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Enlarged Prostate Treatment Without Surgery …

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Enlarged Prostate Treatment Without Surgery …
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Posted by:
Greg Lance – Watkins
Greg_L-W

eMail: Greg_L-W@BTconnect.com

https://InfoWebSiteUK.wordpress.com

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.

Hi,

having had my VERY enlarged Prostate [Benign Prostatic Hyperplasia (BPH)] operated on on Tuesday I was waiting to be TWOCed (Trial Without Catheter) on Wednesday morning in a hospital bed when the hospital paper trolley came round and the front page headline was:

Prostate therapy without surgery: Thousands of men to benefit from new technique that uses plastic beads to block blood supply and shrink the enlarged gland 

  • Successful trial in Portugal being followed up in UK with results due this year
  • If it is successful the technique could be rolled out for routine use on the NHS 
  • Researchers expect it to largely replace surgery as the standard treatment

Tens of thousands of men could benefit from a breakthrough prostate treatment announced today.

The technique uses tiny plastic beads to block the blood supply and shrink the enlarged gland – all without an operation.

A successful trial in Portugal is being followed up in Britain, with results due back later this year. If successful it could be rolled out for routine use on the NHS.

Half of all men over 50 suffer from an enlarged prostate and every year 45,000 have risky surgery to remove part of it.

As well as being painful and invasive, the operation can cause loss of sexual function and even incontinence. The technique uses tiny plastic beads to block the blood supply and shrink the enlarged gland – all without an operation

The technique uses tiny plastic beads to block the blood supply and shrink the enlarged gland – all without an operation

Last night, researchers said they expected the new technique – prostate artery embolisation – to largely replace surgery as the standard treatment.

An enlarged prostate presses on the bladder, while also blocking the urethra. This means sufferers need to make repeated night-time trips to the toilet, often to find they cannot urinate at all.

This can lead to a build-up of toxins that cause severe kidney problems. The bead technique has been tested on 1,000 middle-aged men in Portugal.

Joao Martins Pisco, who led the study at St Louis Hospital in Lisbon, said: ‘Within five years I think this will replace surgery as the standard treatment.

‘Prostate artery embolisation gives men a treatment option that is less invasive than other therapies and allows them to return to their normal lives sooner. 

Time and time again, I see patients who are relieved to find out about prostate artery embolisation because they are not able to tolerate medications due to their side effects.

‘These men also don’t want traditional surgery because it involves greater risks, has possible sexual side effects, and has a recovery time that is relatively long compared to prostate artery embolisation, which is generally performed under local anaesthesia and on an outpatient basis.’

The Portuguese team, which will present its findings at the Society of Interventional Radiology in Washington DC today, concluded the procedure is as effective as surgery and the benefits may last as long. 

Half of all men over 50 suffer from an enlarged prostate and every year 45,000 have risky surgery to remove part of it

Half of all men over 50 suffer from an enlarged prostate and every year 45,000 have risky surgery to remove part of it

Only two patients in the seven-year trial had clinical side effects.

Performed under local anaesthetic, the procedure involves injecting hundreds of 0.2mm plastic beads into an artery in the groin. 

The beads are directed with a thin tube into the blood vessels that flow to the prostate, blocking blood supply to the enlarged gland so that it shrinks.

Dr Pisco added: ‘I have had nine babies born to men who were able to continue their sex lives after having the treatment.’ 

His team saw a 89 per cent success rate six months after surgery, 82 per cent success up to three years, and 78 per cent beyond three years.

Two hundred patients in Southampton General, Guy’s Hospital in London and 16 other clinics are involved in the British trial, which is part-funded by the clinical watchdog NICE.

Dr Nigel Hacking, who is leading the study, said: ‘It is very encouraging. I am always cautious about new techniques but this procedure seems to be showing promise and it seems to be safe.’

Louise de Winter of the Urology Foundation said: ‘This research is very exciting.

‘As the population ages these problems are going to get even more acute.’

An estimated 45,000 men undergo surgery for enlarged prostates every year in the UK.

Dr Pisco claims most of these could be replaced by prostate artery embolisation – although others say the less invasive procedure is not be suitable for all men, and many will have to continue to have surgery.

Two hundred patients in Southampton General (pictured) Guy’s Hospital in London and 16 other clinics are involved in the British trial

Two hundred patients in Southampton General (pictured) Guy’s Hospital in London and 16 other clinics are involved in the British trial

Dr Hacking said that in his own experience, roughly 40 per cent of patients who have embolisation later have to undergo operations.

