The truth is a prostate cancer test can save our lives

10 April 2012

The call came through from Cape Town late. Gone was the usual joie de vivre from my Uncle Victor's voice. He had just been diagnosed with prostate cancer. After telling him I loved him, I hung up but, numbed and pensive, couldn't get back to sleep.

My dad and his brother are from Cape Town, "coloured" as their type of black South African is officially known. Born in the 1940s, they grew up under apartheid. Having spent the past 45 years working as a mechanic, my uncle was now at last beginning to enjoy his retirement. News of Victor's illness confounded my fears. My dad had been diagnosed with prostate cancer about a year and a half ago, and had been undergoing treatment at the Royal Marsden specialist cancer hospital. First my dad and now my uncle.

It is both ironic and serendipitous that my Uncle Victor's call came on 1 March, as this month is officially Prostate Cancer Awareness Month. The facts themselves are stark and harrowing.

Prostate cancer is the most common cancer diagnosed in men in the UK, affecting some 35,000 each year. Right now, there are 250,000 men living with prostate cancer in Britain, yet it is a disease that is too rarely spoken about openly. Most alarmingly of all, it has been estimated that one man dies every hour of prostate cancer in the UK.

I'll come clean from the outset and confess my own woeful ignorance. Prior to my dad's diagnosis, I didn't really have a clue what the prostate gland was, let alone its function or even, for that matter, its location in the body. Only now do I know that the prostate is usually the shape and size of a walnut and lies beneath the bladder, surrounding the urethra (the tube through which men pass urine and semen). The gland's main job is to make the fluid which carries semen.

Prostate cancer mainly affects men over the age of 50. Younger men can be affected but this is rare. The risk of developing prostate cancer increases with age, and also rises if a close family member such as a father or a brother has it. African-Caribbean men are three times more likely to develop prostate cancer than white men.

In many respects I guess my dad had it coming. Age and race were both against him. Over 60, he had no symptoms or pain whatsoever, save the need to urinate more often, especially during the night. It is precisely because of this lack of symptoms, or other, seemingly innocuous ones, that prostate cancer is a silent killer, since often by the time it is detected it has spread.

My dad, like many men of his age and his background, believing in the strength of his constitution and the fact that it was "probably nothing", didn't go to the doctor. But after some gentle persuasion he went to his GP for a blood test to measure the PSA (Prostate Specific Antigen) level in his blood. If there is a problem in the prostate, often caused by cancer, the levels of PSA in the blood can go up. This simple blood test — the cornerstone of prostate cancer diagnosis — can give an early indication of the disease.

Then followed the dreaded physical examination called a DRE (Digital Rectal Examination). They say it should not be painful. Just like those pipe-cleaner tests for STDs at the GUM clinic, don't believe the hype. It can be both painful and uncomfortable but it is over quickly.

Let's be brutally honest. For most men, the idea of some stranger (albeit a qualified doctor) sticking his finger up your bum is anathema, let alone butt-clenchingly painful. But we urgently need to get over ourselves, our misplaced sense of machismo and these antediluvian ways of thinking. The harsh truth is that this test can save our lives. It's high time we remove the unnecessary stigma attached to the gay innuendo and bite the bullet. Sadly, a lot of men simply don't like to talk about these things. It's not typical dinner-party conversation material but maybe it ought to be. Perhaps more lives would be saved if it was.

After these tests, there followed frequent trips to the hospital for biopsies, CT scans and MRI scans to try to gauge how far his cancer had spread. Seeing your dad — a once proud, strong man — dressed in a succession of tawdry operating gowns is both sad and humbling.

Despite their best efforts, hospital oncology department waiting rooms are not renowned for their mirth and merriment. Depressing at the best of times, they have an almost palpable smell of pain, traduced dignity and clinical sterility.

They do, however, succeed remarkably well in focusing the mind, and in helping to differentiate between the trivial and the meaningful.

The mixture of suffering, fear and stoical endurance etched on the faces of patients sitting beside me made me so grateful for my health that it put everything in proper perspective. With mordant precision, I was quickly able to see what things in life are truly important. The unpaid electricity bill, the annoying scratch on the car, the work deadline — all utterly irrelevant fripperies when confronted with the realisation of the impending mortality of someone you love dearly.

There are various different kinds of treatment for prostate cancer: active surveillance, where the state of the cancer is closely observed, if the condition is not likely to advance within your life span; external beam radiotherapy, where radiation is used to kill the cancer cells; surgery, where the cancer is removed, and brachytherapy — where radioactive seeds are implanted into the prostate. After several consultations, my dad chose external beam radiotherapy.

One of the potential side-effects of prostate cancer treatment is impotence, since damage can be done to the nerves and blood vessels that allow erections to occur. Cue more puerile sniggers. As red-blooded men, the very mention of it scares us. As such, it is still the elephant in the room when thinking about treatment.

Foolishly, far too often we let our sexual prowess between the sheets define us. But the thought of dying before my time scares me far more.

So far, my dad has responded positively to treatment and is undergoing regular check-ups. Hopefully Uncle Victor can start treatment soon. But many men are not as lucky.

At 33, I'm still fairly young, and fall outside the target age group for prostate cancer, but the fact that my dad and my uncle both have it significantly increases my chances of getting the disease. Their diagnosis has also brought home to me the necessity of healthy eating, particularly foods which can help reduce the risk of prostate cancer.

This month affords us a much-needed opportunity to banish the outdated, über-macho posturing and dispel the asinine taboos and fatuous stigmas which have grown up around these tests — tests which can save lives. In that much vaunted zeitgeist phrase, it's time we "man up" and start acting like real men. That means confronting things head on, going to the doctors and getting checked out — simple steps which could ultimately save your life, or the life of your father, uncle or best friend, particularly in the African-Caribbean community. The way I see it, getting cancer is bad enough. But dying of ignorance is far worse.

The Prostate Cancer Charity's confidential helpline is 0800 074 8383. www.prostate-cancer.org.uk

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