Prostate biopsy result: a tiny amount of non-aggressive cancer, now under Active Surveillance

"A tiny amount of non-aggressive cancer" is probably the best biopsy result you can get, short of "no sign of any cancer at all." 

And that is why I was so happy to hear those words last week when a urologist gave me the results of the prostate biopsy that I described in some detail here. 

He delivered this wonderful news as I sat in his office, along with a specialist nurse and an audio recording system. I will come back to the audio recording system in a moment; the make purpose of this blog post is to make the point that not every prostate biopsy brings very bad news. 

Even if you are at elevated risk of prostate cancer—based on family history and/or PSA score—that doesn't mean you're predestined to have a serious case of it. Many men live with a low level of prostate cancer that never produces serious symptoms. So, when a urologist says you should have a prostate biopsy, you probably should, even though a biopsy can be an unpleasant experience. 

(To be honest, the urologist had to talk me into getting the biopsy. I was arguing that "just an MRI" would be enough, and they did do an MRI before the biopsy; but that was mainly to get the lay of the and look for signs that the prostate cancer, if there was any, had spread beyond the prostate itself—in my case, it had not.)

Obviously, what happens after the biopsy will depend on how much cancer is found. If there is no sign of cancer? Great! If there is some cancer? You and your doctors have a sound basis for determining the best course of action. 

Transperineal prostate biopsy: a patient's perspective

If you happen to be wondering what a prostate biopsy is like, this article should prove helpful. 

In August, I underwent something called a transperineal prostate biopsy and I thought sharing my experience might be helpful to other people who are facing this procedure. 

(Update, November 27, 2021: My prostate biopsy results.) 

Like most prostate biopsies, mine was performed to evaluate whether or not the patient has prostate cancer. That means biopsies can be an emotionally challenging experience as well as a physically daunting prospect: a scary procedure at a scary time. 

NCI's Dictionary of Cancer Terms

However, while I find the thought of needles piercing sensitive parts of my body unappealing, I found that this procedure can be relatively quick and painless. I say that based on my experience and the feedback of several other guys whom I chatted with over tea and biscuits in the recovery room. This should be positive news, given that a biopsy is an essential weapon in the fight to find and treat prostate cancer. 

Big fun with old UK maps? The National Library of Scotland delivers

This is just a quick blog post to share some fun I've been having lately by combining old maps of England with current satellite photography. To be clear, I'm not the one doing the combining; that work is being done by the National Library on an amazing website that yields views like this:

What you are looking at is a map that shows the River Sherbourne in Coventry in the late 1800s, drawn over current satellite photos of the same slice of England's green and pleasant land. You can go to this interactive map view by clicking here. 

And that's the fun I've been having, because when I was young I played on that land and explored it with my friends. We were all born on the streets you see at the top of the image. (This was in the 1950s so our parents always worried that we would either drown in the river or catch polio from the river, neither of which happened, mainly thanks to common sense, good fortune, and a great vaccine.)

In the two images below I have rotated the view slightly and marked where I was born on both of them. In other words, the house in which I was born sits in what was a field until these streets were constructed (1934-36). 

What you can also see is that the course of the river has changed over time. This is part of the long and complicated story of the River Sherbourne, one that I am exploring these days on foot and, thanks to the National Library of Scotland, online.  

I have already determined that the river was straightened out after the time I spent playing there in the 1950s and early 1960s. Time permitting, I will post photos of what is today called Lake View Park, even though there is no lake (another long story).

Cannabis-based medicine: a personal (UK) perspective

On July 17, 2021, something very wonderful and special arrived at our address in England: cannabis-based medicine prescribed by an English doctor. 

I published an article about what this delivery meant to us, over on Medium: Prescription cannabis and quality of life: a case study from the UK. 

Based on Medium's statistics, this could be the most widely-read article that I have written since I retired in 2019. Here's a quote:

"after four days of taking the capsules my wife was better in nine out of 14 ways, meaning there were improvements in, or reduction of, nine of the 14 symptoms...after seven days of cannabis-based medication, Chey is now enjoying improvement in 13 out of 14 areas."

What's so special about this UK cannabis? 

Friends and family will know that our household is no stranger to medical cannabis; Chey began exploring its potential to ease her pain and suffering even before we moved to California in 2011 and she received her medical marijuana card.

After considerable trial and error with different cannabis formulations—some of which she made herself—Chey found what worked for her: capsules containing a mix of the two main cannabis compounds, THC and CBD.

And when I say "worked for her," I mean: did such a great job of addressing her chronic musko-skeletal pain that she went from taking 140mg of morphine a day to zero, nought, none. She used cannabis to end years of heavy opioid use. Cannabis also put an end to years of nasty and unpleasant opioid side effects, not to mention recurrent medical harassment by doctors who accused her of being a drug addict.

When we decided to move from California to England in 2019 to be near my mum, who is now in her nineties, we knew that the Conservative government had changed the legal status of cannabis medications in 2018 to make them more accessible. What we didn't know until we got here is that the government's actions were in reality far less helpful than they sounded (a hallmark of Britain's Conservative governments for the last decade or so).

Three years on, this is still the case, with only a handful of Brits actually getting cannabis prescribed by the National Health Service. The result is that an estimated 1.4 million people in the UK are still using cannabis illegally for medical reasons. 