But having initial embolisation may enable them to delay that operation while retaining sexual function, and this usually means that when they do come to have an operation it is less invasive and there is a lower risk of side effects.

‘Even if they do need to go back and have surgery it’s a smaller operation,’ he said.

Dr Hacking said it was unlikely the procedure will completely replace surgery, because it requires a highly trained interventional radiologist.

‘It is a fiddly procedure and it would be potentially dangerous for someone without the skills to do it,’ he said.

‘But I think it may give men another option alongside surgery.’

Surgery, conducted either with a hot wire or lasers, have a high success rate – but they come with side effects which can include loss of sexual function, bleeding and incontinence.

The symptoms of enlarged prostate include a frequent need to urinate, but also difficulty starting to urinate and difficulty fully emptying a bladder. 

These symptoms, however, also might be a sign of prostate cancer, so anyone in this way should be seen by a urologist.

To view the original article CLICK HERE

 For another take on the same issue but in a different paper, minded this was added 2 days later & is largely a lift from the first article:

Bead treatment can save men from prostate surgery

About 45,000 men are offered surgery to relieve the symptoms of an enlarged prostate every yearJEFF PACHOUD/Getty Images

Doctors have welcomed an “exciting” technique that could spare tens of thousands of men surgery for an uncomfortable prostate problem.

The NHS treatments adviser is studying closely a procedure that injects tiny plastic beads into arteries to block blood flow to the prostate after research found it safe and effective.

About half of older men have an enlarged prostate. Although it is not a serious health threat, sufferers have problems urinating and their nights are disrupted by frequent lavatory visits.

Medication is often used and an estimated 45,000 men a year are offered surgery to cut away part of the prostate and relieve the pressure of the gland against the urethra.

This requires at least a night in hospital. It also often requires several weeks of recuperation and carries the risk of complications.

Now a trial of 1,000 men has found that the less invasive method of starving the prostate appears to be as good as surgery.

Success rates were 89 per cent after six months, 82 per cent after more than a year and 78 per cent after more than three years, researchers told the Society of Interventional Radiology in Washington yesterday. Only two patients suffered side-effects such as pain.

João Martins Pisco, who led the study at St Louis Hospital in Lisbon, told the Daily Mail: “Within five years I think this will replace surgery as the standard treatment. Prostate artery embolisation gives men a treatment option that is less invasive than other therapies and allows them to return to their normal lives sooner.

“Time and time again, I see patients who are relieved to find out about prostate artery embolisation because they are not able to tolerate medications due to their side-effects.

“These men also don’t want traditional surgery because it involves greater risks, has possible sexual side effects, and has a recovery time that is relatively long compared to prostate artery embolisation, which is generally performed under local anaesthesia and on an outpatient basis.”

A British trial is under way with help from the National Institute for Health and Care Excellence (Nice), which will look at whether the method should be routine on the NHS. Nigel Hacking, of University Hospitals Southampton, who is leading the British research, said: “It is very encouraging. I am always cautious about new techniques but this procedure seems to be showing promise and it seems to be safe.”

Louise de Winter, of the Urology Foundation, said: ‘This research is very exciting. As the population ages these problems are going to get even more acute.”

Last year Nice approved a laser treatment for enlarged prostates to destroy excess tissue, achieving the same results as surgery but allowing men to spend a third less time in hospital.

To view the original article CLICK HERE

Regards,
Greg_L-W.

~~~~~~~~~~#########~~~~~~~~~~
Posted by: Greg Lance-Watkins
tel: 44 (0)1594 – 528 337
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  10. I AM opposed to British membership of The EU
  11. I AM opposed to Welsh, Scottish or English Independence within an interdependent UK
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  14. I AM strongly opposed to the subsidy or use of failed technologies eg. WIND TURBINES
  15. I AM IN FAVOUR of rapid research & development of NEW NUCLEAR technologies
  16. I see no evidence to trust POLITICIANS at any level or of any persuasion
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  18. I value the NHS as a HEALTH SERVICE NOT a Lifestyle support
  19. I believe in a DEATH PENALTY for serial or GBH rape.
  20. I believe in a DEATH PENALTY for serial, terrorist, mass or for pleasure murder.
  21. I believe in a DEATH PENALTY for serial gross child abuse including sexual.
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A TURP op. (PROSTATE) Royal Gwent Urology Dept. Day Unit 07-Mar-2017 …

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A TURP op. (PROSTATE) Royal Gwent Urology Dept. Day Unit 07-Mar-2017 …
~~~~~~~~~~#########~~~~~~~~~~

