The first symptoms

One of the first symptoms of prostate cancer is lower back pain, which is of course a symptom of so much else besides that prostate cancer is the last that will come to mind if suddenly it flares up.

When I look back, I can place exactly when a sudden back pain gave me pause to reflect that this was not like other back pain I had suffered, nor a consequence of any particular strain or injury. It was during the summer of 2009 while cycling to Berlin on a 47:19 fixie, pulling a trailer – a few weeks before my fiftieth birthday.

It is important to mention at this point that in a former life I cycled rather a lot, more in a year than I drive now, even with all these back and forth trips of hundreds of miles to parking spots at the base of mountains. I was in my peak of condition. It took me four and a half days to cycle the 500 miles from where I lived in Utrecht in The Netherlands to Berlin. Every Sunday afternoon, I went forth in a peloton with the local pub cycling club over the same fifty mile circuit that took advantage of every lump to the east of the city on the way out, and returned along the crest of an exposed dyke, more often than not against the wind. I worked three days a week delivering stuff on my bike in and around the city, in all weathers, sometimes cycling more than a hundred miles in a day. During this cycling career I cycled not far off ten times round the planet.

Looking back, it is not too difficult to see that this life at this age was bound to come against a decline or catastrophe of some sort. After the trip to Berlin, I had a growing sense of vague unease in my pelvis, and first took my concerns to a GP at the start of 2011. I was told that because I cycled such a huge amount, there was nothing to worry about: not only might so many hours in the saddle account for pelvic discomfort, so much cycling meant that I must also be fit, healthy and unlikely to be suffering more than mild prostatitis. I was sent on my way with a cursory diagnosis of wear and tear, without either digital rectal examination or blood test.

Looking back I have no doubt I would not now be in the position I am in had the doctor quickly performed a digital rectal examination and ordered a blood test.

No doubt at all.

If I back track the PSA value I later knew, to this time and extrapolate the Gleason Score, with the origin anchored sometime in the first half of 2009, I have no doubt that my trajectory would have been very different, that the cancer may well have been dealt with immediately with either prostatectomy or an appropriate blast of radiotherapy.

When I returned to the doctor a bit more than a year and a half later, about six years ago, I was taken more seriously. For several months I had been aware of something not right going on inside my body. I was often tired and looked sickly to myself in the mirror. Sometimes I would cough uncontrollably and spit out stuff that did not seem to be much like the usual stuff I sometimes coughed up. There was a distinct sensation near my back passage and my urine stream was often little more than a pathetic dribble.

Immediately the doctor asked if I thought I had prostate cancer. Her tone was both friendly and slightly disparaging, suggesting that although she did not want to ridicule me, she still thought it a ridiculous idea that a man of my relative youth and good health should have any sort of cancer. It was the first time the word cancer had been mentioned. I said that I did not know what the matter was, but clearly there was something wrong. She reached for a pair of surgical gloves and spoke reassuringly, asking me to drop my trousers and lie on my side with my knees tucked up to my chest. Although her finger was liberally lubricated, its brief penetration of my anus was not pleasant. I felt the hard ridged surface of my prostate underneath her finger, through the wall of my rectum. An unfamiliar sickly feeling spread through my lower body, and lingered as I made myself respectable again, long after she removed the finger. Hereafter her attitude changed almost imperceptibly. She told me that I would have to go to the hospital for scans and to get my blood tested. And so it all began.

For most of September I was feeling quite cancerous and during last week had a lower back pain. Even although there are many reasons for this, there is only one that rattled around in my head. I was kept awake at night with the worry, which is not made easier by all the other assorted twinges and feelings of sickliness. All this, mixed with the knowledge that if my disease had been earlier diagnosed I would be in a different place altogether, makes the effort of bringing peace to mind rather more challenging.

This is a condition I would wish upon nobody.

Prostate cancers are likely to affect 1 in 8 men at some point in their lives. Even aggressive malignant varieties can be nipped in the bud if they are diagnosed early enough. More often than not though they are discovered beyond the point after which the only treatment is palliative.

Which is why it is vitally important for men of all ages to learn about the signs, the first symptoms, and never to be scared to ask a doctor for a digital rectal examination or a PSA test. Neither of these are definitive, in the sense that neither will determine whether or not there is any cancer present, but both will identify anomalies, which can then be followed up by other tests and scans.

Even men who think of themselves as young, fit and healthy, at the peak of their condition can harbour disease. It does not discriminate. Any sudden difficult to explain back pain, vague discomfort in the pelvic region, dribbly or bloody piss, nippy ejaculations? Think prostate.

Don’t be like me. Don’t allow genuine feelings of being unwell to be fobbed off. Be assertive. If you have any sense that something in there is not what it should be, demand a PSA test and digital rectal examination. Better to be reassured now, than to find out too late.


Author: Duncan Spence

Mountaineer, retired bicycle messenger, philosopher, wordsmith, proofreader, Dutch translator.

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