Prostate cancer: treatment side effects no one talks about
For Prostate Cancer Awareness Month this March, we’re sharing the personal journeys of two men who have lived through prostate cancer. Here, Alec Wightman, who is 70 and was diagnosed with prostate cancer in December 2018 tells his story. He lives in Bramhall, North West England, with his wife Nicki and they have five grown up children.
Before 2018, I thought prostate cancer was something other men had. I knew it was common. I’d once worked with a colleague who’d had his prostate removed and he’d struggled with incontinence after that. But personally? I felt fine. Apart from the usual aches and pains as you get older, I felt well. I was a glass-half-full sort of guy.
Confusing symptoms
My first signs were intimate. I’ll be candid because someone else may recognise them. Twice, on ejaculation, I felt a sharp, momentary pain. Another day, I saw a little blood in my urine. That was enough to call the GP.
Because I had symptoms (some men with prostate cancer don’t have any), the initial exam was the finger test. It wasn’t pleasant but it wasn’t painful either. I also had a PSA blood test that came back high – with a PSA level of around 19. PSA stands for prostate specific antigen. This is a protein produced by normal cells in the prostate gland as well as by prostate cancer cells. A raised level can indicate that you have a problem with your prostate, but it’s not necessarily cancer.2 In my case, the high result warranted more tests and a referral to a specialist.
Speaker 1 Des Reid: I think I knew at the time that turns out, was it was prostate cancer, but didn't really didn't really take it on, if you see what I mean. And the oncologist basically said, you know we think you've got, well, we know you've got prostate cancer. And I just basically went just, just buckled. And then, sort of, that meeting stopped. I felt like a bit of a fool really, but that's that's just the way it is.
Speaker 2 Alec Wightman: I actually got the letter saying you've got, stage three prostate cancer. I got that through the post before I’d gone for the appointment with the consultant. That was a bit surprising.
God, how, can they sort it? Can they fix it? Can I be treated? And then, what's the treatment going to be like? What's that going to mean for my quality of life? So, there's lots of stuff that goes around in your head.
Des Reid: But what was interesting, what was funny infact was the urologist, came in afterwards and he says, oh, what's going on here then, Mr. Reid. And, let me have a look at your biopsy and the scan. And he said, I mean, nothing to worry about at all. And he said it just like in a very blase sort of way. And I thought, well, if you haven't got a problem, then why am I worrying about this? It might be nothing. And if it is something, it's treatable.
And I said, you know, is this going to kill me? He said, no, no, no, no. No, you’ll die of something else. It won’t kill you. You'll be fine. I think that for me, meant a hell of a lot because I'm thinking, well, look, you you're the expert here. You don't have to say that. And once you've said that, well, I feel fairly confident that I'll be okay.
My name is Des Reid I'm 67 years old. I'm married to Joan. We have, between us, two boys and a girl. Before I was diagnosed with prostate cancer. I didn't really know much about it. Joan is a very good researcher. So I'd say that I said that we'd done it together. She'd done basically the majority of the research. And I'm saying, well, yeah, that sounds good.
And at first we said, oh, if you can just take the prostate out, all well and good. Take it out and that's it. But then after looking at some of the side effects, thought twice about it. And I thought at such an early stage, I didn't think it was, the best for me. We looked at the other options and we came to the decision that HIFU (high intensity focused ultrasound) would have been would be the best treatment. Because the side effects are not as bad.
Speaker 2 Alec Wightman: I'm Alec, I'm nearly 70 years old, I will be in a week's time. I live in Bramhall, which is, just a little bit south of Manchester with my wife, Nicki. We're a second marriage, and between us, we've got five children, but they're all grown up. Thankfully. I retired about four years ago. I used to work in financial services. And thoroughly enjoy being retired.
Nicki can't do this, but I can compartmentalise. So I think about it, moan and groan about it, and then put the lid on the box and I can put it to one side. And Nicki can’t, she will think and worry about it. Sometimes she'll say. . .Morning, how did you sleep? Not very well. I've been up in the night thinking about this, thinking about you and thinking about the cancer. Yeah, but I'm quite lucky. I've always been able to, as I say, put things to one side, have a think about it, but then move on.