Posted by:
Greg Lance – Watkins
Greg_L-W

eMail: Greg_L-W@BTconnect.com

https://InfoWebSiteUK.wordpress.com

www.InfoWebSite.UK

~~~~~~~~~~#########~~~~~~~~~~

.

Hi,

a TURP (Trans Urithral Resection of the Prostate)

prostate-03-turp-trans-urithral-resection-of-prostate

Yesterday afternoon I received a phonecall from Steff, in the Gwent Urology Unit, offering me the chance of bringing forward my appointment, due on 23-Mar-2017, for my TURP (Trans Urethral Resection of the Prostate) to tomorrow morning!

Steff suggested that I came into the Urology Day Unit by 10am, having nothing to eat or drink after midnight, so that I could be ready for anaesthetic in the morning if there was any delay or drop out by another patient – meanwhile assuring me that Adam Carter (my consultant urology surgeon) and the consultant anaethetist he had wanted for my op. would deffinitely have an alocated time for me in the afternoon if there was no morning cancellation.

As it turned out my op. was done just before lunch using an epidural anaesthetic – that is the one administered by an injection into the lower back, the downside of this form of anaesthetic, which deadens the nerves roughly below the point of the injection, is that it can, when the patient is taking anti-coagulants as I am, that if ANY mistake is made it can lead to bleeding into the spinal column which in turn CAN lead to long term paralysis!

The advantage, on the other hand is that it does not lead to unconciousness, as with a GA (General Anaesthetic) thus not only does it not leave anaesthetic in the system for a prolongued period after the operation, but it also meant, which I have alwaqys favoured, that I would be fully conscious and able to watch the operation being done on the screen.

Watching the surgeon slice away your own prostate from inside the bladder, whilst chatting about what he is doing, is a VERY strange experience!

The operation went well and just over an hour after the injection in the spine it was finished and after Adam had shown me the glass jar containing all the little bits he had cut away, which was quite a lot, I was transfered from the operating table onto the trolley and wheeled off to recovery where it took quite a while to get my temperature back up!

During the operation there is a constant flow of saline from the stand via the tube, into the bladder and out, sluicing the debris and clearing the blood so that the surgeon can see exactly what he is doing. During the operation I counted around 19 x 2L square plastic bottles of fluid so around 40Ls of relatively cold fluid, which drops the body temperature during the hour of the operation.

Then with a guage 22 three way catheter in place it was off to Ward D5East for a couple of days until the bleeding had slowed down a bit! Eventually, although I was still bleeding quite heavily and still had a 3 way catheter in, Adam Carter responded to my pleas to go home, where I could recover in greater comfort and with much better food! 3 days later the bleeding had reduced dramatically and I went back into the Gwent where despite no allocated ‘slot’ Steff fitted me in between other patients and and removed my catheter so that I could be TWOCed (Trial With Out Catheter), which once I had proved I could safely pass urine I was able to go home.

That is not to say that the bleeding has stopped! Minded that the operation was on the 8th. and it is now the 31st. there is still a small amount of bleeding – I guess mowing the lawn today didn’t help!

That said there seems no doubt that the operation would seem to have been a great success and at least I am not having to get up 3, 4 or 5 times a night to go to the toilet, which was the outcome of having a greatly enlarged prostate! The other great result of the operation was a letter from Adam Carter, the day before yesterday, to tell me that all the tissue he removed from my prostate (the jar!) had been biopsied and had been found to be perfectly normal prostate tissue free of any signs or traces of cancer.

A very reassuring outcome – I can recommend this operation to anyone with Benign prostate enlargement (BPE), also known as benign prostatic hyperplasia (BPH), a condition that affects older men (yep that’s me at 71!). Several friends of mine have had the op. with great outcomes and at the moment a friend of mine in his mid 50s is in The Royal Gloucester hospital with an enlarged prostate, which has inhibitted voiding of the bladder that has led to a severe UTI (Urinary Tract Infection), which in turn led to blocking of the urethra last Sunday night, leading to a blue lit ride in an ambulance, in extreme pain, in the early hours of Monday and now in the early hours of Saturday they finally removed his catheter but are still battling to control the infection and get his temperature down!

I expect that a TURP is very much on the cards for him, once the infection is cleared and his regular urologist can get him a bed in the Royal Gwent for the operation.

In my case – thanks to Adam Carter, Steff and the rest of the team who looked after me in the Gwent.

Regards,
Greg_L-W.

