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 XXXII: For the Boys in the Room: Why Your PSA Matters

Life After Radiotherapy

Much as I have not been giving frequent updates about life after prostate cancer radiotherapy treatment, I can say that life continues with gratitude.

The usual side effects persist; the urinary symptoms are not as concerning and remain quite manageable, there is no discernible bowel issue, and weekday nocturnal insomnia gets some respite with weekend lie-ins.

My voice still vacillates between a weak, hoarse whisper and the normal timbre I am known to have. It does need checking out. When my mother first heard the weaker end of my vocal spectrum, she started casting and binding in the name of Jesus on the phone, with no exchange of pleasantries; it literally freaked me out.

Monitoring My Progress

I have a biannual consultation at the Christie Hospital with an Oncology and Urology nurse, as part of the aftercare monitoring, which may continue for another couple of years. This means that within two weeks of that appointment, I must obtain a Prostate-Specific Antigen (PSA) test, usually from my GP.

My most recent PSA level has now fallen to the lowest reading recorded since that first test in February 2024, which began the journey to an aggressive prostate cancer diagnosis.

I have written quite a bit about what this has involved, but may I suggest that you also listen to the AI Podcast for November 2025, where each of the terms related to a prostate cancer diagnosis is explained in detail.

An AI discussion podcast
on blogs published in November 2025
Reflections on Health, Heritage, and Humanity

Sharing the Good News

Meanwhile, I am doing fine, happy with the progress and thankful for the support and encouragement I get from my partner, Brian, my friends, and my colleagues. Upon receiving the result, I posted a comment in a wider Microsoft Teams chat, where I addressed them thus, with a link for them to assess their prostate cancer risk:

For the boys in the room.

I got some good news earlier today. Having undergone prostate cancer radiotherapy treatment about 18 months ago, my PSA is now the lowest it has ever been. Obviously, there is a hospital visit to review the situation.

Please, take some time to check your risk.

Thanks

Check your risk in 30 seconds | Prostate Cancer UK

Take That First Test

I take every opportunity to advocate for checking your prostate cancer health and going for at least that very first PSA test.

Beyond that, I try to address the concerns and fears that attend having your delicate bits inspected by medical personnel, as I have been through the whole gamut of touches and feel-ups. My verdict: nothing to fear and everything to gain, catching issues early and dealing with them promptly.

I hope you all find this helpful. Until the next update on men's things.

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Blog - A prostate cancer diagnosis, one year on

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A Google NotebookLM AI Podcast on this blog

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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Blog - A prostate cancer diagnosis, one year on

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A Google NotebookLM AI Audio Overview Discussion of this blog

A prostate cancer diagnosis, one year on

Time always matters.

In the passage of time lies the recognition of many things: living, living well, and the joy of living. This is true despite, and in spite of, other issues such as adversity, disappointment, unfulfilled yearnings, betrayals, and episodes of diagnoses that lay bare our vulnerability and mortality.

I count my blessings and celebrate each day as an opportunity to enjoy and behold the goodness in people, ideas, and places. Having the strength and means to do so places us among the privileged in ways we often fail to appreciate.

I rarely consider myself lucky; I am more inclined to think of myself as fortunate, not by my own doing or ability, but by mercy and grace. I can only express my gratitude that each day brings opportunity and ease, ample ability, and extraordinary capacity.

The extent of our imagination and vision defines our limitations; we can only exceed them through inspiration and revelation. The scope of our influence can be limitless, but until we believe it and are convinced of that possibility, we resemble chickens seeking the perspective of eagles.

Once you know, you know.

A year ago today, I was reading hospital notes from the consultant I had seen the day before, and in an instant, I became a victim of computerization without appropriate human oversight.

A diagnosis that I should never have learnt about before meeting the responsible consultant appeared in my records and was something the consultant I visited the day before should have reviewed before posting.

That is how I unwittingly discovered the diagnosis of adenocarcinoma of the prostate. A year is quite a long time when it comes to a cancer diagnosis, as you are left wondering what it entails, if it is treatable, how you will tolerate the treatment once you have decided on whatever course is available, and the aftereffects of that ordeal.

