Alastair Munro is encouraging men to get checked out by a GP as soon as they see anything that doesn’t seem right

When Alastair Munro noticed a small lump on his penis was starting to get bigger he suspected he was dealing with something serious.

He put off going to the doctor for about six weeks but as soon as the GP saw him he was told it was likely to be cancer.

“It was quite a bold thing to say,” Alastair, 49, said. “I was shocked. He couldn’t say 100% but he thought it was cancer.

“A week later the urologist at Raigmore said the same thing. Then it was just the case of getting a biopsy.”

Three months after first noticing the lump, Alastair, a construction engineer from Inverness, received confirmation that it was penile cancer – a rare condition that only affects 80 to 90 men a year in Scotland and 700 across the UK.

This story contains graphic descriptions of surgery.

BBC/Dragonfly Film and TV Productions Surgeon CJ Shukla is standing with the large lights of an operating theatre behind him. He has a beard and is wearing surgical scrubs and dark glasses. He is looking into the camera. BBC/Dragonfly Film and TV Productions
Alastair credits surgeon CJ Shukla with saving his life

“I was pretty shocked but had been confident it was cancer,” he told BBC Scotland News.

“I’d never, ever heard of this kind of cancer before. Things moved pretty quickly after that.”

A CT scan confirmed that the cancer was spreading.

Alastair’s surgery was followed by a BBC camera crew and will feature on Wednesday’s episode of Surgeons: At The Edge of Life.

The complex procedure involved the removal of the tumour and 30% of Alastair’s penis in a seven-hour operation.

The cancer had spread to lymph nodes in Alastair’s groin, so they also had to be removed. His penis was then reconstructed using a skin graft from his thigh.

Six weeks later, Alastair, who is originally from Kingussie, had to go under the knife for a further three-and-a-half hours after results from the first surgery showed a small amount of tumour was still present.

There was a 50% chance that the cancer would spread to his pelvic area.

“They can’t actually tell if its cancerous until they get inside you,” he said. “What they actually do is cut away the cancerous nodes and check them straight away. They are basically just digging through you.

“They keep going until they find the end of the cancer. It sounds pretty primitive but that’s what they’re doing. It’s quite amazing really.”

Alastair then underwent a month of radiotherapy and was given the all-clear in February.

He can’t currently have sex or urinate properly because he has developed lymphedema as a complication of the surgery and radiotherapy. This involves swelling of the skin.

Alastair is likely to have reconstructive plastic surgery to improve this in about a year’s time.

He has been warned that there is a high chance the cancer will return within two years.
Raising awareness

Alastair found telling family members about the cancer hard, particularly as it was one many people hadn’t heard about.

But he also had to tell them his surgery was being filmed for a BBC documentary series.

“The whole purpose of it is to raise awareness of men’s cancer,” he said.

“If there’s one person out there who’s got something wrong with their penis but is too embarrassed to go to the doctor and he watches this programme and says ‘I’d better go to the doctor’, that’s basically the whole purpose of it.

“It’s so difficult to spot. There are very few symptoms. It could just be a wee spot on your penis.

“If anyone finds a lump or is having problems with erection or blood, just get checked out.”

BBC/Dragonfly Film and TV Productions Close-up shot of surgeon CJ Shukla’s face. He is wearing a surgical mask, scrubs and dark glasses and is staring into the camera. BBC/Dragonfly Film and TV Productions
Surgeon CJ Shukla works at Edinburgh’s Western General Hospital, one of only two centres in Scotland that can treat very rare male cancers

Alastair’s lump was on the head of his penis. It wasn’t painful but grew, and at one point he noticed blood.

His surgery was carried out by Consultant Urological surgeon CJ Shukla at Edinburgh’s Western General Hospital.

It is one of only two centres in Scotland able to treat very rare male cancers.

Alastair has already seen a preview of the programme.

“I must admit, I thought it was pretty gruesome to be perfectly honest,” he said. “You see in the programme that I have a major bleed. When I watched it I said ‘well nobody told me about that’.

“But my surgeon just said it was nothing, that it happens all the time.”

Despite the gory content, Alastair – who has been back at work for five-and-half months – admits he will probably watch his surgery again when the programme airs.

“I want to thank the surgeons and all the staff at the Western General in Edinburgh and the district nurses,” he said.

“The treatment I got was unbelievable. I can’t fault it at all. I can’t thank the NHS enough.

“Dr Shukla basically saved my life.”
‘Deeply personal’

Shukla, who has been a consultant for 14 years, said Scotland has the highest incidence of penile cancer in the UK.

“The projection is that by 2030 to 2040 it’s just going to go higher and higher so we need to be prepared to look after these patients well, ” he said.

“It’s typical for us to see patients who have sat on this for two or three months before they see doctors.”

He said many patients had never heard of penile cancer and that even with prostate cancer – where there is more awareness – men shy away from getting help due to embarrassment.

He said GPs can also misdiagnose the cancer as the yeast infection thrush, and it is not until weeks of treatment have passed that the patient is referred to hospital.

Even then, they are usually first sent to a local hospital before eventually getting access to one of the specialist centres.

“It’s important for men to act quickly,” Shukla said.

“The question is why are we higher than the rest of the UK?”

He said risk factors included smoking, obesity, hygiene and having human papillomavirus (HPV) – many of which could be linked to social deprivation.

But, he said, anyone could get the condition, no matter their age or social background. He believes Scotland needs more nurse practitioners and psychological support for sufferers.

This is the first time Shukla has featured in the TV series.

“For me, the driving force was to try and see if there would be patients willing to share their story and Alistair is pretty brave to put his story out there because it’s deeply personal,” he said.

“It’s about sharing his story so other men can benefit from this.”

Surgeons: At The Edge of Life will be broadcast on BBC Two at 21:00 on Wednesday, on BBC Scotland at 21:00 on Monday 11 May and is available after on BBC iPlayer.