Breast Cancer: a Diagnosis That Extends Beyond the Patient

Firefighter Diagnosed With Incurable Cancer After Spotting Sign On A Trip To Toilet

Lorraine: Dr Amir Khan on the signs and symptoms of prostate cancer

A man battling prostate cancer says he "wouldn't be here today" if not for a talk at work, which helped him spot a crucial symptom.

Graham Rooms, who worked as a firefighter, didn't think the information was applicable to him.

But months later, in May 2019, despite feeling perfectly healthy, Graham noticed his urination pressure had dropped slightly.

Recalling that such a tiny change could be a symptom, he got himself checked out.

And in October 2019, tests revealed he had an aggressive form of prostate cancer.

Graham Rooms was diagnosed with incurable prostate cancer (Image: SWNS)

He said: "Specialists sat me down and told me I had an aggressive grade cancer.

"My wife was with me at the doctors, there were a lot of tears.

"That weekend was the darkest of my life following my diagnosis - with aggressive prostate cancer, the immediate thoughts are of death."

Later that month Graham, now 58, had surgery to remove his prostate at the Royal Devon and Exeter Hospital.

He said: "The only suggestion for me was imminent surgery in the hope it would get the cancer out my body before it would spread."

Graham with his wife Karen and daughter Emma (Image: SWNS)

But scans revealed the cancer had already spread beyond the prostate, to the seminal vesicles and bladder, so the surgery wasn't the end of it.

He had 37 sessions of radiotherapy to target the remaining cancer cells in 2020.

Further tests and scans in 2022 showed Graham, who is now retired, had cancerous areas in the lymph nodes, pelvic wall and just outside the pelvic region.

Doctors confirmed they would no longer be aiming to cure Graham, but to control and suppress the cancer.

"That was as dark a day as the day the cancer was first detected," he recalled.

Graham says he is now living life 'to the full' (Image: SWNS)

"I knew I had it for life and I'll die of it. I asked my doctor my prognosis, and she said hopefully I could make it to 10 years."

Graham, who lives with wife Karen, 58, and daughter, Emma, 22, in Talaton, Devon, added: "Now, it's just a case of making every moment count and living life to the full.

In November 2022, Graham started on a hormone treatment and a chemotherapy drug that has been able to control and suppress his cancer.

While they will never be able to cure it, it means Graham is able to live a more normal life between his monitoring sessions every two months.

But he has to manage side effects from the drugs - including fatigue, weight gain and hair loss.

He also experiences chronic lymphoedema - painful swelling of the limbs as a result of his removed lymph nodes.

Despite that, he says he has "embraced the situation" and is aiming to "live life to the full" after the experience.

Now Graham is urging others to be aware of the symptoms to look out for.

To calculate your risk of prostate cancer, use the Prostate Cancer UK's online risk checker at prostatecanceruk.Org/risk-checker.

Symptoms of prostate cancer often do not appear in the early stages but can include:

Needing to urinate more frequently, often during the night

Needing to rush to the toilet

Difficulty in starting to urinate (hesitancy)

Straining or taking a long time while urinating

Weak flow

Feeling that your bladder has not emptied fully

Blood in urine or blood in semen

Bone and back pain

Loss of appetite

Pain in the testicles

Unintentional weight loss.

If you experience symptoms, speak to your GP.

Prostate Cancer: Diagnosis, Treatment, And How To Prevent It

A diagnosis of prostate cancer can be daunting, and you may wonder what is next once you have been given the grim news.

Here is the rundown on diagnosing, staging and treating the disease.

What is prostate cancer?

Prostate cancer is a form of cancer that begins in the gland cells of the prostate. The prostate, which sits under the bladder, is a walnut-sized gland that helps in fertilization and carries semen that nourishes and transports sperm.

Age is the biggest risk factor in developing prostate cancer. The risk increases with age, and peaks around age 68.

