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.

Cancer: No journey is the same

Cancer humanises us

The news that King Charles III has been diagnosed with cancer brings a sense of shared humanity in its frailty, suffering, mortality, and survival. We are told it is not prostate cancer and it was discovered when he went in for a procedure due to an enlarged prostate. [BBC: King Charles diagnosed with cancer]

As a monarchist, a fellow human being, and a survivor of cancer, I can only wish His Majesty a full recovery and restoration to health and vigour. Yet, a cancer diagnosis can come with shock and a dire prognosis, in my experience, is not a battle to fight as only the real tools we have against cancer are faith and hope. Faith that the medicine, the miracle, or both work and the hope that there is a life after cancer.

This looks serious

I watched as what seemed like Athlete’s Foot on my left sole change from the dark blotches of discolouration into a painful weeping sore, I foolishly thought it would go away even as a little voice in me whispered this was cancer tugging at the heart of my life ready to thrust me off this mortal coil.

Eventually, I summed up the courage to go to my doctor demanding urgent attention as the pain had become otherworldly unbearable. The moment she saw my foot, she said, “This looks serious, I have to refer you.” Immediately, she was on the phone to the hospital and moving heaven and earth to get me in as soon as possible, and I got an appointment for the day after.

On observation by the consultant, he said, this is serious and is related to internal diseases, the internist would be in next week on Tuesday, it was Thursday, and I’ll be the first person he’ll see. I was given painkillers that killed nothing, a placebo would have done much better to manage the pain.

I have heard, then again, I know the pain of cancer, I was eventually on 4 different kinds of pain management, the most effective being a Fentanyl patch that I received a doubled dosage of after a few weeks because that pain just refused to fully subside.

We can treat this

Several analyses were conducted on what were fungating tumours that antibiotics did not seem to affect, having eliminated a diabetic cause, a deep biopsy of the lesions was done, and then the consultant came to my bed to give me the news on the 9^th day of my admission to the hospital.

These were his words, “We can treat this, but it depends on how your body can take the treatment, if you can tolerate it, you’ll be fine, otherwise, you probably have 5 weeks.” Two things I took away from this message, the advances in cancer treatment for Kaposi’s sarcoma were such that medicine had confidence, and the fact that mortality loomed 5 weeks away left you with a sense of the gravity of what a cancer diagnosis might mean to anyone.

At that point, I thought, I am going to survive this because I had by then navigated the Kübler-Ross Five Stages of Grief, skipping Depression and Bargaining to reach an Acceptance that I spoke within myself, “Akin, you have cancer, what next?” I was already looking beyond cancer and with that, I had my belief, my faith, and my prayers with the support of many friends and particularly neighbours.

Treating cancer, killing cells

I began my 1^st course of chemotherapy on the 5^th of October 2009, it was to be administered at 10:00 AM but delayed for 3 hours, I did not know that after the course I would be consigned to cytostatic ostracism as the cytotoxic component of pegylated liposomal doxorubicin (tradename Caelyx) meant no one should be in contact with any of my bodily fluids for up 5 days after chemotherapy. Nurses had to don personal protective equipment (PPE) to take blood or dispose of my urine. It was unpleasant, the treatment and the treatment.

As I tolerated the chemotherapy, more sessions were added, and I became more nauseous after every session three weeks apart that by the 5^th session, I was given novel anti-emetic medication to help keep my food down for the days after chemotherapy.

When I saw that a 9^th chemotherapy session was scheduled, I remonstrated to my consultant that I was planning on restarting my life from the 1^st of March 2010 when I was to have received the 8^th chemotherapy dose, they stopped with the 7^th which I took on Monday, the 8^th of February 2010 in the afternoon after I had attended the funeral service of my dear friend Dick van Galen Last who sadly did not tolerate the chemotherapy as well. We had the same oncologist.

By the 4^th chemotherapy dose, the cancer lesions had disappeared, and beneath the necrotised skin which had to be stripped off was fresh pink skin which however did not retain that colour.

