“Losing my chestnut”: one gay man's wrangle with prostate cancer

Abstract

Iam a sexuality activist, researcher and theorist, with 35 years of experience working, thinking, writing and debating in sexuality and gender politics, and 25 years of working in HIV/AIDS. I can talk about sex under water! For me, like everyone else the first time – losing my cherry – was an important moment marking a new phase of my life and I have talked with amusement about that moment with friends and in my work. I want to tell another tale here, no less important in marking a new phase in my life, but perhaps with quite different prospects. I want to tell a tale about losing my chestnut. Cancer. That was the word I dreaded, but had been anticipating as a diagnosis for nearly a decade. Prostate cancer is the most common cancer in men after lung cancer and, it seems, growing in prevalence to equal breast cancer in many resource-rich and developed countries. Indeed, there are just on 12,000 new diagnoses in Australia each year (almost a quarter of a million in the US). It comes at you in scales, scores and stages, with actuarial tables on ages, survival rates over time – it is definitely “men's business” and is handled in a matter-of-fact, man-to-man way. Diagrams of your “chestnut” (it looks a bit like one in the drawings) with little wings (seminal vesicles) make it look like a logo for international airmail, but it is held to earth by a kite string-like urethra. You can live without it, but how well you live is the next question after how long. There is not much room for emotion in the urologist's office. I received the news, the detail, the recommended action – in my case, a radical prostatectomy (RP), complete removal of my chestnut – and a sketch of the prospects for a future life. Then, with a manly shake of hands and a subsequent, decision-yielding appointment made with the secretary who has seen all this before, I found myself on the street heading somewhere, home, work, a bar, with a cloud dulling my senses and numbing my heart. At least for a while. A decade before, I had had an infection in the prostate. How did I know? Some blood in my semen. How did I see that? As a gay man with a reasonably active sex life, I knew about safe sex. “Cum on me, not in me” was a key slogan used in gay men's HIV prevention for years. Need I say more? My general practitioner (GP, i.e. internist, family physician) ordered a Prostate Specific Antigen (PSA) test, the major diagnostic tool for assessing prostatic problems, and did the usual Direct Rectal Examination (DRE). The DRE revealed a somewhat enlarged prostate, but for my age (heading toward my late 40s then) this was not entirely unusual as most men's prostates start enlarging with age. But the surface of the prostate he felt was smooth – no bumps – a good sign as bumps indicate a possibly cancerous growth starting to press against the outside capsule that contains the prostate. The PSA test result came back a “six”, considered a bit high for my age and possibly indicating some problem, but not necessarily cancer. Elevated PSA scores occur with a range of prostatic conditions, including the enlarging that comes with ageing. Off to the urologist – the men (mainly) who “own” prostates. A further PSA test, another DRE, a urine flow test (enlarging prostates can increasingly inhibit urine flow and control) led