230: *6-year anniversary episode* Punch On - Mark’s Prostate Cancer Story: Surgery, Salvage Radiation and Getting on With Life in the Bush

Episode Overview:  In this episode of The Penis Project Podcast, Melissa talks with Mark, a 56-year-old rural firefighter from the South West of Western Australia, about a prostate cancer journey that has had just about everything in it: an aggressive cancer, surgery, a rising PSA, salvage radiation, penile rehabilitation, one very memorable trip to the emergency department, and a bloke who simply refused to sit down and feel sorry for himself.  Mark had never been crook in his life. He only asked for a PSA test because a mate who had been through prostate cancer kept nagging him about it. During a routine work medical, his mate’s voice popped into his head, and he asked the doctor for the test. The GP asked why. Mark asked for it anyway. The result came back with an elevated PSA, and as Mark puts it, he nearly fell off the chair.  What followed was a biopsy in Bunbury, a two-hour trip from home, a Gleason 8 diagnosis, and a radical prostatectomy in Perth, four hours away. Mark and Melissa talk about the tyranny of distance in Australia: every appointment being a whole day, the cost of staying away from home, and the men Mark met who were driving four hours a day for radiation because they had nowhere to stay.  Mark also talks about the parts nobody warned him about. The catheter that started leaking around the sides and scared the daylights out of him. The pads. The pelvic floor exercises he started before surgery because his mate Grant told him to, and which he credits with getting him dry within a few weeks. And then, months later, a phone call from his surgeon to say the PSA was creeping back up. Which resulted in radiation treatment. He declined the testosterone-lowering therapy that was offered alongside the radiation, because he did not want the fatigue and flatness during fire season. He worked right through his treatment, and three days after his last “nuking session”, as he calls it, he pulled up at work to get the job done.  And yes, we talk about erections. Mark did the work: the daily tablets, the vacuum pump, and eventually injections. The first injection dose was too generous and Mark ended up in a country emergency department with an erection that would not go down and, by his count, six or seven people in the room having a look at his old fella. It is a very funny story and also a serious one. It changed how Melissa practises: every country patient now goes home with an emergency reversal injection so nobody else has to make that drive.  This is a warm, funny, plain-speaking conversation about what it takes to get through prostate cancer treatment especially when you live a long way from anywhere, and about why looking after your penis is not optional extra credit. It is part of your body, and it deserves the same care as everything else.    In This Episode, We Cover  Why rural and remote men face extra barriers to prostate cancer diagnosis and treatment, from long travel distances to limited local specialist access    What to expect physically after a radical prostatectomy — catheter care, continence pads, and the importance of starting pelvic floor exercises before surgery   Penile injections as a treatment for erectile dysfunction after surgery, including how dosing is calibrated and what to do if an erection won't go down (priapism)   Why starting penile rehabilitation early — even before erectile function is a priority — supports better long-term outcomes   The decision-making process behind choosing radiation with or without hormone (testosterone-lowering) therapy after a rising PSA   Bowel and bladder side effects of radiotherapy, and that ongoing symptoms don't have to just be tolerated   Why masculinity isn't defined by erectile function — and how partners consistently describe what makes a man "masculine" to them   The value of connecting newly diagnosed men with those who've been through treatment already, so they know what to expect    Key Message from Mark  Mark’s stron