Senior Stories

 Prostate Cancer: rare and aggressive

My prostate cancer journey

by Henry Vhis

 There may come a time in our lives when a critical matter is trust right at our doorstep and a decision is called for. It’s over something that impacts our entire future; only we alone must consider and decide.

We are advised on medical grounds to get a biopsy done to confirm or rule out prostate cancer from common symptoms that include elevated PSA ( prostate-specific-antigen), frequent urination or difficulty in passing urine.  

Do you want to know and face the truth? People who react to this situation generally fall into three groups. People in the first group prefer to treat it as a private and personal matter. People in the second group reject medical advice after listening to family members and friends who tell them about dangerous side effects of biopsy, you can end up with complications and life-long infections, and or after consulting some media sources that diminish the dangers of prostate cancer, or state that elevated PSA is not evidence of prostate cancer, or is slow growing. I belong to people in the third group who accept medical advice and decide to depend on procedures that are based on sound medical science.

My decision to undergo biopsy was not made immediately because, like people in the second group, I was initially influenced by negative information about biopsy. A friend who worked in a hospital told me to ignore PSA. Another friend told me that his father suffered from biopsy complications. But when a GP advised me to seek medical advice because my PSA at 9 was high (in fact I did not ask for that test) I went to the Urology Department of the Singapore General Hospital. There I was asked questions relating to urinary frequency and difficulty, had my urine and blood tested and ultra sound done. I was told to repeat these tests every 3-6 months.

 Two years later, tests showed that my PSA had risen to 24. The urology consultant, Professor Foo, strongly recommended biopsy but I continued to dither. My physical condition was good. I did not have high blood pressure, no high cholesterol, no diabetes. I led a healthy lifestyle: regular golf and walking with my dog, now and then swimming and gym workout. Don’t smoke, don’t drink alcohol.

But about one year later, in December 2019 I began to experience fatigue and unsteadiness, and I had stomach pains for five days. I fell down a couple of times. I went to SGH emergency department on 16 December 2019 and was immediately warded for observation. Consultants from various departments for urology, neurology, cancer, diabetes and metabolism and the colon came to examine me.

The doctors told me that the MRI Prostate was suspicious in June 2017 and shows interval progression compared with the MRI Prostate of 20 December 2019 done on the morning of my discharge. 

After much discussion among them and persuasion from the Urology consultant Prof. Foo, I gave in and agreed to get biopsy done immediately, in order to confirm if malignant cancer cells were present. I was feeling better when I was discharged on 20 December 2019.

On 9 January 2020 I returned as an outpatient to take blood and urine tests, and had an ultra sound done. On 15 January my urology consultant, Professor Henry Ho performed the biopsy. 

About two weeks later Professor Ho went through the biopsy report with me in the presence of my wife. The biopsy showed I had rare aggressive prostate cancer, stage 2. I was not shocked: in a way I was prepared for the news. I asked him what should be done next. He advised (1) radiotherapy (external beam radiotherapy) and (2) a course of hormone injection every three months. Surgery to remove the prostate was not recommended due to my age (86 years old), and the fact that my heart had stopped twice during the biopsy. I was immediately given the first hormone injection.

 My follow-up treatment was at the National Cancer Centre of Singapore (NCCS). Dr Jeffrey Tuan, radiation oncology specialist, my cancer consultant decided that I required 39 sessions of radiotherapy over three months from April to June 2020, every day except on weekends and public holidays.

 In the intervening period of three months, from January to April, I was medically examined by the departments of General Surgery, Renal Medicine & Metabolism, Cardiology, Psychology, Physiology, Oncology (colon), spine and nuclear medicine for PET/CT scan.

  I was professionally briefed about the external beam radiotherapy that was to be done from 16 April to 12 June 2020, how it worked, and my personal responsibility. Radiation eradicates cancer cells when done accurately and precisely. Even though the exact location for the radiation had been recorded and followed for my treatment, radiation still hit some healthy cells resulting in side effects. 

At the radiotherapy centre patients sat in dead silence with their private thoughts in the waiting room. I kept myself emersed in a book on the message of Revelation by Michael Wilcock (New Testament). Therapists were curious about what I was reading. I told them that I read to make myself a better person.

 For the treatment some were required to wear surgical gowns. I was one of them. As soon as I lay down on the treatment table the radiotherapists (usually two or three of them, male and female) applied some cream on the private part and carried out procedures to ensure empty stomach, colon free of gas and full bladder, before getting onto the table inside the machine. There was one occasion when a female doctor came to remove gas from my lower bowel. 