What to expect

Each cancer journey is different, I count myself fortunate that the body of knowledge accrued from many who had no hope when medicine first encountered these cancers, others on whom experiments were conducted and never survived, then those for whom successes led to improvements and advancements that we further down the line took advantage of because medicine was confident and the treatments could be better managed for good outcomes.

• Do they know what you have?
• Do you understand it and how far gone is it?
• Is it treatable and what is the prognosis?
• What particular outcomes do you want, what options do you have, some might just want to go home than face gruelling cancer treatment? 
• How prepared are you in spirit, mind, and body for this journey?
• What is your source of hope in the midst of adversity?
• What support networks do you have to draw on?

Hope springs eternal, I believed and saw myself beyond the cancer and probably not much further, but each stage of progress gave the kind of assurance that there will be life after cancer and even if there was none, I would not have died in despair, hopeless, hapless, and without any sense of having lived well.

It is the most encouragement I can give to anyone facing cancer, it is a difficult process, it is part of the human story, some survive, and many do not, we are all grateful for life, but the biggest battle when faced with adversity is whether you can see yourself getting beyond it or life ending because of it.

There is no judgement in what you see, either way, your life and your story would be you lived, you loved, you touched and were touched, and the rest falls into the annals of timeless eternity, you walked this earth and will never be forgotten.

Editorial: Cancer of the mind

Lazy newspapers

The editorial today is derived from a number of health scares that made the Nigerian social networking headlines within the last 24 hours all to do with how the big C – cancer can be contracted.

From Twitter with a URL that linked to a 234Next.com online newspaper story the eye-catching title was ‘Grilled meat can cause cancer' and then through Facebook to a news story on The Nation Online Nigeria it was ‘Beware! Oral sex causes mouth cancer, Fed Govt warns.’

I will not contest the fact that the function of the newspapers is to inform, but when it comes to health scares, they might well be literate but they are far from numerate, their copy fails to apply reason and the thinking that informs their dissemination of that news story lacks objectivity as they plumb the depths of sensationalist incomprehensibility to produce unbelievable headlines.

Undeserving experts

The blame however cannot be placed entirely on the newspapers even though they are probably best advised to give health scares a wide berth just as readers are supposed to resist the urge to charge as bulls to the matador; propagating these stories until they go viral for the want of an appropriate term and an urban legend is born.

On the matter of grilled meat which is a delicacy called suya in Nigeria the medical expert on the occasion of World Cancer Day proffered that “Cancer cells thrive in an acid environment,” and with that seemingly categorical statement suggested, “A beef based diet is acidic, especially when burnt, so avoid suya and processed meats.”

The assertion about cancer cells was quite quickly debunked by doing a search on the most outlandish statement on Google which lead to http://www.snopes.com the website that pricks urban legends and provides incontrovertible fact over fiction, fable and fallacy.

Facts off course

The statement was false, it was attributed to Johns Hopkins University and circulated via email to the many gullible readers who passed it on without verifying the claims, it was so serious that Johns Hopkins University released a comprehensive email completely rubbishing each one of the claims including the one the medical expert with all the authority of a forum made for public consumption.

Now, indeed there are dangers in practicing oral sex and there is medical or scientific study that suggests the presence of the Human Papilloma Virus (HPV) might well make people susceptible to types of oral cancer.

Experts at quackery

That piece of information coming from the Chief Dental Officer of the Federal Ministry of Health was welcome and useful, however, when the expert veered off into the moralisation and societal consequences of the use of the mouth, she had tangentially departed the commonsense bounds of scientific rigour and defaulted to a quackery of the most impressionable kind reminiscent of snake-oil merchants and street-corner confidence tricksters.

The greater concern is if on the one hand medical experts cannot be trusted to properly validate studies through basic research and verifiable facts and on the other hand they fail to appreciate their limits of the expertise before delving into social commentary that has no basis in incontrovertible truth, fact and unimpeachable scientific data, we find ourselves at the mercy of seemingly esteemed professionals operating as quacks.

