It Sits Between a Man's Bladder and His Old Feather
Mark Shanahan, Mr. 80 Percent video series, 2025
My title is a quote by Stephen Fry who was treated for prostate cancer and bemoaned men’s reluctance to talk about the prevalence of the cancer simply because it involved their penis.
Mark Shanahan interviewed Fry for his video series for The Boston Globe that first aired in 2020 and was updated in 2025. It’s a six-part series that is informative, hugely funny, and quite personal. The interviews with leading cancer doctors, including Dr. Drew Pinsky, are filled with details about how treatments have greatly improved since the 1980s.
Although Shanahan’s father was treated for prostate cancer, they had never talked about it, and Shanahan knew little about the cancer, what the prostate did, where it was located, or that it was the size of a walnut. In 2014, when he was only 48, his doctor noticed that Shanahan’s PSA was elevated, and it continued to rise over the next eighteen months. A biopsy revealed a Gleason 7 score that indicated he had an “intermediate risk cancer.”
Because of his family history of the disease, rather than wait to see if it got worse, Shanahan decided to go ahead with surgery. Unfortunately, the surgeon found the prostate was “mushy” and wasn’t sure he got it all. He could have taken more tissue, but Shanahan had said he valued his sex life and didn’t want to risk losing that, so the doctor didn’t remove more of the margins. The pathology report indicated that surgery hadn’t gotten all of the cancer. The doctor put Shanahan on the anti-hormone drug Lupron and sent him through seven weeks of daily radiation to make sure he got all of the cancer.
As designed, the Lupron took Shanahan’s testosterone level down to zero. This causes some men to have large mood swings, which is what it did to Shanahan. He said he was sometimes out of control, ranted over little mistakes, driven to near madness by the unbearable hot flashes, and he inexcusably inflicted his temper tantrums on his family. Acupuncture helped calm his hot flashes and restored him to some sort of sensible sanity.
One of Shanahan’s regrets was not going to a prostate cancer support group before he decided what to do about his cancer, and then during treatments, because he found out, as he was doing research for his report, just how supportive and informative such groups are.
Now, trucking along post-treatment, he continues to be checked yearly. While he is relieved to have the cancer gone, he is dreading the possibility of its return, because cancer too often does.
Quite a few topics are covered – how men anchor so much of their identity in a working penis, how the development of the PSA blood test was a game changer because digital rectal exams aren’t very accurate, the overreaction of some men with a higher than normal PSA by demanding treatments when they could have simply waited to see if something did develop because most prostate cancer is slow growing, and the disturbing reality that Black men have a higher rate of getting prostate cancer and a higher rate of dying partially because of heredity and diet, but also because of unequal medical care and a learned distrust medical people because of experiments done on Black men in the past.
Cancer research continues to make important improvements in treatment options. I don’t recall if Shanahan had an MRI to determine if all of his cancer was still contained in his prostate before he had surgery, but it wasn’t until the development of the PSMA-PET scan in 2020 that doctors could tell if cancer had moved beyond the margins of the prostate, which is how I found out about the aggressiveness of mine. If Shanahan had known the cancer was already outside, he could have skipped the surgery, with its potential long-term side effects of incontinence and erectile dysfunction that plague a large percentage of men, and gone directly to radiation and the hormonal sleighride of the leuprolide (Lupron).
The “Mr. 80 Percent” video series is a really good overview, and I recommend it. On the internet, type in “Mark Shanahan prostate cancer” and it will show up.
Men should be less uptight about talking with others when their down under equipment is having problems. There is no shame in having prostate cancer or in getting treatments for it. There is also no shame in doing nothing and dying, but then … well … you’re dead.
© 2025 Mark Liebenow
A good, necessary essay on a disease that is not discussed. Although there is more openness about it now. It needs to be discussed. Are rates lower in other countries? If so, what are differences? I have seen that rates in China increased as they became wealthier and ate more meat. Personally, I think there are so many hormones and other chemicals in meat that we consume that we can't tell what the effect can be.