As a rule of thumb the chances of a man getting prostate cancer advance with his decades. Photo / Apostolos Vamvouras, Unsplash
I was told I had cancer by phone. The diagnosis did not come as a surprise; the manner of its announcement did.
I was supposed to see an oncologist in person but a letter from the hospital said the consultation would now be by telephone. Covid, I suppose, although it was never spelled out. I waited all afternoon, not so much to hear the worst but to know how bad.
At 6pm a grumpy consultant rang, questioning why I had not turned up to see him. I explained the letter and my no-show. “It happens all the time,” he said, with an audible shrug of his eyebrows. Three weeks earlier I had a biopsy on my prostate gland. He now read out the findings: two malignant areas had been found, one of a faster growing type of cancer. On the Gleason scale, which ascends in severity from six (mild) to nine (severe), I was at seven. Laconically, the consultant added, “It’s a good idea to treat things rather than leave them as they are.” To put it mildly.
Prostate cancer is a viper of a disease: we know it exists and it can be dangerous, but we chaps can’t imagine it bothering us. In my parents’ time, it was called “the old man’s complaint”. But in those days anything unpleasant was disarmed with a euphemism.
As part of the male reproductive apparatus, the prostate gland was definitely unmentionable, never mind its function. Prostates make semen, the fluid that helps speed sperm about their business.
In our less inhibited times, prostates may now be mentionable but seldom are ... until they go wrong. Only if they become diseased do we pay them attention. Yet in the UK one man in eight can expect to get prostate cancer. For black men the figure is one in four. It is the most common cancer in men and, after lung cancer, the second most deadly. More than 11,500 men a year die from it, an average of one every 45 minutes. Unlike other common cancers, whose incidence is declining, cases of prostate cancer are rising.
That’s the bad news. The positives are that three quarters of prostate cancer sufferers survive. There are about 400,000 men living in the UK who have had it.
As a rule of thumb the chances of a man getting prostate cancer advance with his decades. In his fifties it is a 50 per cent likelihood; sexagenarians, 60 per cent. For me, approaching 80, the risks were nearer 80 per cent. Being overweight doesn’t help, and the risks are higher if your father or brother has had it.
I gave myself a couple of simple ground rules. First, I would make no secret of the fact that I had cancer and second, I would call it by its name: no coy reference to “the Big C”. Cancer is a disease which can be treated and survived.
Mine came to light because I have been scrupulous in having an annual check-up. Ever since I lost a friend to prostate cancer some years ago, I have had my PSA checked. It is one of two simple tests. Neither provides conclusive proof of cancer but, for most people, they are the best precautions available. Both indicate if more investigation is needed. PSA, or prostate-specific antigen, is measured in a blood test. The other check is a manual examination where, to put it delicately, a doctor uses a finger to feel for any enlargement.
My PSA score rose enough for me to be referred for an MRI scan. Whatever the limitations of the PSA test, I would never have known I had cancer without it – certainly not before the cancer was considerably more advanced. I experienced neither discomfort nor blood in my urine. The fact that I was getting up to pee more frequently at night, I put down to my antiquity.
The prostate, normally the size of a walnut, becomes larger with age and that puts pressure on your waterworks. The gland is directly below the bladder and the urethra, the pipework carrying pee, runs through the middle of it. The key question is whether there is anything else causing the gland to grow.
My MRI scan showed abnormalities on either side of my prostate, but thankfully no evidence of metastasis – the cancer spreading; no sign of malignancy in either my lymph glands or bones. My biopsy was performed exactly two weeks after my PSA test.
There are better ways of spending a morning than having a prostate biopsy. Using the MRI images to navigate, tiny tissue samples are nipped from the suspect areas of the gland. It was done under local anaesthetic and felt and sounded as if someone was applying a stapler to my back passage. I lay on my side. To take my mind off what was going on behind, a sympathetic male nurse sat at my head and got me to tell him my life story.
Around five weeks later, I was advised to start hormone therapy – a combination of injections and pills. That would starve my cancer of testosterone and prevent it growing. Apparently, testosterone is manna for ravenous cancers. I would also need a bone scan and then a month of radiotherapy.
So far, I had been treated under the NHS, efficiently prioritised on the two-week cancer pathway. But health service resources were being stretched by the pandemic and I still had health insurance dating from my days working full time. I decided to go private. Apart from anything else, I would be provided with taxis to and from the radiotherapy unit.
Appropriately, the radiotherapy suite was in the bowels of the building. It had its own reception area with pot plants and soothing photographs of a riverside.
The machine took over. Silently the bed slid me further under the “bird’s head”; I confess crematoria came to mind. The bench, or bed, has its own neuron system of little electric motors and sets of bellows to make infinite adjustments to the exact placing of whatever body is on top.
Such kit does not come cheap. A system this sophisticated costs from £2.2 to £4 million (NZ$4.2m - $7.7m), all to ensure that only the tumours are irradiated, not healthy tissue, and that the cancer is targeted every time to within a fraction of a millimetre.
I was now lying beneath the bird’s brawny neck, at the end of which is a metal drum, the diameter of a dustbin, poised about a foot above my stomach. From here the X-rays are fired.
There now began, what would be interpreted in the animal world, as a courtship dance. Warily, the drum orbited my body. Never touching, occasionally pausing, before slowly circling again.
Two other machines, furled into the side of the machine, detached themselves and approached inquisitively. Like silent doctors on their rounds, they stopped to inspect me – literally, as they send CT scans to the high priests of these observances in their next-door control room.
In 10 minutes it was over. Job done, the machines retired.
For me, two side effects of radiation – fatigue and mild incontinence – were immediate and short-lived. But cancer casts a long shadow. My condition will be monitored for the next five years with blood tests alert to any spike in my PSA. Early on in this saga a consultant told me I had an 80 per cent chance of making a full recovery. If I was a racehorse, those odds would make me a clear favourite. I’ll settle for that.
- For more information about prostate cancer, its diagnosis and treatment, visit the Prostate Cancer Foundation NZ.
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