Waiting for the non-digital revolution

Some years ago I met a former colleague – an older man – who was on the way back from his annual medical check-up. He was in good spirits, after getting the “all-clear”, as he said. And it must have been he who brought the particular subject up. But in any case, as we stood chatting on a street corner, the conversation turned to his prostate.

Back then, like many men of my age, I knew about prostate examinations only by virtue of a famous Billy Connolly sketch, the educational benefits of which were outweighed by the exaggerated horror of the procedure it had left me.

The Digital Rectal Examination (DRE), as it was known officially, might as well have been called the Digital Rectal Examination At the Doctor’s (DREAD), given the emotions it inspired. So I inquired tentatively of my friend how he’d borne up under the assault. Whereupon he informed me that – lo! – the days of the manual probe were gone: it was all done by blood tests now.

Deep impression

This happy news made a deep impression at the time. “Brave new world,” I thought, as my friend and I parted. And I was struck afterwards by an amusing irony. We were then in the midst of a technological revolution, that seemed to be transforming everything we did. But here was one area, at least, where the future was non-digital.

As I have since discovered, that wasn’t quite true. There is indeed a blood test for prostate cancer now, and has been for years. But it’s still of limited use. In fact, even insofar as it detects the disease, there are circumstances where the diagnosis can do more harm than good. In short, the DRE is still around, and still the preferred test.

I learned this, not from a Billy Connolly video, but in person, from a doctor. The revelation came during one of my own, overdue check-ups, a few years ago.

And it was a double surprise then because (a) I was still labouring under the misapprehension that this was a post-DRE world; and (b) I thought they didn’t start worrying about your prostate until you were 50, an age I hadn’t yet reached.

Au contraire, the doctor said. Erring on the side of caution, he thought the threshold should be 45 at the latest. Then he asked me if I'd like to have an examination. Or maybe he used a verb other than "like".

But that was the general import of the query – he was giving me the choice.

So, masking a certain tension that had now gripped me, I replied that a DRE was not among the things I’d bring to a desert island. On the other hand, I wasn’t a complete eejit. If the doctor thought I should have the examination, it would be foolish to refuse.

On which note, we both did the needful. And as the short, intense episode unfolded, I found it helpful to keep up a steady stream of smalltalk, pretending I was at the barber’s (although avoiding the phrase “yes, a bit of gel would be nice”).

I know women consider men’s discomfiture with this procedure ridiculous, since similar and worse indignities are a routine part of their lives. In fact, Billy Connolly makes this point in his latter-day routine on the prostate exam. But he doesn’t dwell on it, because that would prevent him extracting another six minutes of hilarity from a favourite subject.

He seems to have been doing versions of the sketch since very early in his career, even at an age when it can’t yet have been based on experience. Either way, the most widely circulated version dates from his 50s, when it was. And his DRE had become an even richer seam by then.

Metaphor

The mining metaphor would normally be unfortunate in this context, except that Connolly’s latter-day prostate skit had his doctor making a more-exhaustive-than-usual probe, as if searching for “the lost treasure of the Sierra Madre”. On that occasion the GP referred him to a proctologist, who eventually ruled out a problem, but not before providing another consignment of comic gold.

Connolly turns 72 next week, and as he revealed in a TV programme earlier this year, he did get prostate cancer eventually. But probably thanks to regular check-ups, it was a non-event. They caught it early and the operation was a success.

Whereas the same day he learned about the cancer, he was also told he had Parkinson’s disease – an altogether worse prospect for a comedian and one about which, to my knowledge, he had never made a joke.

@FrankmcnallyIT