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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Men's things XXXV: A Man's Search for Dignity

Pursuing a Diagnosis

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

I have found myself at the intersection where solutions designed for women seem to be just as suitable for men.

Many years ago, this first arose when I set about addressing folic acid deficiency anaemia. It was flagged when I noticed an out-of-range and irregular reading of my MCV (Mean Corpuscular Volume) blood test, which pointed, in the first instance, to a possible nutritional deficiency of folic acid, iron, or vitamin B12.

At my insistence, I persuaded my GP to order the specific tests for serum folate (folic acid), serum ferritin (iron), and serum B12. It was discovered that my folic acid levels were quite low; hence the diagnosis of folic acid deficiency anaemia.

Since then, I have requested the granular serum tests that sit beneath the headline MCV.

Pills Made for Mothers

I bought over-the-counter folic acid tablets, each with a strength of 400 micrograms. The label on the container carried the message, “Supports the overall health of your baby during conception and pregnancy.”

Well, I did a double take. The ability to conceive or carry a baby is not one I possess. My GP then gave me a prescription for folic acid at a strength of 5 milligrams, twelve and a half times that of the over-the-counter tablet. It meant I was not going to fix my deficiency by popping chemist pills.

A New Reality

Anyway, we have grown inured to watching adverts for sanitary towels and pads on television, and to seeing what the women using such protection get to do once their fear of leaking, and of embarrassingly revealing their flow, has been overcome by advances in sanitary towel technology.

Now, following treatment for prostate cancer with radical radiotherapy, I have experienced occasional bowel incontinence and regular bladder incontinence.

Once, in the case of the latter, it was the cover of darkness and a long overcoat that spared my blushes when my red chinos were soaked through.

Searching for Protection

For anatomical reasons, I could not simply start wearing feminine sanitary pads, just as I had taken to correcting folic acid deficiency anaemia with pills marketed primarily to fertile and pregnant women.

The male incontinence underwear I found was expensive, and it did not contain the urgency to the extent needed to forestall embarrassment.

The protection did not entirely eliminate the fear of emission or excretion; it offered only temporary safety, in the hope that you might reach the refuge of a convenience before the dam burst.

Adverts Not for Men

It goes without saying that the strain of advert music with the line “body formed for you”, or the tagline “Always with wings”, does not pertain to menfolk. Either we are too poorly served, or I need better discreet guidance when I visit a department that accounts for dignity in its solutions, without public spectacle.

So, imagine how I felt when a new advertisement came on television this afternoon for the Always Discreet Maxi Comfort Pads 9 Drop, offering the highest-absorbency pads designed for heavy bladder leaks, with a wider back for 50% more coverage and OdourLock technology. If only that catered for me too.

What We Actually Need

You might ask why I have not considered nappies for adults. It is a valid point, but that also suggests a level of incapacity and loss of control that is probably excessive for my current situation. It is a concession I do not think anyone, adult female or male, would make willingly if nature had not imposed it without option.

Minimal, unintrusive, anatomically aware, fully absorbent, and effective is what we need: coverage, protection, and odour lock without bulking out your trousers. There, I have written the advert for a product that serves bladder incontinence in men.

Breaking the Silence

My own route to this predicament was prostate cancer, but I am hardly the only man walking about with a secret and a spare pair of trousers in mind. Age brings it, an enlarged prostate brings it, so too do surgery, diabetes, neurological conditions, and plain bad luck; the company is far larger than the silence would suggest.

That silence is convenient for everyone but the men living it, and it is worth naming the circular trap at its heart: manufacturers under-serve men because men under-report, and men under-report because they find themselves so poorly served. Somebody has to break the loop, and it will not be the men, who have every reason to say nothing.

Which leaves the people who make and sell these things. I have, after all, written their advert for them; the product is the easy part, and dignity costs no more to design in than to leave out.

A slim thing built for male anatomy, an honest range of absorbencies, odour locked away, trousers uncreased, and a shelf a man can reach without rehearsing an explanation, none of this is beyond an industry that manages it handsomely for women.

A Matter of Dignity

The country decided, from January 2021, that period products should carry no VAT, recognising them as a plain necessity of life rather than a luxury; a woman buys them relieved of tax and relieved of explanation.

Incontinence products, as it happens, can also be had free of VAT, but only once you have declared yourself “chronically sick or disabled”, the very badge of incapacity I was at pains to avoid. [The UK Parliament: VAT on incontinence products (PDF)]

So, the tax is not quite the point. The point is that one necessity is met with a shrug and the other with a form; that dignity, for some of us, still comes conditionally. These things need thinking about, even if men's things rarely get talked about.

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Men's things XXXIV: Saving the life, and saving some lifestyle

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.

