Prostate cancer affects around 5000 men in Portugal every year, 1800 of whom will die.
WORDS Brett Ashmore
The prostate produces a substance known as PSA (Prostate Specific Antigen) in very small amounts. Prostate cancer produces the same antigen. Therefore, when the PSA exceeds the recommended limit, it’s worth having a check-up. There can be several reasons which may not be cancerous, but it needs to be checked.
Living in the Algarve since 2004, I’ve always had yearly blood tests for PSA. Unfortunately, with COVID and moving house, I guess I just plain forgot until July 2022, when I developed a backache. The doctor did a blood test and included PSA. Although the backache turned out to be not connected, my PSA was very high.
The next day was an MRI scan which confirmed my prostate was enlarged and had a lesion on it. The thing to do now was a biopsy. The biopsy takes a tiny slice off the prostate and, if cancerous, a pathologist will give your cancer two grades.
First, it is scored on the Gleason Scale (from 6 to 10), six being low-grade cancer, seven a medium and eight to ten, a high grade. The second scale goes from stages one to five and predicts whether the tumour is slow to fast growing and the chance of it spreading to other parts of the body such as lymph glands or bones.
My results could not have been much worse. It was Gleason nine, stage five: a really aggressive cancer with a strong chance that it had already spread. It was terrifying, but we had to find out if it had spread and where to.
A PET scan was booked. This scan takes quite some time. An isotopic liquid which reacts with cancerous cells is injected into your veins and the scan highlights where the cancer is. You can see in the photo the small orange marks on the pelvis.
I was lucky that the cancer was still local to the prostate and, to everyone’s amazement, had not apparently spread. My doctor realised the urgency and found the earliest appointment with an oncologist. It was obvious now that surgery was the only choice.
Just 12 weeks after the first blood test, my prostate, eleven lymph modes, two seminal vesicles and a small growth were all removed. Only the seminal vesicles showed signs of spreading, all the others were negative (but we didn’t bother putting them back).
Following surgery, in theory, the PSA should be zero (no prostate, no cancer, therefore no antigens). But this was not the case for me. Three months after surgery, the PSA started to rise again, and more monthly blood tests showed an increase to six times the limit. Some cancer cells left behind had started to multiply.
I returned to the oncologist, who prescribed medication and injections which stop the cancer cells from multiplying. My PSA became undetectable, but we knew the cancer was still there somewhere!!
So this time I had a bone scan, another isotopic injection (I should glow in the dark!). But nothing was found. Another MRI scan also came back negative. Another PET scan was done, and it too came back clear? The only conclusion is that some cells remained in the ‘pocket’ or the ‘bed’ where the prostate used to be. The cells are now shrivelled by medication, so the scans can’t see them.
By the time you read this article, I will have just finished radiotherapy (five days a week for seven weeks), blasting the ‘pocket’ or ‘bed’ to hopefully kill what cells were left. After 13 months of stress and not knowing, there is still no certainty it’s over.
This all came about because of a simple blood test that I did not do. If you’re over 50, please, don’t go through what I have been through. Get yearly PSA tests.
A massive thank you to the SNS in Portugal, who have been fantastic.