When the not-so-obvious
is ignored
When I was about 7 or
8 years old, my parents took me to the lawn tennis club to take lessons and learn
how to play tennis. My mother was naturally trim and still in the child-bearing
age range and even though my father had golf clubs, he was more inclined to play tennis and never on the golf course less than half a mile from where we
lived in Rayfield, Jos.
I was not that good at tennis for a reason no one discovered until I was in my 30s. I could not hit the tennis balls because I could not track the distance and the speed
of the ball. I had a lazy right eye, an astigmatism where the eye at rest wandered
off the right depriving me of stereo vision.
That is why I ended up not properly learning to drive for my
ability to judge distance and speed was impaired. I could compensate for it as a
pedestrian, but not with impatient drivers
behind me if I drove a car.
However, the sad part
of knowing this truth was that something could have been done to correct the problem
in my childhood; like wearing a patch over the good eye and forcing the lazy
eye to align and focus. By the time I found out, my brain had already made up for
the handicap, it would have been nigh on impossible to retrain my brain for the new
vision of having astigmatism dealt with.
There is a correction for astigmatism in my lenses, but it does not perfect the entrenched issues with
the condition. It is something you live with, and it is benign that it is not a
concern to be bothered about.
Even knowledgeable doctors
are not God
50 years on, I find myself
ensuring that my concerns are addressed, all perspectives considered, and every
option explained to satisfactory detail in my engagement with the medical profession
to ensure that my expected outcomes are at the forefront of any conversation.
I respect the standard
of expertise and wealth of knowledge that defines this group of professionals but for all they know, they are not gods, their word is not law in and of itself while every diagnostic and therapeutic path cannot be valid without my engagement and understanding.
The prime admonition that
grounds everyone involved is encapsulated in this saying, “It is my body first before it is your Guinea pig.” By all means, I should never feel under pressure,
duress, or deception in making choices. Whatever course I take with regard to the
options before me is ultimately my decision, having been adequately informed by
the experts.
I have learnt that I cannot
be shy about asking questions and fundamentally there are no stupid questions, you
find the form of words to pose your concern, and you have every latitude to ask
follow-up questions until you have been satisfactorily answered.
I understand that doctors
or consultants might feel challenged, they should welcome the challenge and
be up to the task of confidently and convincingly defending their thinking, assertions,
and procedures. It makes them better at understanding and addressing patient needs. Anything short of that, demands review.
Better safe now than sorry
later
As medical procedures
engender risk and can usually be irreversible, they do not run as projects that
you can redefine if certain requirements are not met, you want to be sure that all
issues are adequately and fully addressed before you submit yourself to treatment.
On the prostate cancer
track of treatment of which I have now made the decision to opt for radical radiotherapy
and much of the process of my thinking is addressed in the earlier series of Men’s
things blogs, I have one question based on cancer risk groups which I have not
found in any of the medical notes.
After I called the Macmillan
Urology Specialist Nurse assigned to me at the Christie
Hospital to tell her that I would elect for radical radiotherapy treatment,
I decided I should seek support from Prostate
Cancer UK to see if I could speak to a volunteer who had undergone radiotherapy
without the prerequisite of hormone treatment.
You need to be quite knowledgeable about your condition with the articulation of your understanding of what you have been told about your diagnosis.
A progression of tests
and results
My route to treatment
was a progressive set of checks and tests going back to February and the highlights
I would present again below:
PSA: Prostate
Specific Antigen; this is a blood test that if the reading is high might suggest
the presence of prostate cancer, but other factors might lead to a high PSA reading
and that informs the next stage of investigation.
