I met a man on Braeriach last Sunday who I recognised from the Facebook, where he has shared his experience of prostate cancer. The next day I got a message from an old school chum, living now on the other side of the big water, seeking advice about his recent diagnosis. Each of us has a very different experience of the disease and our circumstances are very different, but we share something.
Prostate cancer is the most common male cancer. It has a similar pathology to breast cancer, which is the most common female cancer. Both are hormone based and as yet there is no cure for either. My oncologist told me not so long ago that a Nobel Prize awaits those who can find a cure for hormone based cancers. Current medical parlance allows prostate cancer nevertheless to be managed, and if it is caught early enough, it can be destroyed, either by resection of the gland or by focused radiotherapy. And here is the nub of the problem. If it is caught early enough.
In spite of the existence of many support and campaigning organisations and charities – Prostate Cancer UK, Prostate Scotland, Maggie’s Centres, Macmillan – it remains much easier for women to discover and discuss the first symptoms of breast cancer than for men to find out about what may or may not be developing in a gland they probably do not realise they have. Without wishing to be vulgar, breasts are more prominent than prostates and are more frequently examined. Anomalous tissue growth in breasts is consequently more quickly identified than in prostates.
Undoubtedly, there is more to this than the physical location of the prostate, its obscure function and its insignificant size. It is not easy for men to talk about how it feels down below or at the back, and men – at least of my generation and older – are not very good at knowing about what is going on inside their own bodies. It often takes the emergence of a cancer for a man to begin this journey into bodily consciousness, this confrontation with a disease that can be managed but as yet has no cure, this awareness of how precious and precarious life is.
Not everybody realises this about prostate cancer, largely because in general, it develops slowly in men over the age of about sixty who have by this age other, more pressing, medical issues. Most men who die of old age have some sort of prostate cancer. In most cases, its growth can be thwarted with hormone suppressing medication, surgery and/or radiotherapy. But the aggressive, malignant varieties – at least according to the statistics – are more swiftly fatal. Statistics are notoriously difficult to use as any kind of estimation of what is really going on in the world, but the best estimates are that between eight and twelve percent of men have prostate cancer – whether they have been diagnosed or not.
Every man who is diagnosed with this disease is confronted suddenly with his own mortality. Each of us then travels a different path, depending on the stage at which it is diagnosed, but we have this in common. The man I met on the mountain has taken a very different journey from me, but we both continue to suffer side effects of medical intervention; my old friend from school is moving into a different future, but most likely his disease will be manageable for a long time to come. It was important for me and for each of them to be able to share knowledge and experience of the disease, not only for the exchange of technical information and tales of bodily dysfunction, but because these exchanges have a quality that places them outside conventional male discourse. The great tragedy of maleness is that if such exchanges were brought into everyday discussion, there would be greater chance that prostate cancer might be more frequently nipped in the bud, identified at an early stage, before it has had a chance to spread beyond the gland itself.
Trying to imagine what this inclusion would look like, I see mates out on the piss and taking a leak together, one noticing that the other is a bit dribbly and having problems squirting out the last drops, and who asks if this has been a recurrent issue and if so suggests his mate get his PSA checked. Or on a building site, one bloke seems to spend too long in the toilet, to emerge looking pained, and who reveals when asked by a mate that it feels as if he has something permanently stuck up there, some sort of blockage that has nothing to do with his digestion. Often these are the only signs that there might be something developing; the next clue is the generalised sickliness of metastasis, or some inexplicable pain deep inside, by which time the process of management – at least according to current medical understanding – will have been already limited.
We all have to get on with our lives as best we can under the circumstances of our diagnoses. These are too often viewed entirely through materialistic reductionist lenses; the processes of the disease are seen as entirely physical and mechanical, while the emotional and spiritual elements are pushed to the periphery, excluded from its pathology. Consciousness of the disease is reduced to knowledge of the facts as presented by the medical establishment.
We prostate warriors know differently, for the experience of living with the disease is very different from understanding how it “works” ….. each of us knows inside perhaps how it all started and can remember when his life became so stressful that cancer could more easily take hold of a minor insignificant gland. Perhaps not. Each of us knows that the effects of medical intervention are never only the suppression, resection or burning out of the disease, but also a whole raft of side effects and consequences, which bring along a new series of challenges and consequences, not only for ourselves, but for our nearest and dearest.
I would like to think that one day it might be possible for men naturally to talk to each other about what is going inside their bodies, so that if a man begins to notice something untoward going on he will be in immediate contact with a culture that can advise, with access to technical discourses that recognise emotional and spiritual elements of disease. If the imperative to be the change you want to see in the world has any meaning at all, exchanges such as the ones I had recently are already a contribution to making this so.