Before I was diagnosed, I didn't know that much about prostate cancer. I'd heard of occasionally odd people at work that might have been tested for it or had got it. But I think I only knew one person, before I was diagnosed. Well, it was a long time ago. It probably was about 15 years ago. So he had quite radical surgery. And I remember going to see him when he was recovering. And he's sitting on a rubber cushion and he's not very continent. And yeah, it wasn't a good story. I know surgery has moved on a lot. They use robotics and it’s a lot more accurate now. But seeing him sitting on a rubber cushion, half incontinent. That put me off surgery.
Speaker 1 Des Reid: My brother was diagnosed with prostate cancer, and he told my son to tell all the other siblings to get themselves tested, and, I got tested. I made an appointment the following day. What happened was I had the PSA test and it came back, and it was 1.9. So, that was pretty good for my age at the time. But for me, I think I was quite lucky because I told her that it was in the family, and she must have made a note on my file to say that, my brother was diagnosed with prostate cancer.
Three years later when, my PSA level went from 1. 9 to 3. 7, although 3. 7 isn't that high, they said oh, it runs in the family, so we think you should get an MRI scan. So I had an MRI scan. I thought Me? MRI scan? I don't think so Des. But you know, I almost didn't have it because I thought I had no symptoms, no nothing. So I thought but if I say I should have it, I'll get it, so I did.
Speaker 3 Grace Davey, specialist nurse at Prostate Cancer UK: PSA stands for prostate specific antigen (PSA) testing and it's a protein that's produced by the prostate. Any man who has a prostate will produce PSA. And it's important to know that healthy prostate cells as well as prostate cancer cells will both produce PSA.
There's a number of factors that can influence the PSA value. For instance, as men get older, their prostates will naturally get bigger. And that's really common. And you might see that your PSA value might increase slightly. There are other things that can temporarily increase the PSA, such as vigorous exercise or ejaculation. And that's just temporary. And there's no need for men to be concerned about that.
So the three main risk factors for prostate cancer is if a man, is over the age of 50, if they have a family history, or if they are a black man. So if your father or brother, has prostate cancer, then you have a two and a half times more likely risk of developing prostate cancer. And that's what we mean by family history. We also know that if you have any other members of your family that have prostate cancer, that does increase your risk, and particularly if they have prostate cancer that's been diagnosed prior to them being 60.
Speaker 2 Alec Wightman: We come from a long line of heart attacks and strokes. But it never, ever entered my head that I would get prostate cancer. I was diagnosed with heart disease when I was 50 and had a couple of stents fitted and never, never thought anything further.
Speaker 1 Des Reid: My gut feeling was, this ain't happening to me. My gut feeling was, you know, you're absolutely fine Des, you’re fit. And surely if you have prostate cancer, then, you'd feel something. And I didn't feel anything. Anything at all. There were no signs whatsoever. Not nothing at all. My health was absolutely fine. One of the symptoms for prostate cancer is getting up in the night, having a wee, 2 or 3 times. I can go all day without having a wee. I can go all day now without having a wee.
Speaker 3 Grace Davey: So most men, with early stage prostate cancers, won't have any symptoms. And that's why it's important for men to understand their risk of prostate cancer. There are, however, very common non-cancerous conditions such as enlarged prostate, that can mimic similar symptoms, say similar urinary symptoms. And that's what's important for men to understand that actually, it might not be a prostate cancer that's causing any changes, to or any symptoms that they might have. It could be a non-cancerous condition. And that's why we ask men to go and speak to their doctor about that.
Common symptoms for, prostate cancer. So that could be changes, in the way that men are weeing particularly, they might have increased, urination overnight. They might not be able to empty their bladder properly. They might be feeling like they have a weak flow or different types of flow. They're kind of common urinary symptoms that men might experience.
