Problems of the Prostate

The phone rang, as it often did, around one in the afternoon. Another cold call, I thought, from someone in the Indian sub-continent offering to sort out the problems on my computer.
“Mr Harvey?”
“Yes.”
“Mr John Harvey?”
“Yes.”
Usually, by this time I’d have said something moderately abusive and set down the phone.
“This is Doctor B…..’s surgery.” I recognise the voice. “The results of your blood test have come back and your PSA is above the acceptable level for men in your age group.”
So … not a computer problem.
“Are you likely,” she asks, “to have been sexually active in the 48 hours before taking the test?”
Momentarily, I’m thrown. How long ago did I take the test? Five days? Six? “Erm, it’s possible,” I stumble.
“Is there any way of being certain?”
I could call my partner at work, I think. And then, almost immediately, I could not call my partner at work. And besides, who am I kidding? I’m a 76 year old male. Wouldn’t I remember if I’d been sexually active five or six days ago?
“I’d like to refer you,” the doctor says, “to the Uro-oncology department at XXX hospital.”
Oh, God, I think. It’s cancer. When my hands have stopped shaking, I log onto the internet to learn the worst.

Less than two weeks later I’m sitting across from S……, a Clinical Nurse Specialist in Prostate Care. He is calm, articulate and clear. Reassuring. My PSA, he says, is only slightly elevated above the normal level for my age. He asks about other symptoms, difficulties peeing at night – too little, too often, too much – suggests a rectal examination in a way that makes it seem no more out of the way than drinking a cup of tea.

I lie on my side with my knees pulled up towards my chest; guarded by a thin glove coated in gel, S….. does the deed. It’s over quite quickly and a lot less painfully than I’d thought; not painful at all, actually, merely strange and only vaguely uncomfortable. S…. asks would I mind if the female medical student observing takes the opportunity to perform the same operation. As she gels up, I realise I’m hardly in a position to refuse.

The results of the examination are positive; my prostate is hard and firm, which is as it should be. S…. suggests another blood test to see if my high PSA was an aberration; outlines the other means of diagnosis, biopsies, ultrasound, the possibility of taking part in research study. He is so good at this, so practiced, that I believe everything he says completely. I am actually enjoying sitting there, being the focus of his attention. If there is anything seriously amiss, it’s S….. I want to be looking after me. Is this, I wonder, the start of some kind of Munchausen syndrome?

Buoyed up, I treat myself to a flat white at Tap Coffee before catching the bus home. S…. phones just a few days later. My PSA has dropped several points. He would like to schedule another test, hopefully to confirm a downward trend. An appointment is fixed for six weeks time.

I know from the internet and the material provided by the hospital that problems of the prostate are not necessarily cancerous; the most common – BPH or Benign Prostatic Hyperplasia – is, well, benign. Most men aged 70 and over are likely to have cancerous cells in their prostate that will never pose a life-threatening risk. But I also know that prostate cancer is the most common cancer in men, and, after lung cancer, the most fatal. 10,000 men die from it every year.  And the various diagnostic tests available are less than reliable.

Oh, boy!

Six weeks roll around. Imagine my disappointment when I discover I am not scheduled to see S…. at all, but a Senior Clinical Researcher and Hon. Consultant Urological Surgeon called R…… Is this good or bad? As it turns out, good. My most recent PSA score has continued the downward trend and is now safely (but what’s safe?) back inside lower limits. R…. sees no need for further investigation or treatment and dictates a letter to my GP accordingly. “This pleasant gentleman …”

Time for another flat white …