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A crimson story: My journey with prostate cancer
I was asked by someone in this forum whether I would care to give some insight into my prostate cancer journey.
The Crimson Clue: A Prostate Odyssey
It began not with a scream but a whisper. In 2008, while minding my own post-coital business, I noticed that my semen—normally the color of indifference—was tinged with blood. Aesthetic? Perhaps. Concerning? Definitely. My physician, however, reacted with the professional urgency of a man told the photocopier was out of paper.
"Ah," he said, with the smug satisfaction of someone who had solved a crossword clue, "probably the baby aspirin. Maybe stop taking it."
Mystery solved. Case closed. Medical system triumphant. Waterloo, where I happened to be living at the time, continued its snow-drenched denial of my subtle descent into oncology.
Years passed. Sperm returned to its less theatrical shade. Even though… sperm volumes continued to decline to negligible volumes, another sign that should have been considered, but wasn’t. No one thought about prostates. Until I found myself in an airport somewhere, imprisoned between flights and existential fatigue, flipping through a health magazine that casually mentioned PSA testing. A footnote. A curiosity. But it stuck.
So, in 2018, I asked my doctor for a PSA test. The result came back as a calm, reassuring 1.0. Low enough to make doctors smirk condescendingly and suggest I go live my best life. I was referred to a urologist, because that’s the thing you do when you’re both cautious and bored.
The man performed a DRE (Digital Rectal Exam, not to be confused with a polite handshake) and pronounced everything “perfectly normal.” No lumps, no bumps, no drama. “See you in a few years,” he said, probably before lighting a cigar and billing my insurance.
Then came 2024. PSA: 26.7.
For context, that’s not a “we should keep an eye on this” level. That’s a “why are you still sitting here and not on a gurney?” level. But our friend, the urologist, gazed upon this Everest of a PSA and said—without irony—“There’s nothing wrong with your prostate.”
It was at this point I began to realize the man was either deeply incompetent or auditioning for a role in a Kafka novel.
It took my insistence—again—to push for more than finger-wagging and placebo reassurance. A biopsy, finally, revealed the enemy: prostate cancer, Gleason 3+4=7. Cribriform glands, perineural invasion, a little architectural flair to go with the malignancy. And a realization that this thing had likely been squatting in my prostate for a decade, undisturbed, unchallenged, and medically underestimated.
So, on to treatment: monthly Firmagon injections, which turned my body into a hormonal wasteland. Then came brachytherapy in February 2025—a process that involved radioactive seeds being embedded in me like I was some kind of human chia pet. External beam radiation followed, five days a week, each session a performance in the Theatre of Futility.
Side effects were plentiful: dizziness, hot flashes, breathlessness, a sense of existential farce. But what lingered most was the growing file of “what ifs.”
And now, with the clarity of hindsight sharpened by radiation and pharmaceuticals, I realize what I should have asked:
I should have asked why no imaging was done in 2008 when I presented with blood in my semen—a symptom more ominous than aspirin-induced nosebleeds, yet treated with less concern. I should have asked why we weren’t doing routine digital exams in my 50s, given my age and symptoms. I should have asked what my baseline PSA was back then—had anyone bothered to establish one. I should have asked why we were relying on a DRE alone, as if the human finger were still the gold standard in the era of multiparametric MRI. I should have asked why, with a PSA rising into the double digits, we weren’t immediately biopsying, scanning, staging—doing anything, really, other than muttering “wait and see.” I should have asked whether cribriform patterns carried worse outcomes and if treatment should be escalated accordingly. I should have asked if long-term androgen deprivation could backfire by selecting for more aggressive variants in a low-testosterone environment.
Instead, I trusted. A doctor said it was nothing, and I mistook confidence for competence. I mistook calm for clarity. I mistook protocol for protection.
But here we are. Mid-2025. Not dead. “Terminally stable,” as I like to call it. Or as the oncologist euphemistically puts it, “responding well to treatment”—which roughly translates to, “still paying bills.”
This is not just a tale of cancer. It’s a fable about the peril of passivity, the comedy of credentialed incompetence, and the need to sometimes be your own bloody advocate—literally.
Turns out the most dangerous growth wasn’t the cancer—it was the blind confidence of the specialists.
