Prostate Cancer Podcast Episode 3

Steve

Welcome back, Dick. Good to see you again, mate. Welcome, Steve. We're down to the meaty end of it now, literally. You know, we've talked about your clinical signs, we've talked about your diagnosis, we've talked about your family decision. And now you come back from holidays and you're going to go to surgery. So, and you're having physiotherapy to improve your pelvic floor and all that sort of stuff. I don't know, did that help at all? Helped a lot. Helped a lot. Helped a lot.

Dick

And it sort of, yeah, I still remember.

Steve

Was there any moment during that where you thought, do I really need the surgery?

Dick

No, no, I was on a bus in Germany doing the pelvic floor exercises while it was snowing outside. I read about that. Yeah, yeah. Was in all the papers. Crazy Aussie tourist. That's right.

Dick

But when we got home, it was time. It was showtime. And so, it was booked in, prepared, you know, said goodbye to everyone, you never know. And was wheeled into the operating theatre. And as I mentioned before, probably got a little bit teary thinking, things might be a bit different when I come out of this. But at the end of the day, it had to be done. So I was very comfortable. I knew I'd done everything right. So, I was very comfortable. Post-op, I woke up and I was alive. So, I was happy.

Steve

But you picked a great surgeon, you know, and did he physically do the surgery? Was it robotic surgery?

Dick

No, he used the robot. And I had heard that another fellow was using the robot and the nurse bumped his arm accidentally and he circumcised the bloke. So, is that a true story? No, of course not. So, I had little concern about the robot. No, he'd done many, many operations with the robot. I felt the robot was as precise as it could be. Right. And it turned out to be correct.

Steve

So, I've done a lot of surgeries in my career. But I've never actually removed a prostate. So, what was the surgical procedure? You're knocked out. You say, "Yeah, I know what's going on." But obviously, they explained to you what's going on.

Dick

Yeah, they cut you open.

Steve

And they- Well, is it endoscopic or is it cutting your guts right out?

Dick

Well, I've still got where they've entered. Yeah. And then they went down with the robot, took the prostate out. Yes. And obviously, removed it 100%, which was great. And by taking, took the cancer with it.

Steve

Which, as a surgeon, that's a delicate surgery. So, you've got this gland that's wrapped around the urethra, which is a critical pipeline from the bladder to the outside world. So, this has literally wrapped itself around the prostate and taking the whole lot out, from four spots.

Dick

Yeah. But precisely, but the interesting thing, Steve, is that not only did I trust the robot then, there's now robots everywhere. And it's priceless. Well, it's not priceless, but it's so precise or as precise as you can get. Well, you said he didn't miss you.

Steve

No. No, no, he didn't. And this was 14 years ago. So, do you think the cost of the surgery might be an inhibitor to people or is that covered by Medicare?

Dick

No, no, no, no. But it's different today. Right. There's so many more machines, supply and demand, basic tenet of economics. So, with that, the prices come down. But at the time I got it done, one of my best mates I went to boarding school with, I rang him. I said, "I've got prostate cancer. How are you going anyway?" And he said, "Well, I've got prostate cancer too." So, we almost got it on the same day. I said, "Well, let's do our research." It was something at the boarding school? No,

Dick

no, no. Let's just do our research and see how we're going to move forward. So, I came back to him a couple of weeks ago. He says, "My mate Foxy." And I said, "Mate, I've looked into it. It's not cheap, but I believe the best guy to do it." And he said, "What's it going to cost?" He said, "I said $18,000." And he said, "Well, I've got a price over here in Czechoslovakia." He said, "My wife's brother's a doctor, and his mate's going to do it, and he's $900."

Dick

And I said, "Oh." I said, "Oh." Not a dentist? I said, "No." I said, "No." Well, I said, "Foxy, you can't be serious. I mean, this is... We do the best possible, whatever we can to make the outcome as best as possible." And he said, "Oh, no, I'm sticking with this bloke. I've heard he's pretty good and he's cheaper." And so I said, "Okay." Well, we both had our operations and fortunately both survived. But there's just one challenge that now when he gets an erection, he gets to the right, he gets...

(Laughter)

Dick

But at least he did he get an erection! That was true. And we thought we might send him off to the Department of Defense to use him as a radar or something. A periscope. A periscope, you know. Not to mention his partner's got to start on the side bench. But the point is that there can be some downside. He was most happy for me to mention I rang him and I said, "It's one of the funniest things I've ever come across." We all know that the surgery can be a little challenging and he didn't mind. He said, "If it makes a difference to any one person to see what he's come out with at the other end, he's happy. He realised he took the risk, but he's alive. He's seen his kids grow up." Sure. And that was terrific.