The cancer of the mind

In essence, not only do we face the danger of cancer in whatever form attacking the body; a cancer of the mind even leaves us more vulnerable to risk-prone, hardly meticulous and assuming people whose guesswork and absence of logic in the process of medical diagnosis might be more fatal than a double tap.

It is then no wonder that Nigeria suffers a serious health crisis if those with ultimate responsibility cannot ensure they get their facts right before they scare us witless with laughable fables.

Blacks after slavery

On a more educational note, I came across a link to a PBS documentary about Black in Latin America narrated by the esteemed Professor Henry Louis Gates, Jr. who finds global fame in being the black man who on identifying himself as the owner of his own residence still ran afoul of the law in God’s own America.

He expounded on how slavery took Africans to Hispaniola, Brazil, Mexico, Peru and Cuba and where the black race after slavery stands today and in comparison to the United States of America. The whole series makes really compelling viewing as it draws you in and the shocks you.

One rather interesting refrain suggested that long-term relationships were rarely formed in many cases between races but somehow sex appeared to be colour-blind. One should take the time to carefully view every single episode and if well-disposed a contribution to the service would also be welcome. You can find the homepage at Black in Latin America | PBS

Acknowledgements

The 234Next Newspaper piece titled ‘Grilled meat can cause cancer’ appeared in February and the news story published yesterday by The Nation Online Nigeria it was ‘Beware! Oral sex causes mouth cancer, Fed Govt warns.’

The Time Magazine did publish information about the study Oral Sex Can Add to HPV Cancer Risk in April 2007 and so did the BBC with the title Oral sex linked to mouth cancer as far back as February 2004; with a BBC3 documentary aired in January 2011 that stuck with the substance of the report.

The findings of the study itself were published in the New England Journal of Medicine with the title Case–Control Study of Human Papillomavirus and Oropharyngeal Cancer downloadable as a PDF file in May 2007.

The Snopes website debunked the “Cancer cells thrive in an acid environment” assertion by publishing the full false email attributed to Johns Hopkins University and the each point in that email for further rubbished by the university in a publication titled - Cancer Update Email -- It's a Hoax! And this as far back as April 2009.

The Henry Louis Gates arrest controversy as documented by Wikipedia, the free encyclopaedia is just what it is.

World Cancer Day 2025

Understanding a cancer diagnosis

For so long, I had viewed my story through the prism of my first encounter with cancer in 2009 and the gratitude with thankfulness for not only having survived but thrived when at the time of diagnosis research studies indicated my kind of situation rarely gave survivors another ten years.

This time last year, my request for a routine blood test began another journey to a new cancer diagnosis, over four months through tests and investigations, I learnt in June by an inadvertent medical disclosure of adenocarcinoma of the prostate.

Choosing and curating the people with whom to navigate the journey through the diagnosis and the treatment of cancer is a strange thing, people generally do not understand cancer and the way you present may not essentially indicate how seriously ill you are. Maybe, experience is the best teacher, if the observer is not self-absorbed. [World Cancer Day: What Is Cancer?]

Living a cancer reality

You take each day as it comes, the process of recovery after treatment is long and you can find yourself impatient when you realise you do not have the reserve of energy that deceptively comes in bursts and then deserts you literally abruptly.

Along the way, I have had such amazing support and understanding; the theme of World Cancer Day seeks to “create a world where we look beyond the disease and see the person before the patient.” In general, I have been seen and there are times I have wrestled with the experts to be seen, this has been encapsulated in the assertion that “It’s my body first before it’s your guinea pig.”

When I think of cancer, I think of many who have not been as fortunate, who suffered in ways impossible to articulate, then of those of us who have come out at the other end with our unique stories, and the united effort of medicine aggregating the body of knowledge acquired from all experiences to battle cancer to victory for our humanity.

More importantly, I focus on faith and hope, a future better than today where cancer is caught early and treatable. The best situation would be to avoid cancer completely. My advocacy is getting more black men to talk about Men’s things honestly, freely, confidently, and proactively for our lives and those we love. Here’s to World Cancer Day 2025.

