And so the day came.....

 True to their word, almost two weeks after the biopsy I received a call inviting me in to discuss the results on August 23.

This time I was seen by a specialist nurse. She was a member of team specialising in the treatment of prostate cancer and that it was the nurses who handled this initial meeting, explaining the results and options.

To cut a long story short, I had a low grade of prostate cancer. She explained that after the biopsy each sample was checked for how different it looked from normal prostate cells and how fast it was replicating.

The nurse revealed that of my 24 "cores", 15 appeared normal, 5 appeared to be of a category where they would normally just monitor and 4 were slightly worse. Overall it was considered a low grade cancer (once itnmy life when being low grade is a good thing), but the presence of the worst 4 tipped me into the category of "warranting treatment".

She also reported that the tumor was to the right (ie not around the "plumbing" at the centre) of my prostate and very close to the outer edge, but still contained within the capsule (the container of the prostate). This helps explain why the previous finger explorations located nothing of concern and why I have no other symptoms.

The positioning raised the question of whether the cancer had escaped the prostate (generally bad news as it will often go to the lymph nodes and bones first). This might have required a bone scan, but it seems the doctors are confident that the cancer is still contained, so no bone scan for me.

So I was "low grade" and "contained" and in their view curable with treatment.

To give perspective prostate cancer is expressed using the Gleason scale where I was a "3+4" giving a score of 7. The extract below comes from my research and not just my recollection:

A Gleason score of 7, a PSA between 10 and 20 ng/ml, and a medium tumor stage indicates medium risk. This means that the prostate cancer is unlikely to grow or spread for several years. You and your doctor will consider your age and overall health when weighing treatment options. 

This scale has been simplified and my rating is now described as Grade 2.

This is consistent with what was said.

The nurse explained that Grade 1 would just be monitored. Grades 2 & 3 are considered curable though the tags of "favourable" and "unfavourable" are attached respectively. Grades 4 & 5 are considered incurable, because of the spread and/or aggression of the tumour.

When questioned the nurse seemed very confident that my cancer can be cured, something that the reader will see was repeated by the other specialists I saw later.

Once this has been digested, I consider this to be almost the best bad news to get in that we now know I have a tumour, it is "low grade, contained and curable" and we can now set about treating. Without this diagnosis the tumour would have continued developing, albeit slowly, and I might not have had any symptoms or reason to be tested until it was too late and my grading would have been a 4 or 5 and incurable.

So what now?

Well, the nurse then went on to explain the two treatment paths, radical surgery (ie removal of the prostate), or radical radiotherapy. There is a third path which I will also cover in a later post.

There was an element of "understandable ambush" about the day as the normal practice was to schedule, but not advise you of two more appointments on the same day; one with a robotic surgeon and the other with a  cancer specialist. The nurse explained that if they told a patient of all three appointments on the phone it would be easy to go into a tailspin worry, but the keen intention to provide full awareness of options as quickly as possible. What was originally a 1-hour appointment becomes something of an all-day exercise. In my case we could only see the cancer specialist that same day, but I did see the surgeon four days later when he had clinic on a Bank Holiday.

The decision on treatment route would be up to me having spoken with the doctors, but she considered each to have a equal success rate.

Quite a lot to process as you can imagine when my wife and I had lunch before meeting the first doctor that afternoon.