It’s often spoken about with a tinge of humour, but the fact that men are traditionally less inclined to seek advice for medical concerns than women is no laughing matter as early detection for many illnesses can make all the difference to outcomes.
Every year, approximately 3,900 men in Ireland are diagnosed with prostate cancer and, as with most diseases of this nature, early detection is crucial. The risk of prostate cancer increases with age and it is advised that men over the age of 50 are screened every one to three years. Men are urged to attend regular screening to have their PSA (Prostate Specific Antigen) levels checked and undergo further checks if necessary.
The majority of cases are found in those over the age of 65, but it can also affect younger men, as Raymond Poole can attest.
Now, aged 60, he had been having regular PSA tests since he was in his mid-40s as his father had bowel cancer in his early 70s and was also diagnosed at that time with an enlarged prostate. He noticed a few symptoms, such as a reduced libido, over the years, which he put down to a hectic work schedule, but in July, 2016, at a routine PSA test, he was informed that levels were elevated.
“My PSA had risen to 9.0, up from 3.5 the previous year, so my GP suggested I come back in August to do another blood test, which had then risen to 10.0,” he says. “My GP then performed a DRE (Digital Rectum Examination), but couldn’t feel anything untoward, so I was referred to a consultant urologist, with an appointment set for November of that year.
“At the consultation, the consultant performed another DRE, but again could feel nothing. However, it was agreed that due to my increased PSA, I should go for a biopsy which was scheduled for December 5th. Up to this stage, neither my wife Selena nor I were overly concerned, however, when it was suggested I have a biopsy, we began to think it could be serious.”
The father-of-two says that, up until this point, he had associated prostate cancer with elderly men and, as he hadn’t experienced symptoms – such as a frequent need to urinate during the night or difficulty with urine flow – he didn’t think there had been anything to worry about.
He had a biopsy in December, 2016, and unfortunately this led to sepsis, which he was treated for and spent 11 days in hospital. Following this, the results of his next biopsy showed no signs of cancer, despite the fact his subsequent PSA test showed a rise to 19.5.
After a spate of infections that saw him needing treatment, his next round of biopsies didn’t take place until August, 2017 and under a new medical team, he was also referred for a PSMA PET/CT scan so that specific areas could be targeted. “This time they took five samples and three came back positive for prostate cancer registering a Gleason score of 9, with 10 being the highest – this confirmed that I had a high-grade cancer.
“To hear someone across a table tell you that you have cancer and that it is a high-grade one is an experience I never expected to encounter, nor would I wish it in anyone. I sat in the chair watching his lips move, hearing intermittent words like cancer, high-grade, T3C, but not fully being present. It was surreal, life was moving in slow motion, the floor felt like marshmallow – as if when I stood up to walk out my feet kept sticking and sinking into the floor. My brain was in overdrive, I was speechless, yet talking to the consultant. I could hear the words come out of my mouth, but couldn’t comprehend what I was asking or what he was saying.
“I phoned Selena, my life not just my wife, she was my raison d’etre, my breath, my being. We had been childhood sweethearts, having first met when we were 10 years old. She was my first ever girlfriend aged 12 and we started doing a steady line in 1978 when we were only 15. She knew, without me saying a word, I couldn’t get the words out I simply stayed silent on the phone tears rolling down my cheeks. My heart was not broken, it had been smashed into pieces.
“Then, in the car on [the] way home, all I could think was how do I tell my daughters, and my grandchildren. My dad (who was also at the hospital for treatment) and I never uttered a word on that journey home. My poor dad, he was now living alone as my mum had passed away from pancreatic cancer a few years before.”
The Wicklow man began treatment straightaway and, following discussions with the team of experts, elected for a radical prostatectomy via robotic surgery. “There were five incision points where the robot had been inserted to remove my prostate and several lymph nodes, a draining tube in my side and [a] urinary catheterisation tube. By 7.30am (the next morning) a healthcare assistant had me up out of bed and in the shower. I was home the next day – there was no time for wallowing in self-pity.
“My most vivid memory post-surgery was when one of the urology nurses came in to visit me to see how I was doing and out of nowhere my first words uttered to her were, ‘I was sexual[ly] abused as a child’. To this day I have no idea why I said that to her as she simply asked how was I doing. It is not as if I ever hid the fact, as it is not my shame to carry, but I think I had managed for over a year to contain that childhood trauma whilst getting DREs, biopsies and the rest - and I just couldn’t take anymore. So, I do think that it is important for consultants to be aware if there is any trauma which may upset a patient while they are getting what doctors consider a routine examination.
“I know of women who were also sexually abused as a child or in coercive relationships and for them a smear test or even a mammogram causes trauma. If anything, I would love to see something on the forms we have to complete for procedures, even a simple check box to ask is there anything which may cause you trauma during this procedure.”
The project manager is now six years post-surgery and is doing “extremely well”, but he has been left with many side effects. “I have had no reoccurrence (of cancer) to date and I’m hoping it stays that way. However, due to the nature of the severity of my cancer and the decisions we had to make at the time of surgery, I now live with permanent erectile dysfunction and incontinence. But the alternative is not even worth thinking of – and I have managed to get from what I was like post-surgery and having to wear 6-8 nappies a day with absolutely no control, to today when I am down to mostly just one or two pads a day using the lowest grade level 1.
“It is a small price to pay for being able to still hold Selena’s hand, walk amongst the trees in the forest and stare into the sky at night while holding her close by my side. My life is truly complete when with her and cancer can never take that from me – so as far as I am concerned, I have come out of this ordeal as a winner.
“Cancer has brought some of the most amazingly wonderful, beautiful people into my life, folks I would have never met but for it. Now don’t get me wrong, I am not suggesting you go out and get cancer as a way of making friends. But should you hear those awful words being uttered in your direction, you should know that there is a world full of people with outstretched arms waiting in the shadows to take you under their delicate fragile wings and provide you shelter from the torment and storm that cancer can whirl up.
“David Bowie once said, ‘I don’t know where I’m going from here, but I promise it won’t be boring’. So break the normal button on your life, it should only reside on your washing machine, and go out there and live your life to the fullest you can. We only get one life, so make it count - and safe journey to you all.”
Your fingers weave through mine
No words are spoken, none needed
Acknowledgement of our love lies within our eyes
Thoughts of the abandonment of my presence intrude
As the nakedness of our love
Lies bare to the storm of my emotions
The hunger is real in this famine
The neglect of my advances
Strewn across the shattered glass
Where the silken thread of love frays
And snags on crushed hopes
Unravelling the fabric of our bond
Lust lies listless upon the bonnet
Of our car crash of emotions
No words just silent tears
As we mourn the death of intimacy
The bruises lie buried deep within
Invisible to the passing eye
Our smiles camouflage the loneliness
Emotions overcrowded by emptiness
Our love is as real as is the pain
- A poem from Raymond Poole’s book of poetry, The Dark Side Of Silence.