Prostate cancer diagnosis

Prostate cancer is the No. 1 cancer found in men and is the second-leading cause of cancer-related death in men. It is important to get screened early, even if you are not experiencing symptoms. Screenings typically happen during a visit with your primary care physician.

If you're at average risk, you're encouraged to start screenings at age 55. Black men are encouraged to start screenings at age 45 because they are at a higher risk of getting the disease and have a two times higher mortality rate.

The types of tests used to diagnosis prostate cancer may include:

Blood tests. The PSA blood test measures a protein in the blood called the prostate-specific antigen (PSA). Only the prostate and prostate cancers make PSA. A high PSA may signal that something is wrong, and a doctor may request more tests, including a digital rectal exam.

Digital rectal exam (DRE). During this physical exam, a doctor will put a lubricated gloved finger into the rectum and feel for an abnormal shape, consistency or thickness of the prostate. A digital rectal exam is often used in conjunction with a PSA blood test. Together, the tests may help find prostate cancer early.

Biopsy. If a patient is confirmed to have a repeated high PSA, they may be referred to a urologist for a biopsy. During a biopsy, a needle is inserted into the prostate to collect tissue. The tissue is then analyzed in a lab to determine whether cancer cells are present.

MRI/ultrasound fusion biopsy. This test combines an MRI scan with an ultrasound image to help urologists target the area of the prostate that needs to be biopsied and guide the needle to the precise spot. These types of biopsies help target the tumors that need treatment, reduce the number of repeat biopsies and allow for earlier diagnosis and treatment.

Prostate cancer treatments

To determine treatment options, doctors need to establish whether the cancerous cells have spread in the prostate or beyond.

In localized prostate cancer, the cancer has not spread outside the prostate. In locally advanced prostate cancer, the cancer has spread to nearby organs outside the prostate. Risk groups — based on PSA, DRE and biopsy results — are assigned before the patient undergoes any treatment and are important factors in determining prognosis, risk and treatment options.

Low-risk group. The tumor is confined to the prostate, and the PSA is less than 10. There is also a subset called very low risk in which fewer than 3 biopsy tissue samples contain cancer cells and the cancer was not detectable during a digital rectal exam.

Intermediate-risk group. The tumor is confined to the prostate, and the PSA is between 10 and 20.

High-risk group. The tumor is outside the prostate and the PSA is greater than 20. There is also a subset called very high risk in which the tumor has extended into the seminal vesicles or the rectum or bladder.

Below are the major treatment options for patients with prostate cancer:

Active surveillance. An option for men who have a low risk of prostate cancer. During active surveillance, men receive repeat MRIs and biopsies over time, to monitor PSA levels.

Radical prostatectomy surgery. This is for patients whose tumor is only in the prostate, and it is an option for all risk groups. During this procedure, the prostate, surrounding tissue and seminal vesicles are removed. The main types of radical prostatectomy include:

Open radical prostatectomy: A cut is made in the lower abdomen or the area between the anus and scrotum. Surgery is performed through the incision.

Radical laparoscopic prostatectomy: Several small cuts are made in the wall of the abdomen. A laparoscope, which is a thin, lighted tube that has a video camera, is inserted through a cut to guide the surgery.

Robot-assisted laparoscopic radical prostatectomy: Several small cuts are made in the wall of the abdomen. The surgeon then uses robotic arms to insert a tool with a camera through one opening and surgical instruments through another opening. The camera gives the surgeon a 3D view of the prostate and allows them to complete the surgery using the robotic arms and a computer monitor near the operating table.

Radiation therapy. A cancer treatment that uses high-energy X-rays and other forms of radiation to keep cancer cells from growing or to destroy them. This is an option for all risk groups. The different types of radiation therapy include:

External radiation therapy. This occurs when a machine outside the body sends radiation toward the area of the body with cancer.

Conformal radiation. A therapy that uses a computer to take a 3D picture of the tumor and alters the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor while causing less damage to healthy tissue.