Giving thanks always.

I was not prepared for a second diagnosis of cancer, but when it came, I encouraged myself with words and sermons about healing and living, seeing beyond adversity, and leaving no room for discouragement, regardless of the prospects ahead.

Obviously, some eight months after completing radical radiotherapy, some lingering side effects remain; my voice is light, high, and sometimes sounds quite tired, but in myself, as Brian would typically enquire, I am doing fine. All thanks to God, my partner, my friends, my colleagues, the teams of medical personnel striving for the best outcomes, and that earnest desire to tell a better story.

This puts everything into perspective; each day is a blessing.

Blog - Photons on the Prostate - XVIV - I Just Can't Wait

Blog - Men's things - XXIV - A presentation

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A second fainting spell, fifty years apart

Just a lift too high

He lifted my right leg by the foot towards the back, and I was out. I cannot tell how long I was out for, but I eventually came to, and considering he neither panicked nor called for help, it could not have been that long.

That was fifty years ago, around this time of the year. We had gone cycling together into the wilderness among the tin mines of Jos, near Rayfield. This was both adventurous and dangerous. We once came upon a gathering of menacing men who not only shooed us away, but they were also quite threatening, though it is unlikely that reporting them to the police would have made much difference.

On that day, we had ridden out on an uncharted route around the paddocks, too deep to approach, with standing water that spelled danger and death by drowning, with the possibility that one may not be found at all. However, that was a story of childhood.

Woozy, down and out

What brought back that memory was suddenly standing up, and I had a serious woozy feeling, very much like when I took my eighth COVID-19 booster on Monday. I had willed myself back from the pharmacy to the office and sat down; everything seemed to sort itself out in minutes.

This time, I grabbed onto something, thinking I was holding on until I heard a crashing sound. It was me hitting the floor, and I lapsed into a kind of dreamland, believing I was still holding on and about to get up.

I was out, quite totally out, and I cannot remember how long for; I just realised I was picking myself off the floor and made for the sofa to sit down and gather myself together. What just happened? I had a fainting spell.

A bit delicate, I realise

Until this afternoon, I had handled these sudden drops in blood pressure caused by standing or sitting up quite well. I think it was exacerbated by my medication, which, as an alpha-blocker, could accentuate light-headedness and, in some cases, lead to passing out.

It was not a side effect I had associated with the medication, having only learnt of this usually rare side effect from a YouTube video this morning. [The NHS: About Tamsulosin]

While I have tried not to feel too delicate in my recovery stretch, the reality suggests that I need to be more careful and considerate of the unforeseen events that could put me at great risk and peril. The knowledge is helpful, and I am doing quite well after that episode.

Postscript: The medication for the treatment of benign prostate hyperplasia (an enlarged prostate), also treats high blood pressure.

Men's things - XXIV - A presentation

Sharing my prostate cancer story

Within the last fortnight, I attended a gathering of black men in Manchester and Liverpool, where I was invited to tell my story about my experience with prostate cancer.

The story on its own could be compelling, as I do have friends and acquaintances, even strangers asking for advice and direction about how to navigate these issues, that I term, "Men’s things".

However, in such a semi-formal setting under the auspices of a registered charity, I felt it should not be a typical story-telling setting, but one where whoever listened learnt something and could act on it.

What the prostate gland does

To that end, I created slides with some images, because in all previous presentations I have attended on the topic of prostate cancer, the issue of the function of the prostate gland as a muscular switch between urination and ejaculation was not clear. For instance, I learnt this long after I had commenced radiotherapy treatment for prostate cancer.

Secondly, I had only found one image that gave a close-up view of how an enlarged prostate gland can present symptoms of difficulty or discomfort with the ease of urination. That visual image alone seemed to get men thinking about having checks on their prostate health.

Courtesy of NHS Overview of Benign Prostate Enlargement

Your active participation in your health, matters

On this perspective, I wove a story around my curiosity about some unusual blood test results outside normal ranges, through insistence to my GP for tests, the referral for further investigation, leading to a cancer diagnosis, then the treatment of prostate cancer, and the post-treatment side effects.

