Mike's Blog

I have been diagnosed with Prostate Cancer (PC). It is the most common cancer in men in the UK. One in eight white men will develop PC in their lifetime. For black men one in four will develop PC. Once I started talking about it with my friends and neighbours, it turns out many of them either had it, and have been treated, have it now, or are at least suffering from some of the symptoms of an enlarged prostate and elevated Prostate Specific Antigen (PSA). And many others have a father, grandfather, brother or friend who has had PC.

But out of every four men with PC, only one will die of it. The other three will die with it; it won’t kill them. And there are many autopsy reports that suggest almost every man has signs of it in their body when they die. It’s a disease of ageing.

This blog is my personal account. I’m writing it because I feel I want to get this off my chest. But if it helps someone else who may be on a similar journey to mine, then I’d be delighted.

But first, let’s explain some basic terms and terminology:

What is a Prostate Gland?

Your prostate gland, usually just called your prostate, is an organ in men that’s normally about the size of a walnut which sits below your bladder and in front of your rectal passage. Its main job is to create seminal fluid, and to squeeze it, and semen, out of the penis during orgasm. It also acts as a tap that switches what comes out of your penis between urine from your bladder, and semen from your testicles. The tube that carries urine from your bladder to your penis is called your urethra, and the prostate is wrapped entirely around the urethra. The prostate sits in a sack known as the prostatic capsule. Remember that for later!

PSA

PSA stands for Prostate Specific Antigen, a substance in a man’s blood that is vaguely related to the health of their prostate. For a normal healthy 50 year old man, the median PSA level in the blood is one nanogram per millilitre (1ng/mL) or lower. PSA levels rise naturally as we get older, so for me (in my early 70s) a PSA level of 6 or more is concerning. But other things such as infections, vigorous exercise and sexual activity can also temporarily raise PSA levels.

And the PSA test is neither accurate nor specific. Which is why it’s not being used as a national screening test, despite the demands of some high profile PC sufferers (Chris Hoy, much as I admire you, I’m looking at you!).

So elevated PSA can be an indicator of prostate cancer. But only one in four men with elevated PSA will turn out to have PC. So 3/4 of men with an elevated PSA do NOT have PC. In the past this has led to over treatment, and some years ago many men had their prostate surgically removed for no good reason, and suffered the sometimes catastrophic side effects.

And the reverse is also true. The PSA test is about 85% specific. Which means that of every 100 men with normal PSA levels, 15 will have prostate cancer and their PSA level will not have revealed it.

What I think Chris Hoy and others should be campaigning for is research for a better, more accurate test that can be used in a national screening programme.

Currently the generally recommended way to utilise PSA tests is to have them at least annually after your 40th birthday, then watch the trend in the scores over time. If it suddenly increases then that’s something to be investigated.

And the tool that’s massively improved accurate diagnosis, and almost eliminated false positives, is the MRI scan. These are readily available, and can easily and harmlessly allow a clinician to measure the size of the prostate, and to identify any suspicious nodules inside it.

My diagnosis

Like all men as we get older, the flow rate of my pee had slowed somewhat, and I usually had to get up once or twice in the night to pee. But I didn’t consider this unusual, and I had no obvious other symptoms.

I went to my GP about some recurring migraines and she recommended a blood test as low electrolytes, particularly potassium, can trigger migraines. We were filling in the checkbox on the screen for what to test for. When we got to PSA she asked if I’d ever had a PSA test – no I hadn’t. So we checked that box. I had the blood test the following Wednesday at the GP’s surgery, and thought no more about it.

The day after the blood test one of the other GPs called me and explained my blood test results had come back and I had a “concerning” PSA level of 26.7ng/mL! He told me that this indicated that I very probably had prostate cancer – my electrolytes were fine, by the way!

I was immediately put on the NHS two-week cancer pathway and was scheduled for a bone scan the following week and an MRI a few days after that. Why a bone scan? Because when prostate cancer metastasises (spreads) it’s almost always the bones it spreads to first. This is what President Joe Biden is suffering from – his prostate cancer was undiagnosed until it had spread to his bones. Once it’s there, it’s almost always incurable although it can be managed and does usually respond to treatment.

My bones were clear (phew!)

The MRI wasn’t such good news. My prostate was enlarged, nearly twice normal size, and there was at least one suspicious “nodule” on the right side, 13mm across. I was immediately scheduled for a biopsy. I asked my clinician, in his experience, how likely it was that this was cancer, and his response was, “on a scale from one to five… five”.