Prostate cancer – part one

Your prostate is the size of a walnut.  Mine was the size of an orange.

– Bill Watson

 

Cancer kills more than 43,000 Australian’s each year.  It is one of our country’s leading causes of death.  In 2010, about 114,000 new cases of cancer were diagnosed.  Half of the people who live to the age of 85 will be diagnosed with cancer.

 

Thirty years ago, about 28,000 people died each year from cancer.  More people are dying now because our population is expanding.  Death from cancer though has dropped by 16 percent.  As research gets better, our doctors get better.  Treatment improves.  Sixty percent of Australian’s diagnosed with cancer in 2012 will live more than five years. 

 

People diagnosed with common cancers like prostate, breast, melanoma, bowel and lung cancer have a better chance of beating the disease.  They’re diagnosed quicker and treated quicker. 

 

Cancer costs Australia about $4 billion each year.  Almost a quarter of health research funding is spent on cancer.

 

The facts are grim.  If you’re married or in a relationship, look at your partner.  One of you will be diagnosed with cancer.  We know this.  We know cancer doesn’t discriminate.  If you never drink or smoke and eat healthily, you can get cancer.  It matters not age, lifestyle or attitude.  It just happens.

 

Bill Watson was 69, awake in the darkness and worried.  For about a week it was taking too long to piss, especially at night.  A function usually afforded a minute was taking two or three.

 

More than ten years he’d been on pills to keep the bladder functioning properly, pisser pills, he called them.  They didn’t seem to be working anymore.  In daylight when he needed to go, the problem vanished.  He was confused but not dismissive. 

 

After two weeks of night time difficulty, Bill went to see Sam, a local GP in Caboolture.  The doc said it didn’t sound right.  If there was a problem with the prostate gland, Sam said it should be apparent night or day.  Bill presented his arm for a blood test.  As the needle went in he wondered the secrets it would withdraw.

 

Given he was having no problems pissing during the day, Sam wasn’t sure it was prostate cancer.

 

A few days later, Bill’s calm manner as he discussed the appointment didn’t suppress my alarm.  My mate Andy has been a paramedic more than ten years.  I studied journalism with a woman called Alexandra, an intensive care nurse.  Many times I sought their counsel over medical issues. 

 

Years ago Andy offered me advice to pass on.  ‘If something happens, tell your parents to call an ambulance no matter what,’ he said. 

Alexandra, who assisted in theatre, told me stories of tending to people following surgery, of nursing them back to health and watching others die in the ward.  She was blunt in her determination.  ‘Your parents are at an age where things start going wrong,’ she said.  ‘Tell them to see a doctor no matter how trivial it seems.’

 

Years ago, over a beer one night I told my parents what to do, whenever anything happened.  ‘Don’t fuck around with your health,’ I said.

 

When Bill told me he was having trouble pissing at night, the alarm quickly dissipated to anger.  ‘This isn’t something you’ve been putting up with for months, is it,’ I asked. 

 

‘No,’ he said.  ‘It’s been about two weeks.’

 

Bills blood was sent away for a Prostate Specific Antigen (PSA) test.  The results took two days to come back.  The PSA levels were elevated, about five nanograms per millilitre (ng/ml) which is a bad sign but not terminal.  Sam referred Bill to a specialist for a biopsy of the prostate gland.

 

It was November 2010.  It took two months to get an appointment.

 

In those two months the uncertainty was maddening.  Different scenarios were played out during phone calls, hollow reassurance offered, don’t worry about it until you know.  Bill said he wouldn’t, but he did. 

 

Leading into Christmas, Patsy couldn’t keep him still.  Bill mowed lawns, repaired the gutters, started building a cubby house and fixing an old trailer long discarded in the back yard. 

 

‘Anything to keep his mind off it,’ Patsy said,

 

In January 2011 they went by train from Caboolture to the city for the specialist appointment, a biopsy of the prostate gland.  The doc took twenty nicks of flesh from the gland and sent them away for analysis.  The results would take a week.

 

As Bill waited he couldn’t stop thinking about cancer.  He talked to Patsy about the house, if he was gone she wouldn’t be able to maintain it.  It’d have to be sold.  He mentioned things she didn’t want to hear.  Bill couldn’t help it.  Pissing at night was still taking too long.  His worry manifested itself in morbidity.  His children tried to settle the worry.  It didn’t help.  Bill’s return date with the specialist, to get the results, was always on his mind.  Everything else was diversionary.

