Standard tests suggested Tim Jackson need not worry about prostate cancer. But the BPC diagnostic pathway indicated treatment for what turned out to be extensive prostate cancer.

Tim Jackson Diagnosing Prostate Cancer

Tim, aged 64, is now fully recovered and competes in Tough Guy events

“When I was 50, I ended up in hospital with a urine infection. I’d been working long hours away from home and knew something was wrong, but put off seeing a doctor until the end of the week. It all happened very quickly and by the time I went into hospital, I was in shocking pain and couldn’t pass urine at all. I had a catheter fitted and a physical examination. The urologist I saw told me – I think you may have a real problem with your prostate.

I’ve had medical insurance for twenty years and called to arrange a private appointment in Wolverhampton. But someone I knew who has worked in hospitals for many years advised me – the person you really want to see is Alan Doherty. Mr Doherty carried out several tests and found my prostate was normal, but there was a stricture which prevented my bladder from emptying properly and caused the infection. Mr Doherty removed it and that was that.

Ten years later, I was still working very hard and not drinking enough water. I didn’t feel right and thought I may have another urine infection. Purely by chance, at the same time, I had a company medical which showed my PSA was raised. The doctor was a little concerned, but said my PSA could be raised because I was taking antibiotics. I had a physical examination and that doctor said all seemed okay. I was recommended to have PSA monitoring but told there was nothing to worry about.

I wasn’t convinced and booked an appointment with Mr Doherty. When he carried out a physical examination, he said although it wasn’t conclusive, he wasn’t sure everything felt right. I had a standard biopsy (called TRUS) and all 12 samples came back clear. Mr Doherty still wasn’t happy and recommended a PCA3 test, which is genetically based and provides a very good quality risk assessment. It came back with a very high risk of prostate cancer and an MRI scan showed there was a lesion on my prostate that appeared to be cancer.

With that information, we proceeded to a template biopsy, mapping out the whole prostate under to be sure of complete coverage. That showed there was cancer, although it seemed to be in one area and at an apparently early stage. Mr Doherty was very frank with me: he said – I recommend you have surgery to remove the prostate, but I’m a surgeon. Go and see someone else for a second opinion, particularly someone with a different approach to me.

I found a very well respected urology professor based in London. We discussed the different options, including ‘wait and see’, or active monitoring. He explained that approach but concluded by saying he didn’t think it would suit my character. The professor undertook robotic prostatectomies and told me – in theory, the robot ought to perform everything better. But in all honesty, I can’t match Mr Doherty’s results, with the nerve-sparing he achieves in open surgery.

When you are having major surgery, you really need to have faith in the person carrying it out and that really confirmed everything for me. I was 62 years old when I had my prostatectomy at the Priory Hospital, Birmingham. When the histology results came through three days after surgery, Mr Doherty explained to me: cancer was present in 50 per cent of my prostate. If left for another 12 months, it would have been very difficult to deal with, he explained. The magic words were “negative margins”. My prostate had been removed before the cancer had spread to the outer lining of the prostate.

In those early days immediately after surgery, I was very sore and I particularly hated wearing the catheter. I went into hospital around one week after surgery to have it removed. The nurse told me to try to wait hold on for an hour after removal and go to the toilet after that. Everything worked absolutely normally, I waited as instructed, then went to the toilet with no problems at all.

I’d been shown how to do pelvic floor exercises before surgery and had been very methodical doing them, before and after surgery. I am sure that helped because I didn’t ever have any major problems with leakage. By two to three months, I might get literally one drop if I was doing heavy weights or an exercise like burpees, but it was very little and after three months, I was completely dry.

Sex is really important to me. Mr Doherty knew this and his understanding of it, plus ability to nerve spare, were critical. He explained there are three objectives in surgery, in this order of priority: cancer clearance, doing as little damage to continence as possible and preserving sexual function as far as he is able. Mr Doherty scores the quality of nerve-sparing during surgery and told me it had been particularly good on one side, a little harder on the other, which meant overall, the prospects were pretty decent. He gave me his telephone number and said I could call him any time if I had questions or concerns.

It is a step-by-step process. I could have an orgasm at around three months but needed erectile dysfunction medication to manage sex. It is challenging because that can feel unnatural and contrived. The key is to feel confident that things are moving in the right direction, but it takes time. By eight months, I had about 80 per cent of my previous sexual function and at 13 months onwards, I would say I have 95 per cent function. The sensations are not absolutely the same as before surgery, but it is very strong and I would say coming through the whole experience has heightened my awareness and appreciation of sex overall.

My post-surgery PSA levels have consistently been at the lowest possible level to indicate full and complete cancer clearance. Without a shadow of doubt, it was the right decision for me. After surgery, I threw myself into building up my fitness again. Watching my son complete a Wolf Run outdoor mud and obstacle run, I told him it was something I fancied doing too. I trained for it and we did an event together and now I’ve done the really challenging Tough Guy and we do about four events every year. It’s not too bad for a 64-year-old asthmatic! I am very grateful that I chose the best quality surgery, made a full recovery and am able to put the experience behind me as I have friends with prostate cancer who have not been as fortunate.”