Intensity-modulated radiation therapy (IMRT). This is the most common type of external beam radiation therapy for prostate cancer. A computer-driven machine moves around the patient to deliver radiation. The intensity of the beams can be adjusted to allow doctors to deliver an even higher radiation dose to the cancer while limiting the doses of radiation reaching nearby healthy tissue.

Image-guided radiation therapy (IGRT). The scanner allows the doctor to take pictures of the prostate before giving the radiation, to make aiming adjustments.

Proton beam radiation therapy. This therapy focuses beams of protons on the cancer instead of X-rays. Unlike X-rays, which release energy before and after they hit their target, protons release energy after traveling a certain distance and cause minimal damage to tissue they pass through.

Internal radiation therapy (brachytherapy). Brachytherapy places small radioactive pellets or seeds directly into the prostate. This therapy is generally only used in men with early-stage prostate cancer that is slow-growing.

Hormone therapy. This treatment uses surgery or drugs to stop testosterone from being made or from reaching prostate cancer cells. Testosterone fuels the growth of prostate cancer cells. Hormone therapy is often given with radiation if a patient has intermediate or high-risk prostate cancer. The duration depends on risk group. If someone has an intermediate risk, its four to six months, while high-risk patients will receive hormone treatment for 18 to 36 months.

Orchiectomy (surgical castration). During this procedure, the surgeon removes the testicles, which is where most of the androgens (testosterone and DHT) are made. This causes most prostate cancers to stop growing or shrink for a period of time.

Luteinizing hormone-releasing hormone (LHRH) agonists. These drugs are injected under the skin to lower the amount of testosterone made by the testicles. The testicles stay in place but will shrink over time. Treatment with these drugs can be considered a form of medical castration.

Luteinizing hormone-releasing hormone antagonists. LHRH antagonists can be used to treat advanced prostate cancer. These drugs lower testosterone levels more quickly and don't cause tumor flare like the LHRH agonists do. Treatment with these drugs can also be considered a form of medical castration.

Prostate cancer prevention

As we tell our patients at Duke Cancer Center, there are ways to lower your risk for prostate cancer. They include:

Early screenings

Eat a healthy diet (increase fish, tomato and cruciferous vegetable intake, reduce red meat intake)

Maintain a healthy weight

Exercise regularly

Do not smoke

Avoid toxins

Be aware of genetic risk factors and family history

'This Is Not An Emergency'

Documents uncovered in a civil rights lawsuit show Florida prison officials and medical staff allowed an incarcerated man's prostate cancer to spread untreated until he was left paralyzed, terminally ill, and afflicted with infected bed sores that rotted to the bone.

When he wrote desperate pleas for help, one official concluded, "This is not an emergency."

In a federal civil rights lawsuit filed last year, former Florida inmate Elmer Williams alleges that corrections officers and nursing staff denied and delayed medical treatment for months after he filed a grievance against them. The complaint argues these delays were not just bureaucratic incompetence but retaliation "intended and designed to prevent [Williams] from receiving a timely diagnosis." The lawsuit alleges violations of the Eighth Amendment and the Americans with Disabilities Act; it names several Florida Department of Corrections (FDC) officials and medical staff employed by Centurion, a private health care provider that contracts with the FDC.

Williams, 56, spoke to Reason from the hospital bed where he has spent most of his time since the FDC granted him medical release last October, and where he will in all likelihood spend his final days.

"Slowly, slowly, slowly, they just let me fall apart," he says.

Many of Williams' claims are corroborated by medical records that reveal staff were aware of his extremely high indicators for prostate cancer, aware of a long-overdue "urgent" referral to a urologist, and aware of his rapidly deteriorating condition. Photos accompanying Williams' suit show deep bed sores on his buttocks and ankles—evidence of atrocious neglect. He has yet to recover from those wounds nearly a year after his release from prison.

