centred response from the Urology consultants.

The raised psa led to an initial consultation, including a digital rectal examination (DRE) to check for any obvious distortions or lumps on the prostate, in my case none. But it also laid out a progress path, including the possible outcomes if cancer were detected, one of which was surgery or other radical intervention. I also took my wife with me, I think its important that you go on this journey together from the start. The journey and search for information had begun.

The examination and elevated psa suggested that an MRI scan should be performed. MRI scanning, sometimes with a contrast medium, is used to check for cancerous cells, not just in the prostate but in surrounding tissues. In November 2020 I had my first MRI scan, the results showed no cancer outside the prostate, but with a score of 3-4, a possible mass inside.

So to the next stage, a biopsy. In a biopsy, several small samples are taken from the prostate gland, the results viewed in a pathology lab to check definitively for cancerous cells. This was arranged for 20th December 2020 at a private clinic, but NHS funded. The results took a couple of weeks, by which time another covid lockdown was in full swing. A phone consultation revealed a Gleason Score of 3+4. This is on the cusp of recommendation for future treatment and watchful waiting.

I opted to wait. This is a very personal decision. Some men can’t bear the thought of having cancer inside them and need it gone, but I knew the side effects of treatment are not insignificant, and at this level, any cancer progression is likely to be slow.

So for the next 4 years, I had regular psa tests.

It was December 2023 before I noticed a difference in urine smell, and there was an uptick in PSA from the previously steady results.

Things were on the move.