Wednesday, April 16, 2008

Third PSA Check and First Biopsy

April 2007
April came round and I scheduled the PSA check ahead of the Urologist appointment. Of course, it had to be fitted round my busy work, running and racing schedule. A week or so later I got a message from the Doc, saying that the “PSA is 6.8, whatever that means”. Not a good sign.

I saw Mr. L. and he recommended a biopsy. I didn’t have a DRE this time, and didn’t ask for it either. The biopsy was scheduled for Tuesday June 4th, the day after the Cork City Marathon, where I was running one of the relay legs.

June 3rd
Cork City Marathon. I was Deputy Race Marshall but thankfully the Marshall was fit and able to cover the event, so I went off and took photos of all the Eagles I came across and also some around the mile mark and again around the two mile and three mile stages – these were all within 200m of each other.

With that done, off I went to my relay handover point; Victoria Road. I was to run the fourth stage, 6 miles, to Leesdale on the Model Farm Road. Probably started out too strongly but felt good. Nobody passed me, relay or marathon runner, until Ballyphehane Church. I’d been battling with someone from the South Link, having made up about 300m very, very quickly. Coming across Ballyphehane, I found the going heavy and thought “I measured this! This is the hardest leg! How the fuck did I end up doing this leg!!” Shortly after this the guy I was battling passed me and by Hartland’s Avenue had gained about 5m on me. I kept repeating the mantra “You can beat cancer!” in my mind. Going down Glasheen Road, towards the 18M mark, I had the upper hand but was mindful of the impending hill coming up onto Wilton Road. That was a tough hill and ‘yer man’ caught me just before the top and powered down Wilton Road, gaining about 15m in a short space of time. I thought he had me buried but, after we turned on to Model Farm Road, he seemed to tread water. He must have thought that he was only going to the turn…but we had another 1.5 miles to go, with about ¾ of that uphill – and the weather was scorching – about 22oC! I poured it on, maintaining my mantra and, very quickly, I felt him drop away, though he made a good early effort to stay with me – heard his laboured breathing. I thought the handover would never come – the handover straight seemed endless and I couldn’t pick out Paul until, it seemed, the end stages of the changeover ‘chute’. I looked back but, unfortunately, couldn’t pick out the guy I’d been battling. The 6.5 mile leg took me 36:15 and I was happy with that. The team, Golden Eagles, ended up in 14th place, in 2:48:xx. Not bad for a group with an average age of 48!

June 4th, 2007
Biopsy today. Not too bothered about this. I’m in good health. As P. says, “You’re running too well to be ill!” I reckon that this won’t show anything and then we’ll have to go looking for other causes of the elevated PSA.
I didn’t find the biopsy too bad. Dr. C did the biopsy and I got little or no info from him. During the insertion of the probe, I reckoned that he didn’t use any/enough lubricant. It felt rough. For the next 6 to 8 weeks, I still had soreness in the anal area. Preparation H and Daktarin (not both at the same time) helped. The discomfort wasn’t there all the time, though. Some time later, my G.P., Dr. C, suggested that the discomfort might have been due to micro-piles. Maybe so, but I reckon that the other Dr. C was too rough and probably didn’t use enough lubricant.

June 2007
I had a long wait for the biopsy results. Mr. L is on holidays for three weeks, so I won’t see him until he gets back. My appointment is for July 27th, however some pleading/grovelling got me in on July 4th. July 4th is a good day for us. I proposed on July 4th 1975 – I call it Dependence Day (it’s Independence Day in the U.S.A.). In hindsight, I wouldn’t advise waiting so long between the biopsy and getting the results. I found the wait very, very stressful!

July 4th, 2007
D & I went for my 10:00am appointment. I was up to high doh! Mr. L. ushered us in, making small talk on the way. Once we were seated, he started speaking about something – I don’t recall what, when I blurted out “What are we dealing with?” D said later that she was amused at my reaction. He told us that “there is no evidence of cancer.” This was a huge relief. We saw the pathology report and there was no indication of cancer whatsoever found. He said I was statistically “well outside the norm”, so I asked what the standard deviations were. He said more than three. I was hugely relieved. No cancer! D had always maintained that my metabolism is “not normal”: My resting pulse is normally in the region 46-48 and when I strolling around, will hit around 58-60, while my blood pressure is consistently 110/70. So she wasn’t a bit surprised that I was clear. At the end of the consultation, Mr. L. advised another PSA in 6 months.

Afterwards, I again started thinking “Doubling Time!” There had to be an explanation for doubling time, “odd metabolism” or not. In hindsight, I think we missed something crucial at this stage. I think that another DRE should have been carried out, irrespective of TRUS biopsy and its findings. I would also do another PSA check after 3 months. If either or both of these had been carried out, then we could have gained a possibly crucial 3 to 6 months advantage on the disease. Hindsight is a wonderful thing!

I’m just an Engineer, not an Urologist, but, in my job, I regularly find problems that I have to extrapolate on and ask the question “Where else are we likely to have this?” and “How can we detect it sooner?” If we’d adopted this type of thinking here, I would have certainly looked for intermediate examinations/tests.

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