The case of Elmer Williams is only an extreme example of medical neglect that is common, not just in Florida prisons but in lockups across the country. The Constitution guarantees incarcerated people the right to basic medical care and hygiene, but indifference, staff shortages, cost-cutting, and the high bar to prove an Eighth Amendment violation have turned its ban on cruel and unusual punishment into a broken promise. Reason has previously reported on how federal prison officials let a man with treatable cancer waste away while lying to a judge about his treatment; how a woman died in federal prison after suffering in pain for eight months while waiting for a routine CT scan; and how prisoners in Arizona died excruciatingly painful deaths while unqualified, overworked nursing staff did nothing.

"The Constitution requires Florida prisons to provide adequate medical care to its prisoners and prohibits them from deliberately delaying treatment for serious medical needs," James Slater, one of Williams' attorneys, says. "Upon arriving at Suwannee Correctional Institution, Elmer Williams presented serious documented medical needs which rapidly worsened. Instead of providing him the treatment the prison knew he needed, prison officials and medical staff forced him to go months without the appropriate treatment resulting in his condition predictably becoming terminal."

Centurion did not respond to a request for comment. An FDC spokesperson declined to comment on Williams' case, citing the department's policy of not commenting on pending litigation.

Williams was serving a 40-year state prison sentence for burglary when he was transferred to Suwannee Correctional Institution in November of 2021. 

He had previously been treated for prostate cancer, which was in remission. However, medical intake records obtained by Williams' lawyers show that a month prior to his transfer to Suwannee he had an urgent referral to a urologist. The level of prostate-specific antigens (PSA) in his blood—an indicator of potential prostate cancer—had recently spiked.

Around the same time he transferred to Suwannee, Williams also started losing his balance and falling. He began complaining of severe back pain and numbness in his legs. On November 18, 2021, he fell out of his bunk and tried to declare a medical emergency. However, Williams claims that both a correctional officer and a nurse refused to provide him with a wheelchair.

Several days later, Williams was thrown in a disciplinary confinement cell for failing to show up for a job assignment, which he couldn't do without a wheelchair. The lawsuit alleges this was retaliation for Williams' writing a grievance against the nurse and correctional officer. 

"It was only many months later that Plaintiff was assigned his own wheelchair, despite the obvious and apparent need for one demonstrated over the next several months as Plaintiff became completely paralyzed from the chest down," the lawsuit says.

In the meantime, he was left alone for 30 days in a confinement cell, where he says he had to drag himself across the floor to get food or use the toilet while correctional officers mocked him.

"I'm stink [sic] more than ever now because my cell floor is pissy from me peeing on it all day when I don't have the strength to make it to the toilet," Williams wrote on December 2, 2021, in a sworn affidavit. "Haven't been given a shower in nine days because I've gone paralyzed from the delayed medical treatment."

That same day, Williams filed a grievance, complaining, "Now my life and health is in jeopardy because I'm being denied a wheelchair when I can't walk, so I can't get my bloodwork done to determine where my PSA level is at and what's wrong with me."

Williams was released from confinement later that month, and his health continued to decline. Medical records show that Williams saw the prison doctor again on December 20, 2021, complaining that he could not walk or even stand. Despite that, the doctor wrote in her notes, "I do not recommend a wheelchair at this time." The doctor also noted that she would "continue monitoring prostate issues," although she was neither a urologist nor an oncologist.

Williams was admitted to the prison infirmary on January 7, 2022, with swelling of both his legs, irregular pulse, decreased mobility, and infected pressure ulcers, also known as bed sores, on his heels. From the infirmary, he began firing off a series of grievances regarding his treatment and his rapidly deteriorating health.

On January 12, 2022, an FDC staffer handling one of Williams' grievances emailed Rebecca Yates, an FDC government operations consultant, and described Williams' litany of symptoms:

(Williams v. Dixon)

"Inmate states his legs, knees, feet and ankles are swollen to the point of exploding. He states his stomach is bloated and every time he moves he has a muscle spasm in his back and his body locks up and he can't breathe or his breathing is labored," the staffer wrote. "He states his nerves are damaged and there is little to no oxygen going to his legs. He states he has become completely paralyzed from his stomach to his toes and that area is extremely swollen. He states he needs emergency care."

