The Shadow of Mortality
The pall of mortality
hovers like a dark cloud at certain times, but you cannot dwell on that feeling
at all. Every time you escape the dread it portends, you are grounded by the
good fortune of survival and by the uncertainty that reliving it might present.
Above all other
questions, it did occur to me whether I had it in me to face another cancer
diagnosis. As much as I presented as stoic two years ago, my concerns and
anxieties were a rumbling thunderstorm in my mind. I reached for comfort in
sermons and in the faith that things, no matter how bad, would be fine.
A Diagnosis Already
Known
However, when I saw
the consultant at the Christie Hospital in mid-June 2024, it was not to
discover anything new. I had already known for a week that adenocarcinoma of
the prostate had been diagnosed, because my medical notes from another
consultation had been merged with the findings from a biopsy taken three weeks
before.
The doctor who made
the mistake offered to redact the notes, but how do you unsee the facts as they
were presented? The damage of letting the information slip through, without the
essential conversation in a controlled setting, had been done.
I was reviewing the
consultant's notes yesterday, and I wondered whether there had not been a haste
to act, considering the stage at which the cancer was found, given their
recommendation of active treatment as opposed to active surveillance.
In the haze of the
moment, you do not see everything your medical results indicate; you grasp at
the headline and let the detail blur. Looking at the same notes two years on
brings a new realisation, a clarity that was simply not available to me then.
Yet what can one do now? The decision has been made, the treatment taken, and
hindsight, however sharp, cannot rewind the clock.
Registered Without
Consent
I attended the
consultation with a friend, but what shocked me still more was that, once
cancer was diagnosed, I was immediately added to the National
Disease Registration Service (NDRS), which comprises cancer diagnosis and
analysis along with congenital anomaly and rare disease registration. No one
told me I could opt out.
Then, on the matter
of cancer, I have always felt that all who have encountered it are treated on
the basis of the body of knowledge acquired from survivors and non-survivors
alike. We are rarely pioneers of this unfortunate human condition.
Brian, because of his
exposure to the medical field, would have been aware of what was developing,
but I wanted to tell him when we met up in Cape Town, and that was just over a
week away.
Weighing the Options
Meanwhile, between
the visible and painful skin cancer of 2009 and the invisible, seemingly benign
prostate cancer of 2024, I was totally conflicted. I was hoping that
chemotherapy, of which I already had some experience from the last time, was an
option, but I soon learnt that the only options were surgery or radiotherapy.
The treatment I
eventually had was hypofractionated radiotherapy, effectively External
Beam Radiotherapy (EBRT), over 20 weekdays in September and October 2024.
This week, NHS England will begin to offer a more targeted radiotherapy treatment for prostate cancer called Stereotactic Ablative Radiotherapy (SABR). This was first proposed in 2021; it's only five years late.
This focused treatment is down to five doses
over a fortnight and lends itself to fewer side effects. [Sky
News: 'Cutting-edge' prostate cancer treatment to be rolled out by NHS from
next week]
Proposed Patient Pathway
Stereotactic ablative radiotherapy (SABR)
for patients with previously irradiated,
locally recurrent primary pelvic tumours [PDF]
Progress and Its Price
More recently, the
website of Elekta, the company that
supplied the radiotherapy equipment for my treatment, features equipment that
could offer the same radiotherapy in two fractions. MR-guided
adaptive radiotherapy even promises minimal side effects compared with
other interventions.
The selling points
are that it lowers acute Gastrointestinal (GI) and Genitourinary (GU) side
effects while better protecting erectile function. That is the elephant in the
room that rarely gets talked about, where cancer treatment saves the life yet
does little to preserve the lifestyle.
Then, one must
acknowledge that these advancements in technology are welcome progress in
tackling these issues. One cannot live in the regret of not holding off on
essential treatment to wait for better options to select from. You work with
what is available, and you study the changes that come along.
The Elephant in the
Room
Even as I insisted on
not being co-opted into a form of chemical sex to ease the issue of sexual
dysfunction, I was invited to take a prescription of sildenafil citrate,
typically at half the normal strength. I feel like the boy of fifteen whose
first job was in a brewery, working in the laboratory, where the first wort was
said to be an aphrodisiac.
Hey! Medicine expects
that, if you can get it up, you already have the sexual confidence for
everything else to follow. I beg to differ, as the package gathers dust in my
bedside cabinet.
Blog - Men's
things XXXIII: Prostate Cancer Screening and UK Black Men
Blog - Photons
on the Prostate: Three Things I Wish I'd Known
Blog - Men's
things: Prostate Cancer blogs
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