Steve

So to my earlier question, if the cost of the surgery is pretty high, and in your case it was, I mean, $18,000, 14 years ago is probably about 50 grand today,

Steve

how much of that is covered by the public health care system? Not even 10%. So it's a significant financial commitment. Yeah, but that was then.

Dick

It's different now. Right. There's robots everywhere. So the prices come down significantly. So at a point in time, someone's the leader of the pack, they're doing it. They're well sought after. They can almost charge them to set their own price. But having said that, now the market is completely streamlined, flatlined, then the prices come off significantly. So the robot's an option. And there are other forms of treatment to certain. I'm not a doctor and I've got to be careful, I say, but at that time, the treatments were still regarded as maybe affecting the outcome of the surgery if the treatments didn't work. So I opted for the surgery because I wasn't prepared to take that risk. Nowadays, you just do your research. Do your research and then you can work out. It's certainly much more sophisticated today. And therefore, it's a much better market to go into than me and one of my best mates in Czechoslovakia. I did have a funny situation myself. The fourth day after surgery, I was lying in bed, still probably resting with the catheter a bit. And I was sort of not sure whether it was right or wrong and you worry about those things. A uniform woman came out of a door across from where my room was. So I called her in for some assistance. I thought, you know, she can tell me if it's right. And I said, look, what do you think about the catheter? Is it sort of set right? And she sort of moved around a bit. And you might say, might have touched me a couple of times in the process, which I thought was a little unusual. But anyway, that's what happened. And then I looked at her and after comments, I said, you're not a nurse, are you? And she said, no, I'm the cleaner! So that's an absolute true story. So she's scurried off. And I was lying there thinking of litigation or something, which of course I didn't do. But I never expected that would happen. So every day when she'd come out of what turned out to obviously be a mop cupboard in a uniform very akin to a nurse, she'd scurry off that way out of embarrassment. But she did come in and she had a little bit of a feel down there, you might say. The good thing is that I could feel it. So I had some sensitivity.

Dick

So as funny as it was-- And did she!

Dick

That's right. So she did. Three days later, I went home. So I'd been in for about seven or eight days. I went up to bed and sort of had a sleep and my wife's downstairs cooking.

Dick

And after a couple of hours, she came up and I was just lying. She said, how are you going? I said, good. And she had a couple of wines while she was cooking. I said, just be a little careful near that catheter, the tube, because it could be a bit problematic. She said, ah, no, I'm all right. And the next minute, she's walked into the damn thing. Well, I can tell you, I nearly went through the effing roof. I used some words I hadn't even heard of. And she turned her back to me and I could see her face moving, which meant, and her shoulders, that she was laughing. And I then realised that my marriage probably didn't have a long way to go.

Steve

You mentioned a little while ago that things have moved on a lot since 14 years ago. Now, I'm a mad cricket fan and was there when Glenn McGrath sadly lost his wife Jane to breast cancer and then created the McGrath Foundation. And what a magnificent thing that's become. So we have the pink day at the SCG test every year. And the McGrath Foundation is now a seriously big organisation and it's embraced far more other cancers than breast cancer. But I'm not really aware of organisations, certainly not, that magnitude that deal with prostate cancer.

Dick

No, it's a very big one. And isn't that a problem? Well, it isn't. It is and it isn't. It's a problem because nothing's been done. It isn't a problem because something can be done. Well, that's so it's an opportunity. It's an idea. Well, initially, I just wanted to, working in health as I do and on a national basis and hearing from pharmacist predominantly and doctors to an extent, but certainly pharmacists, of people who are constantly passing away and dying. It's just it's ridiculous. And this is a manageable disease. And so therefore, the first step is to have a chat like this and say, come on, guys, let's get serious. It's not the end of the world. You might think it is, but you've really got to prepare yourself and go about it. Because otherwise, it's just stupid. I'm not saying anyone's stupid, but if you don't follow the procedure that can prevent a preventable death, then that's stupid.

Steve

Well, I read an alarming statistic that about one in eight Australian men will develop prostate cancer. Now, that's a big number.

Dick

I reckon it's probably higher than that. And I only say that because I am aware that a lot of men are not seeking advice. Correct. So those numbers can only be based on the ones that are treated? That's right. So the relevant stats would depict that. I think it's higher and doesn't have to be. But, you know, to survive, it's 14 years and I'm alive. I climbed a bloody mountain after I did. I rang a mate of mine after I got out of hospital and said, I was so enthused. I said, do you want to ride a bike around Australia with me? That's how ridiculous I was. And he just got out of bed just where I got. Oh, all right. And I thought, wow, that was amazing that he agreed. Yeah. For me to be so euphoric to think that I just had a new lease of life. Sure. So by ignoring that option and that moment of enjoyment, knowing that you're still alive, and it's probable that you're going to be okay, it's pretty, it's pretty, it resonates.

