Flies on the Wall of Evil

Discovering Hidden Routes

We too easily see a place through one perspective, but last week, because of our proximity to Century City in Cape Town, we decided to walk a network of routes from Rugby to the Canal Walk Shopping Centre, which had been the focus of our visits many times before.

After visiting the shopping centre, on our walk back, we bought MyCiTi bus passes in anticipation of using the public bus rapid transit service that we had been shy of approaching in the preceding seven years of staying in Cape Town. However, it was a panel of pictures showing how Century City had evolved since the 1990s that caught our attention, though we were too tired to explore further.

Century City: The History of Century City

A Second Chance

In our move to Pinelands, we could have dismissed this opportunity again, but proximity once more compelled us, not so much to walk it, but to get an Uber from Pinelands to the shopping centre, explore the walkways of Century City, and then walk through Rugby and Milnerton to Woodbridge Island.

It was during this plan that we became flies on the wall of two encounters that left us saddened by the malicious and malevolent intentions of others.

An Uncomfortable Ride

The Uber that took us to the shopping centre was supposed to be a cool, comfortable ride, but for the duration of the journey, the driver was in conversation on the phone. I did not understand anything of what he was saying, but could hear bits about sums of money being pushed about. You could immediately recognise he was involved in some sort of deal.

His name was Trust, but I would pray that no one, and especially Uber, should be trusting him. Had we known what he was up to, we would not have trusted his picking us up either. Whilst we were delivered to our destination safely, he was speaking Shona, one of the major languages of Zimbabwe, which he probably assumed none of us understood, but Brian did. With whoever he was chatting to, they were planning a number of exploitative and manipulative schemes.

Schemes of Exploitation

The first was to register a number of cars with fake identities on the Uber platform, then traffic people from rural areas in Zimbabwe to drive the cars with the aim of paying them poverty or slavery wages as they drove endless hours to bring money home for these chaps with pretensions to being crime bosses.

In the words of Trust, and I paraphrase, "Just put a plate of food before them and they'll be happy as Larry." They had every intention to mistreat, abuse, exploit, and deal wickedly with whoever they were able to entice with the bright lights of South Africa.

A Difficult Decision

I learnt all this after our ride, to which I suggested Brian should have exited with a greeting in Shona, just to let him know we were onto him. Obviously, there was no possibility of us giving him five stars for his service, even if he did not carry out his evil intentions, but we were left in a quandary as to whether to report this encounter to Uber and how to frame what we understood had happened.

Another Overheard Conversation

No sooner had we begun our walk beyond the territory of the shopping centre into Century City proper than there was another wheeler and dealer on the phone. I do not think he was planning a new magic trick for his next performance, but he probably works in one of the offices in Century City. He confided in his interlocutor on the other end of the call about how he had to try to make four million South African rand disappear.

I doubt we'll recognise him, as we only heard him as he walked by us in the opposite direction, and the disappearance of the money can only pertain to him having view of, or access to, that money somewhere in an organisation and scheming to thieve or embezzle it.

The Audacity of Evil

It did make us wonder about both the audacity of calumny and the recklessness of incriminating conversations that others think no one is hearing. These are thoughts that should never emerge as words spoken when there is a conscience alive in us, even if barely so. In both cases, we saw the clear sign that the love of money is indeed the root of all evil.

It is quite likely there are many instances of human trafficking, people exploitation, and embezzlement as we visit places around Cape Town that we are totally oblivious to. Yesterday, I gave a tip to a server in an establishment where the personification of Cruella de Vil superintended with vicious verbiage; the server's deep gratitude would suggest something I am unready to countenance.

The question is, who will stop these evil people before they implement their rotten plans?

A Google NotebookLM AI Audio Overview Discussion of this blog

Thought Picnic: Success, Suffering, and the System That Fails Both

The Illusion of Success

Sometimes, success appears to be a façade amid emotional turmoil, the vulnerabilities that are part of life's struggle that no one else sees. There is an assumption that if you have the means and cachet to buy anything, then you are suitably supplied to purchase your salvation.

