I take supplements. I have told you that before, and I have also told you I cannot prove they have done a thing for me. Other than Stinging Nettle Root - which helped me sleep through the night. So when an article on coffee and prostate cancer landed this week I opened it hoping for a clean answer, because a clean answer about something I already do every single morning would have been very welcome. It is not clean. The part that looks good: a review of nearly 58,000 cases found the heaviest coffee drinkers were less likely to be diagnosed, and less likely to have late-stage disease. The part that does not make the headline: when researchers looked at whether coffee slows things down in men who already have prostate cancer, one older study found a big effect, a 2022 study of more than 400 men found nothing, and a 2023 study found a benefit only in men with one particular gene. And one study found decaf did as well as caffeinated, which rather spoils the story about caffeine being the active ingredient. Then the bit that stopped me. One of the researchers quoted is a cancer doctor at MD Anderson who co-wrote one of those studies. He said this: "We would not recommend changing habits surrounding coffee for the purposes of preventing or treating prostate cancer. Rather, it's important to speak with your doctor about PSA screening." He studied it, and he is telling us to look somewhere else. I have a lot of respect for that. It would have been easy to give a warmer answer and nobody would ever have called him on it. It also lands somewhere a bit uncomfortable for me. Two days ago I wrote about dietary fat, and that one had a real finding worth acting on. This one does not. I would rather show you both than only ever show you the ones where the answer is yes. So a question for the group, and I will go first. What have you changed for your prostate that you are honestly not sure did anything at all? Mine is the supplements. Sixteen years in and I still cannot tell you. Not really, though it has been a long time and remains the same - so that is progress of a kind.

Byron Lockwood ran the police department in Buffalo, New York. Diagnosed this year, nine weeks of treatment, finished in July, cancer-free. He said he made two promises when he was diagnosed: to ring the bell at the end of treatment, and to get the word out to other men. That is not the bit that stuck with me. The bit that stuck with me is where the reporter found him. Not in a clinic. Not behind a desk. Not at a podium with a banner behind him. She found him in the barber's chair, having his weekly haircut, talking to his barber. Sixteen years ago a friend told me about my prostate in an airport lounge. Not a doctor. Not a leaflet. A bloke standing next to me while we waited for a flight. I do not think that is a coincidence any more. I think men say the real thing sideways, in the places where they are already relaxed and already talking, and hardly ever in the room that was built for it. One other line from him, and I did laugh. On the hormone treatment: "I have a lot of respect for women who are going through hot flashes." That is a man being honest in public about something most men would not mention at all. In a barber's chair. That is how it travels. So, a question for the room, and I mean it practically. Where does the man in your life actually talk? Not where he is supposed to talk. Where does it genuinely happen - the car, the shed, the walk, the pub, the barber's, doing the washing up side by side? Tell me where, and I will tell you where the conversation should start. Because trying to have it across a kitchen table at six in the evening is the hardest version of it, and most of us keep trying that one first.

A team at UCSF read 157 posts written by 91 men on three patient forums, all about life after radiation for prostate cancer. It went into the Journal of Cancer Survivorship this year. Nobody funded it. They just read what men wrote. The men were not writing about survival rates. They were writing about how many times they get up in the night, burning in the bowel, and tiredness that sleep does not touch. Of the posts that said when it started, 154 said it started after the treatment finished. 26 said during. I want to be straight with you about where I am standing. I have not had radiation. My own thing is BPH, an enlarged prostate, and it has been sixteen years of that. So I am not going to sit here and pretend I know what that recovery feels like from the inside. What I do recognise is the hour. Men writing this stuff at two and three in the morning, on a forum, to strangers. Not to the wife in the next room. Not to the doctor they saw on Tuesday. To strangers, in the dark. That is not a failure of the men. It is a failure of who was available to ask. The researchers are careful and so am I. The men who post are more likely to be the men struggling, so this is not everybody's experience. But if it is yours, you are not the odd one out. So here is what I want to ask this room. For those of you who have finished a treatment of any kind - radiation, surgery, hormones - did anybody sit you down and tell you what the months after would look like? And did you know who to ring when something started? I would like to know how many of you got that, and how many of you got nothing at all. The picture below may not be true, but I am sure it sometimes feels that way. https://www.skool.com/prostate-paladin-4886/about

A survey of 640 taxi drivers came out in Korea this week. 96.2% had experienced a urinary symptom in the past month. Just under half were at a level that gets in the way of ordinary life. Two things before we go further, because you should know both. That survey was paid for by a drug company that sells a prostate product. I am not going to pretend otherwise, and I am not going to name the product. So I went looking for independent work and found it - a group in Florence, Italy surveyed taxi drivers with nobody selling anything and landed in the same place, that these symptoms are shaped by the type and the length of a man's work. And neither of them proves that driving causes any of this. The prostate grows with age. That is going to happen to nearly all of us whatever we did for a living. Here is what I actually think is going on, and it is not in either paper. The job hands a man an excuse that fits. I did the same thing for years, just with a different excuse. Mine was age. I was getting older, so of course I was slower. Of course I was up in the night. It never occurred to me to wonder whether the explanation was doing any work for me, or whether I had simply found a reason that let me stop looking. A driver has a much better excuse than I had. Long hours in a seat. No toilet when he needs one. A schedule that punishes stopping. Every one of those is true. And all of it together means he can go fifteen years without once treating the symptom as information. The bit that caught me was which symptom came top of the Korean list. Nocturia - getting up in the night - at 78.9%. Higher than any of the others. He is not at work at three in the morning. That one I cannot make the job explain, and I have tried. So the question for this group. For those of you who drove for a living, or did shift work, or had any job where you could not just go when you needed to, or just sat in an office chair for years..... - how long did you put the symptoms down to the work? And what was it in the end that made you look again?

September 15th was European Prostate Cancer Awareness Day. I have been doing this for years and I did not have it in my calendar. I found it because a health minister in Cyprus made the news saying something sensible at a Europa Uomo event. Which tells you something about how quietly this whole subject gets handled. There is a whole day for it across Europe, and it slid past most of a continent without a ripple. What he actually said is the bit I keep turning over. He said the decision to get tested has to be made after a discussion with your doctor, based on your age, your family history, your own situation. Not a blanket rule for every man. He is right. And I think that is also the reason so many men never get there. A blanket rule is easy. A letter arrives, you go. A conversation that you have to start yourself, about a subject you have spent your whole life not mentioning, is a much higher wall than anyone designing these systems seems to notice. Nobody writes to you to say it is time to ask. So I am curious about this group specifically. For those of you who have had that first conversation with a doctor about your prostate - who started it? Did you raise it, did the doctor raise it, or did somebody at home push you into the room? I know for me it was the conversation I had in the airport with my buddy. It was not the repeated references my boss made to his prostate problems. I just did not think they applied to me, until I found out - they did. I would genuinely like to know, because I suspect the answer is not "I decided one morning." https://www.skool.com/prostate-paladin-4886/about