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Men's things XXXIII: Prostate Cancer Screening and UK Black Men

A sobering statistic

The statistics in the UK show that Black men are twice as likely to get prostate cancer and, consequently, twice as likely to die from the disease. In plain numbers, this means that 1 in 4 Black men will encounter the disease in their lifetime.

So, it was quite disappointing when, in November 2025, the UK National Screening Committee (NSC) advised against routine prostate cancer screening for the majority of men.

That advice included the very men most susceptible to the disease, and it was justified by concerns over the overdiagnosis and overtreatment of what might essentially be benign conditions.

Blog - Men's things XXVIII: Shame, no national prostate cancer screening

To withhold the opportunity from a cohort that is most medically affected and usually clinically ignored, especially given the tendency of such men to be culturally diffident on intimate matters, where masculinity, machismo, and sexual virility are taken to demonstrate manliness and personify manhood, was as close to unconscionable as one could get.

Renewed hope: TRANSFORM

It is therefore gratifying that, two days ago, the TRANSFORM prostate cancer screening trial received further funding. The trial, which began in autumn 2025 after being proposed in spring 2024, will now invite men at the highest risk of prostate cancer to benefit from research, early detection, and more effective treatments. [GOV.UK: Major expansion of research and treatment for prostate cancer]

All eligible Black men will be invited to participate in this initiative, which is jointly funded and supported by Prostate Cancer UK and the National Institute for Health and Care Research (NIHR). This should accelerate community engagement and deepen it, particularly amongst Black men.

In June 2026, when stage 2 of the trial commences, all eligible Black men will be invited, including Black men who:

• are aged 45 to 74
• are resident in the UK
• have not had a PSA test or prostate MRI scan in the last 5 years

My own journey

Two years after my prostate cancer diagnosis, and twenty months after completing radical radiotherapy, the prognosis is good. My PSA is at the lowest reading it has been since I was first screened in February 2024.

I urge every Black man to take up this screening opportunity, all the more so if he carries the BRCA2 gene variant and has a family history of prostate, breast, pancreatic, or ovarian cancer.

Know the warning signs

Beyond that, a man should have his prostate checked if he gets up multiple times at night to urinate, waits a while to start, strains to begin, does not feel he has fully emptied his bladder after a visit to the toilet, or has pressing urges to pass urine.

Not every prostate enlargement is indicative of cancer, but it must be investigated by medical personnel. This is good news for Black men; now step forward and take control of your health.

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Men's things XXXI: Can Intimacy Be Reclaimed After Prostate Cancer?

The Unspoken Battle

It is the unspoken conversation, one I have barely had with myself and definitely not with others, including my partner, my medical and cancer support teams.

When I was diagnosed with malignant prostate cancer in June 2024, the first physical urge that left me was sexual desire, as though someone had just kicked me in the balls. It wasn't pain, just a numbness of confusion and incapacity.

Preparing for the Obvious

Even for a man with African heritage and no need for machismo, I have been open about the bowel and bladder issues. I was quite read up on them and ready to attend to the matters concerned. I didn't want a catheter insertion for whatever reason, but incontinence underwear? I was ready to model it for men of a certain age and body, if necessary. I do like my underwear, and I have used linings too; the situation is manageable.

However, on the sexual part—the big mammoth in the room—I have ignored its presence and viewed it as part of the weight-bearing structure of that space, insignificant if it played dead and never moved. But 17 months after radiotherapy, with all things looking good, the mammoth is awakening from its imposed hibernation.

Weighing the Options

If I wanted sex, and I enjoyed sex, this diagnosis exacerbated and crystallised the ideas of sexual dysfunction in my mind.

In choosing the option for treatment, I first spoke to the consultant surgeon about the radical prostatectomy procedure. A year before, a men's advocate who had undergone it explained that the expert surgeon was able to save the nerves necessary to retain some sexual functions.

The surgeon was quite candid with me: my prostate gland was so enlarged that he couldn't guarantee anything could be saved of my nerves until he was in there conducting the surgery.

Imagining the Aftermath

As this procedure is conducted under general anaesthetic, the prospect of waking up to a surgeon trying to express happiness and sadness in the same facial expression was one I was not intent on seeing.

His professionalism and years of experience might have given him the skill as a comic piece, but it would have been a joke at my expense. “Mr Akintayo, we successfully removed the prostate gland. However, your sex life is gone; you're impotent. But we can make some interesting toys for you, to have some sensation and other elements of pleasure.”

I'd be crying tears of joy for being free of cancer, catheter inserted as there is no urinary control for months, finding where my pelvic floor is, and living happily ever after.

Then I ask, even if this smacks of medical paternalism: should surgeons be more proactive in discussing sexual health outcomes?