Society simply does not recognise the struggle of the successful as legitimate. There is little sympathy for those who appear to have everything, and this dismissal creates a terrible sense of isolation in which high-achievers quickly learn that their struggles will not be taken seriously.

Misunderstanding Resilience

There is also a misguided understanding of resilience. Indeed, many of us do exhibit herculean feats of resilience against adversity, fighting storms of life that threaten to overwhelm us, but something inside refuses to give. Belief, faith, grit, or sheer guts: we are bowed but not broken, attacked but never defeated. We become the narrative of possibilities that once seemed insurmountable.

Yet this very resilience can become a trap. High-achievers are often driven by perfectionism, a relentless internal standard that demands excellence in all things. Mental illness does not respond to willpower or determination in the way that professional challenges do.

You cannot work harder to overcome depression. You cannot manoeuvre your way out of bipolar disorder. For someone whose identity is built on achievement and competence, seeking help feels like failure, an admission that you are not as capable as you believed yourself to be.

Recent Tragedies

Two stories in recent times have got me thinking that many mental health struggles are barely addressed or are given the stiff-upper-lip treatment of “you'll pull through as you always do”. We give just enough space not to interfere, and then the news drops: those stalwarts of stoicism, or what appeared to be that, have taken their own lives.

Robert Carradine, 71, died by hanging last week; he had been diagnosed with bipolar disorder. I am in South Africa, and I have just read the news that Ian von Memerty, 61, who was Zimbabwe-born and a South African entertainer who hosted some popular television shows, had died by his own hand in Johannesburg. He had long written about the desire to take his own life.

The Reality Behind Success

None of this brings any comfort because these are successful men who had tasted the kinds of worldly success that many could not even dare to dream of, and yet it is their demons that have driven them beyond the edge of despair to suicide. The fact that these men are quite close to my age range also indicates that you probably do not grow out of the things that ail you.

Success often brings its own form of isolation. As you rise in your field, the pool of people who can truly understand your experience shrinks. Your old friends may feel the distance growing. Your new peers may be competitors rather than confidants.

The high-achiever becomes trapped in a gilded cage, surrounded by admirers but profoundly alone. This loneliness compounds mental health struggles, leaving fewer people to turn to, fewer spaces where vulnerability is possible, and fewer relationships where you are seen as a whole person rather than as your achievements.

There are also practical fears that make seeking help feel dangerous. Will your employer question your ability to perform? Will clients lose confidence in you? Will colleagues see you differently?

Despite progress in mental health awareness, significant stigma remains in professional environments. For high-achievers whose identities are deeply intertwined with their professional success, the risk feels existential.

When the System Fails You

Moreover, even when they overcome these barriers and seek help, they often find the available support inadequate for their specific needs. Therapists may struggle to understand the unique pressures of high achievement: the constant scrutiny, the isolation that comes with leadership, the weight of others' expectations.

The two times I have used therapy, because I presented none of the symptoms of depression, suicide, or a mental health crisis, it was felt I was trying to abuse the service. Yet, I had a compelling narrative. I was recovering from cancer, mounting debt meant I was about to lose my home, and my status was rock bottom.

Surely, with such a catastrophic change in life, I was a candidate for therapy. I guess because I had a modicum of coping mechanisms and I was too articulate for my situation, only shocking assertiveness could pierce into the needed support framework.

The scheduling demands of high-achievement careers often conflict with traditional therapy models, yet their chaotic schedules are often part of what is driving their mental health crisis.

Bridging the Gap

It is impossible to tell how much help, consideration, or support Carradine and von Memerty got through their struggles. For their survivors, bridging the gap between the sorrow they feel and appreciating the release that death brought to the suffering of their beloved ones is something you cannot begin to fathom.

Perhaps the most fundamental challenge is the myth of self-sufficiency that high-achievers internalise. They have succeeded through determination, intelligence, and hard work. This creates a belief that they should be able to handle anything, including their own mental health.

