Jonathan is 63 years old. He is now retired, having been self-employed for the past 24 years in the field of computer maintenance and software development. Jonathan had been having blood tests every two years, and at age 60 one of those regular tests indicated a PSA of 6.9.
Three months later another test showed that his PSA had risen to 7.8. Jonathan was referred to a urologist, and there he underwent a DRE and a further blood test. His PSA had dropped back to 6.3. On the advice of the urologist Jonathan had a biopsy, and of the twelve samples taken three were cancerous. With a Gleason score of 7 and a PSA now of 8.2, the urologist recommended surgery. Jonathan wanted a second opinion and wanted to speak with another urologist and a radiologist. The radiologist agreed that surgery was the best way to proceed. The second urologist looked very closely at the bone scan and noted that it was unclear whether the cancer was still encapsulated. However, he also advised that surgery was the best option.
In August 2016 Jonathan was booked in for a robotic radical prostatectomy in Melbourne. (At that time robotic surgery was not available in Geelong). “That was uneventful,” reports Jonathan, “I had one night in hospital, and post-operative blood tests showed that the PSA was undetectable.”
In November, three months after the surgery, Jonathan began to experience pain when sitting down. “It increased to an excruciating level over time.” He saw his local GP, who “… confirmed that I was in dire need of surgery.” Jonathan’s Melbourne urologist was contacted and he arranged for Jonathan to be admitted to hospital, and for an ultra-sound to be done. The ultra-sound confirmed the need for surgery for a fistula (an infection in the wall of the bowel). Jonathan remained in hospital, and the urologist arranged for him to be seen by a colo-rectal surgeon. That surgeon did some emergency surgery to successfully relieve the pain. He also advised that further surgery would be required. This extended over two years, and it included surgery on eight separate visits and three consultations before Jonathan was given the all clear – “My 63rd birthday present.”
The cause of the fistula is unknown. It may have been linked to an earlier colonoscopy, a very painful prostate biopsy, the surgery, or none of these. Throughout this period, Jonathan’s PSA always remained below .01.
Post-radical prostatectomy surgery continence was not an issue. “Only on a night of serious drinking might there be an issue, and that is very manageable,” reports Jonathan.
Jonathan had quite a network of support during this period. His older brother had had the experience of a radical prostatectomy five years earlier. That brother also suggested to Jonathan that there would be a local support group, which he joined. Attending meetings of the Geelong Prostate Support Group provided Jonathan with a level of assurance and comfort that the processes he had adopted were on track. Another area of his support network came from the medical staff at his wife Heather’s workplace. “But it was Heather who provided the greatest support throughout – for better or worse she transformed from being a lifetime romantic partner, to also being my specialist nurse.”
With the surgery all behind him, Jonathan is ready to enjoy retirement and operating at his own pace. He and Heather have bought a caravan, and plan to travel extensively with no planned return date. “I am going to do ‘nomad computers.’ I might work from our van, servicing the needs of grey nomads. I might provide support to disadvantaged schools that we might encounter along the way”.