Beyond that is the need for black men to participate in surveys, especially when invited for bowel cancer screening, why men’s things should be more widely and openly discussed, and how early detection saves lives.

What I hoped men would take away from my presentation was that, “All prostate issues are not indicative of cancer, but every prostate enlargement should be investigated for cause and possible treatment.”

My presentation slides

Blog - Men's things - Prostate Cancer blogs

Blog - Photons on the Prostate - XIII

References

MedScape: International Prostate Symptom Score (IPSS) Calculator

Prostate Cancer UK: Risk Checker

One is hardly sleeping enough

Another remedy to try

A hot bath with Epsom salts and English mustard comes from the yet unwritten book of Brian' s remedies. He has similar ideas that I have sniffed at which might even work, but I am always a sceptic first until persuaded.

Beyond that, he has recommended chamomile tea; his advice is an earworm. However, when I think of chamomile, I think of a lotion, and the last time I applied it to soothe my skin was during an episode of shingles in June 2009.

Obviously, I need to find something to deal with insomnia; in fact, sleep seems to arrive at any time rather than at designated times for that activity. I use my weekends to catch up on all the sleep I could not get during the week.

Keeping awake doing

While I do not feel the same level of fatigue I had during and for the few months after radiotherapy, there is still a lot of tiredness that hits you in the middle of the day, no matter how much you try to stimulate yourself. With the lack of caffeine, you just depend on nature to stay alert and focused.

Then, in my waking hours deep into the witching hour, I cannot idle about; I just completed five difficult Sudoku puzzles, as if that would tire out my brain. Besides, nocturia is an issue too; whenever I get some sleep, I wake up to pass water, usually four times during the night. I have hit the litre mark a few times this week, and I do not drink as much water as Brian insists I should.

It will get better

I have made a few adjustments, like taking my pills earlier and resisting the urge to drink late into the evening, but I sometimes have a dry mouth, for which swilling cranberry juice might be too great a luxury if you do not swallow after you taste it. I used to drink sparkling water, but I stopped because fizzy drinks do not help urinary function after radiotherapy.

I hate still water, yet I find myself having a glass or two, but never as much as necessary. What I have avoided all along is medically induced sleep; however, the insomnia is a long- term side effect of radiotherapy. I know sleep will eventually come, but I must find ways to prevent this from ruining a productive day.

Photons on the Prostate - XVIII

Just Can’t Wait

At the culmination of radiotherapy for prostate cancer in early October, apart from the fatigue, I had serious bladder issues accompanied with pain and the regular inability to pass urine. Any time I stepped out of my home, I needed to know there was a convenience about, because I needed one within 30 minutes of leaving home and frequently thereafter.

While I had many conversations with the Macmillan Cancer Support nurses, it was the Cancer Support Nurse Consultant that came through my employer’s insurance services who was the most helpful, in that, she had the time for extensive conversations and the knowledge to deal with issues around cancer, treatment, the management of the side effects, and recuperation.

On her advice, I got the Just Can’t Wait card and a Radar key to facilitate urgent access to conveniences when needed. The times they have been life savers and helping the avoidance of embarrassment are precious beyond expression.

Changing side effects

On one of our conferences when I talked about the changing side effects I was experiencing, she intimated the side effects are not textbook experiences that would occur as indicated in the various medical notes referenced. Some may never occur or would occur at different times for different people depending on innumerable factors. I just had to work through them.

To deal with the pain beyond easing the constriction of my much-enlarged prostate after radiotherapy, I was on Codeine which I later learnt metabolises to morphine in the body. This informed my moderated use of it to avoid addiction.

Rather than adhere to the recommended early dosage of two tablets up to four times a day, I only took two tablets at night and immediately weaned myself of it once the pain had subsided, some six weeks later.

Until recently, I have had no bowel issues, they were slightly irregular, but I had no urgency pertaining to that. Codeine could exacerbate constipation, so, I did take a laxative just to avoid complications. It never really came to that.

Please, toilet, now

However, lately, I think I have been quite daring with my outings, I have had some uncomfortable bowel urgencies that have had me considering how I navigate my city and my outings. Pitifully wielding my Just Can’t Wait Card and rushing to access a disabled toilet with my Radar key while preserving my dignity, is a test of composure without paying much heed to embarrassment. Needs must.

