My experience of diagnosis, treatment and recovery from prostate cancer is a good example of the joined-up approach to perioperative care. During my 60s I was aware of the dangers of undiagnosed and untreated prostate cancer. Campaigns such as those launched by Prostate Cancer UK with the well-known ‘man badge’ are very much to the fore. The subject of this disease is kept in the public eye by ‘brand reinforcement’ with the distinctive man badge logo used in the media, especially in relation to popular sports events and broadcasting. The use of celebrities wearing the badge also is a good example of marketing to promote continuous awareness of the disease.
Men who have a family history of prostate cancer are encouraged for example through soap opera storylines to have regular prostate specific antigen (PSA) tests. There are many items on social media and popular press articles promoted by Prostate Cancer UK to remind men (and their partners) of the dangers of this disease. There is strong advice about the treatability of the disease, maintaining a less fearful and more positive message about the need for early diagnosis and treatment.
In my case, both my elder brothers have had prostate cancer and were successfully treated although their experiences were quite different. During my 60s, regular PSA tests suggested there was no problem and I was apparently symptom-free. It was only after I hired a kayak at the seaside that things changed. Whilst I was happily paddling away, the wind suddenly got up and I was worried about being tossed into the sea. I knew I would never get back on board, and the kayak would be half way to France before I knew it. I clenched my buttocks tightly on the hard base of the kayak and made for the shore. After all that clenching, I experienced a different feeling. I assumed this would soon disappear but when the sensation continued for a few days, I thought I should have it checked-out. I only did this because of my heightened awareness of the disease.
My early morning call to the triage staff at my local GP surgery resulted in an immediate doctor appointment. A trainee doctor supervised by an experienced GP made an examination and within a few days I was referred to a consultant urologist at my local district general hospital. Again, an examination was made and the consultant clearly explained that further tests including MRI and bone scans were necessary to assess the extent of any disease, all with the reassurance that treatments were available if necessary. These tests indicated that the disease was present and within a further few days I underwent a biopsy under local anaesthetic, the results of which confirmed the diagnosis and also indicated the stage and extent of the disease.
Further appointments over the following few weeks involved shared decision making including a discussion of the benefits, risks, alternatives and the option of not having any significant treatment. This was all in accordance with the Benefits, Risks, Alternatives and Nothing (BRAN) approach to making a shared and informed decision. I was advised that the ‘no treatment’ approach was not an option as the disease had progressed to an extent that required an intervention. Alternatives were outlined to me including the risks, side effects, and advantages of alternative options of prostate removal, radiotherapy or a newer treatment known as brachytherapy involving the implantation of radio-active seeds into the gland to kill the cancer. After detailed discussion, I opted for the latter. Within a few weeks, I had a preassessment which took into account any comorbidities. Brachytherapy seeds had been obtained from the USA, especially calibrated for my particular disease characteristics and were duly implanted under general anaesthetic in a specialist urology unit. This was a day case procedure taking into account my status as a marginal type two diabetic.
Since then, I have regular monitoring and I report that tests have confirmed that the treatment has been successful. I consider this to be a good example of the perioperative process with a charity doing its job to raise awareness, followed by the GP surgery arranging a quick consultant referral; then consequential hospital tests; followed by shared decision making on treatment options; and a speedy surgical procedure with proper post-procedural follow-up.
This joined-up approach is to be commended. As the patient, I considered myself to be at the centre of the whole process and I am grateful to all involved - including the guys who hired-out that kayak!
Mr Bob Evans, Lay Member, CPOC Board