vendredi 11 avril 2014

My experience with prostate cancer

It all started with a classic PSA screening.  Urged by relatives and my doctor (French GP), I went ahead and did the test.  The result was borderline with PSA levels of 3ng/ml.  Just in case, my doctor recommended I scheduled a visit with a specialist.  I ended up seeing a urologist in a private hospital in Trappes, West of Paris.  This urologist lacked empathy and just saw me as a number in his busy schedule: very quick digital rectal examination (DRE) and jumps straight to the conclusion that a biopsy needs to be performed and subsequent prostate removal surgery if applicable.

I decided against it and did nothing in the short term.

A year later, I went for a follow up PSA test.  The levels rose has soared to 18ng/ml, clearly indicating high risk of prostate cancer.  My GP prescribed a prostate MRI, which indicated a suspicious stain on the left lobe of my prostate.  As a result, he sends me to see another urologist, this time at the Franciscaines Hospital in Versailles.  This urologist had a much better approach and took the time to explain my situation clearly to me.  This time I accepted to do a biopsy, which confirmed malign cancer cells with a Gleason score of 6 (3+3).  The urologist recommends the full prostate removal surgery.  My case is presented to the hospital’s commission which confirms diagnosis and treatment.  We therefore make an appointment for surgery.

But then I started thinking and realized that this commission is com posed mainly by urologists, radiotherapists and surgeons.  They are both judge and party.
Another issue was that they decided to perform an open surgery (“on the open sky” was his term) when there is a Da Vinci robot that allows for a less invasive surgery.  Why wasn’t I offered the choice?

Meanwhile, I tried to get more information through my GP and internet.  There, I come across the urologist lobby in France, the scandal of abusive prostate ablations, pseudo-scientific communications orchestrated by companies specialized in marketing for the benefits of major healthcare businesses, statistics showing that mortality remains almost the same whether or not you undergo surgery, the significant increase of prostate removal surgeries in france, from 7,000 to 28,000 per year in the last 25 years without having any significant impact on life expectancy but still affecting your quality of life with impotence and incontinence…  

And above all, the French high authority of health recommends not to practice routine screening.

There was a lot of food for thought and I decided to cancel the surgery.  To my surprise, no one from the hospital called me to make me change my mind or understand my decision.

In Bangkok, Thailand, I was told about HIFU (High Intensity Focused Ultrasound).  I view it as quite minimally invasive, with side effects greatly reduced compared to other treatments.  Although originally developed in France, French medical authorities still consider this treatment as experimental and do not use it as a first line treatment option.  Yet this method is about 17 years old and has been used more and more in the last 5 years in western countries.  The Samitivej Sukhumvit Hospital in Bangkok is the only hospital in Thailand to offer HIFU and has been using it for the last 18 months.

Passing through the rectum, the prod sends a focused beam of high intensity ultrasound, a bit like a magnifying glass which concentrates the sun’s rays, on the part to be treated.  The cells heat up and liquefy, and are then evacuated by urine.  The prostate stays in place and the risks of impotence and incontinence are very limited.

Why no urologist ever mentioned to me about HIFU in France is beyond me.  Especially when considering the fact that it leaves all other choices open in the event of recurrence of cancer.

So I took an appointment with the urologist at Samitivej, Dr. Isares.  After reviewing my situation, he explained to me the HIFU method, advised me to do a resection of the prostate first and then HIFU treatment immediately after.  Everything passing through natural channels, thus without incision of the abdomen as with conventional open surgery.
I was admitted to the hospital on Monday, March 17, in late afternoon, treated Tuesday morning, sent to ICU Tuesday early afternoon, went back to my normal room on Wednesday and left Samitivej on Thursday.

I was struck by the quality of care that takes into account the medical pain as well as the person.  We are Saturday, I am at home and feel no pain or hindrance, except for the urinary catheter that will be removed next Tuesday.

I would like to thank Dr. Isares for his fantastic patient care and the great job he did, Dr. Sombat the anesthesiologist who was always by my side during surgery with epidural block, the nursing team and all the many “small hands” that made my short stay at Samitivej very pleasant.