Cultural narratives about success emphasise individual agency and resilience, celebrating the self-made person who refused to give up or give in. These narratives leave little room for vulnerability, little space for acknowledging that sometimes, despite all your strength and capability, you need help.

A Personal Reflection

Even with my encounters with suicidal ideation, which I have written about as recently as a month ago, my only prayer still is never to be presented with no other option but to end it all. This is not said from any position of strength, ability, or capacity; rather, it is a recognition of human frailty and vulnerability. We are faced daily with a spectrum of mortality, but for the grace of God, there go we.

Addressing these challenges requires a fundamental shift in how we think about success and mental health. We need to recognise that achievement does not immunise against suffering, that success can indeed be part of what drives mental health crises rather than protecting against them. Until we can create space for high-achievers to be vulnerable, to admit to struggling, to seek help without fear of judgement or professional consequences, we will continue to lose talented, accomplished people to the silent epidemic of mental illness.

The deaths of people like Robert Carradine and Ian von Memerty should serve as a stark reminder that success is no protection against despair. The answer is that success and suffering are not opposites. They can, and often do, coexist. Recognising this uncomfortable truth is the first step towards ensuring that achievement does not become a prison from which the only escape seems to be death.

May their once-bothered souls rest in eternal peace.

Blog - Suicide When Academia Forgets Its Humanity (January 2026)

Blog - Thought Picnic: I think I need therapy (March 2011)

A Google NotebookLM AI Audio Overview Discussion of this blog

Cape Town Apartment Chronicles

Making Do in Cape Town

As a writer of blogs, I could write a review and start a travelogue of all the apartments we have stayed in, the restaurants we have visited, and other venues, whether for tourists or not. However, I suspect you are more interested in your holiday than in a commentary, especially about things not going right.

We checked out early from a place in Rugby to take another apartment in Pinelands. This is something we usually do: splitting our living arrangements in two and having an overlapping day to move from one location to another. Only once have we not done this, because the new place was just 200 metres away and the host had agreed to an early check-in.

The Rugby Apartment

The place in Rugby was one we liked after a few adjustments, including a visit from the host to try to make amends. However, the critical issue, as Brian noted, was that the place lacked a feminine touch. Broadly, it offered just the practical things for essential apartment living. For days, this niggled until the microwave played up and I had to use a mug to scoop food into another pot.

So, I wrote to the host to highlight the issues rather than complain, and this reflects some of what we have experienced with apartments in Cape Town.

Hello, I'm staying at your apartment with my partner. At first, I thought we could manage, but I need to inform you of a few things before I write a very honest review of our experience. It is a lovely place; we are comfortable and feel safe. However, you cannot manage a property from a lock box.

We are very domesticated people and are usually in Cape Town twice a year, sometimes for more than a month, staying in places as varied as Camps Bay, Sea Point, Foreshore, Muizenberg, and Bloubergstrand since 2019. We have a good idea about apartments, service, and the quality of accommodation.

First, we asked for a spare set of keys, which, as I informed you, we have always had with other places. Then, the size of the apartment is about half the over 600 square feet advertised on Booking.com.

Basic stuff: not enough hangers in the bedroom, many crooked. That's manageable. You have a kitchen but no kitchen knife; we bought one yesterday, just as there are no kitchen scissors. The Power Defrost and Power Level buttons are not working on the microwave. This was the last straw for me, because the prawns for our stir-fry ended up cooked, or we would have had to wait hours for a proper thaw.

The clothes rack should have been replaced; it is full of rust, and we can't hang clothes on it. We could use the clothesline, but we are strangers here. There is a litany of things I could list about the homeliness of your place, but we can manage. As I have said, you will need to visit your apartment to see that things work or are right. Having a lock box is not a substitute for that responsibility. Thank you.

We ended up buying a proper kitchen knife, and this is the third time we have had to do this. It could have happened many more times if Brian had forgotten to bring the typical kitchen utensils we had acquired over time: spatulas, a sauce ladle, and some deep bowls.