"Is this an emergency?" the staffer asked Yates.

"This is not an emergency," Yates replied roughly two hours later.

It may not have been an emergency for the FDC, but Williams felt his life slipping away with every minute of delay. 

"Every day this cancer is living inside my body without treatment is another day my organs are deteriorating," Williams pleaded in a January appeal directly to the head of the FDC after one of his grievances was denied, "and who knows at what rate??"

His grievances were all rejected.

In February 2022, despite his festering wounds and encroaching paralysis, Williams was discharged from the prison infirmary and back into the general population. His lawsuit claims he was still not assigned a permanent wheelchair. Williams says he had to pay other inmates to take him to the shower, help him get his diapers on or off, and take him to breakfast. 

If no one was available or willing, he went without. When he did make it to the shower, he said he had to sit on the unsanitary floor.

"I just felt humiliated, degraded," Williams recalled in a deposition for his lawsuit. "Psychologically, I wanted to—I wanted to really like, you know, like hurt myself because that's really a low, that's a low in prison to be exposing in front of 70 some guys walking by you while you just there wiping your butt. And they wouldn't give me no diapers or nothing. I was soiling my clothes and my pants."

Sitting on the shower floor was even worse for Williams because he had developed large, infected bed sores on his buttocks during his stay in the infirmary. As his lawsuit describes it, the sores flourished into "deep necrotizing wounds on his buttocks that went all the way to his pelvis bone." 

Williams said he didn't even realize the extent of the wounds until later. "One day I just so happened to take a mirror and look back there, and I panicked," he said in the deposition. "I screamed. I screamed. The guards came. I'm like, 'What the hell is this? What happened?' And nobody could tell me what happened."

This is far from the first time the FDC has faced accusations of refusing to accommodate the most basic needs of inmates with disabilities. In 2017, the FDC settled a lawsuit by the advocacy group Disability Rights Florida by agreeing to provide accommodations, including wheelchairs, to incarcerated people with disabilities. In 2021, it settled another lawsuit by Disability Rights Florida accusing it of breaching the previous settlement. Williams' lawyers are currently representing another disabled Suwannee inmate who claims staff refuse to give him enough adult diapers.

The FDC and Centurion argue in motions to dismiss Williams' suit that medical logs actually show that he was given continual, attentive care, including antibiotics, dressings for his wounds, and—eventually—an appointment with a urologist.

Williams saw a urologist in March 2022, roughly five months after his "urgent" referral. His PSA level had risen from 5.2, when he first arrived at Suwannee, to 43. The baseline PSA level for potentially active prostate cancer is 4.

In June 2022, Williams saw an oncologist, but by that time, all doctors could offer him was palliative care. The cancer had spread to his hips, spinal cord, and lymph nodes. The lawsuit claims Williams was not informed of his terminal condition until he was transferred to a state prison hospital in August.

Williams would have died behind bars, but the Florida Justice Institute (FJI), a criminal justice advocacy group, came across his case and decided he would be a good candidate for compassionate release—a Florida policy that allows some terminally ill inmates the mercy of dying at home.

"We had been looking into this issue as a way to highlight not only Florida's aging prison population, but we also represent a lot of people both in larger cases and smaller cases with disabilities," Dante Trevisani, executive director of FJI, says.

Williams had previously filed a petition for medical release, which was rejected. FJI refiled the petition on Williams' behalf. He was released from FDC custody in October of last year.

At a real hospital, doctors gave Williams six months to live. He has outlived his prognosis, but he struggles to cope with the diminished quality of life he's been left with. Since arriving at the hospital, he's spent all but 15 minutes lying in the same bed, in the same room.

"I'm hanging in there, but it's very, very hard. Getting used to living this type of life is very difficult mentally," Williams says. "From the pain all the time, and because I only get a visit maybe two times, three times a week, so I'm left here on my back, just suffering, day by day."

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