 

Several phone calls were made to the mobile and landline following that appointment.  When Bill finally answered the message wasn’t good.

 

‘I have prostate cancer,’ he said. 

 

The prostate gland has a simple function.  It secretes alkaline fluid during orgasm to help neutralise acidity of the vaginal tract.  A normal prostate gland weighs between 11 and 20 grams, about the size of a kiwi fruit.  When the cancer is developing there are usually no symptoms.  Most men don’t know they have prostate cancer until they have a routine check up, which includes a blood test.

 

Others develop symptoms before the cancer is diagnosed, such as difficulty urinating or getting and maintaining erections.  Bill, during a cryptic conversation, suggested he had worries other than the time it took to piss.

 

‘I told Patsy there’s got to be something else,’ he said.

 

Doctors don’t know what causes prostate cancer, but age and prostate cancer in the family are the most common risks.  The average age of diagnosis among Australian men is 70, but men as young as 40 have contracted the disease. 

 

Almost 20,000 Australian men are diagnosed with prostate cancer each year.  About 3,300 will die from the disease, which is similar to the number of women who die from breast cancer each year. 

 

Four of the twenty biopsies taken from Bill’s prostate tested positive for cancer.  The prognosis, despite the guarantee of cancer, was better than it could’ve been.  The specialist wrote a referral for another appointment to see if the cancer had spread.

 

The diagnosis of cancer still had boundaries to confirm.  Tests of the lymph glands and bone marrow were scheduled but Bill didn’t care.  The specialist said the cancer hadn’t spread, and the biopsies suggested it hadn’t. 

 

‘If you do nothing you will live for five, maybe ten years,’ the specialist said.  ‘If you have it taken out you will die from something else.’

 

That’s mortality for you.

 

Though the biopsy showed the cancer hadn’t spread, Bill was unequivocal.  ‘I’m just going to get rid of the fucking thing,’ he said.

 

Bill was distracted, frustrated and aggressive, all natural emotions built on stress and Patsy bore the brunt.  Typically she shrugged them off and offered reassurance.  Bill kept up the effort around the property, he just couldn’t stay still.  In the lead up to the operation I spent three days spread over three weekends at Elimbah, working on my old trailer. 

 

During the trailer renovation we talked about anything other than cancer.  The trailer cost about $700 to repair.  Its value as a temporary distraction was priceless.

 

Bill had two options for surgery, by hand or by machine.  My mate Adam installs medical equipment.  During a phone call, Adam assured Bill the da Vinci machine was a viable option.  The machines cost millions of dollars and cut with precision.

Instead of open surgery, the da Vinci robotic system is keyhole surgery, just five small incisions not more than a centimetre long in the belly.  The benefits of the robot seemed to outweigh the human version of surgery.

 

If Bill chose the robot, the stay in hospital would be shorter.  He’d experience less pain and scarring.  The robot can reduce blood loss and the need for a transfusion.  Recovery would be quicker, and the makers claim that urinary control and sexual function return sooner.

 

The robot follows the surgeon’s hand movements with precision.  The doctor can see the surgery through a three dimensional view. 

 

To have the prostate removed by machine cost $16,000.  By hand it cost $8,000. 

 

Money was no object.  Advice was plenty.  Bill was set to use the machine until Sam the GP told him not to pay the extra.  The surgeon, Dr John Yaxley began using the da Vinci machine for radical prostatectomy in 2009.  Prior to that, Dr Yaxley had been doing the surgery by hand.

 

‘Dr Yaxley is a highly skilled surgeon,’ Sam the GP said.  ‘This is what he is paid to do.  You don’t need to pay for the machine.’

 

Bill chose surgery by hand.  The venue was Brisbane’s Mater Hospital at Toowong.  It was February 2011 when Patsy dropped him off.

No one is ever ready for invasive surgery.  It just has to happen.

 

119	Anne (8)
118	Russ (8)
117	Matt (8), Dave (9)
116	Sandra (8), Matt B (8)
114	Wayne (9), The Pole (7), Stevo (7)
113	James F (6), Andy (8)
110	George (8)
109	Eric (8)
106	Dallas (8)
102	Adam L (6), Jim (9)
100	Paul (4)
43	Nemo (0)

 

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