And then say, if the prostate cancer has come out of the prostate or has spread further into the body, sometimes men can experience other symptoms. And that might include, back, hip, pelvis pain, problems with their erections, or maybe blood in their urine and semen.
Speaker 2 Alec Wightman: One of the first symptoms I had was a bit of discomfort when ejaculating. And you think, oh, that doesn't feel quite right. Little bit of blood visible in semen, in urine. And people often talk about blood in your urine, but not usually in semen. And so it was those two things, the discomfort and a little sign of blood that took me off to the GP.
Speaker 3 Grace Davey: Some men might be given one treatment option, but quite a few men might be given lots of different options to pick from. And the important thing to know is there's not one right option for men with their treatments. Looking over different side effects for treatments, how the treatments are given because this can vary quite dramatically. And what might be best that fits in with your life and your family's life as well.
Speaker 1 Des Reid: The oncologist who gave me the my my diagnosis, he says. . .at very early stages and he gave me, about six options that I could have. And then saying basically all these, all these options will work. But what they don't do, they don't tell you what treatment you should have. That's up to you. They say, take this information, do your research, but it's up to you as an individual to sit down and work out what you feel is going to work for you, best. When I decided to go for, HIFU, I spoke to my oncologist and he said, because of my age and my fitness level, HIFU would be a good, choice for me.
What they also tell you is that that might not cure it. But if it doesn't, if it doesn't cure the cancer, you can have another session in 3, 4, 5 years time. So for me, I'm thinking to myself, oh, that is the best option. You know, it's gone for now. It could come back, but I can live with that. And if I have to have another session of HIFU, in 3, 4 or 5, 10 years time, that's all part of the HIFU package.
Speaker 3 Grave Davey: So HIFU stands for high intensity focused ultrasound. And it's where, high intensity ultrasound is used to heat or destroy prostate cancer cells. So some of the pros of HIFU or high intensity focussed ultrasound, is that there sometimes can be less side effects, like urinary or erection problems compared to other treatments. We do know, however, that we haven't got the longer-term data for this, and it might also exclude men for instance, if they have an enlarged prostate, they might not be able to have HIFU treatment. So we suggest that if that treatment option has been given to you to speak to your healthcare providers about that.
Speaker 1 Des Reid: Treatment hasn’t affected my sex life in any way whatsoever, and Joan and I laugh about it. The morning after I had the procedure, I woke up and I had an erection, and I I just laughed. I said, Joan, I said, it's okay. You know, I don't think we've got anything to worry about. I didn't have any incontinence at all. Nothing. I didn't have any. It didn't have a side effect or nothing.
Sometimes I might get up in the night to have a wee, but I done that years ago anyway. I mean, you know, a lot of people get up in the night to have a wee. You know, Joan gets up maybe twice, sometimes to have a wee. It's not a big deal. The only difference now is that there's about maybe 25% or maybe a bit less of semen now than there used to be. And that is the only that is the only difference.
Speaker 2 Alec Wightman: It was a joint decision, between myself and Nicki. We, thought we'd go for the radiotherapy and the hormone therapy. You do a lot of reading about it. A lot of googling, a lot of talking to friends who may have experienced it. And we thought that probably would give me the best chance of, a happy life afterwards, with, with all that sort of mobility and, continence issues dealt with. I was worried about being incontinent, you know, the thought that they might have to take more away because they don't really know until they get inside as to how much they're going to have to take away. It really focused the mind of I didn't want to become incontinent. How old would I be then? 63. So yeah, I was, I was still working, still active. You know, I enjoyed tennis and walking and the last thing I wanted to do was be incontinent.
I had hormone therapy for the first six months of my treatment, and then they started me on radiotherapy quite soon afterwards. This is where I can feel empathy with women who have gone through the menopause because you start to get hot flushes, night sweats, restless legs. You become emotional. Well, less so now, but when I was first on it, I could watch a weepy movie and burst into tears. It was really funny. They were funny side effects. It's really quite interesting how rapidly, once you've had hormone therapy, it does reduce your erections and your sex drive. Well it did in my case. The chances now of getting an erection are minimal. I don't get erections. But also I don't miss it or think about it. It's really strange. It's not on my mind at all.
