Alan- Stage 3b Prostate cancer

THE SOMNAMBULIST

(an idiot’s guide to ignoring obvious signs of cancer)

I suggest somnambulist is a fitting epiphet, because sleepwalking towards cancer is exactly what I did.

Let me explain

I was still in bat in my early 60s; doing ok, 62, not out and I felt invincible. Can’t be bad I thought, as I’d dodged some pretty tricky deliveries in my time. The body armour that arrogance, ignorance and a healthy layer of stupidity gave me had been years in the making and I wore it well. Googlies, wrist spin, whatever came my way, I was going to make it to close of play with a healthy total. I never gave serious illness a thought. Well you don’t really. It’s not an ideal topic to sit and discuss with mates in the pub.

We are going to need a little back ground here, so please bear with me for a paragraph or two.

My name is Alan Morton and I was born in Newcastle upon Tyne, one of 3 boys. My 2 brothers are much older than I am. I still live in the North East of England, close to the village of Ryton, married with 2 grown children, a boy, 24 and a girl who’s 20.

In 1975, my dad died when I was only 15. A difficult and lonely time in my development. My brothers were both married with families of their own, so they were not around at home to offer any kind of support. I don’t blame them, they had others to consider. As a result, I had to toughen up and I developed a lot of body armour. There was no one to speak to about it, so I just bottled stuff up and came to shut people out.

This was my first encounter with cancer, except that I didn’t actually recognise it as that. My dad had Pleural Mesothelioma, an asbestos related disease, a rare and very aggressive type of cancer that develops in the thin membrane that covers the lungs and chest cavity. As far as I can recall, it wasn’t referred to as cancer by anyone at the time. Not by him or my mother.

For the last 18 months of his life, it was agonising for him and he once referred to it as “like having a truck ratchet strap being tightened across his chest”. His only chance was to have a huge operation. Survival rate for PM in the mid 1970s was less than 10%. In 2024, the 5 year survival rate was still only about 12% and still considered incurable. He was resigned to the limited time he had left. A brave guy. He was only 50 years old.

I mention all of this for a reason. When I received my prostate cancer diagnosis in early 2023, I reacted with anger. Anger at myself because I’d been so cavalier in my attitude towards my own health, but also because here I was, keeping things from my lovely wife. Why I felt this way should become apparent if you can be bothered to read on. But first, a little more context.

The neck trauma tales have a bearing on my cancer story, so please bear with me.

One morning in the shower, I noticed a slight discharge of seminal fluid. It was an an odd brick red colour. Well that’s not normal I thought. Bit of typical British understatement don’t you think? I still didn’t consider contacting the doctor or indeed to tell my wife, but obviously it was going to have an affect on the physical side of our marriage. To cope, I resorted to my tried and trusted defence mechanism. I dusted off my armour plating and withdrew from her which affected our intimacy. I couldn’t tell her what as wrong, but God bless that woman, she never questioned nor doubted my fidelity. She believed me when I fibbed and said it was nothing to worry about. It was due to unresolved grief over my dad’s death. I had carried it for years and she knows can still affect me to this day.

One Tuesday morning in early February, 2023 I finally had to act. The blood in my pee was very apparent and had been every morning for a couple of years, but only very first thing every morning. I usually leave for work at 06.20 following a brief visit to the downstairs loo. One day, as I washed my hands prior to pressing flush as normal, I thought nothing about the fact that I had left the loo door ajar. In came my spaniel Fint and he nudged my legs for a biscuit. That simple action of his made me forget to flush. I stepped out into the utility room and gave him a biscuit and left for work. Without doubt, he is responsible for waking me up from the sleepwalking stupor I was in. Funny how life can turn on something that seemed so insignificant at the time.

A little after 08.00 she rang me at work and told me an appointment with a GP had been made for 14.15 that very afternoon, not at my usual doctor, but at a satellite surgery. The doctor gave me a DRE (digital rectal exam) and tested a sample of my urine. Her next few words confirmed my suspicions. My prostate felt hard and irregular (it should feel smooth) and my urine, which actually looked crystal clear in the sample bottle, reacted once a few drops of a solution were added. The sample was full of microscopic blood particles. So bear that in mind guys, blood in your urine can be invisible to the naked eye

I’m pretty sure that doctors are not allowed to swear at their patients, but when she asked me about when I had first noticed the blood in my urine and I answered pre-covid, I could see her lips almost form the sentence ‘You’re effing kidding’ such was the look on her face.

