Travels around my prostate #3

Written 8 March 2014

The operation was set for Tuesday 4 March.  Normally there is a 6 week to 3 month wait however I had told Kris Rasiah, my urologist, that I wanted to fly out of Australia on 26 May to attend my nephew’s wedding in California.  He managed to get a slot on the Robot machine at the SAN hospital in North West Sydney on 4 March so the date was set.

Also I had been recommend to go to Stuart Baptist prior to the operation to learn how to Kegel exercises – improving your pelvic floor muscles.  I saw him Friday 21 February and was very impressed.  He also told me that Kris Rasiah trained under Phillip Stricker (the name in Sydney) for several years and was his assistant.  When Rasiah decided to go out on his own Stricker was pulling his hair out to get as good a replacement.  This was comforting.

Having now watched the DVD they give you about the operation and learned about more nerve sparing as part of the benefits I did call Kris and said how about sparing the nerves. 

He first said that there were 3 objectives with a prostatectomy:

1.      Removal of any cancer

2.      Reducing the risk of incontinence

3.      Reducing the risk of erectile dysfunction.

In my case as I was 69 and obviously had had a good life the third objective was very low priority.

He then rang up and suggested another scan an MRI which again normally takes about 3-4 weeks to schedule but he found a slot in Randiwick (South Sydney) at 8am on Friday 28 Feb.  The scan came back that the cancer was localised on the right hand side of the prostate so Kris decided to keep the lymph nodes and nerves on the right. 

The operation was about six hours and started at 2pm.  My only two memories were the anaesthetist having difficulty inserting the canula in a big enough vein and meeting the back-up surgeon about 5 minutes going in who turned out to be some absolute gun who had done prostatectomies in Los Angeles, Paris, London etc at all the top hospitals.  My wife got a phone call at 9pm saying that it had gone very well.

The drawback of the robotic surgery is that they fill you with gas and it takes about 24 hours for the body to expel it.  It is a relatively painful experience but does pass.

The hospital was terrific.  I was in a private room right at the end of the corridor which was very quiet.  Vivienne could not believe how quiet it was and said Louisa would be so jealous.  She had our first granddaughter three weeks earlier and was in a private room between two squalling babies and had little sleep.  The nurses were great – I was impressed with the SAN.

Anyway we left the hospital on Friday catheter attached which comes out next Thursday.

This morning I had a phone call from Kris Rasiah who was particularly jubilant.

I have fantastic news.  The cancer was big 4.7cc and we regard over 2cc as large.  However it was localised on the right hand side but had not broken the capsule.  The dissection of the right hand lymph nodes showed no cancer present so the strategy of leaving the left lymph nodes and nerves alone was perfect.  On the other hand I am so glad we operated now as the cancer was bigger than any of us expected.  You could not have better news.

Travels around my prostate #2

This was written on 14 February 2014 post the biopsy procedure on Friday 17 January 2014

It has been an interesting couple of days.

First the very good news was that my diagnosed prostate cancer had not spread.  On Monday 3 February.  I had the CT and nuclear bone scans which were thankfully negative.

Secondly this must be the biggest men’s club in the world.  It seems 50% of all the people I now talk to have had prostate issues.  I have now since learnt the odds for getting some cancer in your life time are 1 in 2 for men and 1 in 3 for women.  Two forms (that’s me) is 1 in 10 and three types is 1 in 100.

When I started on this journey I had radiation treatment as preference over surgery on the basis the latter made you both incontinent and impotent.  Also I was worried about the risk of infection.  My good friend Antony Mayer has gone in for triple bypass which was meant to be for 7 days and 48 days later staggered out of the hospital because he had unfortunately picked up an infection.

I then learned about the ‘seeds’ or brachytherapy which as it takes only one day to insert and little risk of side effects sounded the best.  However during Tuesday’s meeting with the radiation doctor I found out my prostate is too big and I would require six months of female hormone therapy to reduce its size before they would contemplate putting in the radioactive iodine.  Also he would recommend a combined radiation procedure that would take visits every weekday for 6 weeks and if you have ever tried to park at Mater where the radiation would take place you would know that it was impossible.

Finally you can have radiation post surgery if there are complications, however as the radiation fries the prostate inside you surgery post radiation is much difficult.  Remembering both the great words from Hamlet:  We defy augury. There’s a special providence in the fall of a sparrow. If it be now, ’tis not to come. If it be not to come, it will be now. If it be not now, yet it will come—the readiness is all and the one bit of advice I kept getting was don’t mess around we decided to discard radiation..

