Putting the Freeze on Cancer With Cryotherapy

A case study about a friend of mine

During the summer of 2022 I learned my friend Les had been diagnosed with prostate cancer. Eagle-eyed readers of this website may remember I wrote an article titled “A Friend Phones With Bad News” where we left Les considering either brachytherapy or cryotherapy to treat his condition.

To refresh your memory, his prostate cancer was discovered relatively early. He had been on active surveillance, so when the bad news came, the cancer had not spread outside the prostate. His PSA stood at 5, and his combined Gleason was 7.

To cut to the chase, Les decided to go with focal cryotherapy, so a brief look at this not-so-well-known treatment seems in order.

What is cryotherapy?

There are two types of cryotherapy: whole prostate and focal. As the names suggest, the former targets the whole prostate and the latter just the cancerous area. Both take place under general anesthesia. Cryotherapy is generally offered if the cancer has not spread outside the prostate. This treatment tends to be less invasive than others, such as surgery

Read on

Grief, Anger, and Coping With Loss

It was my six-month cancer call with the oncologist recently. Thankfully my bullet-dodging skills seem to be in good shape. Two years after completing 36 months of hormone therapy and nearly four years since my last ride in the radiotherapy donut, my PSA stands at 0.41.

Back in February it measured 0.23, so although it has nearly doubled, the figures are still small. With testosterone back in my system, and a welcome drop in side effects, this was to be expected.

So far so good, but if my PSA were to hit 2 then all kinds of alarm bells will start to sound. Obviously, things don’t always go right, which got me thinking about grief and loss and how we deal with those two tormentors.

What grief looks like

I’m guessing many people reading this will have heard the phrase or perhaps even used it themselves. It usually comes in the form of a question: “Is there anything I can do to help you get through this?”

Perhaps I need to back up a little. Some explanation is required. In Hollywood when a character is hit with a life-wrenching event such as the death of a friend or child, a certain amount of destruction seems to be required. Televisions will be smashed on to coffee tables and crockery swept to the floor. Good visual shorthand for grief and anger.

Perhaps it’s my staid middle-class upbringing, but in times of grief our glassware has little to fear as all the action takes place off stage in my head. The hurt and anger is internalized, which is not much use to a film director.

Read on…

A friend phones with bad news

I guess it had to happen sooner or later. An old friend got in touch to tell me he has prostate cancer. A biopsy confirmed he is now part of our unlovely club.

In some ways I’m surprised this hasn’t happened before. I’ve never made a secret of having contracted PC. I’ve blogged about it pretty much from day one, so it’s hardly surprising that a friend would seek me out. For all that, it was horrible news and brought me up short thinking about the day I was diagnosed. But it felt good to comfort someone else and to pass on what knowledge I have on this tricky subject.

It just seems unfair

I met Les through work nearly forty years ago and we’ve been friends ever since. He recently had to undergo a heart bypass, which restored him to rude health after several years of feeling quite frail. It just seems incredibly unfair that on top of that major operation, prostate cancer has now come calling. Not that there’s anything fair about cancer.

Les had been under the ‘watch and wait’ regime and then more recently ‘active surveillance.’ The medics confirmed the cancer has not spread outside his prostate, which is good news. His combined Gleason is 7 and his PSA under 5. I tried to reassure him that his cancer should be eminently treatable.


Dodging cancer

Finally, the side effects are starting to fade away. It had been 18 months since my last hormone therapy shot and the hot flashes have almost completely disappeared. Body hair is now returning and so, too, is my libido.

All welcome events, but what would that mean for my PSA level? The consultation with the cancer center was due in a few days, and already the stats angst was starting to build.

Evidence the treatment was working

When the side effects were in full swing, I used to comfort myself that even though they were unpleasant they were evidence the treatment was working, and hot flashes seemed a relatively small price to pay when it comes to dodging cancer.

Testosterone is like catnip to cancer, and the main purpose of undergoing HT is to reduce its presence in the body to virtually nothing. This makes for unpleasant side effects but means the cancer has nothing to feed on.