Was it fun? The actual procedure is painless, despite it looking like medieval torture. I was helped through it by an Irish nurse who hailed from Belfast. He was a big Rugby Union fan like myself and as the Six Nations were underway, we spent the entire time talking about Ireland running away with the title – to an Englishman, a painful enough experience!

The pathology report came back a few days later and I was called in to see my consultant Mr P. He looked very tired and was rubbing his left eye with his elbows on his desk and announced in the weariest of voices that I had stage 3 cancer. He didn’t look at me, so maybe I took the eye-rubbing thing as a personal affront. But in reality, it was my anger rising and although triggered by what he just told me and the way he was acting (probably out of exhaustion) it was not aimed at him, it was annoyance with myself that I had let it get to such a late stage. I had dithered and ignored blood in my pee for 3 years. My wife sitting next to me was visibly upset and obviously feared the worst. She’d been through it all twice already with her parents and here I was putting her through it all again because of my stupidity. The anger that I felt towards myself was burning through me like that map at the beginning of the TV show Bonanza.

He asked if I had any questions and sat up when I said that I did. Having studied biology for a number of years, I knew a little bit about physiology and the human male reproductive system . So I went ahead and asked “As I had noticed blood in my semen, did that mean that the cancer had spread to my seminal vesicles?” These are attached to the rear of the prostate and produce seminal fluid. As these were outside of the prostate’s enveloping membrane. it sounded to me like the cancer was on the march.

“Yes” he replied. “Your cancer is stage 3B, but nearby lymph nodes showed no sign of cancer. Your bladder looks clear as do your kidneys and liver” So, I was not stage 3. Stage 3 means that any cancerous growth is still within the prostate capsule. 3B puts a slightly different spin in it as that means the cancer has broken out of the prostate capsule and has the potential to spread to nearby organs. The diagram above is a little misleading when it comes to showing stage 3.

The prostate gland is about the size of a walnut and like a walnut, it has 2 hemispheres. Stage 1 usually means that any malignancy is confined to 1 of those hemispheres, stage 2 means cancer has spread to both hemispheres. Stage 3 (sometimes referred to as 3A means further spread, but still confined to being within the prostate ‘capsule’. Stage 3B indicates that the cancer has broken through the wall of the prostate gland and has invaded a nearby structure, such as a seminal vesicle. The diagram therefore shows stage 3B. Stage 4 means that the cancer has metastasised and may have invaded nearby lymph nodes or an adjacent organ or perhaps the spine. To this day I’m not certain why Mr P thought stage 3 would be explanation enough.

Surgery was not an option. Why? Well it is at this point that I should point out the reason that I told you about those accidents I had years ago. When I had a second TIA in August 2023, a deeper more focussed examination was required. I had an MRA scan which looks at blood vessels. It was found that I had stenosis to an artery in my neck, the narrowing caused by bone spurs on a couple of neck vertbrae which had formed as a result of neck trauma, probably from one or more of those accidents. My past had caught up with me. You never know what’s waiting for you down the road it seems.

I was all for cutting the bloody cancer out. A normal reaction surely? Yet, because I had the letters TIA on my medical record, Mr P said that the risk of me having a peri-operative stroke on the operating table was too great. So surgery was not on the cards (or table).

As a result of those accidents many years earlier, I still have my prostate in place. Now that I have looked into prostatectomy and the after effects on guys’ quality of life, I am immensely grateful to Mr P taking the approach that he did and also thankful for whatever caused those accidents!

I have since been as vociferous as I can be in trying to get guys to get them selves tested for prostate issues. Do not ignore your health guys. Nothing is as important as being there for your family. I know that we all need to make a few quid to keep our heads above water, but always make time to visit the doctor if you have even the smallest niggle.

I could go on and on telling you how prostate cancer and the curative procedures that I have had to endure over the last couple of years have affected my life. I could go on and list all of the early symptoms (some of which never actually occur until later stages) but really, I’d be typing for ever.

We’ll see how this blog goes down. If received well, then I’ll add another page which shall detail all the procedures that followed my diagnosis

And the NHS NHS Prostate Cancer page

World Health Organisation (WHO) Facts and figures

A futher note from HLAI.blog team – Alan is currently looking at writing a second article as a continuation to this page, and once Alan has decided on this we will create a link from this page to his next article,

We are currently inviting Authors to produce more pages about their approach and experience with Cancer, if you feel that you would like to share your experience and knowledge on our site please do not hesitate to contact us ian@hlai.ie