In around 2002 our GP decided that I should go for a full blood test to check for things like diabetes, cholestrol, etc. and she decided that it would also be a good time to check for prostate cancer. At that stage the PSA (prostate specific antigen) levels were high normal.
I repeated the blood test in 2003 and in 2004. In 2004 the PSA levels were somewhat higher and she decided that it was time for me to see a urologist. She referred me to Dr Harden. When I first saw him he did an ultrasound scan and a physical exam. He felt that the cause of the elevated PSA might be a infection and put me onto a course of antibiotics which brought the PSA levels down.
Between 2004 and the end of 2007, I did PSA tests around every six months or so and although the levels went up and down they never went over around 7 and I seemed to respond to antibiotics if they were high.
In October 2007, I did a PSA test and the levels were around 7.9. I went onto antibiotics for a possible infection and levels went down a bit but then they went up again quite soon afterwards. I had another course of antibiotics in around March 2008. This did not seem to make much difference. At this point Dr Harden decided to do a biopsy.
The biopsy was done in late May/early June. The biopsy itself was not overly painful but it was very uncomfortable and definitely not a fun experience. The samples are collected by a "gun" which is inserted into ones rectum. The gun fires cylinders into the prostate. These cylinders penetrate the prostate and collect the samples. More details about how the biopsy is actually done can be found at various sites on the web. The process left me feeling totally drained and somewhat violated. I felt compelled to go home, take a long hot shower and then sleep it off. For a few days after the biopsy I had quite a lot of blood in my urine. The urologist advised me to drink a lot of liquid to help flush out blood.
On the 21st of June 2008 my wife and I went to the urologist for the appointment where he told us the results of the biopsy. We were both really shocked to be told that I had cancer. This even though the urologist stressed that it was low grade and localised and that it could be treated. I guess that this is one of those things that one thinks will never happen to oneself. I really can't describe how I felt. It seemed that somehow my life had been altered in a flash. I was now someone who had cancer and cancer is bad!
At this point the urologist also referred me to someone for a full bone scan. The point of doing this scan (as I understand it) is that if prostate cancer spreads then the most likely way for it to spread is into the bones (so as bone cancer).
The bone scan was done at the Rosebank Clinic and involved being injected with a dose of very low radioactivity liquid. The actual scan took about an hour and was painless. The worst part of it (for me) was having to stay still in various positions for long enough for the "pictures" to be taken. Anyone who knows me, knows I don't "do" being still well. This scan turn out to be all clear as far as cancer goes but did highlight significant degradation of my joints (I guess mainly due to many years of playing cricket and squash).
After it was determined that the cancer had not spread I was essentially offered two options by my urologist: radical prostatectomy - this basically means removing the whole prostate - or prostate brachytherapy.
Option 1 is very serious surgery and one could take a while to recover from the surgery (my urologist mentioned the prospect of 5 weeks off work) but it does mean that you can never (as I understand it) get the prostate cancer recurring -- the whole organ is removed. The side effects can be quite serious -- impotence is highly likely and you would be sterile afterwards. There are also serious concerns like infection after major surgery and urinary complications.
Option 2 is less invasive. In the brachytherapy procedure they implant radioactive seeds in the prostate which decay over time but while they are still radioactive they kill off the cancer (and one assumes other cells near by). There is a fair amount of detail about the procedure available on the web.
We then had an appointment with Dr van Niekerk at Sunninghill Hospital to discuss prostate brachytherapy and to decide if that was the right way to go. He was very clear in explaining the procedure and the possibility of successful treatment. One thing that came up at this appointment was that the brachytherapy treatment means that one emits low level radioactivity until the seeds decay. This means that one has to avoid pregnant women and young children. The recommendation is that one should stay at least 1.5 meters from pregnant women except for very short periods of time and also that one should not hold babies or young children in one's lap. This was a very serious complication for Yvonne and I as she was 4 months pregnant in June and would be around six months pregnant when they could first perform the procedure. If I was going to have brachytherapy then it would have to be either before the baby came in which case I would have to stay away from Yvonne or after the baby came in which case I would not really be able to help with the baby.
I spoke to my GP about having the cancer and how to treat it and she was very concerned about "function'' and "fertility'' -- Yvonne and I wanted to have one more child (in addition to the baby who was already on the way). She was happy that the brachytherapy procedure was the best option for me. There was still the risk of infertility due to the radioactivity but the risk of impotence was considerably smaller.
