UPDATE - Issue 31 - Autumn 2007
A Diplomat's Story by Bruce Dinwiddy
Bruce Dinwiddy and his wife
Returning to the UK in November 2005 after my last overseas posting, my thoughts were more on my approaching retirement than my impatient bladder. But I decided after Christmas to see my GP.
My PSA had risen over two years from 2.2 to 5 which resulted in my being referred to a urologist, who arranged a biopsy. Two weeks later, cancer was confirmed: a Gleason score of 7, which the urologist described as aggressive, bordering on nasty. My PSA had risen to 7.5. An MRI scan was arranged for the next day. The following week, on the eve of my 60th birthday, my wife and I were shocked to be told there was already extensive local spread of the cancer.
At first, it was not clear how best to proceed. For a time we felt as though we were on a roller coaster, playing real-life snakes and ladders. New hope dawned with the suggestion that an MRI done only eight days after a biopsy might not be reliable, he said, because of bruising.
The very next day, our new-found optimism was dashed. An oncologist advised there was only a 20% chance that the biopsy had affected the MRI. Surgery was unlikely to be successful. I would need radiotherapy too. It would be better to avoid undergoing two treatments with the greater risk of the combined side-effects to my quality of life. Better, to have 3-6 months of hormone treatment, some intensive radiotherapy, and then 3 more years of hormones. There was a 10% chance that the cancer was already in my bones. I should have a bone scan. If that was clear and I remained keen on surgery, I should first wait four weeks and have another MRI.
The bone scan confirmed my bones were clear. My oncologist stood by his earlier advice, and we decided to consult a second oncologist. She advised repeating the MRI but that surgery was anyway a realistic option. I might need follow-up hormones and radiotherapy - but at a lower dose, for a shorter period, and better targeted than if I relied on hormones and radiotherapy alone.
The second MRI was more promising. The experts agreed that surgery was the best first treatment. I finally had the operation just six weeks after my cancer was first diagnosed - though it seemed more like six months!
The operation went well, and the follow-up biopsy confirmed the earlier assessment. My tumour had invaded the base of one seminal vesicle; but except in one small area the margins were clear. My PSA dropped to 2.0 after two weeks, 0.09 after three, and <0.05 (or undetectable) after six.
I quickly regained strength. But my PSA crept up again in the next three months to 0.12. I was prescribed daily Casodex, which brought it back below 0.05. After two months I started six weeks of radiotherapy, followed by another six months of Casodex. This all went more easily than I feared, with no lasting side-effects. Nine months after the radiotherapy, my PSA remains undetectable.
Whatever the future holds, I am sure the best thing I ever did was seek expert advice. The treatment and encouragement I received from the whole team was superb. I have also relied heavily on my wife, a sympathetic and constructive soul mate throughout. We are thankful too that we decided from the start to be fully open about my condition with family and friends. They too have been a marvellous comfort and support.