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Chapter 4: Radiation? Surgery? Do Nothing?Or: Choosing a Life Path While Mildly PanickingCongratulations. You've reached the choose-your-own-adventure portion of the cancer journey. Three doors await:Door #1: RadiationDoor #2: SurgeryDoor #3: “Active Surveillance,” aka Do-Nothing-But-Stare-At-It-MenacinglyEach option comes with its own risks, side effects, and medical sales pitches. It’s a bit like buying a car, except the extended warranty is incontinence.Option 1: Radiation – Zap First, Apologize LaterThere are two flavors here:External Beam Radiation Therapy (EBRT) -and all of it's associated beam stuff options )SBRT / IBRT) : Daily zaps to your pelvis for several weeks. You lie still while a machine attempts to nuke the tumor without cooking your bladder, rectum, or dignity.Brachytherapy: Radioactive seeds are implanted directly into your prostate. It’s a glowing porcupine in your pants. You can combine both for a “radiation combo platter.”Pros:Non-invasive.Often very effective for intermediate and high-risk cancers.Can be combined with ADT for better results.Cons:Fatigue, bowel irritation, urinary frequency, occasional sexual dysfunction.Long-term effects may sneak up on you years later like bad decisions in your twenties.Bottom Line:Good for those who want to avoid knives. Less instant trauma, more slow-burn inconvenience.Option 2: Surgery – When in Doubt, Cut it OutThis is radical prostatectomy — a charming euphemism for “we’re removing your prostate, seminal vesicles, and possibly some lymph nodes.” It can be done laparoscopically, often robot-assisted, which makes it sound like a video game. Spoiler: it’s not.Pros:One-and-done mentality. Take it out, test it, and move on.Clear pathology afterward — you know what you’re dealing with.Cons:Incontinence and erectile dysfunction are common guests at this party.Long recovery. Higher complication risk for older or cardiac-compromised patients.May still require radiation later. So, bonus round.Bottom Line:Best suited for younger, fitter men or those who find comfort in the phrase “let’s just get rid of it.”Option 3: Active Surveillance – Also Known as “Let’s Pretend It’s Not There (Yet)”This is for the low-risk, slow-growing, probably-going-to-outlive-it type of cancer. Regular PSAs, MRIs, and occasional biopsies. No treatment unless it misbehaves.Pros:No side effects. You keep your bodily functions and your pride.Ideal if the cancer is truly low-risk.Cons:Psychological torture. You now live in a Schrödinger’s Cancer scenario.Requires trust in your doctor, and more importantly, your own denial skills.Bottom Line:Best for very low-risk disease or those with bigger health problems to worry about. Like being married to a urologist.So… Which One?This isn’t a simple multiple choice. It’s a complex Venn diagram of:Your ageYour healthYour cancer’s personalityYour risk toleranceYour bladder’s sense of humorAnd your oncologist’s persuasion skills.The Real Answer?There is no perfect option. There is only what you can live with — and through.If you’re early-stage, your decision is mostly about side effects and preference. If you’re high-risk, you may end up doing radiation and hormone therapy, possibly with a touch of chemo if things get spicy.If you’re in denial? That’s what surveillance is for.Next Up:Chapter 5: Hormone Therapy – Chemical Castration and Other Romantic Adventures(Because who needs testosterone when you can have hot flashes and osteoporosis?)
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2 ReactionsChapter 5: ADT and other assorted ScheisseChemical Castration: Now with More Side Effects!ADT - the charming euphemism for "shutting down your body's testosterone production like a failed startup." If you’ve ever wondered what it feels like to be emotionally unstable, mildly sweaty, sexually inert, and constantly tired at the same time, welcome to the wonderland of Androgen Deprivation Therapy.This chapter is not for the faint of groin.What Is ADT?ADT is the medical version of going full scorched-earth on your hormones. Why? Because prostate cancer loves testosterone. Feeds on it. Cuddles with it at night. So the thinking goes: remove the testosterone, and you starve the cancer.Simple, right?Except… testosterone also runs everything else in your body. Energy. Mood. Libido. Muscle mass. Bone density. Your ability to tolerate long phone calls. All of it.The Flavors of MiseryThere are several ways to experience this hormonal shutdown:LHRH agonists (e.g., Lupron, Eligard): Trick the body into thinking it doesn’t need testosterone.LHRH antagonists (e.g., Firmagon, Orgovyx): Shut it down more directly. Faster, fewer flare-ups, more expensive.Anti-androgens (e.g., bicalutamide, enzalutamide, darolutamide): Block testosterone from binding to cancer cells — often used in combo with the above.Surgical castration (orchiectomy): A one-time outpatient procedure. Surprisingly effective. Not big in Canada unless you’re a sheep.The Side Effects ParadeHere's what you can expect, roughly in the order of annoyance:Hot flashes: Because why should menopausal women suffer alone?Loss of libido: Sex drive? What sex drive?Erectile dysfunction: You’ll need a vivid imagination and excellent Wi-Fi.Fatigue: A bone-deep, soul-sapping exhaustion that makes Netflix feel like cardio.Mood swings: Weeping during insurance commercials is now fair game.Memory fuzz: Forgetting why you walked into a room becomes a lifestyle.Muscle loss & weight gain: Soft in all the wrong places.Bone thinning: You may become osteoporotic and ironic at the same time.Increased cardiovascular risk: Because fighting cancer wasn’t dramatic enough already.How Long Does This Go On?Depends.Short-term ADT: 6 months to 2 years, often paired with radiation. “Short-term” here means "long enough to forget what testosterone felt like."Long-term or lifelong: For metastatic disease or high-risk situations. This is the full subscription model — no refunds, no grace period.Some doctors advocate intermittent ADT (on-again, off-again) to reduce side effects. It's like hormone therapy with commitment issues.But… Does It Work?Yes. Annoyingly, it does.ADT slows cancer progression, enhances radiation effectiveness, and extends survival in high-risk or advanced disease. Which is why many of us agree to it, despite the side effects — the sheer gall of cancer being responsive to such medieval tactics.You don’t have to like it. You just have to survive it.Survival Tips from the Androgen WastelandExercise: Fight fatigue with resistance training. Or at least try walking around the house with purpose.Calcium & Vitamin D: Your bones need all the help they can get.Antidepressants: For hot flashes or, let’s be honest, existential despair.Speak to your partner: They deserve a warning. Or a medal.Track symptoms: Because when your oncologist asks, “Any side effects?” you’ll forget everything except the name of your dog.A Note on IdentityADT doesn’t just change your biology — it can nuke your self-perception. Libido, energy, confidence, emotional stability — all are testosterone-influenced. Losing it can feel like losing yourself. You're not alone.Be angry. Be sad. Be sarcastic. But also, be informed. And stay in the fight.Coming Up Next:Chapter 6: Living in the Post-Testosterone World – The Existential, Emotional, and Sartorial Consequences of ADT(Subtitle: Why I Now Own Seven Cardigans and Cry at the Weather Network)
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1 ReactionChapter 6: The Undefined Man
So here you are. One to six months into Androgen Deprivation Therapy, and things are… different. You no longer experience lust, rage, or even mild enthusiasm for sandwiches. You own house slippers. You’ve seriously considered herbal tea. You’ve entered the Post-Testosterone World, where everything is softer, weepier, and vaguely beige.This isn’t just a hormonal shift. It’s a full-blown identity heist.You may notice you’re:
- Crying at TV ads involving dogs, dads, or dead batteries- Comfortably discussing feelings you never knew you had
-Spending ten minutes debating whether that cardigan is too bold for Tuesday
This is not weakness. This is hormone therapy. You’ve been chemically tilted toward your inner therapist. Or yoga instructor.
And yes, the sex drive is… gone. Not on vacation. Not “taking a break.” Gone like Blockbuster.
Energy: Low Battery Mode ActivatedYou used to mow the lawn, fix the sink, and make dinner. Now just one of those earns you a nap and a thousand-yard stare. ADT fatigue isn’t laziness. It’s cellular-level mutiny. Your muscles are melting, your red blood cells are on strike, and your motivation has evaporatedWelcome to the strange new land that lies beyond the testosterone border — a place where your sweat glands panic without warning, your reflection seems vaguely unfamiliar, and you weep during local news segments about endangered snowplows. This is Life After T, and no one prepares you for the sheer emotional absurdity of it.It is not just hormonal suppression. It is a full-bodied, mood-drenched, cardigan-clad reinvention of the male experience.
Let’s be clear. You’re still technically the same person. You just no longer:-Wake up with confidence (or anything else)
-Finish tasks without a nap
-Respond to flirting with anything more than “That’s nice, dear”-
Know where you put your keys. Or why you walked into the kitchen.
Your body hasn’t betrayed you. It’s just… following orders from a drug designed to rob your cancer of testosterone. Unfortunately, it robs you of everything else too — energy, muscle tone, decisiveness, and your ability to suffer fools in silence.