Blog - Men's things - XXII

For World Cancer Day and every other day

In remembrance

I probably take no notice of the many days that are celebrated in commemoration of something throughout the year. However, the 4^th of February 2019 was one day I could not ignore because I was called out as an inspiration with regards to what the day represents.

World Cancer Day is a day to remember for many reasons apart from awareness and taking action for I belong to the cohort of those who have cancer in remission having survived the ravages of the disease almost a decade ago. Yet, I recognise and aver that we who seemingly and apparently have survived cancer are hardly valiant, we took no sword like knights to battle and vanquish the enemy that invaded our bodies, we are just fortunate.

Not in vain did they die

Rather, I want to commend those who did not have the good fortune I had, who like others would say lost their battles to cancer as if to confer some sort of heroism on those who survived as winners. Those that died are not insignificant, in fact, they in what they suffered and in all that medicine and anything else attempted to do to prolong their lives have immeasurably contributed to the body of knowledge that gives medicine the courage to face up to new incidents of cancer.

When I was verifiably diagnosed with Kaposi’s Sarcoma on the 30^th of September 2009, this is what my consultant had to say to me. “We can treat this, but it depends on how your body can take the treatment if you can, you’ll be fine, else, you probably have 5 weeks.”

On courses of chemotherapy

That knowledge and confidence came from experience and developments in treating others before me, some of whom did not survive the disease but, that had passed to the professor, to his students and the broader field of cancer medicine and oncology. On the fifth day of October 2009, I took my first course of Liposomal Doxorubicin (Caelyx) and I wrote a blog as a primer for cancer and chemotherapy, in trying to explain my condition to a friend.

“The course recommended for me is Liposomal Doxorubicin – liposomal meaning encapsulated in some fatty molecule and Doxorubicin is a very strong antibiotic. What happens is the liposomes allow for a slow release of the disease-fighting chemical into the body after intravenous introduction which just takes an hour, and this is not fully excreted from the body for up to six days.”

Blog - A primer on cancer and chemotherapy

I took 7 courses of chemotherapy every 3 weeks until the last course on the 8^th of February 2010, by which time the blackened cancers lesions had completely disappeared, the necrotised skin had been removed and I had fresh, tender skin in place of the foul and fungating tumours.

The battle for life

The battle I fought, in the end, was not with cancer, but with life in general. Cancer stripped me of everything except my humanity and my dignity. I literally lost my career, I lost my home of over 10 years, things I had acquired I basically gave away and had to start all over again. I gained a new perspective on life and the transience of things, the way the seemingly inviolable and easily become the complete vulnerable.

I learnt of the power of hope, the desire to live, the appreciation of life and an understanding of suffering. I stepped off the rat race and tempered my views with patience and consideration. Most pertinently, as I did not or do not know how much time I have left, I have lived a life of the living rather than of the dying. I am inspired to aspire and for as long as I have breath in me, I intend to thrive and be a story of being granted a second life of purpose.

None of this would have been possible without those who underwent more gruelling and horrifying intrusions of medicine so that my consultant could say with confidence, I could be treated. They are the specimens on which researchers concluded their research and came up for new ideas, solutions, treatments and discoveries. I commend those who died because of cancer and those who learnt from them to improve the treatments for cancer. It is by them that we get to write a different story.

World Cancer Day 2019

Trading away health

Are we aware of the harms?

Attending a cancer hospital is a revelation of how medical science is progressing in the treatment of cancer, and none of what I have witnessed or experienced suggests the treatments are cosmetic salves that soothe you.

The treatments are radical, irreversible, usually impactful, and could be life-changing on the completion of treatment. Early in my treatment cycle, one of the nurses who gave me advice and support had a voice box. I do not intend here to introduce the fear of cancer but to provide a perspective on why we should actively avoid harmful practices.