Read on…

Remembering P.J. O’Rourke

P.J. O’Rourke, the writer and humorist has died aged 74. He styled himself as a Republican but was generally loved by all sides of the political divide as an hilarious curmudgeon. According to his publisher the cause of death was complications arising from lung cancer. So not prostate cancer but I think PJ showed us how to live in a dignified manner with this dreadful disease and be funny at the same time.

If you’re not familiar with his work, it was not all political. One of his first books ‘Modern Manners: An Etiquette Book for Rude People’ contains the quote ‘A hat should be taken off when you greet a lady and left off for the rest of your life. Nothing looks more stupid than a hat’. As someone who regularly wears a hat this always got a laugh from me.

Back in 2008 he announced he had contracted a very treatable form of anal cancer. In an article in the LA times titled ‘Give me liberty and give me death’ he wrote in typical PJ style: ‘I’m told I have a 95% chance of survival. Come to think of it, as a drinking, smoking, saturated-fat hound, my chance of survival has been improved by cancer’. He also wondered why God couldn’t have given him a more dignified form of the disease.

I had the good fortune to meet PJ in Somalia in 1993. The US had sent troops as part of a peacekeeping effort to help the war-torn country. Incessant warfare had led to the destruction of the agriculture system and there was widespread famine.

Initially the troops were welcomed by the locals, though that welcome didn’t last long as anyone who has seen the movie ‘Black Hawk Down’ will know. At the time I was working for ABC News and where the marines go, journalists are sure to follow. Around thirty of us lived in a walled villa on the outskirts of the capital, Mogadishu. This was to be the first of my three visits to the country and definitely the most pleasant.

PJ showed up soon after I arrived. He was writing for Rolling Stone and doing radio slots for ABC. He insisted on chewing the local drug Khat, a kind of natural amphetamine, while the rest of us were drinking whiskey. He was utterly charming, and I discovered he had a great love of poetry. This will sound incredibly pretentious, but I remember he and I quoting half-remembered verses from WH Auden and WB Yeats at each other. Anyway, don’t blame me, blame the whiskey.

He went on to write about Somalia saying: ‘Imagine a weight-loss program at the end of which, instead of better health, good looks, and hot romantic prospects, you die. Somalia had become just this kind of spa’.

Now PJ has died, and the world is a sadder much less funny place for it. Following his first cancer diagnosis he looked at the nature of death and his own mortality and had a parting thought: ‘Thus, the next time I glimpse death … well, I’m not going over and introducing myself. I’m not giving the grim reaper first daps. But I’ll remind myself to try, at least, to thank God for death. And then I’ll thank God, with all my heart, for whiskey’.

Cancer got him in the end, but he remained a man who lived and died with dignity and perhaps a glass of whiskey in his hand. RIP PJ.

Side Effects Sidelined

The treatment has stopped, now when are the side-effects going to quit?

It was a question I was constantly asking and now, as I have a little inside information, it’s a question people are starting to ask me. You may well recognize it: “When are the side effects going to stop?” “Side effects” is often preceded by a punchy Anglo-Saxon verb that’s unlikely to get past the diligent editors of this website. It’s often a heartfelt question, sometime almost a plea.

For the absence of doubt, the side effects I’m referring to are of course related to prostate cancer, which are brought on by the medical profession’s prodigious use of hormone and radiotherapy. As everyone reading this will know, they are used to shrink the tumors that may be lurking in our prostate and beyond.

Hormone therapy side effects

My experiences with these two regimes are clearly not as bad as some patients I’ve read about here and elsewhere. I’ve just dug out the paperwork I was handed prior to starting hormone therapy, and the potential side effects cover two pages of A4.

Read on…

Calling time

It’s annoying when they don’t call on time. Yesterday, at 4pm, I was expecting my six monthly check up call from the oncology department at Guys. A week ago, my blood had been drawn at the Cancer Centre to check my PSA level. Having been off any form of treatment for 18 months, was my PSA set to rise?

Following three years of hormone therapy and two months of radiotherapy my PSA had stood for more than a year at a highly acceptable 0.02. My prostate cancer was barely detectable. At 3.55 I was in a mildly anxious state waiting to find out my fate. By 4.40 no one had called so I took the dog out for a stroll to alleviate the stress.