Yesterday, as I attended the Pearson Vue test centre to take a Microsoft Certification examination, I had missed the direct bus to the location, the alternative was a longer walk than I anticipated, and soon I realised, having a toilet nearby would be a great relief.

We are required to register at the reception but there was no time for that, I walked in and emphatically said, “Please, can I use a toilet, now?” The receptionist helpfully directed me to the toilet dispensing with the required formalities until after my emergency.

Today, halfway back from shopping for ethnic goods, I knew I had to find a toilet before boarding my next bus as I was unsure nature would allow me to avoid any embarrassment.

One would think a shopping centre would have public toilets, but what use are they when they are closed? Even as many public toilets have been closed due to cuts and other issues, I am becoming more aware of people with bladder and bowel issues are limited in their abilities to leave their homes.

The large Tesco store behind the vaunted shopping centre came to the rescue, I would not have survived realising they had no toilets and thankfully, the disabled toilets were close by.

More toilets needed

We can wear incontinence underwear or some with even more serious abdominal issues might have colostomy, ileostomy, or urostomy bags to divert waste or urine from the body where the natural organs have been bypassed due to medical issues. [Salts Healthcare: What is a stoma?]

You do wonder if some public action is required to address access to more public facilities without the need to expose oneself to the indignities, we have little control over.

I am thankful the mishaps have been minimal, contained, or have happened so close to home that they have been bearable. Life is not just finding a toilet but knowing that you can find one when needed makes life a little more fun.

Blog - Men's things - XXII

Blog - Photons on the Prostate - XVII

Photons on the Prostate - XVII

All touched in different ways

I will be the first to say that there is life after cancer for those of us who have been fortunate to have some treatment and even a cure for the dreadful disease. Daily, I encounter many others like me who have put the event of cancer behind them and are getting on with their lives.

At the same time, it is becoming more obvious that a lot of people are affected directly or indirectly by cancer. It requires us to talk about it to learn about experiences, not so to give cancer prominence in our lives but for ideas to help with dealing with diagnosis, prognosis, therapeutics, and post-treatment of cancer.

The value of experience

The expertise and the experience of others have helped me a great deal. Colleagues whose parents have had or are undergoing treatment for cancer along with the issues that entail managing the disease all matter for understanding how it affects people and what accommodations might be necessary for their return to normalcy.

In my case, I am now five months after I commenced treatment for malignant adenocarcinoma of the prostate with hypofractionated radiotherapy. The two lingering consequences of the treatment are involved with my bladder, a known side effect for which I am taking medication and a rare and unusual side effect that pertains to the change in my voice.

A good outlook ahead

My GP has been informed by letter to initiate an investigation of the voice with the possibility of an otorhinolaryngologist (ear, nose, and throat consultant) referral.

I know nothing would happen until I make a fuss about it, as I always have to with adverse blood test results. I guess I am more preoccupied with getting back to normal, but if this persists beyond my next appointment with the oncology department in April, I will be agitating for action.

In general, I feel good, I need to adjust my sleeping patterns as I do not seem to be getting enough sleep at the right time of the day as I should. Things should improve rather than deteriorate, the prospects going forward are good.

Blog - Men's things - XXII

Blog - Photons on the Prostate - XVI

Photons on the Prostate - XVI

Sleep forsakes thee

It is probably time for an update regarding how I am recuperating following radiotherapy, I am up this early because I was up for most of the night, one side effect that I have not given much consideration is insomnia. I sleep to have to catch sleep whenever I can, but it messes up my day because I cannot concentrate fully on what I need to do.

For this, I should find the lifestyle adjustments that would help me sleep consistently and better in what are supposed to be the normal sleeping hours. I am careful about medically induced sleep, in fact, I have shunned offers of this kind of medication for over 15 years, especially when multiple medications then caused drowsiness, it all adds up and you want to wake up too.

Soon after radiotherapy, I also had Codeine prescribed as part of my pain management, as Codeine metabolises into Morphine, I was all too aware of the addictiveness and issues with withdrawal. I only used Codeine at night and just once a day. As soon as the pain and discomfort had eased, I began to wean myself off Codeine and I did it in a week.