Learning from Others

Another friend had undergone the procedure a few years before. He, a straight man, came to me to seek advice about the kinds of sex I know. Much as I could have helped, I felt he needed to join a men's support group to appreciate the experiences of men in similar circumstances before thinking of this, because his views were explorative to my hearing, rather than developed.

From that surgery discussion, I knew it was not for me. At the same time, I needed that cancer excised because, whichever way you look at it, dead men do not have sex.

Another question arises: how do cultural expectations of manhood affect seeking the essential prostate health check-ups first, before considering the treatment decisions and recovery?

Radiotherapy and Its Consequences

As I took radiotherapy, the immediate and enduring side effects have been bladder related, with a few bowel issues. My sex drive is depleted by being unsure of ability and compounded by lacking confidence. It is also not something that can be addressed with bravado.

As you can read, I am tackling this issue alone because I do not understand this vulnerability enough to appreciate the kind of help I need.

The Medication Dilemma

Yes, I can get erectile dysfunction medication and pop pills like sweets, but that not only becomes a prop; it does not address the emotional and mental issues. Rather, it becomes a legalised version of chemical sex, getting a prescription from a pharmacist instead of illicit drugs delivered by a dealer.

The question then becomes, how many highs can I have before drug-induced priapism or severe hypotension with the risk of death is the danger?

Furthermore, because it has been offered, is the medical establishment over-reliant on pharmaceutical solutions rather than psychological support?

Rethinking Intimacy

As men, we are fixated with erection and penetration as the full expressions of sex; the absence of either or both feeds a kind of sexual frustration for the person and their partner. Does sex become a distant memory rather than a present experience with a hopeful better consummation, or are damaged goods being repackaged for a partner with different expectations?

For gay men, where physical intimacy and sexual expression often form central parts of identity and connection, the loss can feel particularly acute. The dynamics of same-sex relationships, where both partners understand male sexuality from lived experience, can create a unique space for empathy and shared problem-solving.

Yet it can also mean both partners acutely feel the absence of what was, and the uncertainty of what might be possible. The fear of being seen as “broken” or inadequate in a community that sometimes prizes sexual vitality can compound the isolation.

For straight men, the challenge often involves navigating conversations with partners who may not fully grasp the psychological weight of erectile dysfunction on male identity. There's the added pressure of traditional gender roles and expectations around male performance.

Meanwhile, bisexual men face both sets of pressures, depending on the gender of their partner, alongside navigating healthcare systems that may not fully recognise or address their specific concerns.

Regardless of sexual orientation, the fundamental question remains: how do you maintain intimacy and connection when the language of physical expression you once spoke fluently becomes halting and uncertain?

Confronting the Fear

Yes, I have literally thought through all this with a clear indication that I probably need to re-engage with a support system that would address many of the pertinent issues after treatment for prostate cancer. The questions are not abstract; they are real issues in existing relationships.

You might wonder, if I have managed the bowel and bladder issues that well, why am I struggling with the sexual one? Whether we like it or not, it defines, to a certain degree, manhood, manliness, performance, and self-esteem. Maybe, just maybe, this is part of the fear that stops us black guys from talking about men's things.

One last question: are Black men receiving adequate support and information about sex, sexual health, and sexual expression after cancer treatment?

Moving Forward

Yet we need to talk. Prostate cancer cannot be the last story, and navigating a way to fulfilled sexual satisfaction after prostate cancer treatment must not be greeted by the shock of the experience, but by the hope of new possibilities through therapy, support, and understanding.

How intimacy changes in relationships is a journey that has no clear answers for both parties, and that might not be the prospect a partner desires in what looked amazing before cancer struck and stole our virility.

Check your Prostate Cancer risk in 30 seconds.

Blog - Men's things XXX: Let's talk Prostate Cancer

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Men's things XXX: Let's talk Prostate Cancer

Making Those Nature Calls

As I was about to leave the office yesterday evening, I followed that familiar credo: "Go before you go." It's one of those habits people of a certain age need to entertain before leaving the safety of indoors for the outdoors.

That is, visit the toilets. Return to that childhood scenario where your parents or guardians asked if you needed to use the toilet before commencing a journey. In fact, they would have probably made you go regardless of how you felt, to forestall a mishap at an unfortunate time.

A Poster to the Prostate

Anyway, I was gladdened to find on the inside of the cubicle doors in the Gents the prostate cancer campaign poster I had recommended, advising men to be aware and to check up on their prostate health.

In my view, it might make for a friendly conversation starter after we have used the facilities and are doing the essential ablutions following these intimate activities. I also hope to find other opportunities to share my experience with prostate cancer: the criticality for us all to know what the symptoms are and how catching issues early saves lives.

A Call to Healthy Brotherhood

Fundamentally, we need forums and spaces not only to broach matters of men's health, but to discuss men's things openly and without embarrassment, to give each and every one of us a fighting chance, and to support each other through challenging times. This matter calls for a brotherhood in arms. I am all for it.

