Mish Middelmann

How prostate cancer screening saved my life

As a fit and healthy 61 year old man, I was diagnosed with prostate cancer in November, 2019. At the time I had absolutely NO symptoms at all. Yet when I had my prostate surgically removed in February 2020, the cancer was just beginning to emerge beyond the prostate itself. This means it was about to spread into the rest of my body. So it is thanks to prostate cancer screening and early treatment that I am still alive today. I am so grateful for this! I am still getting tested every 3 months to guard against the return of the cancer.


Building a recovery and rehab programme

After surgery, I was upset by the serious side effects (incontinence and erectile dysfunction) yet I was given minimal information and recovery options. Compared to other operations there was no clear roadmap, and very little guidance other than “use it or lose it.” A lot of us men feel ashamed and find it hard to talk about intimate matters like erectile dysfunction and urine control. And there are no in-person support groups under lockdown. I complained a lot about these problems, then got going on Google and Zoom.


I learned a lot and spent time building my health and fitness. My doctors remarked how much my general fitness and healthy diet helped. There has also been a powerful spiritual and emotional journey for me to accept things I wished were not this way. And then adapt to the new normal. I am convinced that my love of life and my manhood are much bigger than the parts of me that are broken. I think my business background as an entrepreneur also helped me be open to change.


Online, I also met fellow prostate cancer survivors and wonderful professionals worldwide who helped me learn the simple, practical steps needed for rehabilitation of urine control and erectile function after surgery. Now I also know there are excellent specialist physiotherapists, GPs and others in South Africa who are ready to help us. The rehab programme I have learned has been a great success although it takes patience, dedication and some good luck.


Opening up to my wife

Prostate cancer is often called the “couple’s disease” for good reason. It is very difficult for men and their partners to navigate a new life without that tiny organ deep in our groins that actually has more impact on our urine control and our sex lives than most of us ever realised.


My wife has shared all the doctor’s visits with me, talked openly about what is going on, and her support has helped a lot. I was rather surprised to learn that she was much more open to change, and accepting of my limpness between the legs, than I was. We learned a lot about adapting our lives including our sexual relationship. The outcomes made it much better while I had full-on erectile dysfunction after the operation.


She is also supporting my recovery which is looking on track for 100% as I write this 16 months after my operation.


Sharing stories, building roadmaps: an invitation

Men need to talk. And all those affected by prostate cancer need a roadmap. The Prostate Cancer Foundation is helping. My story is just my story and I’m sharing it at www.recoveringman.net. Step by step, in open and intimate detail. To bring in more stories, experiences and perspective, my wife and other prostate cancer survivors have also written candid guest posts and there are more to follow. You are welcome to visit – and subscribe to the blog if you want to get the remaining episodes in my story and others.




Thulani Sibisi

Thulani’s story is one of a constant struggle to win, despite the odds. He grew up in poverty in rural KZN near to Newcastle. Initially he could only attend school for the first 6 months of every year as he was required to assist on the farm where his parents worked for the remainder of the year. In an effort to assist him with his education they moved and built a house in Blaauwbosch so that he could attend school. But life was still hard as he would have to rise every morning at 4am for the 9km walk to the local school.  Like many of his generation he left school before he had matriculated to seek work in the city.

As luck would have it he got a job as a gardener with Johan Rupert, eldest son of South African business tycoon Anton Rupert. Whist working for Johan he saw a marathon on TV and proclaimed that he could run faster than the athletes competing in the race being broadcast. Johan decided to see if the young man’s boasting was for real and assisted him to enter his first race, the Soweto half marathon.  He placed 5th and his running career began.  He was assisted along the way by a number of famous sporting celebrities, from Springbok rugby player Morné Du Plessis, who organised him his first pair of running shoes, to Johnny Halberstadt, who organised him his first full set of kit, to Bob De La Motte who became a trusted friend.

In 1983 he left Johan Rupert’s employ to join the Frontrunner shop in Sandton and pursue his passion. He was given time off in the mornings and afternoon to run and he began to make rapid progress under the coaching of Tony Frost. But there were still obstacles. These were the days of Apartheid and freedom of movement was against the law. Running alone without a ‘dompas’ could land you in jail, but thankfully there were men who were willing to help. David Flood, the owner of Deans clothing store in Sandton, would often accompany Thulani on his bicycle. Nothing could hold Thulani back, he was hungry for victory.