When the host came to visit, some 30 minutes behind schedule, he brought a set of ten hangers and a bottle of plonk that might have passed for cooking wine, if Brian's taste for alcohol had not got the better of him.

Moving to Pinelands

After church yesterday, we packed up for this new place in Pinelands, which backs onto a Jewish cemetery just about 150 metres away and is clearly visible from the seventh-floor window. You can bet my vivid imagination is under serious curtailment, and I hope the rational will overwhelm the irrational, as I do not intend to lose my mind in the process.

We encountered the usual issues again. People do not cook, hence the kitchen setup is lacking. Once, we had to buy a pot, and this place has just one pot for cooking. There is no kitchen knife, but we already have one. Surprise: there is a pair of scissors in the kitchen drawer.

There is a thriving takeaway and fast-food culture in South Africa, where ingredients for food can be organic, fresh, and healthy, but people are not cooking, except when they have a braai.

Two bedrooms, not really the size that was advertised, but that is a minor point. There is a worktable from where I am typing, but no centre table in the living room, as if we should eat off our laps. In the fire escape, we found two stools and a floor mat that matched the one in the apartment. I think we can consider ourselves resourceful.

Making the Space Work

We had to change the orientation of the bed, as it was just wrong. When our hostess returned that afternoon, she agreed that the realignment was better. However, what I cannot understand is the dearth of sockets in these apartments. We had to get extension leads with dual sockets to have somewhere to plug in our devices.

She cannot remember the Wi-Fi password, as the two she provided did not work. Meanwhile, I found a way around the issue. The Google TV box connected to the television has a Wi-Fi hotspot feature, but when switched on, it disables the Wi-Fi connection. Usually, the WPS (Wi-Fi Protected Setup) button on the router should work, but we failed to get a link.

I connected the Google TV box to the router with an Ethernet cable and set up the Wi-Fi hotspot. That way, we have Internet connectivity without the fuss, or we would have had to wait until Tuesday to get that sorted.

Meeting Miranda Priestly

We joined her in the lift and, whilst she understandably refused entry to another resident with a shopping trolley (though there was enough space for all of us), it was the mother holding a baby that she barred, which left us stunned. Her explanation: "I am the Miranda Priestly of this apartment block." The funny thing is, on my first visit to South Africa in May 2015, I did watch The Devil Wears Prada on my outward flight. I did not expect to meet her in real life.

We have different panoramic views of Table Mountain, and just a glimpse of the sea, even though it is almost seven miles away. For that alone, I am not so forlorn this far inland in Cape Town.

A Google NotebookLM AI Audio Overview Discussion of this blog

Finding Dignity at Zeitz MOCAA

Finding Kindness

Having done some shopping at Woolworths in the V&A Waterfront, I walked to Silo District past the Nelson Mandela Gateway to Robben Island to hail an Uber back home. The Friday evening rush hour, combined with the impending weekend, meant it was quite busy. However, leaving from this end of the V&A Waterfront cuts out a good deal of the traffic involved in exiting Cape Town.

I did not get an Uber for eight minutes, and when a driver was found, he was ten minutes away. Then he cancelled three minutes into my waiting time. Uber began looking for another driver, just as I realised, I had chosen this location to get me home on time, before getting caught in the traffic I might encounter if I had hailed a cab from the Breakwater end of the V&A Waterfront.

A Pressing Dilemma

It became a battle in my mind: should I wait for a cab or seek the use of facilities? The nearest one was about 250 metres away, up flights of steps that I am usually supported in navigating. But I was alone in town with two heavy bags of shopping and a walking cane I could not use if I needed to balance the load.

My better judgement intervened. I cancelled the Uber and decided to try my luck at the Zeitz MOCAA, the Museum of Contemporary Art Africa, which was behind me. As a total stranger, I would not have been able to just walk into any establishment to ask to use their toilets. Or maybe I have never really had the courage to. Besides the museum, there were two hotels nearby, but we had been fully paid-up members of the museum before COVID-19 struck, and I knew where the entrance was.

