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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Photons on the Prostate - Three Things I Wish I'd Known

Full Disclosure

Despite what you read in this blog, I believe the choice to undergo hypofractionated radiotherapy as my treatment option for malignant adenocarcinoma of the prostate gland (prostate cancer) was the right choice.

After the ordeal of a prostate cancer diagnosis, gruelling radiotherapy, and years of dealing with lingering side effects, you would think I am done with reading up on issues around prostate gland health.

Now, I am glad to say it was caught early. I believe I received as good care and support as could be given by advisory and medical teams, and I am convinced that I chose the best medical outcome for my situation.

3 Hidden Problems With Radiation Treatment for Prostate Cancer
© The Prostate Clinic

Unsolicited Advice and Misinformation

In the same vein, I am usually offered tips, hints, and advice about prostate health; mostly information shared on social media, none peer-reviewed by experts in either urology or oncology to prove their efficacy. The impressions are mostly anecdotal.

My father, for instance, has mostly been swindled or scammed by snake oil salesmen offering miracle potions to treat his prostate problems that medical science has been at pains to prove he ever had. We are left humouring him when it might be prudent to sternly upbraid him. He is educated and had a high-profile professional life; he should know better.

The Prostate Clinic Revelations

Recently, I have been following The Prostate Clinic, a YouTube channel hosted by Dr Charles Chabert, a urologist in Queensland, Australia, and it has taken a few days to properly digest what he had to say.

In July 2024, I met with consultants in surgery and radiotherapy for prostate cancer. Later, I spoke to a support worker at Prostate Cancer UK who opined I should opt for Active Surveillance or Watchful Waiting over the active treatment suggested at diagnosis. Even after reading up on extensive material and sharing my journey in a series of blogs, I had to manage my consumption of information to avoid being overwhelmed into stasis.

The Question of Sufficient Information

The question then becomes: how much more information, detail, reports, studies, and research should one access before knowing without any shadow of doubt you are making the right decision, all things being equal?

You are told so much going into treatment but not nearly enough about the aftermath, it would seem.

Three Hidden Problems

The Australian urologist addressed the aftereffects of radiotherapy on the prostate that could leave you concerned about several things, of which sexual dysfunction has been a recent blog topic. He called them “3 Hidden Problems With Radiation Treatment for Prostate Cancer”, suggesting why we should not opt for radiotherapy.

When the prostate gland is irradiated, it could damage the surrounding tissue connected to the bowel (radiation proctitis, very graphic, the pictures can cause distress) and bladder (radiation cystitis) systems. Irradiating the prostate gland shrinks, scars, and can make it fibrotic, leading to two other consequences: limited salvage options or progressively reduced sexual function.

Complications and Salvage Treatments

Complications might arise if there is a local recurrence of cancer, making salvage activity quite difficult. This portends more impactful consequences for the patient and radical alternatives for bowel movements. Salvage treatments are better managed post-surgery than post-radiotherapy, where options are severely limited.

The state of the prostate gland after irradiation means that sexual function will increasingly diminish. This touches on erectile dysfunction and reduced ejaculatory performance. These are weighty matters that make you wonder if you had known all this before you commenced treatment, whether you would have made that choice.

Managing Side Effects

Again, the issue with choosing any treatment comes down to how you perceive you can manage the side effects. For surgery, they are immediate, whilst for radiotherapy they are progressive.

The possible loss of total sexual function, because the consultant surgeon had already indicated my prostate was too enlarged to guarantee the salvage of any nerves, immediately made that option a non-starter. I was not going to wait and see what a malignancy was going to do in my body through Active Surveillance; it would never have been an option for me.

My Choice

Choosing radical radiotherapy was the most comfortable choice in my circumstances. Though having an additional prayer point before I had my prostate gland zapped might have made this discovery less of a surprise and caused less concern.

Ultimately, I believe I did the right thing and will make the best of the good fortune I have to enjoy life and write better stories, with cancer behind me. I thank God.

Check your Prostate Cancer risk in 30 seconds.

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

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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

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

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Recuperation is something you should make time for

Learning to Prioritise Recovery

I completed my last chemotherapy session on 8 February 2010. There was another session scheduled for 1 March, but when I saw the ninth session was set for 22 March, I protested, telling my consultant that I saw my life resuming after 1 March and was not mentally prepared for further chemotherapy beyond that date.

