Photons on the Prostate: My Life After Prostate Cancer Treatment

A Diagnosis at Fifty-Eight

I was just over fifty-eight when I was diagnosed. As a black man in the UK, where one in four of us will encounter prostate cancer compared with one in eight of the broader male population, the PSA test ought to have been offered long before I had to ask for it, especially as other indicators in my blood work already needed addressing.

An AI-generated infographic on the blog content. (Click to enlarge.)

I asked for it in early February 2024, and by the end of March my PSA had risen from 3.5 to 4.0. What followed I have set out in full in my earlier series, "Men's things" and "Photons on the prostate": the examinations, the imaging, and the biopsy that confirmed adenocarcinoma in mid-June 2024. I will not retread it here. [Prostate Cancer UK: The PSA blood test] [Check4Cancer-Private]

Twenty Sessions Begin

Two years ago, I began twenty sessions of hypofractionated radiotherapy for prostate cancer. It was scheduled for weekdays alone, so I thought I could fit both work and the treatment in comfortably.

The treatment began on a Thursday, which gave me two sessions before the weekend. Little did I know how impactful radiotherapy would be. The chronic fatigue set in far earlier than expected, and the weekend literally wore me out.

A Toll on the Body

By the fourth session, I returned from the hospital and had to go straight to bed; I simply had no energy for anything. I obtained a sick note, though with the proviso that I would not be completely signed off work.

Then came a range of side effects. After the fatigue, my voice became a husky whisper, betraying such tiredness and exhaustion that, after one meeting, a participant asked my manager why I was still working. I had the capacity and the facility to continue, yet the toll could not be ignored.

Alongside this came urethral pain, bladder incontinence, and a greater urgency, all exacerbated by a prostate gland reacting to the radiotherapy. Coupled with nocturnal insomnia, I began to wonder whether I could be productive at anything at all.

Planning Around the Pain

Towards the end, I had to plan my outings carefully, as I could not go twenty minutes without needing to visit a toilet. I was prescribed paracetamol and codeine to ease the pain, along with Tamsulosin to manage the prostate issues, which I am still taking. I also obtained a RADAR key to access disabled toilets, and a "Just Can't Wait" card to show premises owners whenever I had an urgent need.

Four weeks later, I was ringing the bell, ending the treatment and ushering in a new life: the beginning of the story after prostate cancer. However, I needed to recuperate by taking long-term sick leave and having someone care for me, because home in Manchester was no longer convenient.

A Journey to Recover

Against the wishes of many, I jetted off to Cape Town to be with Brian, my partner. The trip was comfortable enough, because I used airport assistance for every leg of the journey. Even though I arrived in Cape Town literally a shell of myself, the weather proved almost as good an elixir as the companionship.

Much as I had every urge to return home, I took as much time as possible to recover sufficiently for general activity. My sick leave eventually ran to seven weeks, and I returned to work in January 2025.

In truth, I should have taken a phased return, but the burden at work was light, so I decided against it and settled in well enough. In time, working alongside an occupational therapist, we found ways to manage both the work and the pressure.

Two Years On

Two years on, some side effects linger. The loss of my voice remains unexplained, even after review by an otolaryngologist and her team, and I put it down to one of the rarer side effects. Bowel incontinence can be occasional, bladder incontinence is quite frequent, and sexual dysfunction is not helped by the mental stress of it. The nocturnal insomnia, meanwhile, should have me beavering away late into the night.

Now, better and more targeted treatments are available in the UK, including ultra-short five-visit radiotherapy, tissue-sparing focal therapy, and new at-home medicines, all a far cry from the twenty to thirty-nine sessions of hypofractionated radiotherapy. [ICR: Thousands of men with prostate cancer will now be offered high-powered radiotherapy on the NHS]

Even so, I do not think I would have wanted to wait for these developments, given my determination, once advised to pursue active treatment at diagnosis, to rid myself of the cancer as soon as possible. I would not have been persuaded of watchful waiting or active surveillance in the circumstances.

A Word to Men

Three check-ups at the Christie Hospital, every six months, have had my Prostate-Specific Antigen (PSA) test results read at the lowest level ever. I can only advise that men keep their prostate health in view, have it checked, and follow through on any adverse results.

A visit to the Prostate Cancer UK website for the risk checker, followed by an at-home review of your own symptoms using the International Prostate Symptom Score (IPSS), is a sensible place to begin. Not every prostate enlargement is indicative of cancer, but every such situation must be checked and kept under monitoring. Thank you.

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Photons on the Prostate - XII

Do not defy the prostate

Just over three weeks after radiotherapy treatment, if I am not already aware of what my prostate is, where it is, and what effects noticing it can have on you, I will have been in a parallel universe, but I am here in the full knowledge of this interesting piece of anatomy the size of a walnut.

