Hi all, this evening we have been to our local prostate cancer support group and an urology consultant was the guest speaker. We have several times on here asked why we can’t have scans after treatment and have to rely on PSA tests which, before diagnosis are said to be unreliable!
this is the answer he supplied;
MRI Scans can indicate possible cancer only eg the prostate or lymph nodes enlarged in the area being scanned. There may be microscopic cancer cells which haven’t enlarged a lymph node yet or in areas away from the abdomen.
PET scans can give false positives. sorry, I can’t remember the specific reasons he gave for not being able to rely 100% on other types of scans.
The most reliable way of knowing whether there is any active prostate cancer in the body is the PSA test. You can never get absolutely zero PSA because other parts of the body eg salivary gland and the pancreas secrete very small amounts of it. PSA itself serves absolutely no purpose in the human body but it has a function in foxes and dormice .
he also said:
when they do a biopsy they can and often do take samples from tissue outside the prostate.
Our menfolk cannot be classed as ‘cured’ until 10 years post treatment. Monitoring should be for 10 years post treatment.
we had a very interesting discussion ( and a lot of laughter!,,)about ED following prostatectomy and the various ways of dealing with it. If no nerves have been spared at all, medication is no use whatsoever. If men have pumps, injections, surgical procedures etc etc they can still achieve a climax but no ejaculation and it will feel different! At this point a man in the audience said he could vouch for it being different because it is a lot better!!!! More laughter and lots of blushes from his wife/ partner!!!
Although most men take their partners to the consultations to discuss the surgery and during which incontinence and ED are discussed, it is the man with pc who legally has the right to make the decision - partners and spouses can obviously talk about their concerns but they have absolutely no legal rights in the decision- making. As has often been said on here, some men just ‘want it out’ whatever the risks and some men absolutely don’t want the surgery!
Robotic surgery is the routine mode of surgery these days. The difficulty with this is that there is no ‘haptic feeling’ for the surgeon Ie he/she can’t feel with their hands how hard they are pulling or tying sutures and they rely absolutely on their vision.
He put his hand around the outside of a glass tumbler. He said that the glass represented the prostate and his fingers around and holding the glass represented the nerves. Thus the nerves are stuck to the prostate. During prostatectomy, so long as the cancer is contained in the prostate, he attempts to gently peel back the nerves to remove the prostate but leave the nerves intact. If the tumour has broken through the prostate wall, leaving the nerves risks leaving some of the cancer cells..
He said he encourages patients to talk to both a surgeon and an oncologist/ radiotherapist before making a decision.
surgery after prostatectomy has been attempted occasionally but there is a high risk of severe incontinence problems.
i have had a day of hassle +++ and am really tired this evening. This talk was for about 2 hours so I’ve probably forgotten a lot. But it was a good talk with audience input. Just thought you might all be interested in the bits I can remember !
Thank you, Dafna - I have shared that same worry. I always suspected the lack of scans post treatment was down to lack of resources and might not be in the patients’ best interest. The explanation about the differing difficulties with all types of scans was quite complex and I confess to not remembering the detail sufficiently well enough for me to post here without the confidence that I would be doing so accurately!
I do, though, have more confidence in PSA monitoring post treatment now . 
