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Literary Review
My prostate again
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In 1997 CHRISTOPHER HURST wrote about the operation he had recently had on his enlarged prostate, and the resulting benefits to his lifestyle.
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I SOMETIMES think that the articles I write in this great newspaper just go off into space and are read by nobody. I get some satisfaction from writing them, but that is not really the point. However the 1997 article on my prostate did elicit a response — some of my Indian friends said they had read it. This was gratifying, and it is to them in particular, with especial appreciation of their concern, and craving their indulgence, that I am addressing this sequel nearly six years later.
For four years after the original operation I scarcely gave the matter a thought. I did not contact the urologist who had looked after me (I will refer to him as Peter), nor did he contact me. Then around the beginning of 2001 I became dimly aware of messages coming to my brain from the area of the body where the prostate resides. There was no pain or ache. Function, both urinary and sexual, was unimpaired. Yet I was aware of something — call it a sensation or, to put it in the most minimalist way, an absence of non-sensation. So I went to my GP (general practitioner or "family doctor"), who, since I moved house in 2000, has been an Indian lady, and she arranged for me to have a blood test. This was to be a few days later, but the very day after my visit to her I peed blood.
This set the alarm bells ringing, and made me ponder how I had been able to pick up such an indistinct message. I immediately booked an appointment with Peter and before I saw him had a blood test. The result confirmed every fear that I had not had: the PSA (prostate-specific antigen), which is the index of "Activity" in the prostate, was up to an astronomic 200 — it should be near zero. This, Peter told me, could mean one of only two things: an infection or the onset of malignancy, i.e. cancer, which had not been present in 1997. To find out which it was, I had a biopsy, and the answer came, as Peter admitted he had expected, that it was cancer.
The next thing to do, before anything else, was to find out if it had spread to other parts of the body. These could be the testicles, the pelvic lymph glands and the skeleton. All would be serious, the skeleton perhaps especially so. The first was dealt with by ultrasound — that was clear. Next the skeleton, and a bone scan found that to be clear too. The most difficult one to test was the lymph factor; I was given a scan, but that clearly was not conclusive, and I was told that the only sure way of getting an answer was by removing the pelvic lymph nodes. I only have the vaguest conception of what this all means, but I duly entered the private clinic at Kings College Hospital (I cannot afford private treatment myself, but my insurance company can) for this to be done.
This turned out to be a curious adventure. I must have gone to my room well before noon, and got into bed. I was to be the last patient to be dealt with that day, at around 5 p.m. Two surgeons would be involved: a youngish Danish surgeon who visits London regularly to perform "keyhole" surgery, his speciality; and Peter to guide him. The Dane only came to see me just before I was due to be taken to the operating theatre, and he said, with many apologies, that the staff in the recovery room had decided they wanted to finish for the day, and therefore my operation would have to be cancelled. A considerable amount of medical time, not to mention patient time, had been wasted. But one cannot argue with this sort of thing, as the Dane realised very well.
The next week I came again, and this time was admitted to a public ward because no room in the clinic was available. My section of the ward contained four beds, in two of which were middle-aged men, one a Cypriot and the other a Jamaican, who had had massive operations for the removal of part of the bowel affected by cancer. The Cypriot was full of talk and fury with the hospital; in spite of having an enormous abdominal scar, he constantly threatened to discharge himself and go home. I did my best to restrain him. The Jamaican, an older and calmer man, was in such shock and distress that he could not talk. He was fortunate in that, unlike the Cypriot, he had a large and loving family, and they would turn up and sit round his bed each evening (I was there for 48 hours). On one of these occasions his wife said the Lord's Prayer, accompanied by the others, and then the Creed. (For me this had a special potency when spoken in a Jamaican accent.) The fourth man was English, and he too was a prostate patient. Thinking that this gave us at least one thing in common I went over and spoke to him, although he looked pretty green; but, as if in reply, he vomited copiously over his bedclothes.
The Dane came to see me before we went into the theatre, and he looked grim as he told me that if the lymph nodes were found to be cancerous this would be serious, as there would be every chance that the malignancy had spread to other parts of the body. When I had first been told of the cancer diagnosis, I had adopted a fatalistic attitude: I was 71, had had a sufficiently interesting and enjoyable life, my affairs were in reasonable order, and if it came to the chop, I was ready for it. Better to go when one's powers had not ebbed seriously than live on until one was virtually "sans everything", a burden to oneself and everyone else. Since that first shock I had ceased to have such thoughts, but now they returned. However, after the small operation the Dane came back and he was smiling broadly. "Of course one cannot tell for certain, but they looked healthy," he said. I asked him if he thought they would have tasted good cooked in butter with garlic.
Before this I had been to see an oncologist, a lady I shall call Dr. H., and she was to arrange the course of treatment to follow, but to be preceded by the lymph test, which she arranged. She had warned me that a result of this test might be a swelling of one leg, and sure enough, within a short time it happened. Soon my right foot, ankle and leg up as far as the thigh were affected, and I could no longer put on most of my pairs of shoes. In addition, my male organ had swollen to at least double its normal thickness and had turned the colour of a beetroot. Fortunately the latter symptoms passed off within a few days, but I had to seek the help of a specialist nurse on how to deal with the swelling of the leg: the answer was daily self-administered massage and wearing an elastic "surgical" stocking. This worked like magic, but I have been told one has to continue it for the rest of one's life.
From the moment the condition was diagnosed, Peter prescribed a pill known as Casodex (its active ingredient is bicalutamide). There are two dosages — 50 and 150 mg. — but I was started on 50 mg. The standard side effects are two. Because the drug inhibits the production of male hormones, in which the cancer flourishes, one's libido and one's sexual potency can likewise be inhibited. The second effect is the development of one particular female characteristic: enlarged breasts, accompanied by tenderness. I have certainly experienced the second of these, and the first in a rarefied form. Neither the attraction of women, nor the ability to make love, have gone, but they are more narrowly focused and less generalised than they used to be. If what I mean is not clear, I cannot explain it any better.
I was offered the choice between radiotherapy and chemotherapy. The second involves injections through the wall of the stomach, and loss of sexual potency is certain to result. An old friend of mine in Germany who has received this treatment called himself a "chemical eunuch". The first involves nothing more traumatic than having the prostate exposed to a few seconds of (entirely painless) exposure to X-rays from 3 angles — once every weekday for 7 weeks. Still, Dr H. told me there is a 50-50 chance that this will cause loss of potency. Throughout the late summer of 2001 I received radiotherapy at the Cromwell Hospital in West London, a place much frequented by Arabs — so much so that passing through the outer reception area had more than a slight similarity to being in Dubai airport. As always it is pleasant having one's trousers lowered (even if not below the hairline) by the attractive young female radiographers.
My first blood test after the radiotherapy, early in 2002, showed that the PSA had fallen to 0.5. Whoopee! But by April it had risen to 2.1. Peter suggested changing to 150 mg. Casodex, but I jibbed, and he said he was happy for me to continue on 50. By late summer it had gone up to just above 10. This time I was more than willing to go over to 150 mg. The breast swelling is greater, but the other effect has not increased. Meanwhile I am enjoying life to the full. Since the cancer was diagnosed early in 2001 I have been astonished to find how many of my friends and acquaintances have also had this problem, and I sense that they are enjoying life too.
christopher@hurstpub.co.uk
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