We had asked Dr van Niekerk about the possibility of me being infertile after the brachytherapy and he said that there was a very high probability that I would be infertile. So this was something that we would have to consider and make arrangements for.
I then agreed to undergo the treatment and the procedure was scheduled for 30 July 2008.
Once I had committed to the having the procedure done I spent some time trying to find out more specific details about it - mainly using the web as a resource. There is a lot of "medical" information on the web but not a lot of practical information about how to prepare oneself or how to cope with life once the procedure had been done. I also searched for a "prostate cancer support group" in Johannesburg but did not find any information about such a thing. I guess that is where the idea for this page started....
The main area that I was trying to find information about was the potential effect of the radiation on friends, family and various people that I would come into contact with while I was "radioactive". The information for the brachytherapy unit said that one should stay at least 1.5 meters from pregnant women except for very short periods of time and also that one should not hold babies or young children in one's lap. I was trying to find out what a "very short period of time" was and how strictly one should adhere to the guidelines. I also wanted to know if me (or Yvonne) wearing a lead apron would mean that we could get closer for longer periods of time. I actually could not find out a lot.
I emailed a physicist that I knew who works at Wits. He spoke to some physicist friends of his - one of whom was qualified as a medical doctor as well as a physicist. This person recommendations were similar to the information sheet for the brachytherapy unit - basically to stay 1.5 m away from Yvonne except for a quick "greeting". He felt that sleeping in a different bed for 90 days was a must. So it seemed that basically the safe option for our future child was to follow the safety precautions as given in the Brachytherapy Clinic's booklet.
The doctor/physicist friend also said that in my situation - having low degree and localised cancer "external beam radiation therapy (using intensity modulated radiation therapy)" could also have been an option for me. It was never offered so I don't know if that means that my urologist doesn't think the procedure is good or if his set up does not offer it. I have also since discovered that an uncle of mine chose that option and was "cured" of his prostate cancer-- he died about 15 years later of heart failure. I don't actually know too much about this option or if it is even a real option in South Africa now. I did not spend a lot of time researching it as it wasn't an option for me.
Based on the fact that we had been told that there was a high probability of me being infertile after the brachytherapy treatment, I contacted the MedFem clinic about banking sperm. It seemed that if we wanted another child then we would have to go this route. In the weeks leading up to the procedure I managed to bank three sperm samples.
On Monday 21 July I got a phonecall from the sister at the Brachytherapy Clinic to discuss the pre-operative procedures for my treatment on Wednesday 23rd. This was how I learnt that my procedure had been moved forward a week. Apparently my urologist had said that he was not available on the 30th and no one had thought to inform me of the change in date. I had to do a bit of rearranging of my diary but basically the move wasn't a bad thing for us. It meant less time to worry about the procedure (and obviously doing the treatment sooner rather than late was not bad). The biggest win for us was that it meant the 90 day "stay away" period would be over sooner and so if our baby arrived early there was more of a chance that I would be "safe" when he arrived. A drawback of the procedure being moved forward was that the clinic had recommended that I bank 5 sperm samples and at that stage had only been able to bank three.
On Tuesday 22 July I started the pre-op procedures. Basically what is required is for one's disgestive system to be cleared out. So at around 10.30 am on the monring before the precedure I was expected to drink one sachet of "coloprep" dissolved in warm water. I was actually due to lecture to the first year class so I took the medicine along and sipped during the lecture. Fortunately my lecture theatre was close to a toilet as it wasn't long before I needed to go. Thereafter the pre-op routine was to drink only "clear" fluids and more coloprep. This was not fun and I was fortunate that I had nothing on in the afternoon. I could go home and be near to a toilet. I do not think I would have been able to do any thing productive that afternoon.
On the Wednesday morning I had to be at the Sunninghill Hospital by 6.00am. A friend took me in, made sure that I got to the ward and then left me. The first order of business was a fleet enema -- to make sure that the pre-op routine was complete. That meant a hurried trip to the toilet a short while later. Then it was a matter of being connected to a drip, being given pre-op medicine (including a flo-max tablet which would help me to urinate after the procedure) and waiting for my turn in theatre. I was third in line! At around 9.30 am I was taken to the waiting area outside the theatre. And then shortly afterwards was actually in the theatre.