Every time I see someone light up a cigarette, I wonder whether they might end up in a cancer hospital and hopefully, they might have a favourable prognosis. The discovery of the cigarette-lung cancer link was evident from the 1950s, but the conspiracy of capitalism put tobacco conglomerate profits above global health. [National Library of Medicine: Historical Perspectives of the Causation of Lung Cancer] [World Health Organization: Tobacco industry interference with tobacco control]

As we ignore the warnings

Warnings on tobacco product packaging including grotesque pictures of cancers have hardly served as a scary premonition to smokers, it is not like I could be effective in accosting a smoker on any of our streets and hoarsely tell them I am undergoing cancer treatment, and it is not a pleasant experience, considering it is neither indicative of errors commission nor omission.

The prospect of the suffering and life-threatening effects of avoidable cancer should be informative and cautionary enough, but human behaviour cannot be curtailed even in the best interests of the person. As a species, the quest to survive is equally matched by the inexplicable tendency to self-destruct.

Now, I had a wild adolescence, I smoked from the age of fourteen to eighteen, my preference was for menthol cigarettes, and I did consider at one time getting a tobacco pipe. My cousins had unfortunate parental guidance and adopted snuff, it shows how example creates followers and adherents, quite unwittingly.

When I stopped smoking just over 40 years ago, I simply lost the desire for smoking once I became a Christian. The only time I smoked anything again was 15 years ago when my live-in partner being both a cheese head and a pothead, got pre-rolled marijuana cigarettes and I had a puff or two thinking it might be a palliative for cancer pain. I am however glad smoking never became a long-term habit with the inability to wean myself off nicotine addiction.

Issues of fitness and weight

One other thing I have noticed at the hospital is how unfit we are as a country, there are too many morbidly obese people, with some needing wheelchairs to get around. Even when I consider my weight and how certain aspects of my body do not conform to an aesthetic aspect ratio, I have sworn that once my treatment is over and I get my strength back, I will indulge in rigorous exercise to get fit again.

15 years ago, one of the effects of cancer was emaciation, I lost 25% of my body weight and though doctors then suggested I should carry a weight close to what I am now, I would rather be below 80 kg than find the scales show numbers that have horrifyingly shot up to 89 kg at one time. This event of cancer has hardly shown physiological symptoms, I could even be gaining rather than losing weight.

Dropping the excess baggage

Looking at metric measurements, I do a basic calculation that for your height in centimetres you should ideally not exceed that height minus a hundred for your weight. If you do not have the requisite height in the two-metre plus getting to seven feet category, you must ask why your weight exceeds 100 kg.

There are things we can do in terms of diet, exercise, rest, and checkups to keep healthy and hopefully not need a visit to a hospital or a cancer-related one. If warnings cannot do it, we should have some apprehension about the future and what harm we are doing now.

Illness can easily rob one of our sense of youthful invincibility that usually tends to delusions of immortality, some consideration and I aver, care for our bodies can give some of us assurance and a fighting chance that we won't be plagued by something destructively harmful out of what we are doing or what we have failed to do.

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.

Blog - Men's things XXXII: For the Boys in the Room: Why Your PSA Matters

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

Blog - Men's things: Prostate Cancer blogs

A Google NotebookLM AI Podcast on this blog

Thought Picnic: Comparing my encounters with cancer

Comparing cancer treatments

Fifteen years ago, I was on the receiving end of a cancer diagnosis, and it was the first day of treatment with chemotherapy. Everything was predicated on my ability to tolerate the gruelling onslaught on my body that was eventually delivered every third week on a Monday for seven sessions.

By comparison, between chemotherapy then and radiotherapy today, the latter seems more tolerable though, just as exacting on your body. Chemotherapy was then necessary because, besides the obvious cancer lesions on one sole and the emanating tumours on the other sole, there was a likelihood that cancer could be in different parts of the body.

Rather than try to determine all the localisations of the cancer, chemotherapy with its cytotoxic ability to kill cancer and some healthy cells in the body seemed the best option against radiotherapy. In the case of prostate cancer, this was still contained and localised with the prostate gland and my options were between prostatectomy or radical radiotherapy, and I opted for the latter.