Straining to pee

The bladder and urinary issues are much improved, I am on medication for benign prostate hyperplasia, basically prostate enlargement firstly due to cancer and the resulting inflammation after radiotherapy.

The urinary flow is better, checking with the IPSS Calculator, my IPSS score has fallen to 14, which is still moderate, but it is down from the 19 that was recorded just before I had the clinical consultation for the radiotherapy treatment option in late July. I must accept that these things take time.

I think Incomplete Emptying is not much of an issue, Frequency is moderate, Intermittency is low, Urgency is moderate, I have a Weak Stream, Straining is a feature of me being first as the urinals and the last to leave, I noticed that so many times in Cape Town, Nocturia is about thrice during the night, and I need an improvement in my urinary function.

The last question on the IPSS Calculator – “If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?” Before I commenced treatment, I was Mostly Satisfied, the feeling now is Mixed, I might need an appointment with Urology to talk through these issues.

As I am running the IPSS Calculator under medication for easing prostate stress on my bladder and urinary tract, I would think without medication, the situation is much worse.

Recuperating in Cape Town

Indeed, at this time of the year, any visit to Cape Town would seem like a holiday. This visit was anything but a holiday, it was the most convenient place for Brian and I to meet, so he could support my recuperation, for I had neither the personal nor domestic care I needed at home, as the side effects of radiotherapy worsened.

It did us a world of good, a lot of rest, the summer weather, walks on the beach, cooked meals, and much loving care and attention. We ventured a couple of social events but none of the typical Capetonian holiday stuff like venturing out to wine estates or tourist traps.

I drink cranberry juice, hardly any carbonated drinks, I have eschewed alcohol, I probably have had three glasses of wine in three months and for tea, I have stuck to decaffeinated tea rather than decaffeinated coffee until I am happier with the urinary situation.

Singing for the crows

One lasting side effect is my voice, it sometimes gains strength and timbre, but I do not know if I would totally regain my original voice, or it would settle somewhere near what it was. It sounds tired and slightly feminine, there might be some underlying fatigue to it brought on by insomnia too, possibly a topic for discussion at my next medical appointment.

In all, I can report there is considerable progress, I do tire easily, but I also will myself to do things and find the capacity to get things done. That is a good update.

Reference

MedScape: International Prostate Symptom Score (IPSS) Calculator

Photons on the Prostate - XV

The need for quality support

When it comes to talking about cancer, I have had the best support from a Cancer Support Nurse Consultant (CSNC) recommended through support services with my place of work. We have scheduled monthly meetings where for sometimes more than an hour we can address all my concerns and issues around dealing with cancer.

Our first meeting which was via Microsoft Teams, and I insisted on an audiovisual engagement rather than plain audio, we talked for about two hours, and it involved giving her a full background on the process to the discovery of cancer and attendant issues.

Macmillan Cancer Support, the Christie Hospital, and my GP have been supportive but what I needed most of all was someone ready to spend time listening, understanding, appreciating, and recommending how to navigate a cancer diagnosis through treatment and recuperation.

I dare say my engagement with Prostate Cancer UK was a distraction. I was well on the way to having active treatment based on the diagnosis of malignant prostate cancer, but they thought I should delay treatment for active surveillance. While anyone would prefer not to endure surgery or radiotherapy, I could not postpone treatment for the comfort of normalcy while cancer was having a gnaw at my prostate gland.

The usefulness of helpful advice

My CSNC is a registered nurse and quite knowledgeable about many of the elements around pelvic area cancers. Most of the progressive solutions I have had to manage the symptoms and side effects along with after-treatment conditions have come through our conversations. Everyone else was just at the end of a telephone, she was there to be seen and heard. It made a whole lot of difference.

In our last meeting we talked about emerging symptoms and side effects with bowel functions. The literature suggested with radiotherapy, people have more issues with the bowel than the urinary or sexual functions. I however had serious urinary problems that I hardly noticed if bowel movements were regular and working as expected.