Do not be deceived, its size is hardly indicative of what it portends; it was its growth in size and volume that suggested something untoward was at play.

Evidently, malignant prostate cancer after two PSA tests, a digital rectal examination, a multiparametric MRI scan with contrast that presented a PI-RAD score of 4, needing an ultrasound guided transperineal biopsy of the prostate.

Keep an eye on your prostate health

There are a whole range of issues that could be indicative of an enlarged prostate gland, usually referred to as benign prostatic hyperplasia (BPH) that would normally be non-cancerous but it is necessary to determine that is really the case, no assumptions should be made without a medical assessment.

The male reproductive system - Macmillan Cancer Support

A good check on your prostate health can be started with using the International Prostate Symptom Score (IPSS) Calculator as the site of the prostate gland below the bladder and surrounding the urinary tract as it exits the bladder can present issues with the ease of urination, a high IPSS score should alert you to proceed for the PSA test.

Dealing with a prostate cancer diagnosis

After the biopsy, the prostate was determined to have some cancerous cells and diagnosed as Stage 2 with a Gleason Score of 3 + 4 = 7, intermediate cancer and very amenable to treatment.

The urology department then referred me to a cancer specialist hospital for active treatment of cancer. While there were options for active surveillance, a radical prostatectomy, or radical radiotherapy.

After consultations, I elected for radical radiotherapy taking 20 courses of hypofractionated radiotherapy of the prostate for a total of 60 Gy on weekdays.

The side effects, various and different for each patient are for me concentrated on the waterworks, difficulty in urinating and burning sensation with the same, while presenting with urgency and frequency along with nocturia. Also, there is the fatigue that tends to show up with my voice sounding thin and weary.

Finding time to recuperate

One area my elective radiotherapy option might differ from others is I commenced treatment without neo adjuvant therapy which is hormone therapy to reduce testosterone, I later found out that my testosterone levels were quite low, which might well have been a blessing of sorts.

I was active throughout my radiotherapy treatment including for 75% of the appointments getting myself to and from the hospital as an outpatient. There were two or so days when after radiotherapy in the morning, I had to take the rest of the day off. In the main, I tolerated the treatment well and exercising will and mind over body at certain times.

However, radiotherapy while painless exerts quite a toll on the body, it was malignant cancer, and one needs to find the time to properly rest and recover to give the body the range and scope to return to full health and vigour. Despite the advancements in the science and engineering of radiotherapy, radiotherapy will touch healthy tissue as part of treating the cancer, which needs to heal too.

The outlook is incredibly good, now, get your checks done.

Blog - Men's things - Prostate Cancer blogs

Blog - Photons on the Prostate - XI

Men's things - III

Gibbering not to the wreck

I suppose it was in a flux of apprehension that I forgot my notes, notepad, and pen as I made for my early consultation. Fortunately, I had printed out the Canadian paper that gave a cautionary note on avoidable biopsies and that was my reference document as I boarded the luxury Uber BMW that dropped me off in the maze of the Manchester Royal Infirmary buildings unsure of where I needed to go, until a nurse gave me directions.

At the reception, I was asked to give a urine sample which might well have been under duress as I waited to see the consultant. He had decided I must have a Transperineal Prostate Biopsy, but I had questions, his approach was quite paternalistic even as he implied there was no pressure to go ahead with the biopsy. It was my decision to make, only if I had the essential data, for that purpose.

Decision time truncated

However, my PSA reading was high, increasing dramatically over a 7-week monitoring, the DRE (Digital Rectal Examination) suggested an enlarged but smooth prostate organ, the next thing I needed to know was the PI-RADS (Prostate Imaging Reporting and Data System) score pertaining to the mpMRI (multiparametric MRI) scan I had, just over two weeks before. On a scale of 1 to 5, with 1 being benign and 5 suggesting cancerous lesions, the assessment was 4. [Radiopaedia: PI-RADS]

With that conclusion, I guess I had no other alternative than to go ahead with the biopsy. No time to waste with that kind of assessment. I opted for the biopsy even as the life-or-death implications dawned on me with the sudden realisation of the loneliness that accompanies decisions like this. Your mortality becomes a smorgasbord of conflicting thoughts, you seek a resolution and a determination, with no time to reflect on the import of the moment.

Let’s do this thing

Soon, I was with the doctor who was to do the biopsy, his computer was acting up, and his pen not inking the paper. I lent him my pen that the receptionist had given me to take notes of the questions and points I needed to assess my understanding of the situation, and he explained through drawings what was to be done.

I still had the option not to go ahead with the biopsy, I asked to see the MRI scan, and he zeroed in on the T2 scan explaining the abnormalities on one side that presented the need for a biopsy. [Radiopaedia: Prostate MRI - T2 Weighted Imaging explained here.]