DRE: Digital
Rectal Examination; when your PSA reads above certain nanograms per millilitre
(ng/ml) in your age group, your doctor will use their judgement and discretion to digitally
feel your prostate through your rectum to determine if it is enlarged or unsmooth
among any other unusual or abnormal indicators. An enlarged prostate would suggest
a referral for more analysis.
mpMRI: multiparametric
Magnetic Resonance Imaging scan for prostate cancer. This is an MRI scan taken
of your prostate with contrast. This means a dye solution is fed into your veins to
accentuate the blood vessels and the prostate gland to determine the condition, size,
and possible presence of cancer lesions. The most important score from the mpMRI
scan is the Likert
or PI-RADS (Prostate Imaging – Reporting and Data System) score with a range
of 1 to 5.
A score of 3 or more would
most likely lead to conducting a biopsy of your prostate gland. This would indicate
the likelihood of cancer and the only way to determine this is to conduct a histopathology
examination of cells extracted from your prostate.
The reading from the MRI
scan would give an indication of the prostate cancer stage represented by a T score
and better detailed in the TNM reference later in the blog.
UGTBP: Ultrasound-guided
transperineal biopsy of the prostate is a procedure to extract biopsies of the
prostate gland for examination. An ultrasound probe is inserted in the rectum and
a biopsy needle which operates like a staple gun is inserted through the perineum
under local anaesthetic. The injections can be painful and uncomfortable,
but you should be awake to react.
While it is possible to
have this under general anaesthesia, you lose the facility and ability to react,
and some damage might ensue. After the biopsy, you are likely to have blood in your
urine and semen for weeks. This procedure is the more favoured of biopsies as opposed to the transrectal one which could introduce complications and infection.
The result of the biopsy if positive will set in motion, an entry in the National Cancer Registry and a referral to a cancer specialist hospital.
The most important information from this histopathology examination is the Gleason
score and Grade Group.
Making sense of it all
The investigations and
tests above will inform the medical personnel conclusively if you have prostate
cancer and begin the determination of the course of treatment to take.
The consultant who conducted
the biopsy made two assertions in his medical notes without engaging me, this was
besides the fact that the information was mismanaged by the NHS trust that I knew
what was to be diagnosed a week before I met with the consultant.
His advice was in these
words, “He will need active treatment,” and that meant out of three possible options
for treatment, active
surveillance, a radical prostatectomy,
and radical radiotherapy
of the prostate, the first was off the table before I was engaged.
Having opted for radiotherapy
and found I did not qualify for brachytherapy
because of my high I-PSS
score, the external beam presented a more comfortable treatment plan over the
uncertainties of surgery and the complications that might result.
A welcome intervention
from another angle
That was until I sought
support from Prostate Cancer UK and the nurse having been given some indicators
from the diagnosis wondered why I was not being considered for active surveillance.
CPG: Cambridge
Prognostic Group system; this allows the doctor to assess your cancer risk group
and suggest the best treatment track for the cancer. The indices use values and logical operators of AND/OR to provide an assessment.
From the 5 CPG groups,
the elements landed in CPG 2 and the Prostate Cancer UK nurse vehemently suggested
I ask some questions as to why active surveillance and watchful waiting was not
one of the treatment options on the table.
A radiotherapy
planning CT (computer tomography) scan is scheduled; I have since called
the Christie Macmillan Urology Specialist Nurse service to ask for an appointment
to discuss this option in detail.
This is to address all
the questions before we start anything and to give me both the understanding and
conviction that I am following the course of treatment for the best outcomes.
In researching this blog,
I came upon this piece of tabulated information I have from the onset, sought, to help me choose the best treatment in terms of the options, the long-term situation,
and the consequences of whatever treatment option you choose.
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Choosing the best treatment based on different studies. [Adapted from CRUK (Click to enlarge)]
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Men's Things Blogs
Blog - Men's things
Blog - Men's things - II
Blog - Men's things - III
Blog - Men's things - IV
Blog - Men's things - V
Blog - Men's things - VI
Blog - Men's things - VII
Blog - Men's things - VIII
Blog - Men's things - IX
Blog - Men's things - X
Blog - Men's things - XI
Blog - Men's things - XII
Blog - Men's things - XIII
Blog - Men's things - XIV