Navigating the Process

The first thing was to get my Just Can't Wait card up on my mobile phone, which was running out of battery. I had to put it on Power Saving mode to ensure I could at least call an Uber before it died. I showed the card to security at the door, requesting to use the toilets, and she directed me to reception.

At the reception desk, one of the staff took a picture of my Just Can't Wait card on the phone and then gave me directions to the toilets, which were in the basement. My explanation that I needed urgent use of a toilet because of a medical condition was sufficient.

As I walked to the lifts, another security guard stopped me. I believe he checks for entry tickets, and I did not have one. I explained my situation, and he even offered to have my shopping bags deposited at the check-in desk. But I did not have the time; I needed to be at the toilets immediately. Even the lifts were slow in arriving, but I was soon where I needed to be, as relief and gratitude welled up in me.

People Over Things

My experience with this organisation reminded me of the spirit of their Executive Director and Chief Curator, Madame Koyo Kouoh, who passed away last year after a recent cancer diagnosis, even as she was about to serve as the artistic director of the 2026 Venice Biennale. In the museum's tribute to her, she was remembered for her belief: "People are more important than things," and for quoting the African proverb, "If you want to go fast, go alone. But if you want to go far, go together."

We live in communities shaped by experiences and circumstances. Some are so fleeting and yet significant in simply having empathy and understanding for invisible yet critical human vulnerabilities and responding to such encounters without question or judgement. People do not even have to have walked a long, hard mile in another's shoes. Even in South Africa, where basically no one knows of the Just Can't Wait card, a human story becomes the willingness to help rather than the fear of losing one's job.

Not that I want to remember what happened barely a month before, when I was refused the use of facilities with all the desperation written across my face, in my own Manchester, of all places. Thank you, Zeitz MOCAA, for simply being human. It meant a lot to me.

Blog - The Just Can't Wait Card Test

Zeitz MOCAA Staff Tribute to Koyo Kouoh

A Google NotebookLM AI Audio Overview Discussion of this blog

Long After The Sahara Was Green

Crossing Africa: An Unexpected Route

This passage over Africa was different, as the plane veered east, deviating from the typical western route over France and Spain. We headed towards Germany, Switzerland, and Italy, leaving Genoa to the east to cross the Ligurian Sea, with the islands of Corsica, France and Sardinia (Sardegna), Italy, also to the east, before making landfall over Africa at Skikda, Algeria, a coastal city whose port has been a gateway between Europe and Africa for centuries. Constantine, the dramatic "City of Bridges" perched on a limestone plateau, shows prominently on my map, but it lies much further west of our route.

Pretensions to slumber never came, and one feature of the in-flight maps was missing: the detailed "Flying over..." section that leaves me mesmerised for hours on end. It offers snippets about places up to 250 kilometres away that I may never visit, yet I remain intrigued by their histories, geography, culture, and the people who have made those places their homes.

Above the Sahara

Soon, about four hours into the flight, we were already over the Sahara Desert. I expected to see an ocean of sand without form, stretching into the horizon, but I was in for a surprise.

This place looked as if it were once verdant, the land carved through as rivers sculpt landscapes, as if Eden decided to relocate to the Amazon, took its goods, but left the house bare. I have since learnt that this intuition was remarkably accurate: the Sahara was indeed a green, fertile landscape during the African Humid Period (approximately 11,000 to 5,000 years ago), supporting rivers, lakes, forests, and diverse wildlife before orbital shifts and climate feedback mechanisms transformed it into the desert we see today.

Yet a barren landscape it is not. The circles that resembled cylindrical containers, arranged in patterns clearly indicating human intervention, were in fact irrigation systems in the desert, humanity's ingenious attempt to recreate what nature once provided across the entire region.

I did not spot an oasis from above anywhere from Algeria into Niger. This is a harsh place, where daytime temperatures can soar to totally uninhabitable levels.

