Prostate cancer kills almost as many people as breast cancer, yet few men know about it. Anne Dempsey reports on a new campaign.
'When Dick came out from seeing the specialist he was quite upset. He said: 'I would handle a ewe more gently than he's treated me.' Because it had been an uncomfortable experience, he didn't keep the follow-up hospital appointment, and because I didn't know this was cancer, a time bomb if neglected, I tried to persuade him but didn't insist," says Joy Fanning.
"I've been speaking out since, because I believe that if my husband had treatment then he would be with us today. I want men to listen and act. Prostate cancer is the most common specific male cancer, causing almost as many deaths as breast cancer, yet there seems to be proportionally very little about it. Many women's magazines have good-quality information about health, including cancers. Men's magazines are full of cars and women's bodies but very little about health."
Dick Fanning died in December 2001. He was a widower with a family when Joy married him, in 1982. "While Dick was considerably older than me, it wasn't something that greatly concerned us. For the most part the age gap was not an issue, and we were very happy."
Joy, a teacher and relaxation therapist, is sitting in their home near Glenealy, in Co Wicklow, surrounded by photographs, books and diaries chronicling their married life and times. "Dick always said I had a book on everything but, sadly, not on prostate cancer. I knew nothing about it. The only warning sign was his frequent and lengthier visits to the bathroom in the middle of the night.
"Finally, about 1996, he went to a specialist - an ordeal, because like most men he was quite shy about such matters, and, as I said, the consultant could have been gentler and alerted us to the need to give urgent attention to his problem. I suppose I resent the fact that neither was it conveyed to me that we were dealing with cancer, which, if untreated, would spread.
"By the time we went to another specialist, who was more sensitive and on the ball, Dick was beyond surgery. They tried various treatments to stop the spread, including injections to suppress the body's production of testosterone, which is a very difficult situation for a loving couple and a lonely journey."
Joy says her husband suffered a lot during the last year of his life and yet somehow got up most days wanting to work and be as active as possible. "In ways it was an awful time. We were very open about it, and sometimes I would ask: 'How will we manage without you?' And he'd say: 'My Joy, you will, you'll manage.' We laughed and cried: it was bittersweet but very raw and frightening, too."
They spent their last 17 days together at Wicklow District Hospital. "Dick received superb care. We talked and prayed, argued, held each other and reminisced. I wrote down his words, to try to hold on to the things he said. He wasn't afraid and wanted to give us helpful advice about carrying on. In the early hours of December 6th I told Dick he had suffered enough, that people he loved were waiting for him, that he had done a wonderful job in his life and that we would continue it . . . . I lay down again, and the next thing I knew the nurse touched me and said he had gone. For his sake, I was relieved.
"He asked me to read a poem at his funeral which begins: 'Miss me, but let me go / when I come to the end of the road. / I want no tears in a gloom-filled room. / Why cry for a soul set free? / Miss me, but let me go.' It was his way of encouraging us to try not to be too sad. Being as happy as we could would still be sad enough. Dick always looked to the future. His sorrow was that the future we should have had was stolen . . . "
Joy believes there is no need to die from prostate cancer. "In most men, it is not life-threatening if caught in time. I believe there should be routine screening, as there is for breast cancer, but meanwhile I would urge all men aged 50 and over to have a regular check-up and take any further action recommended. Your life and well-being may depend on it. Don't panic, don't bury your head in the sand. The more you know, the more likely you are to do well.
"Dick is gone. We love him still, now, always and for ever. A later line in the poem I read out at the funeral talks about burying your sorrow and doing good works. I would not have sought the limelight but do wish other families to be spared what we have gone through. If I could feel that something tangible had been achieved in raising awareness, it would help me towards accepting Dick's death and, as he wished, letting him go and moving on."
Men's Cancer Action Week
Almost 1,000 men die in Ireland each year from male cancers. Colorectal cancer leads the field, with 1,011 new cases and 561 deaths in 1999, according to figures from the National Cancer Registry.
There were 1,378 new cases of prostate cancer that year, with 499 deaths, and 105 new cases of testicular cancer and nine deaths. When you add the 953 men who contracted lung cancer and the 915 who died from it, the figures climb even higher. The projected figure for new cases of prostate cancer in the three years from 2000 to 2002 is 4,458, with the graph rising slightly year on year. The figure for colorectal cancer for the same period is 3,169. Estimates for new cases of testicular cancer are not yet available.
But in spite of the number of families affected, male cancers have received relatively little publicity. Until now. Today is the start of Ireland's first Men's Cancer Action Week, launched by the Irish Cancer Society. Its slogan is "Have you had your NCT?" - except here the C stands for cancer. A manual for men will be widely distributed during the week. Written by Dr Ian Banks, a GP, journalist and chairman of the European Men's Health Forum, it is designed to make men take notice - in part with attention-grabbing cartoons (see right).
Dr Banks suggests men are more likely to look after their cars than their bodies, hence the allusion to the National Car Test. "Only an eejit keeps driving when the dashboard lights up like a Christmas tree. Ignoring the body's early-warning signs is an equally bad idea. It could mean an early trip to the garage for some vital spare parts."
The campaign particularly aims to highlight prostate, colorectal, testicular, bowel, lung and skin cancers. Men are encouraged first to make lifestyle changes, such as quitting smoking, eating a low-fat, high-fibre fruit and vegetable diet, taking regular exercise, keeping weight within a healthy range and avoiding overexposure to the sun.
Knowing your family history of cancer and taking your doctor's advice about reducing any risk will also help. Checking your testicles regularly for anything unusual, such as a lump, thickening or swelling, can
protect against testicular cancer.
The prostate is a walnut-sized gland that sits just under the bladder, and men are advised to go to their GPs if there is noticeable persistent change in bladder habits for no good reason.
Difficulty with urinating doesn't necessarily mean the presence of prostate cancer, but it shouldn't be ignored. Watch out for more frequent urination, getting up more at night, discomfort or a burning sensation when urinating.
Ageing is a risk factor for contracting prostate cancer - the disease is rare in younger men. So this week's campaign strongly advises men aged 50 and over to consult their GPs about the merits of screening, which involves a physical examination and blood test to measure prostate specific antigen, or PSA.
Although a raised PSA level does not necessarily indicate cancer, it is a valuable early-warning system, as prostate cancer can be treated very successfully
if it is identified
early.
Population-based screening is not currently available in the Republic, and the jury is still out internationally as to whether such catch-all action increases the chances of a cure.
For a copy of Manual For Men On Cancer Prevention And Early Detection, contact the Irish Cancer Society on 1800-200700 between 9 a.m. and 5 p.m. from Monday to Friday. If you wish to make a donation towards male-cancer research, contact the society at Northumberland Road, Dublin 4, call 01-2310500 or log on to www.cancer.ie