Men, do you know you have a prostate gland?

British men largely unaware of the role of the prostate says a heading to a short article I came across today.

I'm not surprised by this in the slightest. It was only when my doctor - some years ago now - suggested having a PSA test regularly that I even knew I had a prostate. Is that possible? Had I been nearly 50 years on this planet without knowing about this vital part of my male anatomy?

Maybe my prostate had been mentioned in passing, but when you have an internal organ that behaves itself and does the job it's supposed to do without quibble, then you pretty much ignore it. We all know we've got hearts, because we can feel them pumping, or because the heart manages to get into all sorts of common expressions: Have a heart, brokenhearted, he's got a big heart, my heart longs for you, and so on.

We know we have a brain, even though we can't feel it, because the same thing applies: the brain comes into our everyday speech, and reinforces its part in our lives. Use your brain, you great useless piece of leftover spittle. 

But the prostate? Off the top of my head, I can't think of any common, everyday expression that involves the prostate. Worse, it's easy to get it mixed up with another word, prostrate, which has nothing to do with it, and which we sometimes use when we're talking about a person lying down. Or prostrating themselves before someone who's their superior. (Not something Western people tend to do much...at least not in public.)

Otherwise the prostate doesn't get a mention, until your PSA climbs the charts (which it shouldn't) and you're sent off to the hospital for a prostate biopsy. A prostate biopsy, for most gentlemen, is not fun, though a friend of mine (who shares my birthday, as it happens) claimed he came through his biopsy without bother. Plainly he's tougher than I am. 

I learned a lot about prostates when I had problems with not being able to pee, and when my PSA count started to skyrocket. I learned more about biopsies when I had one and it caused other problems. Later, at the encouragement of a fellow-sufferer, I wrote a book about it: Diary of a Prostate Wimp. (Which incidentally, is the only book of mine that I can claim has been a bestseller, mainly because it was on Amazon's top twenty list for books relating to Urology a few times...!)

What I'm saying to any male who reads this: be grateful to your prostate. Be grateful that for most of your life it will work perfectly well. Be even more grateful that these days it's possible to have prostate cancer and survive. I know several guys who've been there and are still functioning well.

But guys, if your doctor says to you, we need to keep an eye on your PSA count, make sure you do. It may save your life.

PS: The majority of men who have a PSA test and a biopsy will prove to have no cancer. Cancer is not a given. I didn't have it. 

PSS: Talking about prostrating oneself, in a Korean TV series we watched some while back, the less important employees bowed to their superiors continually. It was quite disconcerting. 

The Urine Test

In a recent edition of the Otago Daily Times, there was a reprint of an essay Chris Harris wrote on the need to find a better method of detecting prostate cancer.

At present one of the prime methods used is a biopsy in which a needle is pushed up into the man's anus, and then through the wall dividing the bowel and the prostate. Tiny pieces of his prostate are chipped off and then sent to the lab for examination. This is the examination I had back in late 2008. There were complications as a result of this biopsy which I describe in some detail in my ebook, Diary of a Prostate Wimp. [This ebook is currently available at half-price at Smashwords to support Movember, the prostate cancer month.]

The problem with this biopsy - the transrectal method - is that infection can easily occur. In fact, men are routinely given antibiotics after the biopsy because it's assumed there will be infections. It's hardly surprising that there are, because the wall between two parts of the body - one of them intended to deal with faecal matter - is pierced and broken open. It's a bit like sticking your hand in a toilet, then using your hand straightaway to put food in your mouth. If you don't get infected, it'll be surprising.

Chris Harris wrote about a new option that's being looked at to avoid this biopsy. Currently several PSA blood tests are done before a biopsy is considered, in tandem with the unpleasant finger up the bum approach that shows whether the prostate is unduly enlarged or not. Chris says the PSA test was never designed to do what it's being used for now, and writes: 'We aim to take a more direct approach by analysing small amounts of prostate cells exfoliated in urine. There is evidence that very small amounts of prostate cancer cells, between one and a few dozen, are shed normally into the urine at an early stage of the disease. Our aim is to pick out these cancer cells and extract molecular information from them to predict if a tumour is going to become a malignant monster or a benign wimp.'