The Emotional Weather Report: Overcast, with Sudden Flooding
You may find yourself:-Crying during insurance commercials
-Feeling unexpectedly sentimental about paperweights
-Apologizing to your plants-Watching cooking shows unironically
Mood swings? Check. Anxiety? Hello again. Existential dread? Front-row seat. All perfectly normal when your body’s hormone thermostat has been kicked out of the house and replaced with a neurotic intern.Sartorial Side Effects: How You Became a Man Who Owns Slippers for Indoors and OutdoorsOne morning, you’ll open your closet and realize every shirt you own is either breathable cotton or a high-stretch mystery fabric from the “Ease & Comfort” section. You’ll embrace layers because your body temperature now swings like a stock market graph. Cardigans are your new armor. Soft, buttoned, neutral-toned armor.
Your shoes will be selected based on two criteria:-Can you slip them on without bending?-Will they accommodate swelling, bunions, or general despair?-Style may return one day. For now, survival is the aesthetic.Libido: Ghosted by Your TestosteroneRemember sex? It’s that thing you used to think about 17 times a day. Now it’s more of a warm memory, like summer camp or cassette tapes. You’re aware it existed. You're just no longer emotionally—or physically—in the room.You might still be able to perform, technically. Or not. Either way, the impulse is missing. Replaced, perhaps, by a sudden interest in crossword puzzles or cloud formations.This is where you learn that intimacy isn’t just about sex. It’s about shared silence, kind sarcasm, and helping each other find reading glasses.Social Life: You Become "That Guy" at the Support GroupYou used to lead meetings, coach sports, build decks. Now you talk openly about bone density, hot flashes, and Bowel Management Strategies™. You’re the one recommending moisturizers and pelvic floor physiotherapy like a late-night infomercial.And oddly? It feels good. Because someone has to say it. And because your friends don’t understand what it means to chemically transition into a different metabolic species.Existential Upgrades (Or: The Accidental Philosopher Phase)Without testosterone telling you to fix everything or die trying, you begin to reflect. On time. On mortality. On whether your life was as loud and messy as you thought, or just… routine.You read poetry. You contemplate the meaning of existence. You rewatch old films and discover you have feelings about the plot. You start using words like bittersweet unironically.Yes, it’s weird. No, it’s not wrong. You’ve been hormonally disarmed, and your brain is free to ask questions it never had time for when it was busy organizing erections.Final Thoughts From a Man in Fleece-Lined SlippersLiving in the post-testosterone world is not a collapse. It’s a sideways evolution. You’re still alive. Still thinking, laughing, swearing under your breath at your oncologist. Still you — just... version 2.0. Softer, slower, more likely to own Tupperware you’re emotionally attached to.You haven’t lost your masculinity. You’ve just redefined it — with less testosterone, fewer societal expectations, and slightly more oat bran.
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1 ReactionChapter 7 -The waiting. The endless waiting
Subtitled: How Time Slows to a Viscous Gel and the Universe is Measured in 3-Month Increments
Once upon a time—by which I mean two or three urology referrals and a suspicious PSA ago—you were a person. Possibly even an interesting one. You had interests. Hobbies. Opinions about coffee. Then came the news: prostate cancer. Your dance card is filled up with acronyms. PSA, DRE, MRI, CT, ADT, EBRT, HDR, LDR, RP, and of course, the charming and never fully explained T3b N0 Mx. You learned to speak fluent Oncologist in under a week. You made treatment decisions with the unearned confidence of a Vegas poker player with a 4-7 offsuit.And then…Nothing.Well, not quite nothing. You still inject Firmagon into your belly with the regularity of a moon cycle. You burst into tears during car insurance ads and find yourself standing in the kitchen trying to remember why you’re holding an empty mug. The testosterone has been banished like a heretic from your endocrine monastery, leaving in its place a strange stew of cardigan-collecting, REM-cycle-wrecking, spontaneously-sobbing uncertainty.But medically?You’re in the Waiting Room of Time itself.This is the phase of prostate cancer they never write about in the brochures: the inter-treatment existential drift. You’ve joined the church, been baptized in the holy waters of ADT, genuflected before the altar of radiation, possibly had a few radioactive seeds stuck up your unmentionables… and now you wait. For numbers.Because that’s what life becomes now: a numeric cliffhanger.You no longer measure time in birthdays or holidays. You live from PSA test to PSA test, each result a roulette spin at the Cancer Casino. Will it be lower? The same? Higher? Oh god, what does slightly higher mean? You check your patient portal like a teenager stalking an ex on