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Interview 35

Age at interview: 52
Brief Outline: He decided to have a PSA test because of a family history of prostate cancer. The PSA result was slightly raised, so he had a biopsy. Cancer was diagnosed. In May 2005 he had a radical prostatectomy.
Background: Occupation' Sales manager. Marital status' married. Number of children' 2. Ethnic Background' White British.

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He found the biopsy very painful and needed 'gas and air' (Entonox).

He found the biopsy very painful and needed 'gas and air' (Entonox).

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The biopsy, I went to the local hospital to have. And I was very, very nervous before I went there, because I'd heard already that it was unpleasant. And, and, and it didn't disappoint me. It was unpleasant. It was done under, with just some GTN cream and, and some gas and air. And it was very painful, or very painful for me for the ten, fifteen minutes, twenty minutes that the biopsy was taking place. However I must admit that even though it was painful that twenty minutes, two hours later I was fine. I was very shaken up to start with, but two hours later when I got back home I was fine.

So they, did they use a little bit of local anaesthetic? You mentioned a cream?

They used some GTN, glyceryl trinitrate cream, which they applied rectally, and gave me some antibiotics when I had it. But to be fair that, that didn't, that didn't ease, ease the procedure. Then they gave me some standard gas and air, which I could take while I was having the procedure. Which I did take. However the procedure I found very very unpleasant.

Do you know how many samples of tissue they took?

I think it was either six or eight. I, I could have told you at the time because it seemed to be very vivid. But I think my mind's blocked it out since then.

Did they tell you to expect that sort of level of discomfort?

Perhaps they didn't warn me as much as that, you know, as, as much as I thought it was going to be. But from what I understand of talking to other people, it, it just depends on different people as to how painful they find it. I found it particularly painful.

The biopsy was worse than the operation [laugh]. The biopsy was more painful than the operation. 

Well, you're the first person that's told me you had gas and air during the biopsy. Was that easy, was that on hand, or did you have to ask for that?

I said, 'What op?' Well, I said, 'What painkilling can I have?' And they said, 'Well, you can have this gas and air'. So I said, 'Right. Get the mask here. Let's get that mask in my face'.

Did that make you feel a bit queasy afterwards or not?

No, not really.
 
 

Discovered that GPs have very different views about the value of the PSA test, but decided to...

Discovered that GPs have very different views about the value of the PSA test, but decided to...

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Yes, I'd play golf with two GPs and they'd had a great debate about PSA tests. And this was before I'd had a PSA test. This was before I was 50. So I was very listening to, you know, what they'd got to say. And, you know, they were completely diverse. One was saying, 'Well, you should have a PSA test because, you know, that w-, is a sign of there might be something wrong, and we can do something'. And the second one said, 'Well, it, it's a waste of time because the, the end result is, is no better from those who are having the tests and intervention and those that don't have anything at all'. And that's where the debate essentially stopped. But I still decided to have the test.
 
 

The decision to have a PSA test was made with the help of his wife and GP. He knew the test might...

The decision to have a PSA test was made with the help of his wife and GP. He knew the test might...

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'I mean it, it was, it was my final decision, but it wasn't a decision that I went off and did on my own. It was in combination with my family, with my wife and the GP. And we were all happy that we knew what we were doing, and all, we were all happy that, if I was going to have this PSA test, it could lead to where it did lead. Which is, you know, anxiety, but essentially, hopefully nipping things in the bud, because I didn't have any symptoms.

You just wanted to make one important point about the PSA test?

I think that the most important thing about the PSA test is that, if you have a PSA test done, you must do something about it. There's no point in having the PSA test done, because if it comes back abnormal and you ignore it, you might as well not have had it done. So just, you know, the thing to always remember is if you're going to have that PSA test, it might lead to further investigations, and it might lead you down the route of biopsy and further hospital examinations that you might not want to know about.

So you're, you're suggesting that if people have already decided they wouldn't want to have a biopsy or further treatment, better for them not to have the test?

Yes.
 
 

Having seen his father die of prostate cancer he wanted a PSA test so that if cancer were...

Having seen his father die of prostate cancer he wanted a PSA test so that if cancer were...

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As far as the PSA test is concerned I had some knowledge beforehand. The knowledge was that A) my father had prostate cancer, and working in the pharmaceutical industry I get a lot of chance to talk about medical things. And I've had debates on, with, you know, friends who are GPs and consultants about the merits of PSA tests. And also I'd had a couple of friends who'd also had prostate cancer. And my father-in-law had also had prostate cancer. So I had a good, I had a good idea what PSA tests were and also the unreliability of prostate tests. So when I was 50 I decided that I'd go to my GP and debate to have a PSA test. And I had a PSA test when I was 50. And that PSA test came out at roughly 2, of which was normal. And the GP reassured me that that was normal, but he said, 'We must repeat that'. I probably should have gone back and had it repeated after one year, but time lapsed and things, I was busy. And I actually went back after about eighteen months and I had a PSA test done a second time. And that came out at 7.2, which was obviously abnormal. I was called back to the GP. We debated on what to do next and we'd agreed that he would do a rectal examination. Which he did, which he couldn't feel anything wrong. And we took a second PSA test. That second PSA test came out at 6.2, which was, also abnormal. And at that stage I was referred to the local hospital, where I saw a specialist registrar, who again repeated the PSA test and did a second rectal examination.  