Effects on the body

In terms of side effects, chemotherapy knocked me out by the beginning of the third day, there was no strength to do anything and that was also exacerbated by the inability to keep food down so I had to be given anti-emetic medication. Within the first five days after chemotherapy, I also had to be careful that no one had any contact with my bodily fluids as it was toxic to healthy people.

I was not prepared for the shock of being cordoned off in my section of the hospital ward and any nurses who needed to draw blood had to take full hazardous materials (HAZMAT) precautions when approaching me. That little piece of detail was not communicated in our pre-treatment briefing.

While I believed I would survive Kaposi’s sarcoma, I do not think I was thinking of fifteen years ahead to reencounter cancer in my prostate gland. During the preview of options for treatment, I did ask if chemotherapy could be a treatment option for the prostate and the view was except in the case of metastasis, it was not a viable option.

Experience or newness

I guess my thinking was having tolerated chemotherapy well before, a second experience would not be as bad. However, it would have left me less able to do the usual things with the need for constant care and monitoring as I had back then in the Netherlands.

I write this not to celebrate cancer but out of gratitude and thankfulness that I have been fortunate to survive cancer and tell stories of the triumph of humanity over adverse events through medical intervention and so much more, the mercy and grace of God.

References

Blog - Waiting for chemo

Blog - A life of cytostatic ostracism

Blog - A primer on cancer and chemotherapy

Cancer is a human experience, not a battle won or lost

In the great spirit of man

I did not know much about Chadwick Boseman or the body of work he had done. In fact, when Black Panther was a box office hit, I was still thinking of other representative films as Fences, Hidden Figures and Moonlight.

His passing at 43 after suffering stages of colon cancer diagnosed from 2016 during which he exhibited amazing acting prowess in seminal films is not only commendable but a show of stoicism and human spirit under great life-threatening affliction and infirmity. In the great spirit of man are such fortitude and immeasurable strength.

Cancer is not a battle

When I had Kaposi’s Sarcoma, a form of skin cancer as a result of HIV complications in 2009, I was 43, each time I read of people dying from cancer I find it difficult to appreciate the narrative of losing the battle to cancer.

As we live with it and sometimes live through it, it is rarely a battle, we are not at war, that some of us have survived it is one of great providence with many other factors of medicine, medical care, probably good fortune and even state of mind, but I did not cross swords with cancer and leave it vanquished.

We are given stories to tell

I will not pretend to speak for others who have survived cancer as I have, but what I know was at diagnosis, I was given 5 weeks to live, if my physiology did not respond to the treatment favourably. The consultant, however, was confident that if I did respond well, it would be fine. In just 5 weeks, I will mark the 11^th year of my first session of chemotherapy.

Cancer is a scourge on humanity, maybe even a terror and terrorist as it ravages our bodies and we are left at the mercies of many things outside our control except for our human spirit that remains a force of life until our bodies give in to find eternal rest.

For me, I have been given a story and the way I tell it is, cancer happens, it is part of life, some of us live it to the end and others come through it, but until we are gone, we are still here, to some a hope, to others a light, that it does not have to end with just that.

All experiences are gifts to medicine

Any death from cancer reveals our vulnerability even more, to such a young man, there are no easy answers but the fond memories and tributes we can offer in recognition of his life along with the support and sympathy we can offer his survivors.

In everyone’s experience is also some new knowledge for medicine to give us all new hopes for survival. That is what gave my consultant confidence at my prognosis and that is why I encourage inviting medical students to my consultations. I am a story of possibility not of triumphalism over cancer.

May the soul of Chadwick Boseman rest in peace.

Men's things - XI

Generational medicine involves talking

It is one of those unspoken things that even became the butt of a joke and some rather frank talk, though, I am not laughing now. Along the way, I have not acknowledged certain conditions that have appeared in the family, that medicine would consider factors indicative of a predilection to that condition.

This area of generational medical history is somewhat more developed in female medicine, like if breast cancer has been diagnosed in one member of the family with any degree of consanguinity, other females are advised to undergo tests and attend to a regular monitoring of their health to catch issues early. Some females even take radical precautionary measures if genetics suggest a susceptibility.