It's normal for men's prostates to enlarge as they get older. Most of the time this isn't anything to do with cancer; it's a common problem many men will have to deal with - as I did. Surgery is performed to decrease the size of the prostate, thus allowing the urinary tract to function properly. (The urinary tract gets blocked by the prostate rather like a large stone in a small river bed.)

There is hope that the urine test will be readily available soon - possibly within months. In the UK, trial tests of the urine samples were accurate in about 70% of cases. However Chris warns that there is still work to be done to ensure thorough accuracy. And of course, as always, funding is a problem.

What my second ebook (Prostate Wimp) is about

I haven't mentioned my second ebook, Diary of a Prostate Wimp, on this blog as much as I should have. Other things have kept getting in the way - like the writing of the sequel to Grimhilda! which thankfully, is in its last draft (of what feels like the last of several hundred).

Anyway, Prostate Wimp came out at the end of April this year, and I've been considering some of the things that I should point out about it to readers, to give it a better opportunity in the world.

Here are some of the things the book addresses:

If you have any concerns about matters to do with your prostate (here's a list of symptoms from the New Zealand Prostate Cancer Society) talk to your doctor and don't let them put you off. Some doctors can be a bit off-hand about men's issues, and others aren't good at answering questions in sufficient detail. Thankfully I had a very good doctor.

The book focuses on what happened after I'd had a prostate biopsy. The biopsy is done initially to check whether you have any sign of cancer. The current method of biopsy is the transrectal method: through the anus, through the protective skin between the bowel and the prostate, and then chipping off tiny bits of the prostate for inspection. There is increasing concern that this is not a healthy method. Regrettably, in New Zealand at present, this is the main method. There are two articles noted in my book by an Australian journalist, Jason Gale. These are worth reading, even though they're now one and three years old respectively.
Prostate exam [biopsy] deaths from 'superbugs' spur inquiry into cancer tests
and
Prostate cancer test causing sepsis [infections] spurs biopsy concerns.
Gale is not alone in writing about this issue. I have a number of other similar articles on file, which I'll detail in future blog posts.

In the book, a medical friend of mine expresses considerable concern about the use of a blood test, generally known by the name, PSA. This gives an indication of the degree of enlargement of the prostate - something that is normal in men as they grow older. What it doesn't do is tell the medical people whether you have cancer. When my prostate was shown to be enlarged according to the test (and it was accurate on that point) I was informed by a urologist at the hospital that I could well have cancer, and I needed to have a biopsy. In fact I didn't have cancer, and the biopsy caused problems I could have done without. I detail in the book the case of another friend of mine who had considerably worse experiences than me, as a result of the biopsy and subsequent investigations.

An enlarged prostate is not necessarily a cancerous prostate. An enlarged prostate is a nuisance, and will probably require an operation (the TURP) to remove some of the enlargement. An enlarged prostate causes problems with peeing: it can make it hard to pee, on one hand, and on the other, cause you to go far more often than normal. This still doesn't indicate cancer.

However, it is still necessary to take prostate issues seriously. I'll talk more about this in a later post.

Post-Grimhilda!

Now that Grimhilda! is online, I can move onto the next project. Some will no doubt think this will be the sequel to Grimhilda! and originally that was my intention.  However, I've had another writing project sitting on the backburner for some time, and since it's mainly a matter of editing and editing (and perhaps editing again) I've gone on to do that.  I'm planning on getting the book online by April.

It concerns a time in late 2008 when I had a biopsy for possible prostate cancer. The biopsy itself was unpleasant, but the aftermath was much worse. You'll have to wait until the book comes out to find out why.

Suffice to say I didn't go on to have prostate cancer, for which I'm very grateful, but at the time I was going through a painful period, and I wrote a number of blog posts about it on WorkReport, a blog I used - as you might infer by its name - mainly for work-related posts. It had started when I was looking for work in late 2006 and I'm still running it today, though, since I'm now retired, it's changed its focus considerably. That's one of the great boons of blogs: you can move them on as your situation changes.

Anyway, the book is obviously non-fiction, so that'll be something of a shift from Grimhilda!  But for those who are wondering when the sequel to the musical is going to arrive, I can tell you that I had a meeting today with my co-writer, and we threw some ideas around. It may not be quite the sequel you'll expect - it may not be what we expect - but it will be a musical and of course it'll be great fun to be involved in. So put your name down now!  :)