Check your Prostate Cancer risk in 30 seconds.

References

Blog - Men's things XXIX: The Cubicle Next Door

Blog - Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Men's things - Prostate Cancer blogs

Know your symptoms.

1 in 8 men will get prostate cancer.

Know the symptoms.

A Google NotebookLM AI Podcast on this blog

Men's things XXIX: The Cubicle Next Door

An Uncomfortable Observation

Yesterday afternoon, I went to the Gents, where we have cubicles and no urinals. Next to mine, someone had entered, taking the standing stance. To my hearing, the stream continued for a considerable length of time, with different rates of flow.

This might have been an opportunity to talk to a stranger about "men's things". It may not be anything serious, but every indication suggested it should be checked out. When he emerged from the cubicle as I was leaving, it was a middle-aged white man.

Again, I felt no particular urgency comes with screening white men for prostate gland issues. When anything is caught, if it is cancer-related, it is often at a late stage. As an Englishman, I am wont to mind my own business, but is that a good enough excuse when you suspect there might be an issue with a stranger's urinary habits that might portend cancer?

Taking Quiet Action

Having had prostate cancer and knowing how issues with an enlarged prostate can be easily dismissed as signs of ageing or nothing of significant concern, I understand the need to educate people about prostate health. Knowing the symptoms to watch out for is important.

I have just gone down to our reception to suggest that some posters be put in the men's toilets informing them of prostate health issues. I have also received a response that the posters will be printed and put in the toilets tomorrow.

I hope that in doing this, men would become more aware of prostate health and go for check-ups if they are exhibiting any of the symptoms.

References

Blog - Men's things XXVIII: Shame, no national prostate cancer screening

Blog - Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Men's things - Prostate Cancer blogs

Poster from Prostate Cancer UK - 1-in-8 [PDF]

A Google NotebookLM AI Podcast on this blog

Men's things XXVIII: Shame, no national prostate cancer screening

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: Streeting 'examining evidence' after experts advise against prostate cancer screening for most men

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.

Men's things XXVII: The inconvenience of incontinence

We Need a Screening Programme

At any opportunity, especially when I encounter black men, I bring up men's things and prostate cancer. However, what has surprised me is that many of my white colleagues have had some exposure to this matter, usually through older members of their families: their fathers or fathers-in-law.

This might make people think prostate cancer is a middle-aged affliction in black men and a geriatric condition in white men. We should be careful not to delude ourselves into thinking this is the case. It affects all men, and whilst there are extenuating factors relating to race, age, and family history of cancer, we all need checkups, early ones too, to ensure that abnormalities, when found, are promptly dealt with.

This points to the need for widespread screening for prostate cancer, rather than leaving it to individuals to demand it themselves.

Some Aftereffects of Prostate Cancer

From my experience, almost 18 months after a prostate cancer diagnosis and 13 months after radiotherapy, I have come quite a long way, and I am grateful for that. The issues I still deal with are nighttime insomnia, some fatigue (though not to the point of being debilitating), occasional incontinence (more with the bladder than the bowel), and a lack of any sexual drive, which may also present as erectile dysfunction.

Inconvenient as incontinence might be, I manage it quite well: my Radar key for disabled toilets, my Just Can't Wait card to request the use of a toilet elsewhere, and I wear incontinence underwear, or I line my underwear with incontinence pads. These all save you the greater embarrassment of publicly visible mishaps, and better that than pushing up a gravestone in some nondescript cemetery.

Making the Best of It

Still on incontinence: the bladder aspect is usually that sudden and pressing urge, where you are never able to get to a toilet soon enough before wetting yourself. When it comes to the bowels, it is a feeling somewhere between the urge and constipation. Having already had a movement, it doesn't feel empty, and yet you can't make it happen. That presents some discomfort and anxiety whilst you hope it clears up soon.

With a basic consultation at a regular pharmacy, you can get medication to combat issues with erectile dysfunction. Ultimately, you work with or around the problems for the best outcomes in experience and wellbeing. Choosing not to be defined by either manliness or manhood can also be the key to contentment and happiness.

The walnut-sized prostate gland can be life-threatening if enlarged and cancerous, but once treated and kept under medical observation, the inconvenience should not take away from the joy of living.

AI Postscript

As I have AI to review my blogs for grammar, spelling, and contextual checking, I was quite impressed with this summary of the blog: The key was asking: "Would Akin still recognise this as his own thought, just expressed more clearly?" If the answer was no, I didn't restructure it. Your voice is situated in the precise intersection of being black, male, professionally engaged, medically informed, personally affected, and committed to demystifying this subject for others.

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 XXVI: Let's avoid the stigma of prostate cancer

Blog - Men's things - Prostate Cancer blogs