Movember: Why do we wait for something to go wrong with our bodies?

The 2020 Men’s Health in Numbers Trends Report found that men in Ireland died 3.6 years earlier than women. Men’s mental health was a cause of concern too, with 317 men dying by suicide in 2018 compared to 110 women. Yet many men were still reluctant to visit their GP. Data from the Central Statistics Office showed that 68% of men visited their doctor in 2019 versus 82% of women.

Prostate cancer is one of the most common health issues affecting men. “One in six to one in eight men in Ireland will be diagnosed with it during their lifetime,” says Prof David Galvin, a consultant urologist in the Mater and St Vincent’s hospitals in Dublin.

“The average age of diagnosis is 65, which means that 50% of men are younger than that at the time of diagnosis. All men should start thinking about their prostate health from their late 40s onwards.”

According to the Irish Cancer Society, prostate cancer cases are rising. “Ireland has the highest incidence rate in the EU 27 countries and it’s increasing,” says Irish Cancer Society cancer prevention manager Kevin O’Hagan. “It increased from 1,097 in 1994 to 3,503 in 2020.”

This increase could mean more men are being diagnosed earlier, giving them a better chance of survival. “The best chance we have to treat and cure this disease is to catch the cancer early,” says O’Hagan. “The mortality rate is decreasing while the survival rate is increasing, which is most likely due to improvements in diagnosis and treatment.”

The problem doctors continue to face is that many men with early-stage prostate cancer have no symptoms. “Only one in 10 men has symptoms at an early stage,” says Prof Galvin. “This makes it all the more important to act when symptoms develop. Many men think that passing urine more often, especially at night, or having trouble starting and stopping the flow of urine, or having a very slow flow when it does start is an inevitable part of ageing. It could be as simple as that, but it could also be a sign of prostate cancer. They should visit their GP and have their bloods checked to make sure it isn’t.”

‘I took my health for granted’

John Wall, a 51-year-old father of three from Clare, wishes he’d visited his doctor earlier. Shortly after turning 46, he started getting up more often at night to urinate. “I thought it was part of getting older and just put up with it,” he says.

It wasn’t until it got to the point where he was getting up so often that he was hardly sleeping that he decided to do something about it. “My body was talking to me, but it took me a while to listen,” he says. “I took my health for granted.”

His grandfather had had prostate cancer, but Wall never imagined he would get it too. He didn’t know that a family history increases your risk.

Prof Galvin is involved with Irish Prostate Cancer Outcomes Research, a Movember-funded project aiming to improve outcomes and enhance care for men living with prostate cancer. “As part of our research, we collected data from 6,800 men from 2016 to 2020 and found that one-quarter of men diagnosed with prostate cancer had a close family member diagnosed too,” he says. “A family history seems to be the most important risk factor.”

By the time Wall underwent blood tests and scans, he had developed stage-four prostate cancer and advanced secondary cancer in his lymph nodes.

His initial prognosis was grim. “I was to have chemotherapy before getting my affairs in order and then moving to palliative care,” he says. “My mortality was staring me right in the face.”

Wall wanted to have surgery but no one in Ireland was willing to operate on him. He found a surgeon in Belgium instead and had an open prostatectomy there, followed by radiation treatment in Ireland. “That operation has prolonged my life,” he says.

He has devoted a lot of time since then to spreading the word about prostate cancer. “Men should never take their good health for granted,” he says. “We bring our cars for a yearly service even when there’s nothing wrong with them. Why do we wait for something to go wrong with our bodies? We should all have an annual check-up, including blood tests, once we reach a certain age.”

O’Hagan would also like to see men taking more responsibility for their health. “Movember is an opportunity to encourage men over the age of 45 to have a conversation with their doctor about their prostate health, to learn more about the symptoms, to look out for any unusual changes, and to take action,” he says. “Early detection greatly increases the chances of living a healthy life after cancer.”

Prof Galvin reassures men that getting their prostate checked is no longer as invasive as it once was. “Lots of men are turned off by the thought of an internal examination but these days, what we do is take a blood sample and test it for prostate-specific antigen (PSA),” he says. “If that shows a risk, you’ll be sent for an MRI. If that shows cause for concern, there will be a trans perineal biopsy done under sedation so that it’s painless and carries minimal risk of infection.”

