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  • Debbie Kerr

So much to learn about...advanced prostate cancer


Man's beard and mustache to represent movember

In honour of Movember (November was when this post was first published), and my friend, Roy, this post serves two purposes: to provide information about prostate cancer and to describe what it is like for someone who was diagnosed with this “so-called” good cancer when it had already reached stage 4.


Some facts about prostate cancer

The prostate is a gland that is part of the male reproductive system. A normal prostate is the shape and size of a walnut and is below the bladder. The gland surrounds the tube that carries urine (pee) from the bladder and helps to produce the fluid that carries semen from a man’s testicles.


Statistics

The following are some statistics from the Canadian Cancer Society’s website:

  • In 2022, 20% of men diagnosed with cancer were diagnosed with prostate cancer.

  • In that same year, 10% of men who died from cancer died of prostate cancer.

  • When diagnosed with prostate cancer in stages 1 through 3, the survival rate (living at least 5 years after a diagnosis) is over 90%.

  • The death rate for prostate cancer has been declining since 1994.


Based on these facts, it may seem reasonable that some people refer to prostate cancer as the good cancer; however, there really isn’t a good cancer and not everyone survives it.


Symptoms

While women are told to know their breasts so they recognize any abnormalities. With prostate cancer, knowing your regular urination (pee) pattern is beneficial. The following are some symptoms that could indicate prostate cancer:

  • More frequent urination, especially at night

  • More urgent need to urinate (when you gotta go, you gotta go)

  • Trouble starting and maintaining a stream of urine

  • A weak stream of urine and an inability to fully empty your bladder

  • Urine leaks and dribbles (incontinence)

  • Blood in your urine

  • Painful or burning urination


Other symptoms include the following:

  • Blood in your semen

  • Trouble getting and maintaining an erection, and painful ejaculation

  • Discomfort and pain when sitting

  • Pain and stiffness in the back, hips or pelvis that doesn’t go away

  • Fatigue


Unfortunately, there may not be any symptoms for early prostate cancer. It may not be until the cancer is more advanced that the above symptoms become apparent. This emphasizes the importance of having regular prostate-specific antigen (PSA) bloodwork and a Digital Rectal Examinations (DRE).


Roy's story

Roy knows that he doesn’t have the good cancer; in fact, he knows at this point that he won’t survive it. His goal is to be one of the 41% of men who are diagnosed with prostate cancer and make it to the 5-year survival mark. He's so close.


Ongoing health issues

Even before his cancer diagnosis, Roy had health issues throughout his life. He was diagnosed with juvenile diabetes when he was seven and has been dealing with oral and injectable insulin since then.

In his 30s, because of his insulin dependency, he developed high blood pressure and neuropathy (nerve damage). In his late 40s, Roy’s father died at the age of 72 of Hodgkin lymphoma, which is a blood cancer. Shortly after that, Roy was diagnosed with celiac disease when he had a lot of abdominal pain. Ironically, once his celiac was under control, the pain went away, only to have it return when he was 53 and he went to emergency.


It was here that Roy discovered that he had an 11 cm tumour (the size of a baseball) on his prostate gland and pressing on his bladder. His cancer had already metastasized (spread to other parts of his body). Prior to this pain, the only symptoms he had of prostate cancer were frequent urination and a feeling like his bladder was never completely emptied. These symptoms alone never made him think he had cancer.


Treatment options

The term “options” implies that Roy had treatments that could cure him. This was not the case. Surgery was not an option because the tumour was too large, and the cancer had spread to other parts of his body. The only option he had was to receive treatments that would prolong his life. Because of his diabetes, adjustments are constantly being made to his medications to keep his blood sugar levels under control. At this point, the goal is to keep his blood-sugar levels under 20.


Emotional component

When Roy was diagnosed with prostate cancer, he didn’t use the words, “Why me?” Instead, he told himself that it wasn’t the end of the world yet.


Loneliness

He did, however, feel alone. Living in small province like Nova Scotia (compared to larger and more heavily populated provinces like Ontario and British Columbia), there were fewer people who could understand what he was going through, especially when he was nearly 20 years younger than most people diagnosed with prostate cancer. In addition, most other men with prostate cancer had their cancer diagnosed early, received treatments, and were just being monitored for potential recurrence. It wasn’t until he found cancerconnection.ca, a forum associated with the Canadian Cancer Society, that he felt he had people he could talk to and ask questions. He also found a prostate cancer support group in British Columbia. He had found at least virtual support.​


Love of his life

Roy also found the love of his life after his diagnosis. His granddaughter, Althea was born and will be celebrating her second birthday in December. Roy’s face lights up when he is anywhere near her. He wants to continue to build memories with her. He wants to be there for her birthday. A last Christmas with his family would be a bonus.


​His final wishes

While we may feel sorry for Roy, it’s not what he wants. He’s pragmatic and has a great sense of humour. In fact, he told me he wanted to be cremated and have his ashes put in an empty Jack Daniel’s bottle. He wants a barbeque held in his honour and the price of admission will be an agreement to tell a story about him. He wants his family to learn more about him through the stories told. He knows he is dying, and he accepts it. While friends and family grieve, they know his wishes and have accepted what is coming. This acceptance has helped Roy to have a feeling of peace. He doesn’t want the turmoil of people telling him he should keep fighting and try other treatment options.


Current state

When this post was originally published

Roy does what he can to enjoy life. As I interviewed him, we laughed. He talked about how much he appreciated the support he has received from both family and friends, and the wonderful people at the cancer centre. The practical side of Roy doesn’t see the point in being bitter and having people tell tall tales about all the great things he has done. He would rather remain humble and enjoy the little things.


An update

Since this post was first published, Roy has achieved his goal of participating in his granddaughter's birthday party and had a final Christmas with his family. These goals achieved, and knowing that his quality of life was rapidly deteriorating, he decided to use MAID (Medically Assisted in Dying) on December 29th. This was not a quick decision. Roy had already completed the application process and had been approved to use it.


Knowing when someone is going to pass away has some advantages. Up until his death, people were sharing stories about him on Facebook and letting him know he was loved and appreciated. As he read each post, he acknowledged it. This ongoing interaction was like a giant virtual hug for not only Roy, but the people who loved and would miss him.


Roy's tips about prostate cancer

  1. Remember that there are no good cancers. No two people are the same. No two cancers are the same. No response to treatment is the same for everyone. Everyone does not have the same result. Don’t tell anyone who has cancer that they have the good one.

  2. Being bitter does not help anyone.

  3. Men should have PSA bloodwork done, even without symptoms, to learn what is normal for them so they can use it as a point of comparison.

  4. Have regular PSA blood work done in conjunction with Digital Rectal Examinations (DRE) so that prostate cancer can be diagnosed early.


Resources

The following are some resources for additional information:


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