Then, I was prepped for the biopsy, I changed from shoes into my slippers and only had to take off my trousers and underwear to wear a hospital tunic gown.

Ouch! And much else

I swallowed 3 antibiotics Ciprofloxacin 250mg tablets and about 15 minutes later, I was invited into the biopsy room. splayed out as if to be examined by an obstetrician in the most vulnerable state in stirrups, a digital inspection, then an ultrasound probe, a cold antiseptic wipe, and an icy cold spray even so painfully close to beyond endurance, a light introduction to discomfort as I looked up at the scenery of a tropical beach, psychology that was good for the imagination, but I felt better closing my eyes.

I grimaced and let out a shriek, once or twice as the local anaesthetic was injected, I was probably given 6 injections.

Again, the ultrasound probe was inserted and then the doctor began taking the biopsies, I felt much unease and on two occasions pain, the biopsy needle sounded like a stapling gun, and that happened about 9 times.

All done for now

I did not feel at all woozy, and when it was done, my blood pressure was taken with what looked like an old mercury sphygmomanometer with a dial and a stethoscope; the memories of the traditional ways flooded back, before I was chaperoned back to the dressing room.

As I left the biopsy room, I was offered tea and biscuits. I had my first urination which was clear, dressed up and filled in a survey. Results in 2 to 3 weeks, an ordeal in some way and probably a lifesaving act of catching something early.

My advice is not to be too coy about men's things, better to be under medical supervision with knowledge of what needs to be done, than leaving it out of fear or machismo.

It may not be a rite of passage, but I was first at the urology department this morning, and then more chairs were set up, it was like the Church of the Prostate Screening, many men come to worship there, in silent contemplation of what life ahead might be. I had humour to offer that made some laugh. God help us all.

Reference

Diagnosis of prostate cancer: the implications and proper utilization of PSA and its variants; indications and use of MRI and biomarkers [Canadian Journal of Urology] February 2020. (PDF)

Blog - Men's things

Blog - Men's things - II

Men's things - II

Scanning human innards

The hospital is an interesting meeting place of humanity, where our frailty and infirmity meet with a strong will to live, compassion, care, and the understanding used to help us return to healthy and vibrant lives.

With X-rays came an advancement in medical research and observation, then ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT) scans which all provide a non-intrusive view of our innards for experts to review and decide some plan of action; if their observations are indicative of an issue.

The Trafford General Hospital is the cradle of the NHS and where it was launched just over 75 years ago, arriving early on Saturday morning, I was met with a labyrinthine range of corridors, first to the main reception and then to the Radiology department, being the collective term for all these aspects of scanning.

In preparation for it

The aftermath of my bladder emptying requirement was to prepare for an MRI scan of men’s things. The call came in on Thursday evening and the speedy arrangement was once again, a bit unsettling. After a series of questions, I was cannulated as the scan was to be with contrast. The contrast agent which could have side effects is to help tissue and blood vessels show up more clearly.

Having changed into hospital tunics, one back to front and the other front to back, I mentioned my first MRI scan and the poor choice of music, Here Comes The Hot Stepper it was. The nurse offered me choices and I went to Bach and classical calming music, good effort and it was soothing.

Closed to noise and tightness

I was given earplugs, there must be a Nobel Prize for making the MRI scanner silent, this is beyond the one already given for the discovery of MRI. The cannula was connected, I was strapped down around my midriff and the music, the scanning and the noise began. I closed my eyes trying not to think about being in a tube of claustrophobic angst, it did not bother me.

Time passed quickly and I was pulled out and asked to wait for 15 minutes; first to remove the cannula and to observe any contrast agent side effects. I was soon on my way home, with much time still left of the Saturday morning. The results will form part of the review to be had soon.

Other blogs

Blog - Hotstepping into a magnetic resonance experience

Blog - Men's things

A pain in the back

Of bones and pains

It is interesting to understand the vagaries of accumulating years whilst straining to retain a semblance of youth and fitness about yourself.

After many years of back pain that at times had my slender partner stand on my back to ease the pain and little medical remedy for the occasion stabs of pain in the ribs, one had found some accommodations to live with it.

In other places, it was shin splints, I could walk very fast, but that seemed to present somewhat unbearable pain that obviously prevented me from running as no matter how cushioned my feet were, the pounding with running or jogging presented a threshold of pain I was not ready to endure in any masochistic way. I stuck to walking.

Canes and pains

Then for a few years, I had an umbrella for support, literally as a walking cane, sometimes unsightly but necessary as I found that walking for a while, standing for too long, or sauntering in a queue left me socially inadequate for certain settings.