So my wife and I have come to a sort of compromise agreement where we know, yeah, that’s fine, it is what it is. It doesn't have to be sexually physical to build intimacy. It's still possible just with a, you know, a kiss, a cuddle and a kind word and snuggled up it's all possible. It doesn't have to be sexually physical. I might just add that if this happened when I was 45 or 50, I might have a different view. But at nearly 70, it's it's less of an issue.
Speaker 3 Grace Davey: There's lots of things that will inform your treatment options. One of them is where your prostate cancer is for instance, if it's located still within the prostate, that's called localised prostate cancer. If it starts to spread to the edges of your prostate, that might be referred to as locally advanced cancer. And, if it’s spread to other areas of the body, it might be referred to as more advanced prostate cancer. And it's not the only thing that health care professionals look at as well. They take in a range of different factors.
Speaker 1 Des Reid: When someone hears the word cancer, they panic and they think it's all bad, you know, it's going to be difficult to be treated and stuff. In my mind with prostate cancer, it's different for everybody. You know, and for me, you know, I don't think I knew then, but if caught early it can be treated and you can get through without any without any problems.
With this group Cancer Don't Let It Win, if someone is diagnosed with prostate cancer you know, I just felt a lot better because I was chatting to someone who had been through this before, and it just made a massive difference. I think, you know, if you can join some sort of group of men who have been diagnosed with prostate cancer, it's helpful.
Speaker 3 Grace Davey: So there's loads of support out there that we speak to for men. For instance, we've got the specialist nurses at Prostate Cancer UK that you can call. You don't have to be a man with prostate cancer. You could be a family or a friend. We’re happy to speak to everyone about any kind of issues related to, your prostate or any kind of side effects or, or treatments that you're thinking about that you need some support with.
If you have any concerns around any sexual side effects from treatment, we also have our sexual support service, which you can contact via our specialist nurses. We also have a volunteer service where we can match you with another man that's had similar treatment. Although if you have any questions around prostate cancer, sometimes it's a good idea to speak to a man that has been through the same experience.
Speaker 2 Alec Wightman: Do not be afraid. It's far better to know than pretend and not want to know. You've got to go and have yourself tested. If you are getting up a little bit more in the night, is there a reason for it? But it might just save your life.
I can remember sitting in hospital. So, I’m stage 3. And, treatable. Old chap sitting next to me in a wheelchair who was probably 20 years older than me. And I said, well, you're here for the same thing. I said, how are you getting on? He said, well, I'm stage 4. He says, I took no notice of my wife. I just ignored the fact that I was peeing every few hours and getting up in the night, and now it's incurable. So don't leave it that long. Yeah, get checked out.
Speaker 1 Des Reid: I don't feel like a survivor. I don't, I hate to use, like I'm a cancer survivor. I don't I don't feel that. I feel that I was diagnosed with prostate cancer. I came through it and I come through it very well. No side effects, no nothing. I do feel like a bit of an imposter.
The hospital consultant’s exam was more conclusive, and I was booked for a biopsy. Back then, biopsies were often done through the rectum under local anaesthetic. A tube went in, anaesthetic was injected, and then a dozen needles were used to collect tissue samples from the prostate through the bowel wall.
It was uncomfortable, with sharp stings, and they gave me pads afterwards for bleeding, plus IV antibiotics because of the infection risk. These days, men have an MRI scan first to detect prostate cancer more accurately. This has reduced the number of men who need a biopsy. Today, perineal biopsies have helped to reduce infection risk and made the process less invasive – it’s a welcome change.
Getting a diagnosis
About two weeks later, the results arrived. Mine arrived in a letter that was meant for my GP. To receive the news like that was a shock and really upsetting, especially for Nicki, my wife. But I wasn’t surprised, I am a realist and with my symptoms and PSA results, cancer felt likely.
