You have been warned

PORTFOLIO POINT: Your health - much like your portfolio - should never be placed on cruise control.
It was just over a month ago at 7.30am on January 21 at the Epworth Hospital in Box Hill, Melbourne, when my surgeon Laurence Harewood walked into my room and told me that tests had confirmed that the removal of my prostate had been successful. The tumour had been contained.

Many of you may have wondered why I haven’t appeared in Eureka Report so far this year. Now you know. I am recovering well, so I want to start 2011 by sharing my experience in the hope that it may help other readers who find themselves in a similar situation.

Looking back over the last decade or so I believed in two fallacies – first that provided my urine was running well and the occasional (unpleasant but not painful) physical check was a negative I would not have a prostate problem. I am not sure how I came to have that opinion, but it was wrong.

As I now understand it, once you reach the stage where problems with your prostate are detected in the manner described above, it may mean that the tumour has moved outside the prostate. If this is the case, then removing the prostate may not be the solution and further treatment is likely to be required.

Because of cholesterol problems I have been having relatively regular blood checks. Over the last two or three years my GP has mumbled something about my PSA being a bit higher than it should be, but we didn’t do anything about it.

What he was testing for was the levels of prostate specific antigen in my blood. A raised PSA level can indicate prostate cancer, but it can also indicate events unrelated to cancer.

Late in 2009 my PSA jumped above seven, so the GP sent me to an urologist. At the time I really didn’t take much notice of the specialist that he had chosen, and so I didn’t realise the importance of that decision. If I had gone to an inexperienced urologist the outcome might have been different.

The urologist he sent me to was Associate Professor Laurence Harewood, who flashed into fame when he was the surgeon who handled Sam Newman’s prostate problems that were covered by Sixty Minutes.

Harewood immediately ordered a biopsy, which involves a general anaesthetic and taking a series of what I call core samples from the prostate (apologies to my geologist friends). These are then studied as the urologist tries to determine whether there is a tumour in the prostate.

Apparently most people are able to manage biopsies fairly easily and within a week or two life is back to normal. But back in 2009 I had a very different experience and I was raced off to hospital where I stayed for three days. I don’t remember much about the early part of that experience, except that I apparently kept bemoaning the fact that I hadn’t been able to send my latest Eureka Report column as usual.

Our editor James Frost came to the rescue and later went to my house to personally retrieve it. It took me about five or six weeks to recover from the physical effects of the biopsy, but recover I did. Laurence Harewood told myself and my wife, Barbara, that in one of the 16 samples he had encountered a small tumor and he gave me a series of options including the removal of prostate.

His advice was to not to remove the prostate at that stage but to do another biopsy in a year’s time. Many people carry small tumours in their prostate for their entire life and it was possible that I would be in that category.

Meanwhile in the next test the PSA fell back, although it was close to four and slightly higher than is was prior to the 2009 jump. So last December I had another biopsy. This was a much smoother test, but Harewood took 18 core samples and revealed that the tumor was larger and there were signs of a second one. I was given a Gleason score of six. A score of seven or eight was more dangerous, but I was too close to the danger level for comfort.

In theory I could have taken a punt, but almost immediately my wife and I decided that the prostate had to come out. Once that decision was made I was given exercises I had to undertake prior to the operation and extensive briefings on what would happen afterwards. Almost all the events took place, but on each occasion I knew why because I was well briefed.

There are two ways of removing a prostate – the first is via what can be termed conventional surgery, which is still widely practised around the country. But my GP had sent me to one of Australia’s experts in the DaVinci surgical system, which is robotic-aided key hole surgery. I am in no position to evaluate which is the best, except that for me the robotic system produced outcomes that were exactly as predicted.

The particular robotic machine at the Epworth hospital in Box Hill Melbourne was purchased five years ago and my prostate was the 421st removed by Laurence Harewood and his team over the last five years using the robotic DaVinci method. Harewood has embraced this new skill at age 60, which is an inspiration for other professionals who suddenly find new technology means a new set of procedures.

The worst feature of the robotic system is the initial pain, but in my case within in a day and half it substantially subsided and from then on every day got better. I had the operation on the Wednesday. By lunchtime Saturday I was home. Harewood believes you recover faster at home and he was right.

The catheter is obviously uncomfortable, but if your surgeon is experienced his team will brief you on how to manage it – and it is manageable. The hardest thing to manage is not so much the catheter but the wave of tiredness and the feelings of self pity that come over you, particularly at night. But once again I had been warned this would happen, and so I was alert and had a strategy to manage it.

Ten days after the operation the catheter was removed and Harewood showed me a map of my prostate, which showed the tumour was very close to the edge. Had I waited another six to 12 months the story might have been different.

My message to Eureka readers is first that while the PSA in itself is not a reliable indicator as to whether there is prostate problem or not, it appears to be the best early warning system that a biopsy may be required. I urge male Eureka readers aged over 40 to have regular blood tests and to check their PSA.

If it starts to creep up from two to three to four, or jumps further, have a serious discussion first with your GP and then with an urologist experienced in prostate removal. I will be forever grateful to my GP who saw the problem and referred me to a great surgeon. Meanwhile, I must emphasise again that PSA rises can have nothing to do with prostate cancer.

I have since learned that people who go bald in their 20s are supposed to be amongst the most vulnerable to prostate problems in later life. I am in that category but I was blessed with the knowledge of my problem before the tumour pierced the prostate wall and affected other parts of my body.

It should be the aim of all male Eureka readers to make sure they monitor their situation. I am constantly reminded that it was prostate cancer that has killed a number of people I knew including Dick Pratt. Had Pratt and others known what I now know, they would probably still be alive today.