Interview 06

Age at interview: 56

Age at diagnosis: 56

Brief Outline:

Diagnosed with prostate cancer in 2000. Hormone treatment, and external beam radiation planned.

Comments that although he eats healthily he wishes he had paid more attention to diet.

Have you ever thought about what might have caused it in the first place, did that ever come into your head at all?

No I don't think it has really. I'm conscious now that there are, although I don't think any of the actual medical doctors and consultants I've seen have endorsed it, there are a lot of people who will suggest that diet and other factors may have an influence and I am probably sorry that I didn't take a bit more notice of that. Although having said that for many years I've eaten in a way which I believe is healthy. I wasn't aware of the sort of deeper aspects of dietary prevention, if indeed that's possible, like for example not eating dairy produce which I now understand may be thought to be an influence. But for many years I haven't really eaten very much red meat, I've tended to have a reasonably high fibre diet and and so I think I've eaten pretty healthily, and I've always had a pretty healthy lifestyle.
 

Explains that although he had certain symptoms his doctor had been reluctant to request a PSA test.

Anyway to return to last September; about a year ago I first asked about a PSA test, and was persuaded then [by the GP] that it wasn't necessary, there was controversy about whether it was sensible and so on. I was given a physical examination, which didn't pick up any abnormality.

So again, nothing happened until earlier this year, about February or March. At this stage I had this cramping or discomfort, and also possibly the stream becoming a little worse, although it's not an enormous problem for me. Knowing what I know now there were other signs, which I could have related if I was a bit more knowledgeable about it, and I suspect I could have forced the issue earlier. But at that stage I was seen again and I asked again about a PSA test, and still my GP thought it was probably a bladder infection which was causing the discomfort that I was having. But he agreed to do a PSA test and of course that's when we found it was an initial score of 59 and no urinary infection and he immediately referred me to a consultant under the two week rule.

Describes his experience of the MRI.

On the MRI?

I was given good information beforehand and I suppose it could be problematic for some people. You are placed in quite a narrow tunnel which does feel a bit claustrophobic and I can quite understand that some people might find that difficult, however you are reassured by the nurses and you can communicate so if things become too difficult you can certainly ask to be taken out. It's very noisy as the magnets are moved around and even with hearing protection which you are given that can be a bit unsettling. But having been in other environments which are unpleasant, I didn't find it particularly difficult. So it's not uncomfortable, it's a little claustrophobic and a little noisy but I was happy to almost go to sleep and let things happen. It does last rather longer than you expect; you are placed in different positions while the images are taken and some of the tests themselves last for several minutes so you actually have to lay still in this little tunnel with rather loud clunking noises going on around you.
 

Describes his active lifestyle.

My two particular sports at the moment are squash and running and I do both quite a lot. Since I was diagnosed it's been one of these ways, in a sense, of dealing with it; I don't feel ill and I don't choose to feel ill and so [laughs] I've actually wanted to if not actually train but exercise with rather more focus, and indeed to eat sensibly and to be sensible to perhaps a rather greater extent than I did before. 

Describes how he was consulted about deciding on treatment.

The MRI scan didn't show any evidence of any lesions or whatever in the bones, and so the consultant discussed the options for treatment; surgery wasn't even discussed, I don't think it was even mentioned but if it was it clearly wasn't seen as an option, because of the localised spread I assume. I didn't press that issue either, I suppose as much as anything because I'm aware that surgery carries the possibility of severe side-effects and clearly doesn't seem to me to be worth pursuing unless there's real evidence that it's likely to be very effective. The consultant explained that in my situation as far as current medical practice was concerned, the two realistic options were either hormone treatment only or a combination of hormone treatment and radiotherapy. 

He mentioned that a study was about to start in which a number of people would be randomly selected for one or the other and he asked if I would be interested in taking part. I declined on the basis, as I explained, that I'm used, in terms of any problems that comes up, to try and get the best possible advice and consider the options and then select what I think is the best way forward. I didn't think therefore being randomly selected for one or the other was the way I wanted to proceed. He accepted that although that wasn't necessarily a final answer because we had agreed anyway that I should be referred to the oncologist who would be responsible for the radiotherapy who also knew about the survey. And so it was agreed that I would be referred but I would also start hormone treatment because I understood that hormone treatment could start immediately and indeed the radiotherapy tended to lag behind that in any case if one underwent it. 

And indeed my tendency, subject to advice, was that, if I was a suitable case for radiotherapy and aware that the side-effects of radiotherapy are much less dramatic and hopefully not permanent, I was inclined to take the option of radiotherapy which could give a more radical and dramatic result if it worked albeit that hopefully the hormone would slow down or stop things for a while. So I was referred to the oncologist, or rather his registrar. I saw him in mid September and the survey wasn't actually even mentioned but it was said that the regime that he would be recommending would be a combination of hormone treatment and radiotherapy. He felt that I was suitable for radiotherapy and what's more it would be radical radiotherapy with a view to trying to attempt to cure. I'm realistic about that, I suspect I shall be very fortunate indeed if that actually is the outcome, it certainly helps one to have a more positive aspect and approach to it all anyway.

Concludes he was well informed but was disappointed at the lack of consensus over what can be done.

I was very impressed with the registrar for the oncologist who explained everything in great detail and certainly answered any questions. So as an individual I felt I had all the information he could possibly give me and he explained it all very well. I'm aware that there doesn't seem to be any total measure of agreement in what is best in the approach to the disease and the treatments in various countries vary enormously. So I don't know. I have discussed it with other medical friends and as far as I can see the choice that I've made and was being made for me seems to be as good as any in terms of current thinking. I am, I suppose, a bit disappointed that there isn't a bit more consensus yet over what should be done at various stages and what can be done but I think, I think I'm happy with the information flow.

Explains how the diagnosis can act as a relief after continuing uncertainty.

Please could you tell me, what was the impact of the diagnosis on you and your family, only tell me what you want to say but it's something other patients might want to know.

I'm trying to think back to sum it up. Of course it's upsetting initially, particularly if you think you're very fit but I suppose it wasn't that much of a surprise because I'd been suspicious that something was wrong. And I suppose in a funny sort of way it was almost a relief to know what it was on the assumption that that is all that's wrong. We don't know necessarily that's entirely the case but it was something of a relief to have confirmation of the position rather than the sort of continuing uncertainty, and perhaps the worries that it could be something even worse.