Prostate cancer and the love of God
Noël Staples considers how his recent diagnosis has affected his relationship with God
1 February was quite a day! I went for a sigmoidoscopy to check for diverticulosis. This revealed a normal, healthy sigmoid. Then my life fell apart.
The discovery
The intra-rectal digital examination found a hardened nodule on my prostate, palpable immediately in front of the anal sphincter from just inside the anal canal. Cancer! I had no symptoms. Two weeks later a blood test showed a PSA (prostate specific antigen) count of 5.2 nanogrammes of PSA per millilitre of blood —not particularly high, nor a definite cancer indicator as there are other causes for raised PSA. There is no reliable screening indicator so I needed a biopsy, not a pleasant experience. If there is a suspicion of cancer, then the biopsy, with its slight risk of damage to what may be an otherwise inoffensive prostate quietly minding its own business, is not really avoidable. However, if the painless, risk-free MRI scan first shows no cancer, a needle biopsy can be avoided. Only biopsies show if cancer cells are aggressive and immediate action needed. Mine showed cancer cells with a Gleeson aggression score of eight from four prostate cell cores on the rear right side and six from two left rear cores. The other six cores were normal. The Gleeson range is, curiously, from six to ten. Cancer cells rated ten menace passers-by! (Can’t take it too seriously!)
Because of the aggressive cancer cells, further tests were needed to check for metastasis (cancer spread beyond the prostate capsule). An MRI scan (thirty-five minutes in a noisy, narrow machine) to detect choline, an amino acid produced by prostate cancer cells, showed no metastasis.
Next came a full body bone scan in which a radioactive isotope, technetium 99m, which has a six hour gamma particle emitting half-life, is injected from a lead-lined hypodermic. Two hours later you lie on a table passing slowly under a scanner detecting isotope concentrations in the skeleton. Areas of concentration are then X-rayed to rule out arthritic degeneration or healing fractures. The bone scan detects whether the cancer has spread to the bones. I’m lucky (sort of!). My cancer hasn’t metastasised!
Choices
Now my choices are two: surgical removal of the prostate by robotic laparoscopy that removes the cancer completely, but is traumatic in its after effects; or radiotherapy to kill the cancer cells, preceded by hormone therapy for three months to block testosterone production and shrink the prostate as much as possible – thus reducing the radiation needed to target it. Prostate cancer cells need testosterone to grow and spread.
Surgery takes three-and-a-half to five hours under general anaesthetic, only involves a short stay in hospital, but leaves you catheterised for two weeks with a urine bag strapped to your lower leg to allow the sutured join reconnecting the bladder to the urethral sphincter muscle to heal. Then follows a period while you get the sphincter muscle working properly again, with the obvious problems that involves. As the urine voiding system has been traumatised it can take time to get it functioning adequately again. However, ninety per cent of men return to more or less normal urine control.
Radiotherapy involves three narrow, high intensity X-ray beams briefly focussed on the prostate every weekday for seven weeks, killing the cancer cells but risking some collateral damage to the bladder and rectum. There is about a five per cent chance of radiation cystitis in the bladder or radiation proctitis in the bowel. Impotence and erectile malfunction follow all procedures. After a struggle choosing between a rock and a hard place, on Friday 13 April I started hormone/radiotherapy treatment.
The love of God
Over the years I’ve been much perplexed by the relationship between my spiritual and material life. While Christians struggle with their notion of ‘a loving father God’, I’ve no experience of a God who is loving or caring in any human sense. I seek to articulate some understanding of God’s relationship to creation by inference from observation of creation as a whole, not just humanity, pondering over what we know of the workings of this immense cosmos. That wretched second law of thermodynamics springs to mind! It’s always frustrating trying to talk about one’s relationship with God. Words are the tools of the intellect. Pointing one’s intellect at God simply doesn’t work as I have nothing adequate with which to compare the experience. As Blaise Pascal said: ‘le coeur a ses raisons que la raison ignore.’ (The heart has its reasons which reason knows not.)
Ever since I was aware I’ve had a sense, as Wordsworth memorably expressed it in his poem ‘Tintern Abbey’, of ‘the still sad music of humanity… of ample power to chasten and subdue…’
Of something far more deeply interfused,
Whose dwelling is the light of setting suns,
And the round ocean and the living air,
And the blue sky, and in the mind of man:
A motion and a spirit, that impels
All thinking things, all objects of all thought,
And rolls through all things.
As an undergraduate I was attracted to the poems of our local Peterborough nature poet John Clare and joined the then recently formed John Clare Society in 1985, subsequently writing my undergraduate dissertation on manuscripts in Peterborough Museum. Anyone reading Clare’s poetry must realise that he was also deeply aware ‘of something far more deeply interfused.’
How, then, to come to terms with this powerful, joyful, numinous presence, this quotidian living with that ‘mysterium tremendum et fascinans’, as Rudolph Otto put it? How can I simultaneously have my life ‘fall apart’ and, alongside it, experience this profound and beautiful relationship? I tried to talk about my perplexity to the oncology nurse. I was feeling pretty devastated, yet, grudgingly perhaps, it brought the usual smile to my face and sense of – what can I say? – overwhelming, often frightening power, beauty, a ‘flow’ perhaps, almost a gentle breeze sighing through me, sometimes with a cold edge to it, who knows? I couldn’t be without it, in and all around me, but it didn’t change the distress and shock from confronting cancer.
So there we are, the ‘love’ of God perhaps! It helps sustain me. I feel part of something infinite, something very, very big, quite awesome. It’s a lovely sense of ‘belonging’ to everything and everyone, which doesn’t change, be my material life never so nice. That sense of ‘belonging’ to everything imparts the desire to care for, to like, at the very least to do no harm to everyone and everything.
Life changing
I urge men over forty to consider a PSA blood test. Get your GP to do the undignified ‘intra-rectal digital prostate check’ (sounds impressive, but merely a finger up your bottom! – remember how often women are examined, legs akimbo, fundament on display!). This is an ‘indolent’ cancer, quite treatable. Caught early, before it has spread beyond the prostate capsule, it can be eradicated completely. More men die ‘with’ it than ‘of’ it. A 1992 New York study found half of a sample of men in their forties killed in gang crime already had prostate cancer!
The life changing discovery that you have cancer makes you think hard about the ‘love of God’, about your relationship with God. Re-examining again and attempting to talk about my relationship with God has deepened and furthered my spiritual journey…
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