Settlements and Landforms

My map showed named settlements within 50 kilometres of our flight path: Djanet, known for its proximity to the UNESCO-listed Tassili n'Ajjer plateau with its ancient rock art; Ghat, a Tuareg town near the Libyan border that has served as a trans-Saharan trade post for centuries; and Tamanrasset, the largest city in southern Algeria, as we flew towards Agadez in Niger, once a crucial caravan centre and sultanate on the trans-Saharan trade routes.

I see alpine landforms, but not of ice. These are gullies eroded by winds rather than water, dunes drawn by the hand of nature, moving as if alive, and they surely are.

A Desert Redefined

A desert is more than its definition. It offers another perspective: the presence of hardy species of flora, fauna, and animal life that thrive in what we might consider impossible conditions.

As we continued south, the landscape gradually shifted. Flying over Nigeria, I caught sight of place names that stirred something deep within me: Jos, the highland city built by tin miners; Bukuru, where I attended primary school; Rayfield, where we lived; and Vom, the veterinary centre where we took a school trip. These are places emblematic of my childhood, each one a marker of memory suspended between earth and sky.

Now, flying past Douala, Cameroon, to catch a sight of the Gulf of Guinea, I realised something striking: from over 30,000 feet, some nine kilometres in the sky, there had been no clouds above the Sahara. Not a single wisp dipping its toes in that vast expanse. I suspect I need a deeper understanding of the ecology of that extraordinary place.

A Google NotebookLM AI Audio Overview Discussion of this blog

When Schedules Don't Matter: Between Flight Times and Body Times

Journey Times and Assumptions

Now that I think of it, these things should not be left to guesswork. The assumption I had, and the reality were different things, even when traversing time zones. How I could have missed that timing escapes me, especially for a journey I have made so many times. This time, I saw it plainly: the flight information stated 11h25, not the 10h30 I always had in my mind and when talking to people about it.

I am looking forward to a long journey watching Africa displayed before me as my kind of long-haul flight entertainment. As aeroplanes do not get given speeding tickets in the air, we did Amsterdam to Cape Town in 10h28. The scheduled duration and actual flight time rarely align, yet I still find myself calculating based on what I think I know rather than what the timetable actually says.

The More Immediate Concern

Before settling into my seat, though, there was a more pressing matter to address. Using the customer assistance service meant I was one of the first to board the aircraft, and I went to the toilets first before returning to my seat to check the journey duration. It was then that I noticed the discrepancy in flight times.

The flow is low and feels constricted. Whilst the urgency is pressing, the initiation starts late and the duration is long, much longer than usual. However, there are times when it suddenly seems to unclog with the greatest ease and relief. I have noticed this in the past couple of days, and it elevates concern.

The trouble with bladder plumbing, a consequence of prostate cancer and radiotherapy treatment, is one I cannot ignore, even if I seem to manage it well. Though on Saturday, as I walked back home, I found neither refuge nor respite, no place to flash my "Just Can't Wait " card. Consequently, I wet myself. The incontinence underwear was no match for the torrential release.

A Saving Grace

The cover of darkness and the length of my winter overcoat became my saving grace, concealing the wet patch on my bright red chinos and sparing me the shame and embarrassment. What a relief when I eventually got home.

The usual dearth of facilities for people with conditions like mine is something I navigate daily, but Saturday reminded me how fragile that management can be. We make assumptions about many things: flight times, the availability of toilets, our own bodies. Sometimes reality has other ideas.

A Google NotebookLM AI Audio Overview Discussion of this blog

Photons on the Prostate - Three Things I Wish I'd Known

Full Disclosure

Despite what you read in this blog, I believe the choice to undergo hypofractionated radiotherapy as my treatment option for malignant adenocarcinoma of the prostate gland (prostate cancer) was the right choice.

After the ordeal of a prostate cancer diagnosis, gruelling radiotherapy, and years of dealing with lingering side effects, you would think I am done with reading up on issues around prostate gland health.

