An Unexpected Conclusion
I catch up on the news through the refined medium of chat shows, so I was unaware of the day's developments when my friend called to get an opinion. It was the news that national prostate cancer screening has not been recommended for men in the UK.
Whilst I am disappointed by the
development, the science and research might suggest it could cause more harm;
men could be diagnosed and overtreated for something benign. Because the usual
growth rates for prostate cancer are quite long-term, stretching into more than
a decade, immediate intervention is not always needed.
I appreciate all those arguments, but I can only share my own experience.
Pushing for Action
Firstly, the decision to get a PSA
test was primarily at my own instigation and insistence. My GP had blood test
results suggesting I had an anaemic deficiency for over two months, and did
nothing about it until I asked why a reading was off the scale. During that
investigation, I tacked on the PSA test.
As a black man aged 58, I fell into
the cohort of those who could be affected by prostate cancer. Then my father indicated that he had it too, though I could not conclusively ascertain the
facts.
The urinary symptoms of incomplete
emptying or urgency I had attributed to the expected rather than the unusual. I
was not expecting anything untoward.
Towards a Cancer Diagnosis
In early February 2024, the PSA
reading was borderline on the high side of the normal range at 3.5 ng/ml. The
other issue was that I had folic acid deficiency anaemia. I got a prescription for
folic acid supplements and returned for another blood test at the end of March
2024.
By then, my folic acid levels had
fallen outside the normal range, but the more concerning issue was the PSA at 4.0
ng/ml over the course of seven weeks.
The doctor then took the initiative to
invite me to discuss this reading and conducted a digital rectal examination
(DRE). His conclusion was an enlarged prostate gland with no nodules, but we
needed to determine why.
This led to a referral to a hospital
urology department, which, within weeks, scheduled a multiparametric MRI (mpMRI)
scan at the end of April.
Challenging the Orthodoxy
At which point, I was reading up about
tests, results, and indicators in the diagnostic path for prostate cancer. I
then got an appointment with the urology department to discuss the MRI scan
results.
We had barely exchanged greetings when
the specialist literally blurted out, "We need to do a biopsy." No
assessment, review, or discussion before telling me that. I pushed back and asked what the reasons were behind the decision, as the whole thing was both shocking and a surprise.
The specialist would win no prizes for bedside manner.
Along with the many questions I asked,
the answer that made me acquiesce was when he told me the PIRADS score was 4.
That result meant there was something
concerning that had to be checked. There was no comfort with the
ultrasound-guided transperineal biopsy of the prostate; even the lidocaine
injections were painful, but I braced myself.
Cancer of the Prostate Gland
I had an appointment to review the
results in mid-June. But my medical data in another hospital was merged into
another assessment in early June, and there I learnt of the diagnosis of
adenocarcinoma of the prostate gland.
When I met the urologist at the
urology department, I told him I already knew, and we should cut to the chase.
It was Stage 2 cancer, a Gleason score of 7 (represented as 3+4), contained in
the prostate gland, and immediate treatment was recommended. I opted for
radiotherapy.
In the process, I consulted with
Prostate Cancer UK. I realised I could only be put on the longer
hypofractionated radiotherapy over 20 working days, as my prostate was too
enlarged for surgery to consider what could be saved of any sexual function,
and brachytherapy could lead to serious complications.
You Always Excise the Cancer
Prostate Cancer UK felt I should have
opted for active surveillance, but I had come so far in the medical analysis to
back out. Apart from the fact that, besides the recommendation to treat it, I
was not going to endure the presence of cancer in my body, waiting to see what
it might do in years or decades.
Whilst the side effects were close to
debilitating, they were manageable with good advice from the cancer health
nurse consultant that my company recommended as I began treatment.
As prostate cancer leads the cause of
deaths from cancer in men in the UK, and it impacts black men twice as much, the
decision not to recommend national screening is quite unfortunate.
Get Screened and Scream Too
Even those with the BRCA gene mutation
that suggests greater susceptibility to cancer will not find that out unless
they are screened for it, probably in a separate medical checkup.
Reviewing all my medical notes, I
cannot find any indication of any BRCA1 or BRCA2 gene mutation, and yet I have
had two episodes of cancer malignancy in the space of 15 years.
Obviously, it means men must have a
voice in their individual medical situations and advocate for the necessary
interventions towards the best outcomes.
From my perspective, every time I have
a platform to speak about men's health, I will say: if you're a black man over
45, you need to get the PSA test and go the full course until you are satisfied
everything is fine.
Then, if anyone in your family (and
that is mother, father, sister, or brother) has had cancer, get checked too.
Demand to be seen as a person before you become a statistic.
Putting your health first, above any
cultural, societal, or personal embarrassment, is paramount. Prostate cancer is
treatable, especially when caught early. The lack of a national screening
programme does not make it less incumbent on every man to step up and be part
of ensuring that prostate cancer is no longer the biggest cause of cancer
deaths in men.
Thank you.
BBC News: Men's things
XXVII: The inconvenience of incontinence
References
Blog - Photons
on the Prostate - A year from starting radiotherapy
Blog - A
prostate cancer diagnosis, one year on
Blog - Photons on the Prostate - XVIV - I Just Can't Wait
Blog - Men's
things XXVII: The inconvenience of incontinence
Blog - Men's things - Prostate Cancer blogs
Key
The PSA unit ng/ml is nanograms per
millilitre.