~~~~~~~~~~#########~~~~~~~~~~
Posted by: Greg Lance-Watkins
tel: 44 (0)1594 – 528 337
Calls from ‘Number Withheld’ phones Are Blocked

All unanswered messages are recorded.
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NB:
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  2. ALL MY BLOGS & WEB SITES are clearly sourced to me
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  4. I do NOT use or bother reading FaceBook
  5. I DO have a Voice Mail Message System
  6. I ONLY GUARANTEE to answer identifiable eMails
  7. I ONLY GUARANTEE to phone back identifiable UK Land Line Messages
  8. I do NOT accept phone calls from witheld numbers
  9. I Regret due to BT in this area I have a rubbish Broadband connection
  10. I AM opposed to British membership of The EU
  11. I AM opposed to Welsh, Scottish or English Independence within an interdependent UK
  12. I am NOT a WARMIST
  13. I do NOT believe the IPCC Climate Propaganda re Anthropogenic Global Warming
  14. I AM strongly opposed to the subsidy or use of failed technologies eg. WIND TURBINES
  15. I AM IN FAVOUR of rapid research & development of NEW NUCLEAR technologies
  16. I see no evidence to trust POLITICIANS at any level or of any persuasion
  17. I do NOT believe in GODS singular or plural, Bronze Age or Modern
  18. I value the NHS as a HEALTH SERVICE NOT a Lifestyle support
  19. I believe in a DEATH PENALTY for serial or GBH rape.
  20. I believe in a DEATH PENALTY for serial, terrorist, mass or for pleasure murder.
  21. I believe in a DEATH PENALTY for serial gross child abuse including sexual.
  22. I do NOT trust or believe in armed police
  23. I do NOT believe in prolonging human life beyond reasonable expectation of sentient participatory intellectual existence
  24. I believe in EUTHENASIA under clearly defined & legal terms
  25. I try to make every effort to NOT infringe copyrights in any commercial way & make all corrections of fact brought to my attention by an identifiable individual

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23-Feb-2017 – 10:30hrs. Royal Gwent Urology Dept. Day Unit for A TURP op.

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23-Feb-2017 – 10:30hrs. Royal Gwent Urology Dept. Day Unit for A TURP op. :
~~~~~~~~~~#########~~~~~~~~~~

Posted by:
Greg Lance – Watkins
Greg_L-W

eMail: Greg_L-W@BTconnect.com

https://InfoWebSiteUK.wordpress.com

www.InfoWebSite.UK

~~~~~~~~~~#########~~~~~~~~~~

.

Hi,

well if I was in any doubt that I needed this op. the numberr of times I woke and had to go to the toilet during the last few nights was fairly convincing! One starts to wonder why one goes to bed if you get up in the morning more tired than you were at bed time, the odd nap not withstanding!