Instagram. You refresh. You guess. You predict. You bargain.The days leading up to your PSA test develop their own kind of weather. A low-pressure system of anxiety creeps in around day -3. You feel it in your bones. Or maybe that’s just the EBRT. By day -1, you're checking if the lab tech looked concerned while drawing your blood. By day 0, you’re Googling “PSA fluctuation after radiation” and “Can stress raise PSA?” while eating bran cereal and despair.Then there’s the time after the test but before the result—a Schrodinger’s cancer interval in which you are simultaneously cured and terminal. You parse your oncologist’s opening words like a Kremlinologist. Did he say "Good to see you" or "Good to see you"? Was there a pause? A sigh? An ominous throat-clearing?If the result is good—undetectable, flat, beautiful—you feel, briefly, like someone has lifted a boot off your chest. You smile. You celebrate with... what, exactly? A nice walk? A cup of decaf tea? A single, dignified fist pump while alone in the bathroom?But the feeling doesn’t last, because in three months, the roulette wheel spins again.If the result is bad—well, you spiral. You google more. You question everything. You wonder if that single glass of wine six weeks ago unleashed biochemical hell. You re-read your treatment plan looking for hidden betrayal. You ask yourself what the hell you’re supposed to do now. And then... more waiting.No one prepares you for this chapter. Not the pamphlets. Not the earnest young oncologist with his iPad of doom. Certainly not the nurse who said “It’s a slow cancer” like that was supposed to help you sleep.This is the chapter where you are not actively dying, but not actively living either. You are suspended. Medical limbo. You grow your hair back. Or lose it somewhere else. You get used to hot flashes and bone aches. You write half a novel, or learn to knit, or doomscroll articles about how prostate cancer is now "95% survivable," all while your identity—your entire sense of self—gets annexed by lab results.You are, to all outward appearances, fine. But you are also living in a quantum fog of fear, tinged with just enough hope to keep the whole damn farce going.And so you wait.For numbers.For evidence.For time to pass.For the next chapter.Possibly titled: “Oh Look, Another Scan.”
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2 ReactionsHans,
This is all rough stuff for everyone, but your humor is so good. I'm hoping that these humous essays you write are a screening test of sort (like PSA :)) for a feelings of hope and joy that you still have,, mixed in with all the other tough stuff we all feel to different degrees. I feel better after reading this post of yours. I hope you have a good day!
Thanks for your post. I am struggling with this for 2yrs now and it's hard. I've had 2 biopsy (neg) with a PSA of 10. Waiting to test again to see if it has moved in any direction. Now everything i feel make me think prostate. Frustrating.....
My hunch/intuition is that time is suspended for you while involved in the creative endeavor of writing. Now, if you can live creatively full time…
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3 ReactionsThanks for all your writing, I am so fortunate my treatment was nowhere as dark as yours.
Stay Strong Brother, We Got This.
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1 ReactionYou nailed it again H.C. Fortunately (unfortunately.?) the lab I use has a turnaround time of less than 24 hours for PSA. So I only have to click and refresh about 100 times in one 24 hour period!
My wife is a psychiatrist. This is how she would respond:
1. The Clinical Response: "Darling, I see you've been crowd-sourcing your identity again."
She adjusts her glasses, not because she needs to, but because it’s part of her Diagnostic Gaze™.
"Did it give you the illusion of control? A sense of agency in the face of your medically induced chemical castration?" She’s supportive. But in the way hostage negotiators are supportive.
2. The Passive-Aggressive Response: "I saw your post, by the way. On Mayo."
She says it like she just found a half-eaten donut in your sock drawer.
"It’s adorable how you think the comment section is therapy. Maybe next time try not to refer to your ADT as 'emotional neutering.' People have triggers."
3. The Psychoanalytic Response: "Fascinating. You're projecting your abandonment fears onto strangers with usernames like 'PSAwarrior_1972'. Tell me, what unmet childhood need is driving your need for digital affirmation from semi-literate men named Ron?"
4. The Bitterly Supportive Response: "Well, it’s not like I’ve been a licensed mental health professional for thirty years or anything. Why ask your wife when you can ask a guy named ‘TexProstateDude’ from Minnesota?"
5. The Darkly Humorous Response (spoken while topping up her wine): "Go ahead, tell the Mayo forum all about your Gleason score, your cribriform pattern, your sobbing over supermarket onions. But when they start sending you 'thoughts and prayers,' don’t come crying to me. Literally. You’re retaining fluid again."