She then suggested the documented side effects are not essentially a textbook expectation, that side effects can occur at any time during and after treatment in no particular order along with the fact that for some people, they might not experience some side effects at all.

Some outstanding concerns to address

I was recommended to keep a diary of nutrition and excretion patterns, noting the regularity of movements to find what might be the issue beyond the healing process from radiotherapy. While my energy levels are improving, I still find that I tire easily, my need to use the conveniences intervenes with my comfort, and I need to sit down after walks.

Much as I want to believe I am doing well; I am still not where I need to be. I must consider if a phased return to regular activities is needed. That conversation can wait until late in January. What I must do now is relax, rest, recuperate, and recover. Manage the symptoms and side effects as best I can while celebrating the gift of life.

Blog - Photons on the Prostate - XIV

Blog - Men's things - Prostate Cancer blogs

Photons on the Prostate - XIII

Many improvements in symptoms

Thinking of the process of recuperation after radiotherapy, I am getting better at least with the signs I have observed. There are fewer occasions of my voice sounding tired and waned from exhaustion, the weather might have contributed too as it is summertime in South Africa.

The symptoms with the waterworks persist and while it will not be defined as benign prostate enlargement the fundamentals of it still exist as the prostate was enlarged because of acinar adenocarcinoma of the prostate, the radiotherapy treatment of the cancer would have further inflamed the prostate and constricted the urinary tract, for which I have to take daily medication to ease water flow.

The image below best describes issues of an enlarged prostate, and links at the end of the blog give more context. The need to check your prostate health is important, I suggest you use the International Prostate Symptom Score (IPSS) Calculator as a starting point to buttress the case to your doctor for a Prostate Specific Antigen (PSA) test.

Courtesy of NHS Overview of Benign Prostate Enlargement

Other symptoms of concern

As pertains the waterworks, a polite reference to the bladder issues; there is lesser urgency or frequency, but the weak flow, straining, and nocturia are issues to manage as the prostate heals and hopefully returns to a normal size.

One other side effect that statistically affects others more but has been less of a concern for me is with bowel issues. They are manageable, but mishaps do occur. I reckon part of my original pain management medication has positively impacted expected diarrhoetic symptoms, but I must watch for irregular bowel movements.

What has not normalised is my sleep patterns, they are out of kilter. I suffer a lot from insomnia leading to tiredness during the day with the documented sleep record on my smartwatch showing barely 3 hours of night sleep and naps of about 60 to 90 minutes dotted around the day.

At the church service that I attended yesterday which started at 9:30 AM, I was wilting within an hour into the service. I hope this improves without having to resort to sleep inducement through medication. It might be something to discuss with my medical team.

Appreciating rest and recuperation

More importantly, it is the immediate support and care of my partner that has helped me. It was not easy facing a cancer diagnosis alone in Manchester, I had to rearrange some priorities for the uncertainties ahead. I received a confirmed diagnosis in mid-June but postponed any discussion about options for treatment for a month, while I took time to meet with my partner.

After I returned, the discussion about radical surgery and its side effects were not that encouraging, but I had to wait another fortnight to discuss radical radiotherapy and what confusion followed the different options in that area that we had a lot of back and forth. It was the second-hand experience of others that gave a better insight into what it entailed.

When the radiotherapy commenced in September, I worked through it, keeping up my routine as much as possible, though the fatigue set in, from the onset, at the first weekend, just after 2 treatments. Then, I tried to maintain productivity for another month after the treatments concluded as I realised radiotherapy did have a greater toll on my body than I anticipated.

Making the best of this rest period is critical even as I yearn to get back into professional activity. The art of restful relaxation is one I am yet to master even as I try to distinguish between holiday and recuperation, I should not make my recuperation seem like a holiday, just because I am away from home.

Blog - Men's things - Prostate Cancer blogs

Blog - Photons on the Prostate - XII

Other references

MedScape: International Prostate Symptom Score (IPSS) Calculator

Mayo Clinic: Benign prostatic hyperplasia (BPH)

Urology Care Foundation: Benign prostatic hyperplasia (BPH)

NHS: Prostate Specific Antigen (PSA) test

Prostate Cancer UK: The PSA blood test

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