Now, I am glad to say it was caught early. I believe I received as good care and support as could be given by advisory and medical teams, and I am convinced that I chose the best medical outcome for my situation.

3 Hidden Problems With Radiation Treatment for Prostate Cancer
© The Prostate Clinic

Unsolicited Advice and Misinformation

In the same vein, I am usually offered tips, hints, and advice about prostate health; mostly information shared on social media, none peer-reviewed by experts in either urology or oncology to prove their efficacy. The impressions are mostly anecdotal.

My father, for instance, has mostly been swindled or scammed by snake oil salesmen offering miracle potions to treat his prostate problems that medical science has been at pains to prove he ever had. We are left humouring him when it might be prudent to sternly upbraid him. He is educated and had a high-profile professional life; he should know better.

The Prostate Clinic Revelations

Recently, I have been following The Prostate Clinic, a YouTube channel hosted by Dr Charles Chabert, a urologist in Queensland, Australia, and it has taken a few days to properly digest what he had to say.

In July 2024, I met with consultants in surgery and radiotherapy for prostate cancer. Later, I spoke to a support worker at Prostate Cancer UK who opined I should opt for Active Surveillance or Watchful Waiting over the active treatment suggested at diagnosis. Even after reading up on extensive material and sharing my journey in a series of blogs, I had to manage my consumption of information to avoid being overwhelmed into stasis.

The Question of Sufficient Information

The question then becomes: how much more information, detail, reports, studies, and research should one access before knowing without any shadow of doubt you are making the right decision, all things being equal?

You are told so much going into treatment but not nearly enough about the aftermath, it would seem.

Three Hidden Problems

The Australian urologist addressed the aftereffects of radiotherapy on the prostate that could leave you concerned about several things, of which sexual dysfunction has been a recent blog topic. He called them “3 Hidden Problems With Radiation Treatment for Prostate Cancer”, suggesting why we should not opt for radiotherapy.

When the prostate gland is irradiated, it could damage the surrounding tissue connected to the bowel (radiation proctitis, very graphic, the pictures can cause distress) and bladder (radiation cystitis) systems. Irradiating the prostate gland shrinks, scars, and can make it fibrotic, leading to two other consequences: limited salvage options or progressively reduced sexual function.

Complications and Salvage Treatments

Complications might arise if there is a local recurrence of cancer, making salvage activity quite difficult. This portends more impactful consequences for the patient and radical alternatives for bowel movements. Salvage treatments are better managed post-surgery than post-radiotherapy, where options are severely limited.

The state of the prostate gland after irradiation means that sexual function will increasingly diminish. This touches on erectile dysfunction and reduced ejaculatory performance. These are weighty matters that make you wonder if you had known all this before you commenced treatment, whether you would have made that choice.

Managing Side Effects

Again, the issue with choosing any treatment comes down to how you perceive you can manage the side effects. For surgery, they are immediate, whilst for radiotherapy they are progressive.

The possible loss of total sexual function, because the consultant surgeon had already indicated my prostate was too enlarged to guarantee the salvage of any nerves, immediately made that option a non-starter. I was not going to wait and see what a malignancy was going to do in my body through Active Surveillance; it would never have been an option for me.

My Choice

Choosing radical radiotherapy was the most comfortable choice in my circumstances. Though having an additional prayer point before I had my prostate gland zapped might have made this discovery less of a surprise and caused less concern.

Ultimately, I believe I did the right thing and will make the best of the good fortune I have to enjoy life and write better stories, with cancer behind me. I thank God.

Check your Prostate Cancer risk in 30 seconds.

Blog - Men's things XXXI: Can Intimacy Be Reclaimed After Prostate Cancer?

Blog – Photons on the Prostate - A year from starting radiotherapy

Blog - A prostate cancer diagnosis, one year on

Blog - Men's things - Prostate Cancer blogs

A Google NotebookLM AI Audio Overview Discussion of this blog