The training paid off and he soon began placing amongst the top athletes of the day. Placing 2nd place in The Peninsula and Stock Exchange Marathons in 1985 earned him a place as one of the serious marathon runners of the day. But it was the Two Oceans title that he really wanted. In 1983 he had been dropped after 43 km’s by the formidable Bruce Fordyce and he had sworn that the next time he entered the race he would win it. But he knew that guts alone was not enough, so he took his time and learned the strategy required to compete against the elite runners of the day. By 1986 he was ready. His only obstacle was to find the money for a plane ticket and accommodation in Cape Town. He went back to his old boss Johan Rupert, who booked him a plane ticket and accommodation. He jokingly told Thulani that if he didn’t win he would expect a full refund. He stepped onto the plane and couldn’t believe it when he was ushered into business class. He couldn’t believe that only 5 months before he had been sitting in the back of a police vehicle, arrested for not having a ‘dompas’. He won the race and sent Johan a video of his performance to thank him. He had earned his place as one of the top athletes in the country.

In 1987 he finished 2nd behind Thompson Magawana, who is still the record holder. Unfortunately he had also reached the end of his career as a runner due to continuous problems with stress fractures. But his greatest challenge still lay ahead.

In 2012 he began experiencing urinary and bowel problems. His condition worsened and it was when he collapsed on the way to work one day that he realised that something was seriously wrong. The timing could not have been worse, it was just before Christmas and although the doctor had already picked up that there was a prostate problem with the digital rectal examination, he would have to wait until after Christmas for the PSA results. But cancer cells don’t take holidays and Thulani’s body had had enough. On Christmas day his prostate cancer caused a blockage of the urethra (the tube that transports urine from the bladder out of the body via the penis).  He thought that drinking lots of water would help to clear the blockage. This only served to make things worse as it caused his bladder to distend. Unable to urinate he was taken to hospital and catheterised. The PSA tests confirmed a strong suspicion for prostate cancer and he was placed on the waiting list for a biopsy. The results of the biopsy confirmed the diagnosis of prostate cancer and treatment was initiated.

I asked Thulani what he found the hardest about his ordeal. His answer encapsulates the typical male sense of denial when it comes to serious health issues, “my biggest challenge was to accept that I had prostate cancer.”

With the acceptance came the realisation that something more needs be done to create awareness about prostate cancer. Today Thulani uses every platform available to him to talk about his experience and to encourage men to be more responsible about their health. He is one of the founding members of the Soweto marathon and he hopes that this event can be used to educate men within the community about prostate cancer. He believes that men need to support each other more. His own life bears testimony to this.  He has weekly contact with two of his old running comrades, Johnny Halberstadt and Bob De La motte, despite the fact that both live thousands of kilometres away.

He believes that his life has been spared for a reason and his purpose now is to help men to be open about prostate cancer. He has the tenacity and motivation to make a difference in the lives of South African men. His victory now will be to save lives by motivating men to go for screening and to give support to those who have been diagnosed with cancer.

By Andrew Oberholzer CEO of The Prostate Cancer Foundation.

From an interview conducted in September 2015 with Thulani.

John McPetrie


I was 43 back in 1996 when a doctor whom I’d seen for an executive health medical asked me when I’d last had my PSA tested. I’d never heard of PSA.  And so began a long journey. My first reading was 4.5 which I learnt was outside the normal range and far higher than a man of forty-odd should have. Things got worse from there. By the early 2000’s I’d had PSA checks more or less every six months and more fingers stuck up my rectum than I care to boast about. But the results were always the same – ‘small and soft’ (the sort of situation I face now but on the other side!). The PSA tests generated more interest because the score kept rising. I went on to heavy antibiotics and eventually I had my first biopsy. What joy! The results came back negative. I said “I told you so”, everyone spoke of a ‘false positive’, I urinated and secreted blood for a while – and then things went back to normal.