A young man’s issue too

Testicular cancer rates are increasing among Irish men too. Figures have risen from 69 cases in 1994 to 204 in 2020.

The Movember campaign is tackling this by supporting the multinational Tiger Trial, which involves 55 hospitals, including St James’s in Dublin, trying to determine whether high-intensity chemotherapy results in a longer and better quality of life for testicular cancer patients.

If prostate cancer is most common in middle-aged and older men, testicular cancer is a younger man’s issue, with most cases occurring in the 15- to 39-year-old age group. Symptoms include a painless lump or swelling in the testicle; discomfort in a testicle or the scrotum, groin or abdomen; an enlarged testicle or a change in the way it feels; or a heavy feeling in the scrotum. If, as happens in one of 10 cases, the cancer has spread outside the testicle, men may also have a dull ache in their back, a pain in their abdomen, shortness of breath or swollen lymph glands in their stomach, groin or chest.

Comedian Keith Fox is a classic example. He was 23 and backpacking in Australia when he started to feel a dull pain in his lower abdomen.

“I told myself I’d head to the doctor if the pain wasn’t gone in a week,” he says. “I consulted Dr Google in the meantime, which prompted me to examine my testicles and I noticed one of them felt harder than it used to.”

His doctor initially thought it was an infection, but Fox pushed for a scan, which showed signs of cancer. “I booked a flight home and went straight from the airport to hospital, and my testicle was removed about a week later,” he says.

He needed chemotherapy when his bloods showed an increase in cancer markers a few months later and has had a minor complication that required surgery on his hips in the years since. “Otherwise, I’m doing great,” he says. “I’m 36, I have two kids, and life is good. When I look back at that time in my life, I don’t see that day I went to the GP as the start of my cancer. I see it as the start of me getting better.”

Like Wall, he is eager to spread the word, so he’s organising a comedy gig in the Workman’s Club in Dublin on November 29. “It’s called Showvember, tickets are on www.eventbrite.com, and it will feature performers from the Irish comedy scene,” he says.

Another event also taking place this Movember is ‘Life After Cancer: Breaking the Taboo for Men’, a free seminar for men affected by cancer taking place in Cork on Friday, November 25. It will take place in person and online and registration is now open on www.eventbrite.com.

Raising awareness of men’s cancer risk is one aspect of Movember. Shining a light on their mental health is another. This year, one of the Irish Movember projects that does this is the ‘Social Connections Challenge’. Delivered in partnership with Age Ireland, it aims to improve digital literacy in older men living in rural locations and in the process give them the skills they need to grow their social connections.

Minding our first responders

In 2020, the Movember campaign decided to address this problem by launching its ‘Veterans and First Responders Mental Health Grant Programme’ which supports promising mental health and suicide prevention programmes all over the world.

Hugs@Home is the first Irish project to have received their support. Led by Michelle O’Toole from the Royal College of Surgeons Ireland, its aim is to train families and friends to support the mental health of Ireland’s first responders.

“Hugs stands for ‘hearing, understanding, guiding, and supporting’,” says O’Toole. “We know that first responders get support from within their organisations, but they often seek support at home too and this can be a huge burden for families. We want to provide them with the social support they need as well as practical stress management skills.”

For the past six months, O’Toole and her team have worked with friends and family of first responders as well as representatives from first responder organisations, asking them what the problems are, how well existing supports are working, and what solutions they would recommend going forward.

“Our next step is to build on that knowledge with simulation-based education,” says O’Toole.

“This will involve videos and role play activities that will prepare participants to recognise the signs and symptoms of stress reactions, apply some basic techniques to manage the stress response, and to engage, support and empower their first responders while also being mindful of their own self-care.”

Hugs@Home also hopes to create connect cafes for participants to stay in touch with each other. “By connecting family members and friends of first responders with other likeminded people in the same situation, we hope they will be able to help each other help the first responders in their lives,” says O’Toole.

This two-year project is coming to the end of its first year. “By this time next year, we hope to have proven that this approach works within the firefighting and paramedic world and for it then to be implemented more widely,” says O’Toole

• For more information about these events or initiatives or to be inspired to grow a moustache and raise funds for men’s health this November, visit ie.movember.com/en/events