My objection resulted in my multidisciplinary team cancelling the eighth session, but that was not my original intention.

Having been given my life back, I was back on the job market, seeking an opportunity, when my consultant said I needed another six months of recovery before returning to work.

Although I had a very generous welfare package, I wanted to return to work. My sense of independence drove me, just as it was clear that bills and the mortgage had not taken a break due to my illness.

The Cost of Returning Too Early

Within seven weeks of my last chemotherapy session, I was back at work. Then my body told me a different story: I neither have the strength nor the capacity for this responsibility. I need to negotiate an adjustment or resign.

The management was very understanding, and I was granted Wednesdays off. This break helped greatly throughout 2010. It was clear I had not allowed myself enough time to recover. However, I did not have the luxury of taking extended time off, as I was self-employed.

More recently, when I was diagnosed with malignant prostate cancer in June 2024, I chose radiotherapy and decided to work through the treatment in September and October of the same year.

On three weekdays during treatment, I had to finish early due to unmanageable fatigue, a known side effect of radiotherapy.

Pushing Through Despite the Warning Signs

Yet, after radiotherapy, I worked for another month as my strength waned, and I realised I needed more specialised care, for which I am grateful Brian provided in Cape Town. I was on sick leave for seven weeks, and although I was paid, I felt the urge to return to work halfway through the leave.

I returned on the first working day of 2025. I was not fully ready, but my spirit was willing; my body struggled beyond its capacity. I pushed through when another two months off would have been ideal.

Throughout 2025, aside from my holidays, hospital appointments and an episode of epididymitis—after attending the hospital, I returned to work; by December, I still had 14 days of annual leave remaining.

For someone coming off a cancer diagnosis and radical radiotherapy, I had overworked myself out of recovery and into a demanding work environment, complicated further by political issues within management. The mentality of just powering through.

A Wake-Up Call

When, on Monday, I experienced the recurrence of unexplained juvenile stomach cramps, there was a suspicion that I could endure the pain, and I did for hours.

A contractual obligation that we delivered to the client every Monday, which I controlled, I promptly completed ahead of schedule, posting the results before I left the office.

While the stomach ache did subside, it took its toll. I was in bed all of Monday, on nil-by-mouth except for essential medication. The same continued through Tuesday and most of Wednesday.

Amidst this, I realised: I do not give myself enough recovery time because I am driven, compelled or obligated by responsibility, circumstance, or situation. None of which is healthy.

A Commitment to Change

It is a realisation I must keep in mind. I am not in a competition of appearances. Good health will always lead to greater productivity; any shortcomings become visible somewhere.

A Google NotebookLM AI Audio Overview Discussion of this blog

Photons on the Prostate - XXI: Living with the Trade-Offs

Following the Rules

It is somewhere between following my own rules of "Go Before You Go", or the situation making the rule irrelevant because it simply did not apply. I left church yesterday feeling alright and planned my route home in the rain.

I stopped off at Marks & Spencer, hoping to get a Christmas cake: that thick icing covering the juicy and moist fruitcake, that bargain offer after the season, going for a song. They had everything but that.

I could have made for home directly, but I took a circuitous route, going through an arcade or two, hoping to see a cake shop, until I was approaching home from an entirely different side of town.

The Cold Walk Home

As I was walking through the breezy, cold, barely above-zero weather; a scenario that activates the bladder at a higher frequency and urgency. I quickened my steps, hoping to get home just in time. Much as I did enter the foyer intact, I did not make it into my apartment before an unfortunate recurrence of something I thought was history.

I can report that I have a sufficiently longer time between visits to the toilet, though I might wake up thrice during the night for that too. I do try to gauge what opportunities I have to get to places before I need to wield my "Just Can't Wait" card. It is, however, not an exact science.

Managing the Reality

This is something I have grown accustomed to living with. The apparent safety that incontinence underwear offers means the dangers of embarrassment are reduced. It is usually a leak, then a full wetting.

In view of this, getting rid of prostate cancer through treatment, rather than having full bladder, bowel, and sexual function whilst under the threat of cancer you cannot predict, is always the better option. I would write on the matter of sexual desire at some point.

References

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

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

A Google NotebookLM AI Podcast on this blog

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.