Richard Y

Age at interview: 51

Age at diagnosis: 50

Brief Outline:

Richard mentioned his frequent urination in passing to his doctor who gave him a PSA test. A score of 18.5 prompted a biopsy and other tests which gave a diagnosis of prostate cancer in 2009. He began his brachytherapy treatment just before Christmas 2009.

Background:

Richard is a medical librarian and self-employed artist who is married with two teenage children. Ethnic background is White British.

More about me...

Some months before his fiftieth birthday in 2009 Richard noticed that he was going to the toilet more frequently than before but didn’t go to his GP for several months. When he eventually did speak to his GP it was in relation to an injured leg rather than his frequent urination which he mentioned in passing. The GP gave him a digital rectal examination and arranged for a PSA test and seemed more concerned about this than the leg injury. The PSA result was ‘raised’ and Richard thought that this might mean he had something like an enlarged prostate. He was referred to a hospital where he was told his PSA was 18.5 and that it was likely he had prostate cancer. Other tests were swiftly arranged and Richard had a sense that he was picked up by the system very quickly. In considering his diagnosis Richard was reassured by thoughts of a relative in his seventies who had lived with prostate cancer for over ten years. An MRI, CT scan and a biopsy showed that the cancer was confined to the prostate. This information and a Gleason score of 6 contributed to him being advised by his surgeon that he should have his prostate removed as this was thought the best way to deal with it as he was of relatively young age. While initially he agreed that this sounded very straightforward, on further reflection the thought of having an organ removed and the subsequent side effects prompted him to consider other treatments. He expressed his concerns to his surgeon who happily referred him to a radiologist but this specialist also advised surgery. By this time Richard was keen not to have surgery and so approached his decision making in a very organised way scoring each treatment according to those things in his life of most value to him and to the side effects. In this way he decided to have brachytherapy and felt much better once his decision was made. Other good news for Richard was that his PSA had dropped from 18.5 to 11 which put him in the preferred category for brachytherapy. He had his first stage of treatment just before Christmas 2009 and the second stage in February 2010. He stayed in hospital two nights and was back at work in three days for half days for a week or so before resuming normal working hours.

Interview conducted in 2011 by Anne Montgomery.

Richard also looked at websites which helped him to make his decision to have brachytherapy. Quality of life was very important to him.

I got a folder, and I made, and I made three sheets in it for each of the treatments that I was going to consider, and, so I read through what was there and I summarised on the sheet myself, and then underneath I wrote down what was most important for me, coming out of it, so you know, you looked at what the side effects might be, there were suggestions that, you know, in terms of, how long you live, that the prostatectomy, taking the prostate out, was the better option, and you were likely to have, you know, longer survival, if that’s the option that you chose, but to me, quality of life was as important if not more so, in my decision making, than the idea of sort of living to ninety or something, and the, the surgeon who was the first consultant I saw who I liked very much, he also showed me a website, which was a sort of, a sort of decision support thing, which was from an American university, where you could put in your Gleason score and your PSA and it would actually give you information as to what the likely outcomes were for the different treatments that that there might be, and in fact, and, and he thought that that clearly indicated surgery was the best option for me, and I was very happy to look at that because I wanted to take on as much information as I could, but it seemed to me that the differences were actually quite minor you know sort of cancer free survival at five years or at ten years there were, there were maybe five percentage points or something, but it was still, you know, the brachytherapy it was never lower than sort of seventy five or eighty per cent, which to me sounded like quite good odds so, but it was quality of life aspects to me that were most important in making the decision.

 

And those were?

 

Sexual health, lack of urinary problems, bowel problems you had to sort of balance these things up cos they're all subtly different between the... between the different treatments.

 

When I was making up my mind about which treatment to go for, I actually looked at some qualitative research, sorry because I work as a librarian, you know, I know how to track this stuff down, and I was interested to read peoples experiences, so you had that on some websites, and also you had people who’d carried out research and actually in those papers you can read what people have said verbatim, you know, in their own words, and that was very powerful and quite sort of influential for me.

 

Richard was given plenty of information about all the possible treatments suitable for him.

And then when I saw the consultant for the first time they gave me lots of written material, on alternative treatments, a booklet from Macmillan I think, and one from prostate cancer charity, so I had that, I had a lot to take away, and they, they covered, at that stage they covered all the possible treatments- so they had watchful waiting, a leaflet on watchful waiting as well, which in the end they didn’t think was appropriate for me, and brachytherapy and radiotherapy and, having the prostate removed as well, so I had that stuff given to me at that point, which was all very useful, but when it came to me considering what treatment I wanted, I had to sort of digest that into my own form to be able to sort of help make the decision.