So on Wednesday after a long discussion with the urologist we decided to do the operation ASAP.  You have two choices the robot (De Vinci) or open surgery.  The public health service only offers open as robot as it is too expensive so that made up my mind, robotic it is.  Here is a clip about the process http://www.youtube.com/watch?v=VJ_3GJNz4fg.

It turns out this is what why elder daughter Louisa had when they removed a dermoid cyst last year.

However there was another glitch is that I had to see a cardiologist to see if I my heart would survive the operation.  That was Friday’s little fun event but that went ok and I was given the go ahead.

The operation has now been provisionally booked for Tuesday 4 March.

Some interesting observations/advice:

If you are diagnosed with PC over 80 they just let you die.  Surgery is regarded as too dangerous.

Make sure you have drunk all the good wines in your cellar.

A dead man has no libido.

Travels around my prostate #1

This was written on 20 November 2013 and if you are over 50 and male could be the most important blog you will read this year

I have just finished reading The Signal and the Noise: The Art and Science of Prediction by Nate Silver. The book discusses a how a diverse set of forecasts ranging from politics, baseball and the weather are prepared, the errors that are often made and how in many cases ‘expert predictions’ should be treated with many grains of salt.

However a real strength of the book is the description of Bayesian reasoning in Chapter 8 which is a technique every manager should learn.  A lot of management effort and time is spent altering forecasts as new information is received.  Unfortunately most of us just apply such information intuitively.  Bayes allows to you make better predictions. This book made me really learn about Bayes Theorem.  I am the first to admit that although I had listened to lectures about Bayes at both Cambridge and London Business School I have never really sat down and learned it.

Simply put one starts out with a prior probability.   One then takes the probabilities of a new event being either true or false and then calculates a posterior probability. Say x equals the prior probability, y equals a new event probability that is true, and z equals a new event probability that is false. The posterior probability is xy over xy plus (1-x)z. The secret to Bayes is calculating both the true and false positives.  An example will make this much clearer.

Say for example there has been an accident in a city involving a taxi cab.

* 85% of the cabs in the city are white, and 15% are silver.

* A man identified the cab involved in a hit and run as silver.

* The court tested the witness' reliability, and the witness was able to correctly identify the correct color 80% of the time, and failed 20% of the time.

What is the probability the taxi cab was silver?

Here's how we figure it out using Bayes theorem.

If the cab was silver, a 15% chance, and correctly identified, an 80% chance, the combined probability is .15 * .8 = .12, a 12% chance. These are true positives.

If the cab was white, an 85% chance, and incorrectly identified, a 20% chance, the combined probability is .85 * .2 = .17, a 17% chance. These are false positives

Since the cab had to be either white or silver, the total probability of it being identified as silver, whether right or wrong, is .12 + .17 = .29. In other words, this witness could be expected to identify the cab as silver 29% of the time whether he was right or wrong.

The chances he was right are .12 out of .29, or 41% which I would suggest is much lower that people would expect.

Now recently I took a PSA test and my reading was above the supposed danger level.  What is the probability I have prostate cancer?

The chances of having prostate cancer at various ages are as follows:

For a man in his 40s - 1 in 1000

For a man in his 50s - 12 in 1000

For a man in his 60s - 45 in 1000

For a man in his 70s - 80 in 1000

I am 69 so my chances of prostate cancer would be 63 in 1000. However I have now had a positive PSA test result.

Now according to a medical website for every 100 men over age 50, with no symptoms, who have the PSA test:

10 men out of 100 tested will have a higher than normal level of PSA. These men must then go through other tests and examinations. At the end of these tests:

• Three of the ten men with a higher than normal PSA level will be found to have prostate cancer.

• Seven of the 10 men with a higher than normal PSA level will be found not to have prostate cancer at the time of screening.

90 men out of 100 tested will have a normal PSA level. Of these 90 men:

• 88 of the men with a normal PSA level will not have prostate cancer.

• One or two of the men with a normal PSA level will actually have prostate cancer, undetected by the test.

The probability that the PSA test gives a true positive for me is 0.063 x 88/90 or 0.0616 (xy in the formula; note two people out of 90 are missed.)

The probability that the PSA test gives a false positive for me is 0.927 x .07 or 0.0656 ((1-x)z in the formula.

The sum of the true and false positives is 0.1272 and so according to Bayes the probability that I have prostate cancer is 48% which is much higher than I originally thought and means that I will definitely go forward with a biopsy.  

I never would have come to this conclusion without reading Silver's book. 

Chris Golis Australia's expert on practical emotional intelligence website: www.thehummhandbook.com Linkedin: www.linkedin.com/in/chrisgolis blog: blogs.bnetau.com.au/aussierules/category/improving-your-eq/ mobile: +61-418-222219