Steve

Yeah. So the post-op process, the catheter eventually comes out. Tell me about that.

Dick

Well, I went into my surgeon's nurse's office and she said to lie on the bed. And, but before I'd gone in there, a doctor had come out and he was a little upset with the world because he had to have the catheter in for a little bit longer. Sometimes that happens. Don't worry. I heard later, very, only several days later, that he was very happy. It had to be done for a reason. So even the bad things, the worst things, they are not retrievable, but solvable. So I went in, fortunately, the nurse said to me, advised me to lie on my back and to cough. And I did cough. And at the same time, the catheter exited from my penis. And I probably was as happy as one could be under those circumstances. Right. Left, went home, and immediately realised that the nappy stories were true.

Steve

So Dick, let's talk about nappies or diapers, as some people like to call them.

Dick

Well, the big thing is buy them in bulk because you'll need them. At my time, 14 years ago, I would march into the chemist and demand nappies and, you know, thinking, well, I'm going to say it's from a neighbour who's broken his leg, etc. But I just went in and got them. They've heard everything before. They don't care. They know that men's health is a big thing, certainly. So I just bought the nappies, wore them. And I will tell you some strong advices that wear them. And particularly if you're with friends that you know, tell a lot of jokes, because if you laugh unexpectedly, you'll wet yourself. Literally pissing yourself laughing. Yeah, you're literally pissing yourself laughing. So at the end of the day, you've got to be careful. You'll never wear light coloured pants again. It'll always be black or navy blue. Get used to it. In the first six months, it's as you teach yourself control. I don't now, it's great. But you will have leakage. Occasionally, you can wake up where the bed's a bit warm. Don't think it's the end of the world. Don't think you're losing control. It can happen. You know, just be sensible. If you're going to have a big night out and drink probably too much, wear a nappy to bed. Certainly in the first six months. And it happens even after that. And men are very open about it with other men who've had a similar problem. So the nappies is part of it. It's definitely something you adhere to and doesn't show that much. It's not the end of the world. Nappies are there for a reason. Do not worry about them. There are other things to take into account though. One is shrinkage. Your penis ain't the same as it was once before. And I will tell you that as far as myself, as far as I'm concerned, that probably wasn't something that I was terribly happy about. But some of my other mates, and we've all played footy together and done different things, have sort of said, "Well, yes, it does get a bit smaller." And it certainly does. And what you'll find is often when you're walking through town, you might have to rearrange yourself a little bit. I've got it down to such a fine art that I'll do it while I'm walking. My daughter did say to me at one stage, "Dad, did you just rearrange yourself? Or fix yourself?" And I said, "I might have." But at the end of the day, it's now something that's just part of your life. I mean, I'm comfortable in talking about this now because there's plenty of guys out there who maybe take this a lot more seriously than they should. It's a fact of life. If you're alive and breathing, then you're in front. And there are some downside of that. If someone said to you, "You're going to need a nappy occasionally. You're going to wear it for the first six months, but stay alive." You'd take it every day of the week.

Steve

So in the next episode, let's talk about life and sex life after surgery. But just to wrap up today,

Steve

was there post-surgical physiotherapy? You talked about it pre-surgery and improving pelvic floor strength and things like that. Was physio part of the post-surgery process?

Dick

I engaged in some physio for a while, but the good work, the hard work was done prior to the operation and it worked. And so I still engaged, but I was very careful because you're a little bit tender afterwards and you've got to heal, which happens quite quickly. But at the end of the day, the control you become, you teach yourself to control and to literally not pee when you don't have to. You actually learn control. It's amazing. And that strengthening of the muscles, it helps round the bladder in that area and it helps enormously. So yeah, post-surgery, I mean, you're alive. Are there going to be some problems? Yeah, sure. Are they life-threatening problems? No. It can come back if they don't get it all. But if you treat it properly, you're increasing your chances enormously to get the cancer before it gets into your bones. And that's the whole purpose of our discussion today.

Steve

When we catch up next time, let's talk about sex life after surgery.

Dick

Okay, well, that's something to talk about for sure. And I really appreciate it. If people do take something out of this, then it's worthwhile because hopefully we can make a little bit of a difference and move on from there.