At the same time, a few thousand people in the UK have managed to navigate "the private option" in which you pay a special doctor at a special clinic to examine your case and legally write you a prescription. (I have described the process in this Medium article: Getting prescription cannabis meds in the UK legally: a beginner’s guide.)

When Chey's supply of California-sourced cannabis meds ran out, and her health got worse and worse, we decided to try the UK's pricey private option. This required many phone calls and emails, took many stressful weeks, and of course involved paying consultation fees and product costs. Not ideal for someone who is suffering multiple symptoms that are seriously eroding their quality of life.

Eventually, and very thankfully, we achieved the transformative delivery that happened in July. Since then Chey has been able to get her dose adjusted and her prescription renewed. Yet this is bad news as well as good news; it's good news for Chey, but bad news for millions of Brits who cannot afford to get cannabis through this process. This is clearly wrong.

Frankly, I fail to see how the UK's convoluted and deeply unethical three-tier approach to cannabis medication can continue in the face of mounting protests and outrage. Most Brits are repulsed by the current a situation in which "the rich get high quality cannabis meds, the poor do not, unless they take their chances breaking their law."

Fortunately, there are plenty of groups working to change this. I have included some here, along with some relevant articles:

• Towards a United Kingdom of Cannabis: One of the best articles I've found about the UK cannabis situation.
• Patient-Led Engagement for Access: PLEA: a volunteer-led non-profit community interest company, established to challenge the inequalities in access to cannabis-based medicinal products in the UK.
• MedCan Support: MedCan Support provides free resources and educational material on medical cannabis, with a focus on paediatrics and lobbying for NHS access.
• The Centre for Medicinal Cannabis: a membership association for organisations operating at the forefront of the UK medicinal cannabinoid industry. 
• The Medical Cannabis Clinicians Society (MCCS): an independent community of medical cannabis pioneers, "the first prescribers of this treatment in the UK".
• Cannabis Patient Advocacy & Support Services: a collaboration of patients, medical teams, institutions, NGO's & industry.
Cannabis on the NHS in 2021? It’s long past time for the NHS to embrace medical cannabis as a credible treatment: another good article on tghe UK situation.
• Project Twenty21: working toward affordable medical cannabis treatment, aims to create the UK’s largest body of evidence for the effectiveness and tolerability of medical cannabis. 
• Law Enforcement Action Partnership UK: a global network of law enforcement figures which seeks an alternative to our failing, punitive drug laws.

Clearly, the absurdity of the current status of cannabis-based medicine in the UK is well understood in some circles. What is needed now is to spread that understanding and ensure that it reaches all corners of power and governance in the country. An enlightened approach to cannabis, led from the top, would enable huge improvements in quality of life for millions of people as well as generate jobs and wealth. Consider the manifold benefits of a blended model in which:

a. recreational use of cannabis becomes a revenue stream for UK companies (growers processors, dispensaries), employees of those companies, and of course the UK treasury, much akin to the alcoholic beverage industry today, and

b. the national health system provides affordable medicinal cannabis prescriptions to people in the UK who need them and thereby: reduces use of addictive opioids, treats conditions such as depression, anxiety, ME/CFS and Long Covid; potentially eliminates some conditions, such as childhood epilepsy; and generally improves quality of life for millions. 

There are no legitimate barriers to the UK adopting this model and becoming a world leader in responsible cannabis production, research, and medicine. I would certainly vote for this, and I have no interest in consuming cannabis myself. 

[Disclaimer: future changes to my health may create a personal interest in taking cannabis for medical purposes, but in the past I tried recreational use of cannabis and did not enjoy it.]

Finally...

If you are writing about cannabis-based medicines, I have a request and a free offer. The request is that you use the more accurate terms "cannabis-based medicine" or "medicinal cannabis," and avoid using "medical marijuana." The latter is now widely considered to be inaccurate, confusing, and potentially inflammatory or prejudicial.

The free offer is a high resolution version of the public domain image below, created by me for anyone who is illustrating articles, brochures, blog posts, etc. about cannabis-based medicine. This image makes a welcome change from overused and grossly misleading graphics using smoke-shrouded foliage. Free to download from UnSplash using this URL: https://unsplash.com/photos/qzD_H7-Jcj4.

Missing links and images

Like their creators, websites age over time, and sometimes they forget things, like where a particular image or document is located. This page is an attempt to provided some of the things that have gone missing on the various Cobb websites, starting with a link to my master's dissertation:.

*Getting to know CISOs: Challenging assumptions about closing the cybersecurity skills gap, a Security and Risk Management master's degree dissertation (pdf).

*The Rock Throwing GIF: I made this to make a point and you are free to use it as well.

With many thanks to readers who have taken the time to use my Contact page to let me know of missing links and pages.

Classic Glass Photography: pursuing a hobby during lockdown

I'm into classic glass photography. That's using lenses from old 35mm film cameras to take pictures with modern digital cameras (for example, the Minolta lens on my Olympus camera shown here). 

I will write more about my hobby here on this blog. Here are some articles on classic glass:

• Vintage glass
• Classic Glass - Outdoor Photographer
• 10 vintage lenses to add to your kit: an in-depth investigation

BTW, if you have old 35mm SLR camera lenses around you might want to use them like this, or sell them on eBay. I get the impression that some old lenses are now fetching decent prices if they are in good condition.

 

(Just FYI, this blog post is being used as a test. I want to see if the image of my camera—shown above—appears automatically when I tweet the page.)