Men, doctors and my prostate

In my younger years, I considered a bloke's equipment to be a Wysiwyg arrangement - what you saw was what you got

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The telly is on as I write this, and the PM is in full leading-while-listening mode. And he's just extended breast-cancer screening to another 450,000 women. Which is good. But I wonder how he is: which parts of his male, Prime Ministerial fleshly being are working properly, and which are beginning to show signs of wear or worse. And I'm wondering that partly because I am also looking at the letter from the consultant urologist confirming my appointment in November.

The telly is on as I write this, and the PM is in full leading-while-listening mode. And he's just extended breast-cancer screening to another 450,000 women. Which is good. But I wonder how he is: which parts of his male, Prime Ministerial fleshly being are working properly, and which are beginning to show signs of wear or worse. And I'm wondering that partly because I am also looking at the letter from the consultant urologist confirming my appointment in November.

No, no, no. This is not - I am pretty sure - the beginning of a series of articles chronicling my descent from happiness to pain and beyond. This visit is the result of my being very pushy and my GP's being ultra-cautious. But I have been pushy where too many men are not, and my doctor has been quick where others might not have bothered. Breast cancer is the second-greatest cancer killer of women, and it's good that more women will be screened. Prostate cancer is the second-greatest cancer killer of men, and there, Tony, you're on your own.

With me it was peeing. Sorry. I'd love it to be rashes or deafness or some problem that wouldn't have my readers asking whether they really want to know all this, but it can't be helped, and yes, you do. So, when, a few months ago, I found myself in a state of semi-permanent micturition, I put it down at first to the mild ravages of age. I recalled an episode of Frasier in which getting up in the night to go was described by the father as one of the consequences of passing 40, along with an involuntary exhalation when sitting down on a low sofa. It was probably the muscles in the bladder becoming slacker, or something.

Then I decided to count. When, one day, I had to go no less than 13 times, I decided that it was excessive. I took myself off to the doc's. On went the rubber gloves, in went the finger, out went my vanity. She was looking for signs of an enlargement of the prostate gland, the underside of which can be felt if you take the back passage and turn sharp left. There was, she thought, some small degree of enlargement and - as much to make me feel better as anything else - she referred me to the consultant.

If I were not a journalist, I don't think I would have gone along to the surgery - not until I had seen much more troubling symptoms. For a start, as a writer, I am aware that I can turn embarrassing experiences into columns, so I have an incentive for allowing strange people to violate my inner space. And I might not have had the leisure nor the equipment to go rootling around on the internet to try to find out about what was going on.

In my boyhood and younger years I considered a bloke's equipment to be a Wysiwyg arrangement - what you saw was what you got. Stuff got made here and came out there, and what else did you need to know? I am not joking, by the way, or exaggerating for effect. I was ignorant. Tony may be ignorant. Men are ignorant. Only when I began to hunt around for the facts did it become clear to me that more was happening inside than out: that a tangle of tubes, ducts, glands and muscles worked away backstage, so to speak.

The prostate gland is the best, deepest-hidden of all these various bits and pieces. The size of a walnut, it sits just below the bladder. Slap through the middle of the prostate, like a river between cliffs, runs the urethra. The job of the prostate is to make some of the ingredients (about a third by volume) that need to be added to sperm for successful fertilisation. At appropriate moments the gland downloads its brew into the urethra. And Bob's your dad.

What they don't tell you is that it starts changing after 40. In many men it atrophies - grows smaller. (That's natural. I mean, who's got the energy?) But in half of all men the bloody thing hypertrophies, or grows. As it grows, it constricts the urethra, causing mild blockages and sudden floods. And that is happening to a fifth of all men aged 40. So how come I reached 40 and had never heard of it? More of that later.

The chances are that I have either a mild infection or benign prostatic hyperplasia, which seems to be just doctorspeak for "bigger prostate - no cancer". If I were unlucky (and there is no reason to suppose that I would be) it could be the early signs of prostatic cancer. A further series of simple tests will give a pretty good indication of what the score is. Whatever it is, however, I've got in quickly. Most men are referred (or refer themselves) long after the first symptoms, which helps to reduce survival rates from prostate cancer to something around 50 per cent. Diet, exercise and drugs can all be used to lower the chances of needing surgery - surgery that often damages the nerves in the area and leaves blokes impotent. There's one they do that looks as though they've shoved a monkey wrench up your... Oh, God. It would be worth trying out a lot of different therapies to avoid that one.

Why didn't I know? Why had I also never heard of testicular self-examination until I was past the age of main incidence (35)? Why wasn't I told at school? Why wasn't I sent leaflets by my GPs? Why weren't there notices up in the surgeries? Why weren't there any TV programmes? Why no awareness weeks (until very recently)? Why was the only mention I had heard of prostatitis the hilarious references to Edna Everage's hubbie, Norm, who'd been in hospital for five years with his prostate? Are ovarian cysts funny? Or ectopic pregnancies? Or is the sexual health of the over-30 male some kind of natural joke?

These are deadly embarrassments. My late father would take himself off to the doctor's at the slightest sign of faintness or a barely perceptible palpitation. He was certain that his heart would kill him. Yet he ignored the passing of blood for several months because it was at the wrong end. By the time they opened him up, his colonic cancer was huge.

There are things doctors can do. The American Urologists' Association recommends a digital rectal examination once a year for all men over 40. That would help. In the case of benign prostate problems, we ought to be researching why half of all men do not suffer from hypertrophy: that suggests there is nothing inevitable about prostate growth. There may be preventive measures that could be taken.

But the biggest problems are the self-imposed silence, the refusal to learn and the ignorance and shame that men have of their bodies. It is remarkable that, even today, newspapers can run articles on prostate cancer or other disorders without once saying what the prostate does, where it is and how to find it. Such misplaced prudery is damaging. I don't suffer from such restraint any more and have probably helped my chances a great deal. Maybe a man near you has not been quite so fortunate.

David.Aaronovitch@btinternet.com

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