The reminder to lie down and remain very still on the treatment table was standard practice. Once inside the machine the top section spun slowly around the body several times, from left to right and then back. All together preparation and machine time took less than 10 minutes for completion of each session and the procedure was painless. But I still found myself attending to some background sound coming from the machine and counting the number of times the top of the machine spurn overhead, in anticipation of the end of the procedure.  

The radiotherapy treatment required a lot of self-discipline and a strict diet regime. Before every session I had to stop eating after midnight, clear my bowel in the morning and drink two cups of water to keep a full bladder forty minutes before the treatment. The need to clear my bowel at different times on different days over a period of three months was a huge challenge (the therapists decided the times of treatment). The need to keep a full bladder for the duration of the treatment required a strong will and control. But the fear of side effects, the need to minimise side effects like bleeding in stools and urine stiffened my resolve to fulfil the requirements of the treatment. My wife helped tremendously, ensuring that I took correct diet to facilitate bowel clearance. Still, it was a lonely time for me, having to travel to the Singapore General Hospital for the 39 radiotherapy sessions over a period of three months, April to June 2020, every day except Saturday, Sunday and public holiday. There was also the constant fear of Covid infection from the frequent hospital visits during the Covid shutdown.  

The period of the radiotherapy treatment seemed like eternity! About nine days after the first session the side effects started to kick in. I had to deal with loose and painful bowel, and from sudden and uncontrollable urges to urinate or defecate. That was troublesome especially when outdoors. It was a long, lonely, difficult and heavy-burdened journey. But it was mitigated by reliable information and advice from the hospital staff, who fully understood my physical and psychological stress, and went out of their way to be helpful. Fortunately, these episodes stopped after the radiotherapy period. I kept the card of my radiotherapy appointments very close to me, looking hard at the dates and wishing for the last date on my attendance card to arrive quickly. Thirty-nine days seemed so unbearably long. Thirty-nine days when privacy did not count. 

The anticipated last day of the thirty-nine radiotherapy sessions arrived on 12 June 2020, and I regained my privacy. I brought a cake to celebrate the occasion with the therapists.

My two consultants, Professor Ho and Dr Tuan took up from there.

 Professor Ho made regular checks on the level of my PSA. He checked my blood, urine and testosterone, took x-ray and ultra sound in July 2020, Sept. 2020, Jan. 2021, July 2021, Jan 2022 and Sept. 2022.

Dr Tuan, radiation oncologist checked my PSA from blood tests and gave hormone injections in July 2020, October 2020, January 2021, April 2021, July 2021 and October 2021. During this period when my PSA went down slightly from 0.9 to 0.7 Dr Tuan continued with the hormone injections to deprive the cancer cells of “food and sunshine”. He changed the schedule for blood test from three months to six months: October 2021 to April 2022 to October 2022, without hormone injection. Following our discussion we decided to stop the course of hormone treatment for further review. We took into consideration that I had hot flushes, which I think had aggravated my eczema. And whilst my breasts became enlarged, there was contraction below. On 21 June 2022 I went for circumcision surgery: hormonal treatment had played a part in it. 

Blood test eventually showed that my PSA went down to 0.67 in September 2022.

Professor Henry Ho expressed satisfaction with the result and decided that it was no longer necessary for me to continue further consultation with him.

Dr Tuan has decided to continue monitoring my PSA through 3 – 6 monthly blood tests. 

 I still need to go for laboratory investigation and consultation at the department of Renal Medicine & Nephrology, and at the department of Surgical oncology.

The general public does not know very much about prostate cancer, or the dangers and treatments available. When one becomes a patient he is forced to learn about it to decide what he must do about it. It’s a serious matter because the course of his future depends on his knowledge and what action he can take.

CNA has interviewed me in person on my prostate cancer journey. The report of the interview under the heading “Prostate cancer: Survivors talk radiation, loose bowels and battling a disease more common than you think” appeared on 29 November 2020 and updated on 04 February 2021. It was also reported in Lianhe Zaobao.

Now, when some friends ask me about my health and say I look well, my stock answer is: “I’m getting on quite well. My wife helps me to take care of my health. I eat well, keep a healthy and well balanced diet. I exercise regularly by swimming, playing some golf, working out in the gym and walking with my dog.” Now at 89 years of age, I still sing as a choir member of Wesley Herald, Wesley Methodist Church. In the time available I devote my life to doing what I can in the community. I have good relationship with friends, and above everything else, I have a love relationship with Jesus, my Heavenly Father.”

Henry Chia

31 October 2022

Two titles suggested for the book

Over The Hill There’s Light

Thoughts from the Grey World