Figure 1: A dazzle of zebras
Welcome back everyone!
My excuse this time for the multi-month WHV blogging hiatus is that I was dealing with prostate cancer.
I was diagnosed in February, but I wanted to wait for calmer waters before writing anything.
Extremely fortunately, those calmer waters have arrived, and now I can talk openly.
I wanted to write up this whole story firstly because this blog has a long history of stories about significant life events, but also just in case it could help anyone else who might find themselves in a similar boat and would like to talk. If you are such a person, please email me or leave a comment down below.
On to the story:
Discovery
In January my GP randomly tacked on a PSA (Prostate Specific Antigen) test to the Apolipoprotein B (ApoB) blood test, which at that point still was the main topic of our interest.
The tacked-on PSA came back at 6.5ug/L, which is convincingly above the range for my age, and hence was suddenly promoted to The Main Topic of Interest.
Three weeks later a repeat test at the urologist came back even a tad higher, and so I was scheduled for a prostate biopsy two weeks after that.
This procedure, fortunately under general anaesthesia, is where the urologist sticks a number of needles into one’s prostate in order to gather actual tissue samples that can be studied by the pathology lab.
Those biopsy results came back with…
Prostate cancer.
ULP… although my science brain had deduced that this was probably going to be the outcome (low CRP = probably no prostatitis, few other indications of BPH), my human brain was in panic.
To be more specific about the diagnosis, it was Gleason score 3+4 aka grade group 2 (on the favourable side of “intermediate risk”) prostate cancer. 9 out of the 13 biopsy cores (samples) were cancerous, with both lobes of the prostate involved.
Cue some more shock here…
After that initial shock came the more cognitive realisation (thanks science brain!) that as cancers and cancer gradings go, this was quite… reasonable.
That being said, the existential dread caused by this disease, which was entirely willing and able to kill me, was quite visceral.
By the way, you know that thing about the atheists and the foxholes?
Contrary to the wisdom of the foxhole, I found immense peace in my science, and endless strength in my family and my friends.
Surgery
My urologist explained that for someone at my age, with this diagnosis, he would recommend in no uncertain terms to have the prostate removed, preferably via robot-assisted laparoscopic prostatectomy, aka my new friend Wreck-it RALP (silent H).
In my previous career as academic in The Netherlands, a significant part of my research was computer-assisted surgery. Although I did most of my work in orthopaedics with the academic hospital in Leiden, the Da Vinci surgical robot (previous generation!) was very much on our radar.
Little did I know that a decade or so later I would experience its successor, the Da Vinci X, very much first hand.
(It’s hard for me to put in words how grateful I am now for all of the thousands of hours of research and development that have gone into robot-assisted surgery… thank you colleagues!)
On March 30, my partner and I left home at 4 AM to report at the hospital at 5.
First that horrible open-at-the-back hospital wear, and then the warm enema they brought in shortly after admission, were pretty clear signs that things were getting uncomfortably real.
My experience of the surgery itself was of course sublime – oblivion is indeed bliss! – thanks to the anaesthetist’s magic.
The main procedure was performed by Dr Conray Moolman, a urological surgeon who specialises in RALP, with hundreds of prostatectomies under the belt.
(Why yes, I am in fact now expected to brandish this level of punnery, thanks for asking.)
Having the operation done by someone with his level of experience is a best case scenario for me personally, but the role of that experience in the surgical outcome is underlined by much of the literature on robotic prostatectomy.
As you can see in the handy Wikipedia illustration below, the surgeon has to cut out the prostate and some of the surrounding tissue, and then attach the remaining urethra to the bladder neck.
The poor urethra is just expected to stretch to the occasion.
All of this happens via the Da Vinci X’s many robotic arms, a number of them inserted into my abdominal cavity through the five incisions (four small and one larger) in my abdomen.
One of the main challenges for the surgeon here is that, along with the whole prostate, they need to remove as little as possible of the surrounding nerves, which would result in certain post-operative functional deficits, but enough of the surrounding tissue to include cancer cells that may have progressed to there.
Post-op
I was able to walk a little bit on the same afternoon, with the expert help of the physiotherapist, and in spite of the interference of my new and fortunately temporary augmentation the Foley catheter, which had to remain in place for at least a week to give the new bladder-urethra hook-up time to heal.
A few days later, the first fantastic bit of news was that the post-op pathology report, completed a few days later, showed that “all margins were clear”, meaning that it was highly probable that all prostate cancer cells had been taken care of.
I was able to return to work just over two weeks after surgery.
The first post-op PSA test 6 weeks afterwards showed a new PSA level of 0.01.
I have not been able to find out if that amount is just what the test shows at its lower end, or if there is somehow some residual PSA left in my system.
My urologist seems happy with this result, which is important.
For the first year, I’ll have to repeat this blood test every three months to ensure that there’s really nothing there. I am keeping my fingers crossed.
Closing thoughts
As I write this, exactly three months after the prostatectomy, I am looking out over the Crocodile river, at the end of our traditional winter KNP break-away.
Shortly after the 6-week PSA test, I had to have another small surgical procedure due to a urethral stricture which developed most probably due to the catheter. Fortunately the stricture was very distal (ahem), far away from the critical new urethra-bladder-neck junction.
I am almost back up to pre-surgical strength, although I do have to go to the bathroom substantially more regularly (also at night) due to the remaining nerves (most of them, fortunately!) still having to learn new tricks, but probably more due to the urethral sphincter being exactly the part that is newly sutured to the bladder neck. Other than that, my running fitness took quite a hit, and is now in the slow process of building up again.
On the mental side, my confidence in my own health and physical resilience has taken a bit of a knock. This is something I really need to work on.
Through all of this, support from work, friends and family has been absolutely phenomenal.
Amongst many other lessons, this has shown me how much even that random WhatsApp from a friend who I haven’t seen in ages can mean, and so I have resolved to send that random supportive message through whichever medium, whenever there’s an opportunity.