So anyway we got up showered etc. in a less leisurely manner than normal – then checked I had meds. and other kit sorted and off to the Royal Gwent, in Lee’s car the buffeting of Storm Doris was considerably more noticeable than in the Volvo!
Lee dropped me off and ensured that I wasn’t subject to an NHS unscheduled cancellation but all is well and at least I know all the medical staff apart from the young Doctors on rotation! I must have had around 14 or 15 trans urithral procedures for bladder cancer etc. over the years.
This is somewhat more consequential but much the same.
So it was now the waiting game I had to check in in the morning but I am on Adam Carter’s afternoon list due for 14:00hrs.
Registrar Matt came round explained procedure yet again.
Then Catlin (Consultant Anaethatist) was with me for about half an hour! Going through details and facts and finally arriving at the conclusion that she was not happy to do the op. without a direct instruction and further discussion as she felt on a rough estimate that there was a 10 to 15% chance that due to anti coagulents I might well bleed sufficiently to catastophicly drop my haemaglobin level qand supply of oxygen to my heart thus inducing a heart attack that could/would prove fatal for me.
So it was time for all to think again!
I said I believed that the risk was mine to take and if this was the best odds available I would go ahead!
After prolongued conversation with Adam Carter (Head of Urology) who I have had as my consultant for many years and further talk with Catlin we have decided to try to improve the odds by closer contact with my cardiology consultant Patrick and ensuring Catlin & Adam were hands on for the op. and a HDU (High Dependency Unit) bed was available, pre booked for 3 or 4 days, for me so that I can be closely monitored after the op.
So now we are aiming for 23-Mar-2017 to go ahead with everything in place!
If you are reading this as a prospective TURP patient or a friend of someone about to have one DO NOT PANIC – each person is very different and my case is fairly extreme as I have no lefy coronary artery, and have had a massive heart attck as a result and already I am a bit of a miracle to be here atall! My coronary consultant has said I must take anti coagulant daily and this increases bleeding and the risk as a TURP under those circumstances can bleed heavily and take longer to heal. So don’t panic – I’ve had TURPs previously to my heart attack and had absolutely no problems.
Regards,
Greg_L-W.

~~~~~~~~~~#########~~~~~~~~~~
Posted by: Greg Lance-Watkins
tel: 44 (0)1594 – 528 337
Calls from ‘Number Withheld’ phones Are Blocked

All unanswered messages are recorded.
Leave your name & a UK land line number & I will return your call.

‘e’Mail Address: Greg_L-W@BTconnect.com

DO MAKE USE of LINKS,
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Also:

ABOUT ME, Details & Links: CLICK HERE
Accuracy & Copyright Statement: CLICK HERE
UKIP Its ASSOCIATES & DETAILS: CLICK HERE
Summary & archive, facts & comments on Ukip: http://Ukip-vs-EUkip.com
General ‘Stuff’: http://GL-W.com
Leave-The-EU Referendum & BreXit Process CLICK HERE
Documents, Essays & Treaties: CLICK HERE
The Hamlet of Stroat: CLICK HERE
Data & The Study of a Wind Turbine Application: CLICK HERE
Health Blog.: CLICK HERE
Chepstow Chat: CLICK HERE
Christopher Story: CLICK HERE
Des Watkins DFC; CdeG: CLICK HERE/
Hollie Greig etc.: CLICK HERE
Psycheocracy: CLICK HERE
The McCann Case: CLICK HERE
The Speculative Society of Edinburgh: CLICK HERE
Stolen Kids, Dunblane: CLICK HERE
Stolen Kids, Bloggers: CLICK HERE
Views I respect & almost Totally Share: CLICK HERE
A Concept of Governance Worthy of Developement: CLICK HERE

Skype: GregL-W

TWITTER: @Greg_LW

Stolen Kids Blogs with links:
http://StolenKids-Bloggers.Blogspot.com
Stolen Oyster with links:
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Stolen Trust with links:
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Stolen Childhood with links:
http://StolenChildhood-Bloggers.Blogspot.com
NB:
  1. I NEVER post anonymously on the internet
  2. ALL MY BLOGS & WEB SITES are clearly sourced to me
  3. I do NOT use an obfuscated eMail address to hide behind
  4. I do NOT use or bother reading FaceBook
  5. I DO have a Voice Mail Message System
  6. I ONLY GUARANTEE to answer identifiable eMails
  7. I ONLY GUARANTEE to phone back identifiable UK Land Line Messages
  8. I do NOT accept phone calls from witheld numbers
  9. I Regret due to BT in this area I have a rubbish Broadband connection
  10. I AM opposed to British membership of The EU
  11. I AM opposed to Welsh, Scottish or English Independence within an interdependent UK
  12. I am NOT a WARMIST
  13. I do NOT believe the IPCC Climate Propaganda re Anthropogenic Global Warming
  14. I AM strongly opposed to the subsidy or use of failed technologies eg. WIND TURBINES
  15. I AM IN FAVOUR of rapid research & development of NEW NUCLEAR technologies
  16. I see no evidence to trust POLITICIANS at any level or of any persuasion
  17. I do NOT believe in GODS singular or plural, Bronze Age or Modern
  18. I value the NHS as a HEALTH SERVICE NOT a Lifestyle support
  19. I believe in a DEATH PENALTY for serial or GBH rape.
  20. I believe in a DEATH PENALTY for serial, terrorist, mass or for pleasure murder.
  21. I believe in a DEATH PENALTY for serial gross child abuse including sexual.
  22. I do NOT trust or believe in armed police
  23. I do NOT believe in prolonging human life beyond reasonable expectation of sentient participatory intellectual existence
  24. I believe in EUTHENASIA under clearly defined & legal terms
  25. I try to make every effort to NOT infringe copyrights in any commercial way & make all corrections of fact brought to my attention by an identifiable individual

Please Be Sure To
.Follow Greg_LW on Twitter.

Re-TWEET my Twitterings

& Publicise My Blogs
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~~~~~~~~~~#########~~~~~~~~~~

pre-op for TURP – 08-Feb-2017 – 14:30hrs. Royal Gwent Urology Dept.

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pre-op for TURP – 08-Feb-2017 – 14:30hrs. Royal Gwent Urology Dept. :
~~~~~~~~~~#########~~~~~~~~~~

