John Foley didn’t think he’d live this long. Six years ago, the now 62-year-old was diagnosed with aggressive, stage four prostate cancer following a routine blood test.

“I had a six-monthly blood regime going on with my GP and she had always included a prostate-specific antigen (PSA) test. That’s used to measure the prostate antigen in your blood,” says John. “She had noticed that it had been increasing over a number of tests, and although I had few symptoms, she referred me to a urologist.”

An MRI revealed a lump, and subsequent biopsies found it was cancerous. John had his prostate removed in late 2020 and was referred to a medical oncologist. “I was immediately put on hormone deprivation therapy after having the prostate removed, then I went through chemotherapy and radiotherapy,” he says.

“Since then, it’s all been medical oncology. I take a daily tablet and go to the GP every three months to have an injection. I also go to an oncology ward every six months to have an IV infusion to protect my bones.”

John’s cancer had metastasised by the time he had his prostate removed and to date he has had three tumours in his bones. Each time, the warning sign is a rise in his PSA levels and, when the tumour is big enough to be located, he undergoes treatment. Currently his PSA level is slowly rising again. It’s a waiting game but John is taking every day as it comes.

I sat in the house all day for a long time, just thinking, ‘How long have I left?’ Then I had the realisation, I need to snap out of this and start using the time that I have left

“I’ve gotten six years so far. Considering I’m stage four, I’m doing OK. I never expected to still be here.”

While he has an admirably stoic attitude to his condition today, that was not always the case. Life was very dark for a time. “For the first couple of years after I was diagnosed, I shut down and was sort of preparing myself for death,” says John.

“I sat in the house all day for a long time, just thinking, ‘How long have I left?’ Then I had the realisation, I need to snap out of this and start using the time that I have left.”

John began to research cancer support groups, which changed everything. “Suddenly I was finding other men who had walked the same path as me. It opened up the whole area of advocacy for me. It gave me a new purpose for life and a new focus.”

Today, he is an ambassador for a number of cancer charities including, the Marie Keating Foundation, Movember and Prostate Cancer Ireland.

Finding support

Finding support and talking to people who have also experienced cancer has been vital, John says. “I would tell anyone who’s gone through this to get involved. Most groups are online, and you can join in and listen to other men’s stories. Eventually, like most men, you end up telling your own story.

You ask questions. You get advice. You get support because you’re dealing with people who have the same treatments as you and the same side effects too, whether it’s the incontinence, the erectile dysfunction, or the fatigue. Talking about it is so important.”

Living with a serious illness can sharpen the view and in John’s case, it was the catalyst for his decision to make the most of every day. When his son was living in Australia, John went to visit for a month – and fulfilled a lifelong ambition of jumping out of an aeroplane.

“When I went to Australia I said, ‘I’m going to do it’,” says John. “I don’t care that I’m 62 and I have cancer. I’m going to do this because it’s something I’ve always wanted to do. So I did it, and it was the most magnificent experience I’ve ever had. I absolutely loved it.”

John is by no means alone in his cancer experience. According to The Irish Cancer Society, one in six men will be diagnosed with prostate cancer during their lifetime. That equates to about 4,000 men receiving a diagnosis of prostate cancer each year in Ireland. It’s an issue men tend to see later in life, says Dr Richard Moore, consultant radiation oncologist at Mater Private Network, and the average age is around 70.

“It’s the most common non-skin cancer type of cancer in men,” he says. “It’s also got the highest mortality for men as well.” However, that mortality rate has reduced considerably in recent years, he adds.

“In the UK, the long running ProtecT trial (Prostate testing for cancer and Treatment) shows that most men don’t die of prostate cancer. If it’s early and it’s localised, 96-97% of men are alive in 15 years. So, that’s reassuring and should encourage men to consider their health and get regular check-ups.”

More men are now being treated for localised, or early stage, prostate cancer when there are no symptoms, says Dr Moore.

“That’s a common presentation nowadays with prostate cancer. Men have no symptoms, there’s just a small rise in their PSA. They’ve been diligent and checked with their GP, and that has given us a diagnosis of prostate cancer and prompted further investigations.”

Often patients come in, and they have a choice regarding treatment. The surgeons will have talked through what they expect to happen in surgery, and I’ll do the same in radiation

That’s not to say there are never any symptoms. Some men may notice a change in urinary flow, getting up to go to the toilet at night, or blood in the urine.

“Very rarely, there will be changing bowel symptoms, and then sometimes men notice that erectile function can change a little bit.

“It can be very subtle. It can be over a year or two, and sometimes men put it down to age. But in retrospect, when you look at these cases, perhaps they are potentially to do with the tumour, and they would be considered red flags.”

When it comes to treatments, Dr Moore says it’s important that men feel they can have open conversations about what is best for them.

“Often patients come in, and they have a choice regarding treatment. The surgeons will have talked through what they expect to happen in surgery, and I’ll do the same in radiation. I encourage the patient to really think about what’s important to them and make the choice. I think that’s important for the patient.”

For many men, there is a real fear around the potential side effects of certain prostate cancer treatments, but they are less common than people might think, according to Dr Moore.

“I spend a lot of time reassuring patients about the side effects with radiation, which come under the headings of bowel and bladder, sexual function and erectile function.

“Generally, serious side effects that require repeated visits or extra medications are uncommon. Less than 10% of the patients that I treat run into bothersome effects. For the most part, it may not affect people as badly as they fear.”

As Dr Moore explains, prostate cancer doesn’t often announce itself with symptoms, so it’s all the more important to have regular GP check-ups and blood tests. For most men, that should be from the age of 50 or 45 if there’s a history of cancer in the family.

Consider it something like getting a regular MOT for a tractor or a car.

“It’s actually quite a good way of thinking about these things,”Dr Moore advises. “Humans need a physical service – that includes mental health checks as well.”

Echoing John’s advice, Dr Moore says the initial step in dealing with this, or any health issue, is to start talking about it. “The first thing to do is consider your health as a whole and to talk about things,” he says. “I’m sure families and partners are talking about their health, so it’s about encouraging men to have that conversation too. If you’re concerned about something, speak about it.”

Help and support

See prostatecancerireland.ie or mariekeating.ie