Most of the sampled tissue contained aggressive prostate cancer, I was told. I was stage 3, and locally advanced. Scans showed it had grown just outside the prostate capsule into a seminal vesicle. This is one of a pair of glands in the male reproductive system that produce fluid that makes up semen.
When I met with the surgeon to discuss the results, he also told me what he’d choose for himself – to ‘whip it out’, he’d said. But I remembered my colleague who struggled after having his prostate removed and I was reluctant to have mine out.
A multidisciplinary team recommended radiotherapy and hormone therapy as the safer bet for me. Operating might have meant cutting into the bladder or bowel to track down the cancerous cells.
Treatment begins
Radiotherapy came in two parts. First, I had high-dose brachytherapy. This was done under general anaesthetic. Radioactive sources were inserted through my perineum into my prostate to deliver a focused blast from inside. I was in hospital overnight and thankfully the painkillers meant I had very little discomfort. I went home the next day with minimal side effects. It left me a little sore for a few days with a small amount of bleeding from where my prostate gland had been punctured.
Ten days later, I started external beam radiotherapy, five days a week for six weeks. At each visit I had to lie still while a radiation machine orbited my pelvis and delivered a dose of radiation to my prostate from outside. This daily external radiotherapy was tiring but very manageable.
Unwanted side effects
After radiotherapy, I began hormone therapy. This is the part men don’t talk about enough. The idea is simple: starve the cancer of testosterone, which is the male hormone that is said to be like ‘food for prostate cancer’.
The lived reality is a lot harder though. Within weeks, the side effects hit me like something out of nowhere. A lot of the symptoms I had were similar to what women get when they’re going through menopause.
Hot flushes would flare unexpectedly – some days I had none, other days three or four – and night sweats soaked the sheets. I experienced fatigue and lost some of my strength, along with my chest hair! My libido shrank to nothing. Achieving an erection became impossible. For two years, I stayed on hormone therapy, and I watched my PSA fall.
I hoped that would be that.
The cancer returns
For a while, it was. I recovered well, returned to work and enjoyed an active life. But in August 2023 my PSA was rising and in October 2023 I was immediately put back on hormone therapy with the regular six-monthly reviews.
In June 2024 I asked for a second opinion to consider other treatments that might be available. In September I had a very detailed PET-CT scan to help doctors understand what was going on. The result was not good, it showed more cancer cells in my prostate, two lymph nodes ‘lit up’ and a possible spot in my pubic bone.
A trial of a second, tightly focused radiotherapy had previously been mooted, but the spread ruled that out. I immediately went back on hormone therapy. The side effects returned like unwelcome houseguests – the flushes, the restless legs, the drag on my energy – and I had to make peace with the long game. It was prolonging my life, which I wanted, so it was worth it.
There were bladder problems too. Urgency went from occasional to constant, and my capacity seemed to halve. I needed to go more often, with less urine.
After the first round of treatment, I had originally trained my bladder capacity back up towards normal using pelvic floor exercises. But now, that was no longer the case. When a urine infection was suspected, my doctor recommended antibiotics. But sometimes the burning and frequency were just radiation irritation flaring. Some nights I was up three or four times. Other nights I was fine. Symptoms came and went.
Effects on my sex life
Sex is the elephant in the room for many men. I’ll say the quiet part out loud: hormone therapy wiped out desire and erections for me.
My wife and I stayed close – hugs, warmth, the daily life we love – but our sex life disappeared. We were okay with that; love and companionship mattered more, and Nicki is very supportive. Other men will feel differently about this aspect, and that’s understandable.
What helped was talking – to each other, to the specialist nurses, to men who’d walked this path before me – and hearing that there are options: tablets, injections, pumps, counselling, and more. No one should be left to figure it out alone.
What I wish I’d known
If you’re at the start of your journey, there are a few practical things I wish I’d known.
First, the pathway has improved: perineal biopsies are now standard in many hospitals, and having an MRI before biopsy helps avoid unnecessary procedures.
Second, radiotherapy can’t be easily repeated. But in some centres, there are trials of carefully targeted second rounds. So, ask your team what’s realistic for your case.
