Prostate Cancer Patient Case Study: Angus Watson

Prostate cancer is the most common cancer in men in the United Kingdom, affecting nearly 50,000 men a year. During the peak of COVID-19, between March and September 2020, urgent referrals for suspected cancer were down by 31% compared to the same period in 2019, equating to 42,000 fewer people. It’s clear that many patients are not being diagnosed – and may not even show symptoms – yet, an early diagnosis can help not only increase survival rates, but also offer a more varied choice of treatments with improved quality of life.

Angus Watson, a 61-year-old man from Scotland, did not show any symptoms of prostate cancer. In fact, he only went to his local GP back in 2020 due to having signs of a hernia. However, his doctor, who was in training at the time, asked him whether he had any family history of prostate complications – and this is when he revealed that a close relative had prostate cancer.

Once the trainee-GP found out about Angus’ family history, he advised him to undertake a prostate-specific antigen (PSA) blood test, which came back with a low-borderline score of 2.66ng/ml. Typically, levels over 4 ng/ml are considered abnormal, but Angus’ doctor was keen for him to undergo further testing due to his family member’s prostate cancer: “I was very fortunate that I had a doctor who listened and had the time to pay attention to me, rather than pushing me out the door and instead, monitoring my prostate levels.”

At this time, COVID-19 was at its peak – with the NHS under unprecedented pressure, while GP consultations dropped by 30%. However, the pandemic didn’t put Angus off progressing in getting tested: “I was willing to go to the hospital, as well as the GP, despite the pandemic. At the time, COVID infection rates and hospital admissions were fairly low, so the timing worked in my favour, but I didn’t want it to stop me from checking my own health.”

In early 2021, Angus, who was living in Dorset during his diagnosis, went to Dorchester Hospital to have his biopsy undertaken.  Of 30 samples taken 17 were found to contain cancerous cells, with a Gleason Score of 3+4, which qualifies as a “good prognosis”. Due to his prostate cancer being found early, Angus’ cancer was well contained in the prostate, and in turn, he was diagnosed with stage two prostate cancer.

As his first consultation post-diagnosis, Angus was referred to a consultant surgeon and was advised to go down the same route as his relative – a prostatectomy. Angus explains: “Because the surgeon had done the biopsy, surgery was the first route I was offered,  and because they are the experts, I decided in my head that this must be the best pathway for me.”

However, due to the COVID-19 backlog and his low-level diagnosis, Angus was subsequently referred to a consultant urologist to discuss other treatment options. During these consultations, the multi-disciplinary urology team discussed various treatments with him, and recommended LDR brachytherapy: “They said that brachytherapy was the perfect solution for me, which I agreed with as it’s a focal therapy that targets the cancer cells locally.”

“The consultants also emphasised the importance for me to know my options and to make the best decision – rather than going to the first one I hear, which is what I nearly did. I almost ran the risk of having significant side effects from surgery, which I haven’t had with brachytherapy.”

Angus had his brachytherapy treatment at Poole Hospital, which he described as “very straightforward and painless.” He said: “I said to the nurses, I’m not even sure you’ve done anything. I stayed overnight, and I was back home the next day. The brachytherapy team at Poole Hospital were phenomenal, they were also checking that I was okay.”

Since his treatment, Angus has not suffered from any side effects – apart from having to occasionally get up in the night to go to the toilet. He has had three PSA tests since his treatment, where his levels continue to drop. “The last one I had was at the beginning of March, and the doctor said to me, “It doesn’t get any better than this” so that’s a really good result.” Angus’ next PSA test will be in six months and will continue to be monitored for the next five years.

Following his prostate cancer journey, Angus now encourages his friends and family to keep an eye on their health – and emphasises the need for them to get checked. “Because I had no symptoms, if I hadn’t gone to the doctor with my hernia in 2020, it struck me that I could have had much more aggressive prostate cancer, but I caught it early. My message to men is that you don’t necessarily need to have symptoms to get checked.”

Additionally, compared to other cancers, such as bowel cancer and breast cancer, there is no ‘mandatory screening method’ for prostate cancer, which Angus highlighted needs to change. “I know it’s not straightforward, and a lot of things can affect your PSA, but if a gentleman over 50 gets his PSA checked every six months, doctors can start to see trends and spot any warning signs earlier. Please make sure you get it done, and then tell them you want another one in six months, even if it was a low score.”

Particularly getting diagnosed and treated over the pandemic, Angus comments: “We’re seeing on TV all the time the pressures NHS staff are under. And if men, like me, haven’t got any symptoms, it’s easy to think that there are other people who are a much higher priority, and to not ‘bother’ healthcare professionals. But all we’re doing is delaying a much larger challenge for the NHS, because the longer men leave it – the more delayed and aggressive cancer can become – which in turn, will be a much bigger and expensive challenge to solve long term.”

Commenting on his LDR brachytherapy experience, Angus concludes: “Brachytherapy worked really well for me. It was painless, straightforward and it seems to have sorted me out. My main piece of advice is to not make a decision based on the first answer or treatment option you discuss. Make sure you do your homework and speak to various professionals.”