Posted by:
Greg Lance – Watkins
Greg_L-W

eMail: Greg_L-W@BTconnect.com

https://InfoWebSiteUK.wordpress.com

www.InfoWebSite.UK

~~~~~~~~~~#########~~~~~~~~~~

.

Hi,

well that was very straightforward!

I arrived very early as the management of the Royal Gwent leaves much to be desired, most noticeably on the issue of parking! For over a year now the car park at the hospital has been a building site where they have been building a really ugly structure that looks for all the world like porta cabins faced with tedious red brick with defacing paterns in a yellowy coloured brick – to replace the porta cabins that have housed A&E for years.

There is now virtually no parking at the Royal Gwent rendering the hospital even more dysfunctional than control of the Trust has increasingly been under5 the aegis of the National Ass. for Wales! (so aptly named).

I was fotunate and found space at my regular side street parking (sorry no clues 😉

Arriving at the urology department I popped in to see a few ‘old friends’ staff who have been providing me with excellent treatment for almost 20 years now, yes there are a few who have been in that department that long including two nurse practitioners Maureen and Janet.

I was fortunate to bump into Adam Carter my Consultant, who I last saw in June last year when we discussed the advisability of my having a TURP (Trans Urithral Resection of the Prostate)

prostate-03-turp-trans-urithral-resection-of-prostate

and he decided this should be scheduled as urgent! The aim being not to remove the prostate gland, which should be about the size of a walnut, but in many older men (& yes I have reached that stage!) the prostate becomes enlarged. Thus the aim is to cut away (resection) part of the gland to reduce its size as it can cause difficulty in urinating but also causes increased fgrequency, poor flow and urgency! We had a somewhat woefull laugh at the state of the service under the National Ass. for Wales’ management such that urgent had finally brought me in 7 months later for my pre op.!

Once again Teresa carried out my pre op. with the normal range of urine test, questions, swabs of mouth, nose and groin to check for any infections, blood test, normal obs. (weight, blood pressure, Oxygen levels, pulse rate, temperature etc.) + a detailed check on my all too dodgey heart and finally an ECG.

I was pronounced fit to join Adam Carter’s list for surgery but with the proviso that my results were cleared by my Cardiologist and the Anasthetic Department was aware and appointed a suitable consultant anethetist to manage any problems that might develope during the procedure – including, I pressume, the detail that my heart might stop!

The normal procedure in the Gwent Urology Department is that on the next working day, Bridget who is responsible for scheduling and the battle with the bed management department in the hospital phones and lets you know when and where to turn up to be sliced and diced!

Because of the checks with other departments it was not until the following Thursday that she was able to alocate a ‘slot’.

I am now due in at 10:30hrs. on Thursday the 23-Feb-2017 showered (no creams or talcs. etc) having had nothing to eat and only a small amount of plain water to drink that day – I will be on Adam Carter’s list for operation that afternoon and since I have to have a full anasthetic I will be in, at least, overnight!

I would normally have had this op. on an epidural block where they inser a needle into the lower spine and anethatise the nerve serving the body from there down – however as I am on blood thinners to cope with my heart and the absence of a Right Coronary Artery a needle in the spine can cause a bleed that could result in paralysis, if not worse!

My urology consultant would rather I stopped taking the blood thinners but my cardiologist rather ruefully points out that I can continue to function with a hugely enlarged prostate and a dodgey bladder but I wont last much over a few minutes without a hear!

All rather a simple decision, but it does make my surgeon’s job a little harder and calls for a consultant anethetist!

Somewhat like Arnie – ‘I will be back’ with details after the op. I may even have some diagrams but I promise no photos!

Think of Lee on Thursday for whilst I’m sleeping my way through the whole procedure she will, yet again, be concerned about the outcome!

Regards,
Greg_L-W.

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Posted by:
Greg Lance – Watkins
Greg_L-W

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.

Hi,

Prostate Cancer: Stages and Grades

Approved by the Cancer.Net Editorial Board, 01/2017

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread, as well as what the cancer cells look like under a microscope. This is called the stage and grade. To see other pages, use the menu.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer’s stage, so staging may not be complete until all of the tests are finished. Staging for prostate cancer also involves looking at test results to find out if the cancer has spread from the prostate to other parts of the body. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

There are 2 types of staging for prostate cancer:

