“You’re Young To Have Prostate Cancer”

Warning: May contain pathetic euphemisms for body parts to avoid the use of embarrassing medical terminology plus details of eyewatering medical procedures applied to those body parts. The words are mine, based on my recollection of experiences and understanding of conversations. No accuracy or medical advice should be inferred!

“You’re young to have prostate cancer.” I never figured out how to answer that. So, I went for “Thank you”, as it sounded like a compliment.

I’m not sure in what order things occurred but I think it was: got pregnant, left job, diagnosed with cancer, because my only thought was, ‘I need to live long enough to see my boy grow up and pass on what bits of knowledge I have gained in my 48 years’.

During a health check for men on the high side of 40, I had asked if they tested for prostate cancer. I ticked the ‘gets up frequently in the night to urinate’ and ‘weak urinary flow’ boxes on the symptoms list. I had just put these down to age.

The doctor called within hours. Normal PSA (used to screen prostate cancer) is below 4. “Yours is 41.” Shit.

The Fickle Finger of Fate
“We’re going to do a digital test,” said my consultant. People in his profession must become experts at reading facial expressions. He sensed I misunderstood and repeated, “A digital test.” This time raising his hand and pointing to the sky. Oh, a digital test!

Lay on my side. Face the wall. Knees towards chin. Snap of a latex glove behind me. The squelch of lube. One more squeeze please, I thought. Just relax, wait for it… “If I’d known about this I wouldn’t have come on my bike.”

I then realized why a nurse was there; to hold me down in case I changed my mind halfway through the procedure. The last thing the hospital wants is a consultant unable to operate, on account of a finger being dislocated by a patient springing like a startled gazelle from the examination table while he is clamped knuckle-deep in said patient.

Just Say It!
In my experience, you will never get a medical professional to say ‘cancer’ unless they have no option. You have more chance of getting Kenneth Branagh to shout “Macbeth” in every theatre in London.

The more tests I had, the more obvious it was to me that it was cancer. But all I got was platitudes from the doctor’s handbook: “It could be a false positive”. “It could be a number of things”. “We need to do more tests”.

From memory, the tests I had in order were:
• Prostate-specific antigen (PSA) — Needle in the arm, fill a test tube with blood
• Digital exam — Lay still. Relaaaax
• Pee flow — How fast, how strong?
• Magnetic resonance imaging (MRI) — Bed moves in and out of a big magnetic doughnut. Gives black and white images of your insides
• Positron emission tomography (PET) scan. Like MRI but with radioactive substance injected into me first. Gives colour images of your insides
• Prostate biopsy. Lay still. Relaaaax. Insert device in usual orifice, extract pieces of prostate

Before the biopsy, I was grilling the consultant about why he wouldn’t say whether he thought it was cancer. Probably not the wisest move given he was about to shove a small torpedo where the sun doesn’t shine.

Adopt the position — face wall, knees to chin. This time, one nurse lay across my legs while another pushed down on my shoulders. Like a WWE tag team ganging up on their opponent. Brace yourself… Woah!! Have you put a fire extinguisher up there by mistake?

“You might feel a little discomfort” the consultant said. There was a short ‘clack’ sound, accompanied by a sharp tug somewhere deep inside me and a split second of pain. “OOF! You and me need to discuss your definition of little!”

With that over, I continued to push on whether it was cancer. “I am very rational. I won’t freak out. I just need information. If you don’t say anything, I’m going to think the worst anyway.” The doctor replied, “How about I take the rest of the samples, get this thing out of you, and wash my hands first? Then we’ll talk, OK?”

Just Go With The Flow
The flow test, my consultant explained, measured the pressure and speed at which pee left my body.

As a child, I would compete with friends to see who could pee furthest up a tree. Maybe my consultant wanted me to do that? Seems a bit unscientific. Or maybe it’s distance. I stand on the edge of a long jump pit and measure to the furthest wet sand. Or combine these events by peeing over a high jump bar, increasing the height until I can’t clear it. Wait, have I just invented the Pee Olympics?

Turns out the test was simply peeing into a funnel placed inside a toilet bowl. Shame.