However, twenty years ago, in December I decided to get a proper and decent walking cane, it had an ivory screwball at the top, but I soon settled for a Derby cane as that had a hook, I could put over my arm. It suited me well as much as I never conceded any sense of disability despite needing a walking aid.

Just about 6 years later, I had skin cancer in my left foot, the appearances in my right foot were not as serious, but the unbearable pain of cancer that I have written about many times before meant I could not walk on my two feet for almost 6 months, I had to use crutches, though, living in Amsterdam, I could cycle anywhere and the result of that was I got a bit of respite for the back pain.

Soon, I realised with a good pair of trainers or sneakers, I could probably get around a bit without my cane, but that did not ease the occasional back pain if I was standing or sauntering, the support of a walking cane even one I can disassemble into parts to carry around in my bag remained necessary.

Walking through airport security in Manchester, I get presented with a standard cane as mine is checked through security scanners. Their canes are, however, not of the standard one would be inclined to steal away.

Scan the spine

Then in late August, I had a conversation with my consultant, and we decided to get to the bottom of why I have needed a walking cane, all this while. It was never a fashion accessory, I just thought, if you were to use a cane, get a distinctively nice one that gave the support needed and looked fashionable enough.

An MRI scan without contrast was booked for early October for a full scan of my spinal column and now at least there is a medical understanding of why I have had back pain for about 30 years whilst not thrilling news, there is a kind of justification for the use of a walking cane, as for the terms involved in explaining the conditions, they are new to me and I am still reading up on the causes and possible treatments.

I guess one good point determined from the diagnosis is that I have lost no height due to kyphoscoliosis or the two osteophytes in the vertebral column. This is up for discussion with my consultant as to what ameliorating or mitigating factors should be considered. I am generally fine and relieved that some knowledge is gained.

Hotstepping into a magnetic resonance experience

Walking with a cane

For 20 years in December, I have used a walking cane. This was to help with the pain that I felt in my lower back for about a decade and there were times I had my much lighter partner stand on my back just to ease the pain.

The pain was exacerbated by standing still in queues or sauntering, I needed to be moving well or sitting down not to experience the pain. At times I have spoken about the pain either in the chest on my ribcage or in my back to my GP, and they have tried to put me in the scheme of enduring it rather than treating it. The walking cane gave more than the support and comfort to reduce or avoid the pain, altogether.

Obviously, when I got my first walking cane, it was a long black rod with an ivory ball to hold onto, as from the beginning I had decided whilst the walking cane was not a fashion accessory if you were to use a walking cane, get a good and fashionable one. Eventually, after trying many kinds of canes I have settled for Derby canes that have a rounded hook that could be hung over the wrist or the arm, hands-free.

Let’s have a closer look

In a conversation with my consultant a few weeks ago, we talked about my use of the walking cane which in addition became even more pertinent when I had cancer in my right foot some 14 years ago that I could not walk using the leg for almost 6 months. She proposed we have a scan of my spine to determine why I was having the back pain and if anything could be determined from that review.

Today, I attended a radiology session for an MRI scan of my spine without contrast. The without contrast part suggested I would not have ink injected into my veins to provide contrast in observing other organs in my body. I read up on the notes and was sure no adverse effect was expected as I had no metallic enhancements or augmentations had been done to my body. At least nothing I have consented to except if one had been abducted by aliens.

Stillness and noisiness

Having filled out the consent forms, the nurse invited me to the waiting room before the radiographer called my name and ushered me towards the theatre. At first, I was assigned a locker to put in my valuables, watch, love bangle, wallet, and satchel bag. I only had to take off my jacket and leave my cane outside.

I sat on the MRI gurney and as I was about to lift my legs to lay on the bed, I was told it might take 30 minutes when I planned for 10 minutes tops, I had to remain still, and the device was a disturbingly noisy thing that you needed earplugs and headphones. I had heard much about the containment from others with claustrophobic tendencies, and I decided not to be regaled by any more of their sordid tales.

As I lay down and set myself for the experience, I decided to close my eyes as the headphones belted out Ini Kamoze’s Here Comes The Hotstepper, certainly not what you want to be hearing in a magnetic tube, but that was what was on offer rather than the calming strains of classical music that I suggested might be a better offer.

Slipped out of it and sleep

I drifted off as the three shrill sounds suggested my insides were being peered into without intrusion, the wonders of medical science for which a controversial Nobel Prize was awarded in 2003. [The Lancet: The Nobel prize for MRI: a wonderful discovery and a sad controversy]

There were times I opened an eye, but I never gave thought to the idea I was in an enclosed space. Then the gurney slid right out, and we were done with a commendation from the radiographer that I took the session really well.

I got fully dressed up, collected my things and returned home, an interesting experience and in a few weeks, I should get a review of what was seen.