  • The clinical stage is based on the results of tests done before surgery, which includes DRE, biopsy, x-rays, CT and/or MRI scans, and bone scans. X-rays, bone scans, CT scans, and MRI scans may not always be needed. They are recommended based on the PSA level; the size of the cancer, which includes its grade and volume; and the clinical stage of the cancer.
  • The pathologic stage is based on information found during surgery, plus the laboratory results, referred to as pathology, of the prostate tissue removed during surgery. The surgery often includes the removal of the entire prostate and some lymph nodes.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?
  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?
  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4). The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.

Here are more details about each part of the TNM system for prostate cancer.

Tumor (T)

Using the TNM system, the “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. Specific tumor stage information is listed below.

TX: The primary tumor cannot be evaluated.

T0 (T plus zero): There is no evidence of a tumor in the prostate.

T1: The tumor cannot be felt during a DRE and is not seen during imaging tests. It may be found when surgery is done for another reason, usually for BPH or an abnormal growth of noncancerous prostate cells.

  • T1a: The tumor is in 5% or less of the prostate tissue removed during surgery.
  • T1b: The tumor is in more than 5% of the prostate tissue removed during surgery.
  • T1c: The tumor is found during a needle biopsy, usually because the patient has an elevated PSA level.

T2: The tumor is found only in the prostate, not other parts of the body. It is large enough to be felt during a DRE.

  • T2a: The tumor involves one-half of 1 lobe (part or side) of the prostate.
  • T2b: The tumor involves more than one-half of 1 lobe of the prostate but not both lobes.
  • T2c: The tumor has grown into both lobes of the prostate.

T3: The tumor has grown through the prostate capsule on 1 side and into the tissue just outside the prostate.

  • T3a: The tumor has grown through the prostate capsule either on 1 side or on both sides of the prostate, or it has spread to the neck of the bladder. This is also known as an extraprostatic extension (EPE).
  • T3b: The tumor has grown into the seminal vesicle(s), the tube(s) that carry semen.

T4: The tumor is fixed, or it is growing into nearby structures other than the seminal vesicles, such as the external sphincter, the part of the muscle layer that helps to control urination; the rectum; levator muscles; or the pelvic wall.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes near the prostate in the pelvic region are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to the regional (pelvic) lymph node(s).

Metastasis (M)

The “M” in the TNM system indicates whether the prostate cancer has spread to other parts of the body, such as the lungs or the bones. This is called distant metastasis.

MX: Distant metastasis cannot be evaluated.

M0 (M plus zero): The disease has not metastasized.

M1: There is distant metastasis.

  • M1a: The cancer has spread to nonregional, or distant, lymph node(s).
  • M1b: The cancer has spread to the bones.
  • M1c: The cancer has spread to another part of the body, with or without spread to the bone.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classification. See the table below the stage descriptions for all of the TNM combinations for each stage.

Stage I: Cancer is found in the prostate only, usually during another medical procedure. It cannot be felt during the DRE or seen on imaging tests. A stage I cancer is usually made up of cells that look more like healthy cells and is usually slow growing. 

Stage I Prostate Cancer

Stage IIA and IIB: This stage describes a tumor that is too small to be felt or seen on imaging tests. Or, it describes a slightly larger tumor that can be felt during a DRE. The cancer has not spread outside of the prostate gland, but the cells are usually more abnormal and may tend to grow more quickly. A stage II cancer has not spread to lymph nodes or distant organs. 

Stage IIA Prostate Cancer

Stage IIB Prostate Cancer

Stage III: The cancer has spread beyond the outer layer of the prostate into nearby tissues. It may also have spread to the seminal vesicles. 

Stage I Prostate Cancer

Stage IV: This stage describes any tumor that has spread to other parts of the body, such as the bladder, rectum, bone, liver, lungs, or lymph nodes. 

Stage IV Prostate Cancer

Recurrent: Recurrent prostate cancer is cancer that has come back after treatment. It may come back in the prostate area again or in other parts of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Stage Grouping Chart

Stage

T

N

M

I

T1a, T1b, or T1c

N0

M0

 

T2a

N0

M0

 

Any T1 or T2a

N0

M0

 

 

 

 

IIA

T1a, T1b, or T1c

N0

M0

 

T1a, T1b, or T1c

N0

M0

 

T2a

N0

M0

 

T2b

N0

M0

 

T2b

N0

M0

 

 

 

 

IIB

T2c

N0

M0

 

Any T1 or T2

N0

M0

 

Any T1 or T2

N0

M0

 

 

 

 

III

T3a or T3b

N0

M0

 

 

 

 

 

 

 

 

IV

T4

N0

M0

 

Any T

N1

M0

 

Any T

Any N

M1

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org

