I want to put something to you that I had not thought about properly until this week, and I suspect some of you know far more about it than I do. Howard Wolinsky is a medical journalist in Chicago. In 2010 he was found to have the lowest grade of prostate cancer there is, the kind doctors watch rather than cut out. His urologist said he would die with it and not from it. So he went on monitoring, and he has kept every appointment since. When he went to renew his life insurance, eight companies turned him down for having untreated cancer. He had done exactly what he was told. Somewhere between the consulting room and the underwriting desk, watching and waiting became untreated. I will be honest, my first reaction was annoyance, and then I remembered I have a smaller version of the same story. I was taking blood pressure tablets when I changed insurance companies, and the new one would not cover anything to do with the circulatory system, because of the high blood pressure pills. The circulatory system covers most things. I signed it anyway, because what else do you do. Two things I want to be careful about. The first is that this is not an argument for treatment. Wolinsky says plainly that he does not know whether surgery would have made the insurance any easier, and he is the one who lived it. Nobody should be reaching for an operation to satisfy a form. The second is that his was an American policy and two brokers told him they cannot predict that every man being monitored will be refused. So this is a question to ask, not a fact to be frightened of. Maybe a question that needs to be posed to the insurance companies to see what their reaction is. The question is the useful bit. Ring whoever holds his current life insurance and ask whether the policy treats monitored prostate cancer as untreated cancer. Write down the answer, the date, and the name of the person who said it. Now here is what I actually want from you, and please answer it straight. Has anyone here hit a wall like this? Insurance, a mortgage, travel cover, a medical on a job, anything at all where the diagnosis caused a problem that had nothing to do with your health. I would rather build a proper list of what to watch out for from people who have been through it than guess at it myself.

Those are the words of his son when he told him. Andrew Ley, 51, Edinburgh. PSA came back at 3.58 in October, just over the line. A scan in December found something. Diagnosis in January. Surgery in March. It had not spread, and he is still having regular blood tests. That is the medical part. Here is the bit that stopped me. He and his wife knew something was coming, and they decided not to tell their two boys, 15 and 12, until there was a plan. So they did Christmas anyway. The tree, the dinner, the whole performance, with that sitting underneath it. His words: "You do catastrophise, you go to quite a dark place." I know that place. Not with cancer - mine is an enlarged prostate, which is a different thing and I want to be clear about that. But I know the version where you have a number you do not understand and three weeks before anybody will explain it to you. The waiting is its own separate injury. Nobody warns you about it. He told the boys on a Saturday morning after their sport. The 12-year-old asked him straight out. He said yes. Six months later he rode 90km and raised five thousand pounds for Prostate Cancer UK. So here is my question this week, and I would genuinely like the answers. Who did you tell first? And how long did you sit on it before you did? There is no wrong answer here. I sat on mine symptoms for years, before I realized that I had BPH. https://www.skool.com/prostate-paladin-4886/about

There was a piece out of Saskatoon this week. A man called Murray Hill runs the prostate cancer support group there. He is a survivor himself. A reporter asked him what happens when a new man turns up at his first meeting. "People come to the meeting nervous or afraid. And they'll get met at the door by some of the guys, and they'll invite them over to sit at their table. They start talking and just socializing and then work their way into it. And then they realize that once they get in there, everybody in the room has got prostate cancer. So, it takes away that sort of stigma that you have coming in the door." Then he said this, which I have not been able to put down since. "You can see the weight lifted from somebody's shoulders when they realize they're not alone. That's the hardest part about getting a diagnosis of cancer of any kind, prostate cancer or any kind. You feel sick. You feel alone." Sixteen years ago a friend told me in an airport that the problem I did not know I had was my prostate. I did not feel alone because of a diagnosis. I felt stupid, because I had lived the symptoms for years and had no idea what they were. Different thing. Same silence. Not cancer, but still a prostate problem. What I keep coming back to is that the men at that door were not doing anything clever. They were not explaining anything. They made it easy to sit down. So a question for the room, and I would like real answers. For those of you who found somewhere to talk about this - a group, a friend, a wife, or here - what actually got you through the door the first time? What made it possible? https://www.skool.com/prostate-paladin-4886/about

A trial called STAMINA was published in The Lancet Oncology this week. 700 men on hormone treatment across 15 NHS hospitals in England. Supervised exercise, diet advice and behavioural support, built into their normal care rather than left for them to go and organise. The men on the programme kept about a third more of their quality of life than the men who did not get it. More than 80% of them were still turning up after a year. I want to be straight about the limits of it. This was a trial pathway. Men were referred in by NHS staff who had been trained to spot them. You could not walk in and sign yourself up, and it is not a routine service everywhere yet. Nuffield Health has started a programme off the back of it, but that is England. Still. For years the answer to "what do I do about the fatigue" was a shrug and a sympathetic face. Now there is a trial with a number attached, which means you can ask. I am not a doctor, and I have not been on hormone treatment myself. My own trouble is the benign kind. So I would rather hear from the men here who have. When you started hormone treatment, did anyone sit you down and tell you what was coming? And did anyone offer you anything at all to help with it? https://www.skool.com/prostate-paladin-4886/about

I want to put a table in front of you, because the numbers do the talking better than I can. Researchers at UCSF, Stanford and MD Anderson followed 512 men aged 40 to 79, all diagnosed with low-risk prostate cancer between 2016 and 2022. Published in July. I read it this week. Active surveillance means watching it closely with regular checks instead of treating it straight away. For low-risk disease it is often the right call, because treatment carries side effects that watching does not. Who actually chose it: Overall 70.9% White men 76.6% Asian American / Pacific Is. 75.0% Black men 64.1% Hispanic men 57.3% Same low-risk disease. Different answers. Then two more findings. Men over 70 were much more likely to put the decision off. Men who had a partner were much less likely to. And the men who delayed were not rewarded for it. They reported more anxiety at follow-up, and were less satisfied with the choice they eventually made. I have said for years that the person standing next to a man changes what he does. This is the first time I have seen somebody measure it. Important, and I will say it twice. This is low-risk prostate cancer only. Nothing in it applies to more advanced disease. I am not a doctor, and what is right for any one man is a conversation with his own. Question for the room. If you have been through this - who was in the room when you decided, and did it help? https://www.skool.com/prostate-paladin-4886/about