By 2010 my PSA reached 10.8 and after all those fingers again, I went for yet another biopsy. Also negative. And then my PSA began to fall. My urologist was convinced that whatever it was that had caused the high readings (for 15 years or so!)had now healed itself. (Be warned–  I’ve since learnt from my oncologist that cancer can ‘put the squeeze’ on the PSA reading so that a falling reading can  actually mean advancing cancer…). Then in mid-2017, I had my lowest reading ever, 4.02, and my urologist retired. Almost scornfully, I went to one of his partners  who, after the finger check  (“not so small John, nor so soft…”), suggested I go for an MRI. Ho, hum. Off I went to the Kingsbury and fell asleep in that noisy machine. The good doctor phoned me to say that I should come to see him. I was convinced I was fine.My PSA was falling, for heaven’s sake, and it was year-end and I just forgot.

In July 2018 I went for my usual mid-year PSA test and it was 4.4 but this time the very good doctor reminded me that he had had something to tell me. It turned out that the MRI had indicated that not only did I have cancer but that it was quite likely already out of the capsule. This led to a third biopsy and the confirmation that I had prostate cancer alright but with a Gleason score of  7 (3 plus 4) which is a Gleason grade group score of 2 . (Gleason grade group 1 is the least aggressive and Gleason grade group 5 is the worst). I  needed to have the prostate out in a hurry. “No problem,” said everyone, “no one battles with prostate cancer. They whip it out, you pee yourself for a bit and then everything comes right”.  Off to a  urologist who, I learned, did something called a radical nerve-sparing robotic prostatectomy and then off for another more definitive MRI out in Milnerton. The results of that little expedition were sobering and perhaps for the first time I began to realise that I might be in some trouble. My Gleason score was not a low 7, but a solid 8 which is a Gleason grade group 4. The cancer was not confined to the prostate but had invaded  the seminal vesicles and the nerves that run along both sides of the prostate which are responsible for erections.I was at Stage 3(b). I had all the signs of locally advanced cancer. About the only good news was that the cancer did not appear to be  in my lymph nodes from where it can spread all over the body and particularly into the bones (this is advanced metastatic prostate cancer for which there is no cure). Nevertheless, despite what I was beginning to understand was a fairly advanced and aggressive cancer – if localised to the pelvic area – the urologist was pretty confident that he could get it all out.

Going into theatre was nothing special; the surgeon’s clerical assistants do all the preparatory work with the medical aids and you just pitch up early in the morning of the day of the operation. In my case the op was in the afternoon and I spent a quiet morning reading and getting my vital statistics taken by a succession of pleasant nurses. Then it was time for theatre and I was wheeled to the operating area where the anaesthetist met me and took me through the drill. To add to the interest, my surgeon had recently taken on a new robotic operating machine and a crowd of newspaper reporters and photographers were there to get some copy and pictures. I learned that I was his 16th patient on the new machine, which was comforting. When I was wheeled into theatre, my surgeon greeted me from the far side of the room where he was seated in front of a monitor. The robotic machine which was going to do all the work (it sends in five arms, one with a camera) was at the far side of the room. I was moved toward the machine and told that my legs would be put into stirrups  but I don’t recall getting that far. Someone put a mask over my nose and I was gone…..It was the 9thNovember – I had my very own personal 9/11 experience.

The op went well enough, if a little longer in duration than usual because the good doctor had to ensure that all the cancerous tissue was removed in order to ensure negative surgical margins (the pathology lab checks all tissue removed for cancer cells). Recovering from the procedure wasn’t much of a hassle – I’m fit, which helped.  My urologist assured me that despite having to go to the margins, he felt that he’d ‘got it all out’, along with a seminal vesicle and about 75% of my bilateral nerves. This was not great news on the erectile front but hey, if it meant that the cancer was gone, both my wife and I were up for it. Well, sort of.

I’d had some training on how to hold my urine with the single remaining sphincter and slowly, over two to three months, that element of my pelvic function returned to normal, along with the odd mishap. I’m a regular short distance runner, so I rested for about a week then started walking for another and within two weeks I was running again, ‘nappies’ and all! I even had the experience while running, early on, of hanging onto my pad as I jogged past some other runners who asked if I was okay. I explained that ‘my nappy had come undone’ and we had a good laugh and then chatted about the rigours of prostate cancer! Things went well. I got back into my normal routine and was running with smaller and smaller pads until, after a few leaks, eventually no drips at all. If all the cancer was out, the operation was entirely successful.

But it wasn’t all out.In February 2019, I had my first post-op PSA test. I popped across from my office for what I hoped was to be a short visit, hoping to hear that my PSA reading was down below 0.02, or better, at the undetectable level. But it wasn’t. The reading was 0.18, far too high for a lad with a Gleason 8 and Stage T3 readings. I needed further treatment. The rest of the session was about meeting someone I hoped never to have to visit – an oncologist.