Can I just interrupt? You're quite young. What made you decide to have that PSA test?

The only reason I decided to have the PSA test done in the first place was the h-, family history, my family history of my father having prostate cancer. And I knew that there was a greater increased risk of prostate cancer. But at that moment in time when I had the PSA test done I had no symptoms at all.

Would you mind just going over a little bit about what might have influenced you to have the test?

Well, I think the biggest influence was that my father did have prostate cancer. He had a number of other medical conditions at the time, but the end condition which he died of in, in a hospice was, was cancer, and that was, that was prostate cancer that had spread to the bones. And I suppose having seen my father die and been there nearly at the end of his death, then I wanted to make sure that, you know, if I could have treatment I'd have aggressive treatment to start with. 

 

He expects to have three monthly PSA tests for a while so that his surgeon can check whether or...

He expects to have three monthly PSA tests for a while so that his surgeon can check whether or...

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After the operation I recovered quite well and everything else. And I had an appointment to go back and see the consultant after six weeks. And I had a PSA test done with my general practitioner, and that is to look at, 'Is there still any prostate cells that are left, even though I've had a radical prostatectomy?' And the good news from that was that the, the PSA s-, result was less than 0.01. So it was virtually unreadable. And that's, that is tremendously good news because that means that hopefully the problem has d-, then disappeared. So I went to see the consultant. He asked me a number of questions about how I was feeling, how my continence was feeling, impotence, talked about impotence, and talked about, about the result. But he also talked about the pathology of, of my prostate, which he'd taken out, and unfortunately the Gleason score which was first at 7 had moved to 9. And so that was, that was slightly disappointing, on the good result of having a very low PSA count, was that the, the tumour that is now removed was very aggressive. So I'm now under a regime of, of seeing him again in three months. And he said he will continue to see me three-monthly until, until we decide that things are clear.

So you'll have three-monthly PSA tests and then go and see him?

Yes. The situation now is I've, I've already put a date in my diary to go to see the GP to get a PSA test. And I've got another date to go and see him early November.
 
 

Thinking something was 'drastically wrong' he worried while waiting for the result of another PSA...

Thinking something was 'drastically wrong' he worried while waiting for the result of another PSA...

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What was it like waiting for the results, those days?

Not good. The, the first, the first signal of the PSA being high, raised, because I knew that the first one was 2 and the second one was 7.2, that, that immediately put alarm bells into me that something was drastically wrong. Unless it was an absolute false test then I was very, very worried. And, and subsequently when the second test came back at 6.2, that further increased the, my worry that there was something, there was something seriously wrong. 

What was your understanding of what might have caused a raised PSA if it wasn't a, a serious problem?

Well, the two understandings I had was either it was c-, it was a benign growth, which w-, wasn't cancer in prostate, or it was, it was prostate cancer. And in my case it turned out to be prostate cancer.

 

He was given four options: 'do nothing', a radical prostatectomy, radiotherapy or hormone...

He was given four options: 'do nothing', a radical prostatectomy, radiotherapy or hormone...

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After I'd had those two scans I went back to see the consultant and we discussed the various options for me, having prostate cancer. And the three options that were, well, four options were available, was to do nothing, because I had no symptoms, I was completely symptom free and it wasn't causing me, I was very fit, no problem at all. So I could have done nothing. I could have had a radical prostatectomy, which is the prostate gland removed by surgery. I could have had radiotherapy, which meant that that would also hopefully have got rid of the cancer. Or I could have had some hormone therapy.

Was brachytherapy mentioned?

It wasn't at that stage.

As a form of radiotherapy?

It wasn't mentioned at that time as a form, but it was just tuned into the, the radiotherapy.

And were you given plenty of information at that stage?

I was given information, but I'd also gone through some of that with the senior registrar very early, very early on. So I'd gone through a, a conversation with the senior registrar much before I got to this stage. And w-, the consideration I took at the end of it all was that, that radical prostatectomy, for my age, because 52, was the, was the best chance of cure, or early cure. And also, from, from the consultant, if I went for radiotherapy then in his opinion I couldn't go back and have surgery later. So I've gone for radical prostatectomy and I've kept the two jokers, which is the hormone therapy and the, the radiotherapy, up my sleeve just in case things hadn't worked out.

Did you feel that decision was a joint decision with you and your doctors and the family? Or was it very much your decision?

It was a, it was a decision that I took with my wife and in consultation with, with the consultant. And I think afterwards, even though, you know, he c-, he didn't, he didn't actually try to sway me one way or the other, later, after we'd had the operation, he actually said to me he would have made the same decision. So it made me feel, feel, quite comfortable that I'd probably made the right decision.

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