Reluctantly, it was during an eye test a few years ago that I volunteered the information that someone else in the family had glaucoma. I did not and do not, but that information alone meant from that time on, my eye tests were free on the NHS. When the patriarch did attribute certain chronic health issues to the prostate, I found myself dismissing the concern as that of a hypochondriac. [Refer to the first sentence of this blog, for the context.]

The cancer you can see

Prostate cancer is now an issue to deal with but differently from when I first had cancer some 15 years ago. Then with Kaposi’s sarcoma, I saw it appearing for almost a year like the slight irritation of Athlete’s foot that did not respond to any fungal treatments and then a discolouration that I ignored even as others where noticing that my health was beginning to deteriorate. I just put a brave face on things and continued as I always did.

Then, it became a painful weeping sore, at which point, it is was stupidity that took hold, I could weather this problem, I thought. Just bandage up the foot and walk, it was bearable enough until it became unbearable. When I finally went to see my doctor, if there was any alarm in her voice, she was as measured as she could be, as she said, “This is serious, I need to refer you.”

She probably had seen many presentations of late cases like mine before, her urgency coupled with care and understanding without any judgement, condescension, or condemnation was very helpful in accepting the seriousness of my condition. I could feel the cancer, I could see it too, it was utterly dreadful and thankfully something could be done about it.

Appreciating the graveness of my condition was exemplified in the statement of my consultant, just two weeks later. “We can treat this,” he said, “but it depends on how your body can take the treatment.” He continued. “If you can tolerate the treatment, you’ll be fine, if not, you probably have five weeks.” Five weeks! Life could have ended before the end of 2009.

A different prospect presents

With prostate cancer, everything is internal, the biopsies would suggest cancer has been detected very early and again something can be done about it. Apart from the results of the Prostate-Specific Antigen (PSA) test that led to the Digital Rectal Examination (DRE) suggesting an enlarged prostate and so, a multiparametric Magnetic Resonance Imaging (mpMRI) scan, and consequently an ultrasound-guided transperineal prostate biopsy, these are all internal medical indicators, I feel fine and well.

The weight of this situation is inferred in many other ways, as being added to the National Cancer Registry with a diagnosis and the initial prospect of treatment options that on the face of it have no particularly pleasant outcomes.

The invisibility of this invasion on my particularities and what might portend has me in a dalliance of disbelief and anxiety. I am steeling myself, not with substance abuse, but with the encouragement of the Word of God.

It is probably a kind of delayed shock too; I am here with my partner, and it is difficult to bring up the subject in the first instance and then begin to assess the situation. Yet, we must face up to what we intend the outcomes to be, first with myself and then together. It feels like we are hardly anywhere there.

Why I am writing about this

Any health condition is difficult to talk or write about, especially among men and even more so when it comes to men’s things. Black men are too macho for such talk.

I took the PSA test as an add-on blood test in trying to address an anaemic situation that I had tracked through two previous sets of results that were indicative of a deficiency in vitamin B12, iron, or folate (vitamin B9).

Years ago, I had folic acid deficiency anaemia and knowing that it is essential in binding other vital vitamins and minerals for good health, I wanted my doctor to address it, this has given rise to a series of Men’s things blogs.

One alarming statistic is, 1 in 4 black men will get prostate cancer in their lifetime. [Prostate Cancer UK], I don’t know if 1 in 100 or even 1 in 1,000 black men get the basic PSA test to forestall any indication of prostate activity for medical intervention. I reproduce the information from the Prostate Cancer UK website below:

You may also be more likely to get prostate cancer as a Black man if:

• you are aged 45 or over – and your risk increases as you get older
• your father or brother has had it
• your mother or sister has had breast cancer.

As for my journey, I already have a diagnosis and will avail myself of all medical expertise available strengthened by faith whatever the situation. We never quit living and living well.

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Blog - Men'sthings - II

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Blog - Men's things - VII

Blog - Men's things - VIII

Blog - Men's things - IX

Blog - Men's things - X

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?

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

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