Walking up the road, the phone goes, and I duck into a side road pulling Bucket after me to find out the latest instalment of Jim’s cancer capers. In short, the news is good. My PSA has increased, a small amount, and now stands at 0.23. The lady from the Cancer Centre described this figure as ‘magnificent’ which rather surprised me but hey, I now have magnificent cancer or rather lack of cancer. At diagnosis my PSA was 5.03.

This time they also measured my testosterone level which is not something I’d had done before. The hormone therapy reduces testosterone in men to something like zero which as you can imagine produces some irritating side effects. (hot flushes and loss of libido etc.) Testosterone is like catnip to cancer, hence the need to irradicate it for a while.

My testosterone level is now a plucky 18.6 which meant absolutely nothing to me until I learnt that in men the range is generally somewhere between 9 and 30. Of course I’ve no idea what my level was prior to my treatment but it seems to be in a relatively good place.

The brutal reality is that my PSA level will probably continue to rise, but it’s impossible to say how far and how fast. Once it hits 2.0 some of the dreary treatments may have to recommence but now, I have another six months until my next call and I’ll be putting cancer to the back of my mind. It’s something I’ve become rather good at. But next time Cancer Care at Guy’s, can you please respect the calling time.

Keeping cancer in its place

It was several years ago now, but I remember an older work colleague telling me he had just been to a close friend’s funeral. I commiserated and he said: “Jim, these days it’s like shucking peas.” He was in his seventies then, and friends were starting to fall away. I’m 67 in a couple of weeks, as of my writing this, and it looks like I’m now on the same trajectory.

A farewell to a friend with prostate cancer

Last Sunday, as of this writing, I attended a farewell and celebration of the life led by my old friend Geoff. He died a couple of weeks earlier at his home in Switzerland, and this was a chance for his UK friends to bid him bon voyage.

Geoff contracted prostate cancer some years back and was treated using High-intensity focused ultrasound (HIFU). This form of treatment uses ultrasound energy to destroy cancer cells in the prostate.

He suggested I investigate HIFU when I, too, was diagnosed with prostate cancer. My doctor deemed it would not work for me, but to all intents it appeared to have worked for Geoff. Sadly, he died very quickly from a brain tumor, but there is some thought that the cancer may have been linked to his prostate cancer. Read on…

Do You Talk to Your Cancer?

I was asked an unexpected question the other day: “Do you talk to your cancer?”

Frankly, I wasn’t sure what to say, and unclear what sort of answer they were seeking. Given how many questions I get about my cancer, this was refreshingly new, but more of that in a moment.

A difficult guest

The simple answer is no, I don’t talk to the intruder in my prostate, but I do come close. My cancer is certainly a character who right from the get-go I called my Unwelcome Guest. It became the name of my original cancer blog.

Inevitably I mined the term for all its metaphorical worth. So, there was always talk in the blog about the ‘guest’ checking out, and once I was in remission, there was the inevitable fear of him checking back in. At one point I remember talking about cancer as someone who overstays his welcome, leaves the bath taps running, floods your apartment, and brings the ceiling down. I became a bellboy to a nightmare lodger. Read on…

How Can I Shift This Weight When I’m Hungry All the Time?

I’m one of those irritating people who has never had much trouble with their weight. I’ve been tall and skinny all my life. Even when middle age hit and I put on a few pounds, they were easy enough to take off again. So yeah, for a lot of people: Deeply irritating.

When I left school at eighteen, I didn’t exercise at all until I reached thirty, which coincided with the mid-80s when it was all Jane Fonda, aerobics and legwarmers. I’ve never played any competitive sport since leaving school, but I’ve paid regular visits to the gym, though my days of doing aerobics are long gone.

Weight gain after treatment

At the back end of 2017 I was diagnosed with prostate cancer, and the doctors indicated that a prostatectomy would not be a good treatment for me. My cancer was very near my bladder, and one slip of the surgeon’s knife might mean colostomy bangs and all kinds of other horrors.

Instead, I took the hormone and radiotherapy route, which has done what old age and a slowing metabolism failed to do. I’m now hungry most of the time. My “I’m full, I don’t need to eat any more” off switch seems to have been gummed up by the hormone juice, and now I could eat all the time. The pounds have piled on, and my slim 32-inch waist has expanded to something I don’t even want to mention. Read on…