Gleason score for grading prostate cancer

Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.

The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 1 to 5. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the doctor determines the main pattern of cell growth, which is the area where the cancer is most obvious; looks for any other less common pattern of growth; and gives each 1 a score. The scores are added together to come up with an overall score between 2 and 10.

The interpretation of the Gleason score by doctors has changed recently. Originally, doctors used a wide range of scores. Today, doctors no longer use Gleason scores of 5 or lower for cancer found with a biopsy. The lowest score used is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.

Doctors look at the Gleason score in addition to stage to help plan treatment. For example, active surveillance, described in the Treatment Options section, may be an option for a patient with a small tumor, low PSA level, and a Gleason score of 6. Patients with high Gleason score may need treatment that is more intensive, even if it does not appear that the cancer has spread.

Gleason X: The Gleason score cannot be determined.

Gleason 6 or lower: The cells are well differentiated, meaning they look similar to healthy cells.

Gleason 7: The cells are moderately differentiated, meaning they look somewhat similar to healthy cells.

Gleason 8, 9, or 10: The cells are poorly differentiated or undifferentiated, meaning they look very different from healthy cells.

Recently, pathologists have begun to adopt a new Gleason grouping system that arranges the scores into simplified groups that are translated as follows:

  • Gleason Group I = Former Gleason 6
  • Gleason Group II = Former Gleason 3 + 4 = 7
  • Gleason Group III = Former Gleason 4 + 3 = 7
  • Gleason Group IV = Former Gleason 8
  • Gleason Group V = Former Gleason 9 or 10

Prostate Cancer Risk Groups

In addition to stage, doctors use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Two such risk assessment methods come from the National Comprehensive Cancer Network (NCCN) and the University of California, San Francisco (UCSF).

NCCN

The NCCN developed 4 risk-group categories based on PSA level, prostate size, needle biopsy findings, and the stage of cancer. The lower your risk, the lower the chance that the prostate cancer will grow and spread.

  • Very low risk. The tumor cannot be felt during a DRE and is not seen during imaging tests but was found during a needle biopsy (T1c). PSA is less than 10 ng/mL. The Gleason score is 6 or less. Cancer was found in fewer than 3 samples taken during a core biopsy. The cancer was found in half or less of any core.
  • Low risk. The tumor is classified as T1a, T1b, T1c, or T2a (see above). PSA is less than 10 ng/mL. The Gleason score is 6 or less.
  • Intermediate risk. The tumor has 2 or more of these characteristics:
    • Classified as T2b or T2c (see above)
    • PSA is between 10 and 20 ng/mL
    • Gleason score of 7
  • High risk. The tumor has 2 or more of these characteristics:
    • Classified as T3a (see above)
    • PSA level is higher than 20 ng/mL
    • Gleason score is between 8 and 10
  • Very high risk. The tumor is classified as T3b or T4 (see above). The histologic grade is 5 for the main pattern of cell growth, or more than 4 biopsy cores have Gleason scores between 8 and 10.

Source: Risk group information is adapted from the NCCN.

UCSF Cancer of the Prostate Risk Assessment (UCSF-CAPRA) score

The UCSF-CAPRA score predicts a man’s chances of having the cancer spread and of dying. This score can be used to help make decisions about the treatment plan. Points are assigned according to a person’s age at diagnosis, PSA at diagnosis, Gleason score of the biopsy, T classification from the TNM system, and the percentage of biopsy cores involved with cancer. These categories are then used to assign a score between 0 and 10.

  • CAPRA score 0 to 2 indicates low risk.
  • CAPRA score 3 to 5 indicates intermediate risk.
  • CAPRA score 6 to 10 indicates high risk.   

Information about the cancer’s stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

To view the original of this article CLICK HERE
 

Regards,
Greg_L-W.

~~~~~~~~~~#########~~~~~~~~~~
Posted by: Greg Lance-Watkins
tel: 44 (0)1594 – 528 337
Calls from ‘Number Withheld’ phones Are Blocked

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  14. I AM strongly opposed to the subsidy or use of failed technologies eg. WIND TURBINES
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  16. I see no evidence to trust POLITICIANS at any level or of any persuasion
  17. I do NOT believe in GODS singular or plural, Bronze Age or Modern
  18. I value the NHS as a HEALTH SERVICE NOT a Lifestyle support
  19. I believe in a DEATH PENALTY for serial or GBH rape.
  20. I believe in a DEATH PENALTY for serial, terrorist, mass or for pleasure murder.
  21. I believe in a DEATH PENALTY for serial gross child abuse including sexual.
  22. I do NOT trust or believe in armed police
  23. I do NOT believe in prolonging human life beyond reasonable expectation of sentient participatory intellectual existence
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