The procedure took 73 minutes (according to the anaethatists bill!) and I was back in the ward by around 11.30 am. At this stage I still had a catheter in. This was very uncomfortable and I was told it could only be removed after I had been "scanned". As it understand it the scan was to check the positioning of the seeds. I had to wait around 45 minutes before being taken for the scan. The scan itself was over very quickly and then I was taken back to the lab and the catheter was removed.
A while later Dr van Niekerk came to the ward and told me that I could go home as soon as I had passed urine. I was still really uncomfortable from having the catheter in and so did not rush. At around 2.00 pm I went to the toilet and managed, with a great deal of discomfort, to pass a small amount of very bloody urine. This, however, was enough to secure my release so I phoned my friend and asked him to fetch me. We left the hospital at around 3.30 pm after picking up my post-op medicine from the hospital pharmacy. It was a good thing my friend arrived with his credit card as I hadn't been told that I would be expected to pay for the medicine before I could get it and leave. That cost was not considered part of the procedure and so had to be paid for separately.
Getting home on the afternoon after the procedure was actually quite a heart wrenching experience. I felt like I needed to be comforted by Yvonne and I wanted to hold her but that was not "allowed". I even went to sleep in a different bed in a different room in the house.
I went to work the next day -- pretty much as though nothing had happened. For the first few days peeing was definitely not fun -- my urethra was swollen, bruised etc. by the procedure and my prostate was inflamed by the radioactivity. That gradually got better as time passed and I guess the FloMax (medication to help one urinate) helped. A few days after the procedure I spoke to the physicist who did the procedure with Dr van Niekerk to ask his advice about keeping away from Yvonne etc. His attitude was that the risk was greatly exaggerated (for legal reasons more than medical reasons) and that there were places in the world (and in South Africa) that have ambient radiation levels higher than that from the seeds. He felt that we could behave normally, even to the point of having sex, but did advise that we slept in different rooms. We discussed this and decided to go the conservative route. Both of us would have felt terrible if our son had suffered any ill effects just because we were not cautious enough.
About two weeks after the procedure I saw Dr Harden for a follow up consultation. At that stage the focus was mostly on determining whether I had any problems from the procedure (being unable to urinate) or was manifesting any side effects (rectal problems etc.). By then, I was already feeling pretty comfortable except that urinating was still pretty uncomfortable, there was a lot of blood in my urine and I had a very frequent need to urinate. This definitely improved with time.
The ninety days until I was no longer a threat to the baby passed relatively quickly and I was back to sharing a bed with Yvonne by the time Aidan arrived. It was hard most of the time but I guess we had a good reason for being strong.
Shortly before Aidan was born, in fact on the Monday before, I got the results of a PSA test I had done a week before. The levels were down, Dr Harden and Dr Wedgwood were both very pleased with the progress and it seemed that the procedure was successful. I have since had a number of follow up tests (see the Time Line page for details) and my PSA levels are even lower. All good news.
(Note that I have been told that there is often an increase in the PSA levels at the three month test so the real "proof of the pudding" is the six months PSA test.)
We discovered in Mid-March 2009 that Yvonne was pregnant again - only 4 months after Aidan was born. This despite the "high probability" of me being infertile. It was quite a surprise for us! We were not too upset about it as we had planned (hoped) to have a second child but the timing meant that our children were going to be very close together in age. This seemed somewhat scary -- having to deal with a new baby and a one year old! Anyway, Rachael was born at 10.04 am on Tuesday 27 October 2009.
Today (September 2022) Aidan is 13 (almost 14) and Rachael is 1 year younger. They can be best of friends and play very nicely together and they can be worst of enemies. We are still thrilled to have them both. The current situation (of dry ejaculations) means that Yvonne getting pregnant again so quickly after Aidan was born was a real blessing.
It seems from what I have read on the web and other places that brachytherapy treatment for prostate cancer generally seems to be "as good as anything else". There are lots of scientific papers that show it is "at least as good" as any other option and many papers are very positive about it. Especially for relatively young and still active patients (i.e. people like me).
So at this stage: Would I do the same again? Yes, probably (maybe even definitely). I believe I did what was best for me and for my family. I also believe that I will be cured. About whether this can spread -- it is cancer so yes it can (as I understand) but it is also one of the least active/virulent cancers and so localised treatment is VERY successful.
See the Time Line Page for details of follow up visits etc.