Every hour, in the UK, one man dies of prostate cancer. Respected racing journalist, David Ashforth, has prostate cancer. David kindly agreed to write this guest piece to help publicise a charity walk a few of us are doing next month to raise money for the Prostate Cancer Charity.
John Hanley, a racing broadcaster, organised the walk which was completed successfully and raised its target of £10,000 thanks to many racing and non-racing folk who donated. There’s a report on the walk, and a short video here which is good, at least, for a few chuckles.
Joe, preparing (I hope) for his charity walk in the Lake District next month, has invited me to write a frank piece about my experience of prostate cancer; prostate cancer with the jokes taken out. The important bit had better come first, in case the next race at Wolverhampton is looming up or you’re bored already.
If your peeing habits change – if you persistently pee more often than usual, or have trouble peeing, or ‘leak,’ or notice some other change – go to your doctor, even though you don’t want to. If you are over 50, and the doctor doesn’t suggest it himself/herself, ask to have a PSA test. Even if you have no symptoms, ask about an annual PSA test, which is standard practice in the USA. Doctors have different opinions about the value of such tests but, if you are over 50, at least discuss it with your doctor.
Prostate cancer is the most common cancer in men, with 36,000 new cases diagnosed every year, and 10,000 deaths each year. It is rare in men aged under 50 and, in common with many other cancers, early diagnosis can significantly increase the chance of a cure.
PSA stands for prostate specific antigen, a protein produced only by prostate cells. The prostate is a walnut size gland which produces semen. It is situated near your bladder. The PSA test is a simple blood test. I used to dislike needles but since I’ve become a pin cushion they don’t bother me anymore.
There is no symptom unique to prostate cancer and a higher than normal PSA reading can be caused by other things but, if you have prostate cancer, you will have an elevated level of PSA. It is a prompt for further investigation.
The most difficult thing I had to deal with was not discovering that I had cancer but the knowledge that I should have been diagnosed earlier. I have always had good GPs – with one exception. Unfortunately, it was the one that mattered. In 2004 I moved and got a new doctor. I wasn’t impressed by him and thought of asking to change but didn’t. Several times during the next few years, I saw the doctor about peeing issues. He didn’t examine me, or suggest having a PSA test, but told me that it was part of ageing. If I had known then what I know now, I would have insisted on a test.
Eventually, in 2008, when I was 59, my doctor arranged a PSA test. My reading was 11.2. The doctor told me that, if it had been 7 or 8, that would have been alright but, as it was higher, it was probably advisable to see a specialist. 7 or 8 is not alright. Anything above 3 or 4 is cause for concern. It is not just patients who need to be better informed about prostate cancer, so do some doctors.
The next step was a biopsy. They stick an instrument up your backside to take samples of tissue from different parts of your prostate, to find out whether or not there are cancer cells and, if so, how widespread they are. It didn’t take long but was quite painful. The results are expressed on the Gleason scale, from 2 to 10. My Gleason score was 7. I had a fairly aggressive cancer which had reached the edge of my prostate.
Depending on the nature of the case, various treatment options are available. I was told that I needed to have my prostate removed and, in October 2008, had a radical prostatectomy. It is a major operation, which took over four hours and, because the cancer had reached the edge of my prostate, surrounding tissues were also removed, which made nerve damage more likely. In terms of quality of life, the two main potential impacts are incontinence and impotence. Mercifully, I was largely spared the first but not the second. If you like penetrative sex, prostate cancer can be pretty disastrous, although there are things that can be done, particularly if you are prepared to stick a needle in your penis and inject a drug. Losing erections is better than losing your life, probably.
Friends, meaning well, would tell me that I’d live to be 90 – not necessarily a prospect to relish – but my reaction to my situation was to make myself as well informed as possible. I wanted to know the likely course of events and, for me, the fact that nothing that has happened since has been a surprise (well, apart from a spell in hospital with blood clots in both lungs, and surgery following bleeding in an eye) has made it easier to deal with. To me, it is not a battle but just a matter of the way in which cancer cells behave and the medical profession’s imperfect but improving ability to deal with it.
Since only prostate cells produce PSA, your PSA reading after having your prostate removed should be close to zero, preferably no higher than 0.1. Mine was initially 0.2. Last year, when it reached 0.5, indicating a recurrence of cancer, I was given a course of radiotherapy, “retrieval radiotherapy.” If the cancer cells were confined to the area near the site of my prostate, there was still a chance of a cure. Last autumn I had 33 treatment sessions. The radiotherapy itself is painless and, until more than half way through the course of treatment, I experienced virtually no side-effects. Later on, the lining of my bowel was affected, along with my bottom, and I was glad when it ended. There is still some legacy of that.
My PSA dropped to 0.2. By May this year it had returned to 0.5 and, by the end of July, had reached 0.9. Cancer cells are multiplying and producing more PSA. The consultant wrote to tell me, “the difficulty is that we are limited in other treatment approaches apart from using hormone manipulation.” I will be seeing him on September 1 to discuss hormone therapy. That will inhibit the progress of the disease but has some unwelcome side-effects, does not offer a cure and is effective only for so long. I will find out more when I see the consultant.
Unless something else strikes me down in the meantime, the cancer will eventually spread, and kill me. If, for me, diagnosis turns out to be a death sentence it is a suspended sentence. It is now three years since I was diagnosed and I am feeling well and happy. Finding peace of mind is important. I make a point of seeing friends and enjoying life, and am doing some work for the Prostate Cancer Charity, to raise awareness among followers of racing.
I am now 62. I’ve had and have a great life and have a fighting chance of collecting my state pension, while being spared the horrors of extreme old age. I have got nothing to complain about, except the infuriating slowness of my selections. Let’s hope Joe doesn’t trip over and kill himself during the walk.
Please share this article by whichever means you can in the hope someone is alerted to ask for that vital PSA test in time. Thanks.