I briefly mentioned Alberto and his dad in my last blog. Alberto had interrupted myself and Charles dispensing TV justice to thank me for the prostate cancer talk that I did in the workplace a few weeks previously. He was to go on and have a story that left me open mouthed.

I met Alberto in the reception with his dad Giovanni and his wife Rosa. Giovanni certainly didn’t look sixty five.

I would have believed him if he said he was fifty five. I would definitely have taken another ten off for his wife. If I am here next week and not run over then I was generous or pretty near the mark for her. We shook hands and ventured over the road to one of my ‘favourite’ highway robbery coffee shops. The three of us ventured upstairs to try and find a seat while Alberto was robbed at the tills.

These coffee shops and a particular cheap fast food burger restaurant have one main thing in common. They are both full of ‘table blockers’ who manage to block off a table for the price of a coffee and are happy to stay the whole day there. It’s comparing two groups of hobos – one with laptops sucking up the free wi-fi and another without. You may have guessed that I was slightly irritated that there was a lack of free tables but we managed to find the last one.

Giovanni had been a carpenter his whole life had just retired late in 2018. He had many plans to do things that he could not whilst working, instead he started off his first week of retirement with hospital visits and investigations. This would leave him filled with worries and anxieties. I asked him what he knew of his father’s health and he said his father came from that generation where they went to the doctor and the doctor examined them, gave them some medicine and they never asked any questions. With the absence of grandchildren (they mentioned them more than once in our conversation as they were both looking at Alberto, who had a hand scribbled target drawn on his forehead) he was looking forward to travelling the world with the lovely Rosa. Rosa is a nurse and certainly does not look like she will be retiring anytime soon.

Giovanni had just gone to his doctors for a small mole on his leg, just before his holiday. The doctor suggested that he should also have his PSA tested due to his age.  There was no rush, however, and he could take it once he had come back from holiday. Giovanni left it a few more weeks before he returned to get his PSA tested. When the results came back, a couple of weeks later, his PSA levels were slightly elevated compared to his last test a few years ago but still within the normal range. His GP texted him back and invited him in for the Digital Rectal Examination (DRE). There was another delay of three weeks for this appointment as the senior GP, who needed to do the test, had a heavy workload.

That very same morning that Giovanni had come back to the surgery for his DRE, his doctor had heard on the radio that, the government had set new PSA guidelines for different age groups rather than one normal range for all. As his PSA level was now over the new level for his age group, he was referred to hospital for an MRI scan and then finally a biopsy. I asked him if he experienced the infamous ‘peeing razor blades’ effect. This is where, in my experience, about the day after the biopsy I was just watering the King as you do. Within seconds I was gripping the sink for dear life as I experienced the most excruciating pain as I was peeing out ‘razor blades’. I was later to find out that what had happened was that I was passing out the blood clots from my biopsy. He looked inquisitively at me and shrugged his shoulders. He had no idea what I was talking about.

Just lucky, lucky me then, well that’s a surprise.

If a tumor is found, then another important scoring system kicks in. This is called the Gleason score and is used to describe the aggressiveness of prostate cancer. The Gleason score is in the range six to ten, but it is actually made up of adding two numbers. The first number is the primary grade and describes the cells that make up the largest part of the tumor and the second part of the number is the secondary grade and that describes the next largest area. For example, you may see a Gleason score written as 3+4=7. This means the biggest tumor area is grade 3 and the next biggest area is 4 so the total is 7. The higher the Gleason score the more likely the cancer will grow and spread quickly. Typical Gleason Scores range from 6-10.

Giovanni’s Gleason score was 7. A Gleason score of 8 is described as highly aggressive. Prostate cancer would show it has a sense of humor and don a santa claus uniform and deliver the news to Giovanni on Christmas Eve.

Had he come in for the check earlier, he would have been sent home after the PSA result because it was within the limits at that time.

There was a delay in taking the blood test.

There was a delay in having the DRE.

There was a GP, who was on the ball, innocently listening to the radio.

Without these three factors, the end result could have been a very different story.

Giovanni went to the hospital to speak with the consultant. I told them the choices I had and how I had made the decision to have the radical surgery. He went through the list of side effects and added one more that I didn’t know about. Apparently, the specialist            uro-oncology nurse told him that the prostate has radioactive seeds inserted into it and he will have to stay away from pregnant women and cannot have children sitting on his lap. This is while the seeds are active and they would stay in the body permanently. They both looked at Alberto again when they said the thought of not being able to cuddle future grandchildren was too much. Alberto took the burning spotlight in his stride – he had been getting it for a while. At thirty five he was getting old which just made them keener. Giovanni has decided to undergo the radical operation.

I told him what to expect, giving him the road map that I wished that I had been given. I laid it all out for him, the catheter, the incontinence, blood thinners, impotence, stitches, the pump – I gave him the works. He has also read much of the blog. He was surprised as he had never heard the information laid out in a ‘road map’. We both agreed that doctors probably don’t want to give patients too much information at the start and scare them off and instead just drip feed it. Everybody is different though and he was grateful he got it all up front so he could peel off what he needed.

What made me smile was the fact that he was more bothered about the surgery putting a temporary dent in his travel plans than anything else.

We went from earlier formal handshakes to old friends and bear hugs as we said our goodbyes. I told Giovanni to please keep in touch and if he wanted to talk at any time he just had to say and to let me know how the operation goes.

The structure of the prostrate gland is a blessing and a curse. It’s an enclosed ball that will keep the cancerous tumor contained until it ruptures, that’s the blessing. The curse is that we don’t conclusively know how to check it without the invasive biopsy procedure. Still the health service think it is in men’s best interest not to mass PSA screen men of a certain age.

You also have to question how effective was the official mechanism for informing doctors  of the PSA changes related to age.

I said to him someone was looking down on him and he totally agreed that it was God looking down on him.

If there are two horses in a race and I pick one, you pick the other.

You should know that by now with me. Even if the other horse has three bow legs, manky, one eyed, tongue hanging out to one side, crook-necked and the Incredible Hulk is the jockey eating a tuna sandwich that’s the one you pick. Giovanni is the complete opposite. I am going to ask Giovanni what horse he is betting on in the next Grand National.

Alberto and his brother, Mario, will need to have regular PSA tests once they hit their mid-forties.

I also said I would remind Alberto that they still wanted grandchildren.