Third, hormone therapy side effects vary wildly; some men breeze through, others struggle. If it’s rough, say so. There are tweaks and supports – for bone health, hot flushes, sleep, mood – that can make a difference.
Emotionally, the hardest stretch was the waiting. Waiting for scans, waiting for results, waiting to hear if the PSA was drifting, rising or diving. I’m a chaser by nature and Nicki and I stayed on the phone, nudging appointments forward and asking for results.
For me the fear is simple: will I live long enough to see my grandchildren through school, graduate and start their lives, and of course to clink glasses with my wife on our next holidays?
On good days, I book those trips and live life fully. On bad days, I breathe, remind myself that early treatment bought me time, and take the next step. My glass is half full, still.
Advice to other men
To the man reading this who’s scared of the finger test or terrified of the word ‘cancer’: please check whether you’re at risk and if you are, go and get checked. The worst stories I heard were from men who waited until they were stage 4 and out of options.
If you catch it early, you’ll likely have more choices than I did six years ago, with good outcomes. If you need radiotherapy and hormone therapy, you’ll be far from alone. Talk. Ask questions. Push for information. And when the side effects arrive, don’t suffer in silence. There’s more help out there than you think.
The expert’s view – Grace Davey, Prostate Cancer UK Specialist Nurse.
Alec's personal prostate cancer – through his diagnosis, treatment and aftercare – highlights experiences, thoughts, and feelings that are shared by lots of men who've been affected by this disease.
Alec mentions that when he was diagnosed, he had a trans-rectal biopsy where they take tissue samples from the prostate via the rectum. Today, it’s common practice that a targeted trans-perineal biopsy is done. This is where prostate tissue samples are taken through the perineum. This practice has reduced rates of infection. You can read more about biopsies and the diagnostic pathway at prostatecanceruk.org.
When a man is diagnosed with prostate cancer, it's common for him to be offered different treatment options. These will depend on how aggressive his prostate cancer is, if it’s spread to other parts of his body, and his medical history.
As in Alec’s case, he was given a treatment of high-dose brachytherapy (a type of internal radiotherapy). He then had external beam radiotherapy alongside hormone therapy treatment. It’s a common treatment plan to have external beam radiotherapy with hormone therapy.
High-dose brachytherapy is rarely given as a stand-alone treatment and is often considered in more high-risk prostate cancers. It involves passing a source of radiation down thin tubes inserted into the prostate under anaesthetic to destroy cancer cells. The source of the radiation is then removed, so no radiation is left in the body.
Alec then went on to have external beam radiotherapy and hormone therapy. External beam radiotherapy aims to destroy prostate cancer cells using high energy X-ray beams targeted from outside the body. Hormone therapy works by stopping the production of testosterone, which helps shrink and stop the growth of any prostate cancer cells.
As Alec has mentioned, these treatments can cause different side effects. Common radiotherapy side effects include fatigue, and bladder and bowel problems. Hormone therapy side effects can vary for each man, but some common side effects include hot flushes, fatigue and changes to your sex life, such as loss of libido.
If you have any questions or concerns about treatment options and side effects, you can speak with your healthcare team. You can also call one of the Specialist Nurses at Prostate Cancer UK on 0800 074 8383 for more information and support. Check your prostate cancer risk in 30 seconds here with Prostate Cancer UK.
Nobody likes to think about being diagnosed with cancer. But our health insurance gives you personal cancer care with support at every stage of your treatment for as long as you have a policy with us. Learn more about our health insurance.
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Sources Sources
- Hormone therapy for prostate cancer – side effects incl. hot flushes, libido, bone health. Prostate Cancer UK. Prostatecanceruk.org, updated November, 2024
- What is the PSA blood test? Prostate Cancer UK. Prostatecanceruk.org, updated January 2025
- Seminal vesicle. Britannica. Prostatecanceruk.org, updated December, 2025.
- Living with hormone therapy: A guide for men with prostate cancer. Prostate Cancer UK. Prostatecanceruk.org, last reviewed February 2019.
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