Now things began to change. I found myself in a state of limbo not knowing whether the reading might  be indicative of cancer not detected and not removed during the surgery, or cancer in some other part of the  greater pelvic area or worse, in some more distant body part, or in the bloodstream, either dying away (one prays) or looking for a place to hook up.  And that is what the oncologist and the wonderful folk at the Radiation Department, down in the bowels of the Rondebosch Oncology Hospital, wanted to sort out.

At this stage I want to digress to observe that this is a very good time to get a book by Dr Patrick Walsh called “(Dr Patrick Walsh’s) Guide to surviving prostate cancer”. You’re no longer part of that nice big fraternity who had the op and all is well.  While they’re focusing on getting out of pads, how quickly their erectile function returns and getting back on the road or into the gym, you have other things on your mind. You’re part of a much smaller group for whom the operation was not wholly successful (but a very good thing, nevertheless), and you’re starting to think about how long you’ve got to live! Doctor Walsh’s book gets you in touch with everything you need to know and probably quite a lot you don’t. But being informed helps you to ask questions and to make decisions.

This is also a good time to find others like you, ‘ in the same boat’ as it were, who can ease the strain of being alone out there. As you’ll gather, I’m happy to chat about the various aspects of the disease, the surgery, therapy, exercise and my own personal condition – what does and doesn’t work. It’s good to find others to chat to because it helps to put things in order, in perspective and it can help with decision-making. Also you need to talk to those you love. Keep them in the picture; they are your best support. And if I may suggest, don’t get too embarrassed by what you can’t do anymore or may perhaps never be able to do again. I’ve found it much easier to laugh at the issues than to be depressed by them. What the hell, you get to live once and we’re on a journey just a little different from others. The prognosis is not all doom and gloom.

Anyway, the oncologist told me that because they couldn’t know where this 0,18 PSA reading was coming from, they would assume it was from the ‘prostate bed’, the area where they had operated. They would focus therapy in that area and in the nearby lymph nodes. So, I was going to have 34 bouts of external beam radiation which involves  aiming  high-intensity beams precisely at that area to destroy any remaining cancer cells. Just how precisely is another story which isn’t of consequence here, but you end up with little tattoos to help the therapists position you under the machines! And because prostate cancer is hormone sensitive (weakened in a low testosterone environment) to further enhance the chances of killing off what cancer remained, I’d be getting injections of something called Luteinizing Hormone-Releasing Hormone (LHRH) agonist, a form of chemical castration. This treatment, also known as Androgen Deprivation Therapy (ADT), turns regular bursts of instructions from the pituitary gland into one long unbroken signal which confuses the hell out of the bits and pieces between itself and the testes. The end result is a shutdown of testosterone production from the testes. That’s how I remember it, anyway.

I found absolutely no discomfort associated with the radiation therapy – you just lie on a table of sorts, attended to by wonderful, kind, friendly radiation therapists, while the machine buzzes around you for 10 to 15 minutes.Getting away for 34  consecutive working-day sessions, however, is a hassle. And the hormone injection, to implant a small pellet which secretes its contents happily into your abdominal fat over the next three months, is something to remember.  The needle is bigger than a bayonet, but hey, it’s only once every three months. You’ve got lots of time to recover and you almost forget the experience….. But don’t be fooled, hormone therapy is not a fun ride. I’ve had two major negative responses – hot flushes, which seriously impact one’s sleep, and a serious loss of stamina when exercising – not surprisingly, because I have no testosterone. The hot flushes hit you regularly but it’s those at night which make a lasting impression. The loss of stamina has gotten tougher as the treatment has progressed.And remember, this is aside from the complete loss of libido and erectile function (if you’d got it back, in between!) -‘you lose your software, your firmware, your hardware, your desire, your ability and um.. any hard evidence’. In addition I’ve lost a lot of my body hair which is no big deal; my skin has dried considerably; my balance has been affected (although I have complicating factors here) but, those aside, there are a lot of other possible side effects, far more serious. Doctor Walsh’s book spells them out in some detail, moreso than the doctors do, be warned. The message is to keep as fit as possible despite the increased effort required. Don’t lose muscle mass, don’t put on weight, watch your vital signs…..and don’t listen to the little voice that says you can’t do it, because that’s tempting. You can and you must push yourself.