The Treatment Decision
This came down to two main options: surgery to remove, or radiation to kill, the prostate.

Initially I thought, ‘Get it out of me’ with surgery. Even more tempting when I discovered the surgery might involve a robot. Called Da Vinci, it has several robotic arms, each with a scalpel at the end, which cut out the tumour through small stomach incisions. The arms are controlled remotely by a surgeon, I imagine reclining in a gamers chair wearing virtual reality goggles. ‘Player 1, choose your hands: Freddy Krueger, Edward Scissorhands or Wolverine.’

There was an issue with surgery. I was too fat. Apparently longer blades weren’t an option(!) so I had to lose weight. Fast. Previous weight loss attempts went like this, ‘You just had a carrot. Well done. Have a Twix.’ But hearing the word ‘cancer’ does wonders for determination. My wife researched and designed my meal plan. Result: 27kgs in 6 months.

Then I had one of several strokes of luck. At my friend’s summer party, a guest was introduced as a prostate surgeon. I asked if he could spare a moment, apologising for talking shop at the weekend. “No problem, I took two out earlier” he said, casually. He probably saved, or at least extended, lives that morning and now he’s enjoying a spritzer in chino shorts and flip-flops. Wow.

I wanted to know about treatment after-effects, particularly continence and erections. I learned details about my illness, my body and it’s functions that sunny afternoon. As did the couple sat on the opposite side of the table. “Good afternoon,” I said. “Lovely weather for a party.”

I chose radiation treatment. I couldn’t ignore the risk of surgery not removing all the tumour or nerve damage. Also, as the tumour had broken out of the prostate, I had cancerous nodes which couldn’t be surgically removed.

The… Erm… Bank Deposit
I was advised that, if we wanted more children, to freeze sperm as after treatment ejaculations would be no more. “Excuse me?!”

I’d never thought about what my bits did in the baby-making process. Now I wanted to know exactly what I would, and would not, be able to do. Essentially, sperm (made in my nuts) need a wave (made in my prostate) to surf to the egg, tissue, or whatever. But after the treatment, no more waves. Forever.

“But I’ll still get the sensation of cumming. Pointy toes, leg quiver and everything?” The sensation without the physical evidence. Truly firing blanks…

No need to make space next to the ice cream in our freezer because the National Health Service will store the sperm. So, after signing numerous forms at the hospital, it was time to enter the sample room. “I could be some time, as usual”, I said to my wife with a wink to mask my nervousness. She rolled her eyes and said she would sit in the waiting room.

I expected a clinical room. What I got was a converted office. And by converted, I mean the desk chair had been swapped for a leather recliner. Easy wipe, I guess. How depressing. I’m about to have possibly my last normal wank and it’s in Barry from Accounts’ office. I hope he hasn’t just gone for a cigarette.

On the desk is a TV, an in-tray full of adult magazines and a box of tissues. I realise I am probably not the first person to use these items for this purpose. And some previous users may have had a weaker relationship with personal hygiene than me. So now the challenge is to do this without touching anything. The magazines are out. And I’m not sitting on that; under a UV light it probably resembles a Jackson Pollock. So, TV it is.

Press the standby button with a tissue and there is a playlist of adult movie clips. I have to give another sample later, I thought. I wonder if I can set up a favourites list?

Top of the sample bottle secured, I left the room (open door with tissue, throw tissue in bin). I went to the waiting room where my wife was just unwrapping her sandwiches. “Oh, much quicker than I thought,” I said. “As usual,” she replied.

The Treatment Begins
Treatment 1, hormones — Started immediately. Tablets first, changing to an injection to block testosterone production. Sex drive departed. Hot flushes arrived.

Treatment 2, chemotherapy — In a ward with 10 other patients sitting in comfy armchairs. Nurses scurrying between patients. Charity workers serving tea and biscuits. How peaceful it was. I saw the spectrum of emotions of course. But other than the equipment and drips it could have been afternoon tea at the local cafe.

Fluids entered through a cannula on the back of my hand. Saline, followed by the chemo’ chemical, then more saline. I was in the chair for about 2 hours.