I’m a year into my hormone treatment. Along the way, I’ve had three PSA readings which have come out at ‘below 0.01-undetectable’. That’s great, but it’s also what it should be, given that I’m on ADT.  I’m battling with the impact of the interrupted sleep and my running, which I try to do five or six times a week, is becoming tougher with each injection. My exercise routine is less impacted, strangely, than my aerobic exercise, but it too has suffered. My body shape has changed, subtly, with my fat moving from my hips to my belly, though I’ve been able to keep my weight down without much effort. It’s not great fun, though, I confess.

How long does one stay on this LHRH/ADT stuff? At the time I began writing this tome, my  oncologist  had just come back from a high level overseas oncology convention where this very issue was debated. Despite what Doctor Walsh notes in his book, namely,  that there is no benefit in extending hormone therapy beyond 9 months, more up-to-date evidence suggests that 18 months is the ideal length of time. Less, and you don’t give the body enough time to work on the weakened cancer which has survived radiation; longer, and you take a hammering along with no evidence of further benefits (at least that is how I understand it).

I’m now into my second year on LHRH agonist therapy. I work for a church and I’ve adapted my life and my workday (with thanks to my colleagues) around the impact of poor sleep. My wife and family have been great support. So too have the lads who are part of our little group still undergoing treatment. Lots of laughs as we speak of the struggles and successes. As I’ve said, I try to exercise everyday and I’ve found that even as my stamina slowly wanes, my strength is pretty much unaffected. Most importantly I feel that my faith keeps me balanced and keeps things in perspective. I do earnestly propose, as does Doctor Walsh in his great book, that if you are a prostate cancer sufferer this is a very good time, in the context of your mortality, to carefully consider the reality of ‘The Transcendent’.  This provides not simply comfort (referred to cynically by some as ‘a crutch’), but a real sense of purpose, which one can practise by simply reaching out to another sufferer…..

Keep positive; keep communicating, keep fit and keep the faith.

John McPetrie 042020.



Ian Johnston

Prostate cancer is the most common cancer affecting South African men. It affects about 1in 9 white males and 1 in 6 black males.  There are usually no symptoms in the early stages of prostate cancer so if men are not going for regular screenings, the cancer could progress and by the time that they have symptoms and seek help it may no longer be curable. The more education and awareness that is created about prostate the more likely men are to go for screening tests.

Cancer is something that we all fear, but it remains like a distant relative, until it knocks on your door and informs you that it is moving in! I have always been diligent about going for my yearly medical check-up. This included the much feared digital rectal examination (DRE) and PSA blood test.  Through these regular examinations I discovered that I had an enlarged prostate.  Elevated PSA levels don’t necessarily mean that you have prostate cancer.  Inflammation or infection of the prostate can also cause a higher than normal PSA score.

Due to a consistent rise in my PSA levels I was referred to a urologist for a biopsy to determine the cause of my high PSA levels. I received a phone call from my urologist and my heart sank when I heard my urologist said to me; “Iain I am afraid the results of the biopsy came back positive, you have prostate cancer.” You hear the words but still struggle to come to terms with it. The first thing I did was to put the diagnosis into perspective. I reflected on the reality that there were many people who were less fortunate than myself, people that had serious health issues, managing disabilities, terminal diseases or who were living in abject poverty. They were all faced with far greater challenges every day than me.

I am by nature a positive person and always look for the positive outcome or for a solution as opposed to spending immeasurable amounts of time dwelling on the problem. It was Einstein who said; “Problems are seldom solved with the same degree of intelligence that created them.”

I, like most people, have read great heart-warming stories of cancer survivors and unfortunately, also the sad stories of those that due to the severity of the cancer have succumbed to the disease. Prostate cancer however is can be successfully treated and managed if it is diagnosed on the early stages.

When you receive a cancer diagnosis it is important to have people to talk to, be they family members, friends or professional people. I am always available to anyone who is faced with the uncertainty of what lies ahead if they find themselves having been diagnosed with prostate cancer, or even someone who is apprehensive about the annual check-ups. But whatever you do PLEASE go for your annual prostate cancer check-up, the early detection of prostate cancer can save your life.