Talk about the rollercoaster of life; we drove directly from my first chemo’ session to our first antenatal class, to help us prepare for the birth of our baby.

I felt least alone during chemo’ treatments, because the people in that room really understood. I had stopped talking to everyone else about my condition and treatment; it felt like they didn’t want reminding that life is short and I didn’t want to think about it more than necessary.

Following precautions discussed with my consultant (I was susceptible to infection) I worked throughout the chemo’. It was important to me to have something else to focus on. This, along with my calorie deficit diet, helped with the weight loss but I was constantly tired.

Treatment 3, brachytherapy — If you don’t know what brachytherapy is, strap in. Imagine inserting several long needles through your perineum and into your prostate. Like a wrinkly pin cushion. And then pushing a wire with a bit of radioactive material on the end in and out of each needle. “Please tell me I am unconscious for that!”

Treatment 4, radiotherapy — Same time every day for 23 days. An hour before each session I drank half a litre of water and used a laxative to open the bowels.

Doesn’t ‘open your bowels’ seem overcomplicated? Did the world’s medics get together and say, “We need a less confusing term for this. ‘Bowel movement’ sounds like a protest group. ‘Defecation,’ a problem with hearing. ‘Taking a dump,’ a trip to the recycle centre. And does anyone even remember why we started saying ‘stools’? Can we come up with something simple and technically accurate?” Silence… “What about ‘opening the bowels’?” “Perfect! Right, time for lunch.”

The liquid laxative was inserted into the usual hole. The first time is all about finding a position which allows good grip on the syringe and eliminates spillage. Yoga skills are useful here. You fire it in and wait… Then, just when you’re convinced it hasn’t worked, the urge hits and you toilet dash at a pace Usain would be proud of.

Then, off to hospital. Lay still while beams of radiation are fired at my two new little target tattoos, one on each hip. Sadly, no superpowers were gained as a result.

After-effects
You wouldn’t have guessed I was having chemo’ through hair loss, since my head has been exposed to the elements for years. My eyebrows and leg hair thinned. I didn’t shave much but that could have been the hormone injections. Nor did I get nausea.

There was the issue of dysfunction in the erectile department hanging above me like a flaccid sword of Damocles but, as I’m not a swinger, only incontinence had potential for embarrassment in front of a crowd.

I emptied my bladder into my pants twice. Once while taking my son for a walk. But it was raining hard, my jeans were already wet and nobody noticed. Actually, the flood of warmth was welcome.

No matter how hard I squeezed, it could not be stopped. It felt like the problem was psychological rather than physical. So, I tried not to think about it and slipped a pad in the front of my boxers as a backup. Eventually my water works returned to normal.

One of the medicines I took post treatment was to encourage blood flow around my vital organ and increase the chances of erections later. The most well-known brand of this might be Viagra. The prescription said it was to be taken daily. The pharmacist, puzzled, said “Just take it when you want to…” I sensed she had started that sentence without thinking through how she was going to end it, “when you want to… when you want the effect.” I thought about explaining why it was required daily but it seemed much more mysterious to leave it there.

I didn’t have an erection for over two years. That’s a long time. For you and your partner. But because of the hormones, I didn’t have the desire either. That’s hard on your partner (no pun intended). When testosterone returned it was a rush. Not puberty again but thoughts and sensations returned that I hadn’t enjoyed for a while. I certainly didn’t miss the hot flushes.

The Changes Are Not Just Physical
I am physically different now. Something that gave me years of pleasure no longer looks or works the same. I can’t perform things I did as a husband and lover. These changes have made me question my identity as a man and in truth I haven’t accepted them yet.

There have been positives. The compassion of strangers, health professionals and charity volunteers. I rediscovered things about myself: purpose, optimism, discipline, gratitude. I learned to focus on process, not outcomes. I believe these, and the unwavering support of my wonderful wife, were key to my currently low (but not undetectable…) PSA result.

So, this is my journey so far. To those on their journey, and those that may be forced to embark on it in future, I wish you strength and positivity rather than just luck. Please don’t rely on good luck.