Category: Guy’s Cancer Centre

Putting the Freeze on Cancer With Cryotherapy

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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…

Calling time

Posted in Cancer, Guy's Cancer Centre, Hormone therapy, Prostate Cancer, RadiotherapyLeave a comment

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.

Prostate Cancer Screening At A Supermarket

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It sounds like science fiction, but according to Mark Emberton, Professor of Interventional Oncology at University College London, prostate cancer screening could be coming to a supermarket near you.

10-minute scans

Professor Emberton is in charge of a clinical study which he’s hoping will transform prostate cancer screening. The $6.5 million trial, which started in August of 2019, stalled in the spring because of covid, but is now back on track. His team is looking at scans that take only ten minutes, which could potentially be rolled out to the general population.

I sat down with Mark to hear about his work.

Prostate cancer screening difficulties

In the UK, there are only a few nationwide screening programs, including breast cancer for women and bowel cancer for men.1 Prostate cancer is now the most-commonly diagnosed cancer in England, but nationwide screening has proved elusive, as it has such a poor diagnostic record.2

Traditionally, tests start with a digital exam followed by a PSA blood test, neither of which are particularly accurate or trustworthy. Around 75% of men with high PSA levels don’t have cancer, but about 15% with normal PSA levels actually do.3,4 I should know: when I was diagnosed with a malignant tumor, my PSA stood at just 5.03.

Read on.

Zoom call with the grim reaper

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Well of course it wasn’t with the grim reaper, death is always reluctant to take calls, but it was with a friend who before too long is booked in for a consultation with the scythe-wielding, black-cloaked spoilsport. I may be pushing the analogy a little far, but you could say the grim reaper was hovering in the background.

An honest conversation with a good friend

My friend, an artist who I’ve known for many years, isn’t sure how long he’s got but isn’t expecting to host a birthday party next year. At 88 he’s in pretty good spirits and has enjoyed a full and vigorous life. Make no mistake though, his departure will leave a big hole in the lives of many. Shakespeare has a line in Anthony and Cleopatra: “Make death proud to take us.” Death should be honoured to take this proud man. Read on.

Proton Beam Therapy: A Survivor’s Story

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Proton beam therapy is a hot discussion topic in this community and when I received an interesting note from Vickie about her partner’s proton experience, I knew I wanted to dig in and find out more.

What is proton beam therapy?

In very simple terms proton therapy is a type of radiation therapy that uses targeted beams of high-energy particles. It’s used to combat various forms of cancer particularly in children where cancer is located close to vital organs. The claims made for it are that it’s less likely to damage other organs and produces fewer side effects.

At first glance, it looks like a no-brainer, what could be better than a treatment that whacks the cancer and leaves the healthy organs intact?Unfortunately, it’s not that simple and the jury is out as to how effective proton therapy is at combatting prostate cancer. Read on…

Prostate Cancer is Top of the (Medical) Charts

Posted in Cancer, Guy's Cancer Centre, NHS, Prostate Cancer, RadiotherapyLeave a comment

Just this spring, we got the unwelcome news that prostate cancer is now the most commonly diagnosed cancer here in the UK. Men, we are top of the charts, though admittedly on one of the unlovliest hit parades in the world.

I may be clutching at straws, but there is an upside to this because it means many more men are coming forward to get tested and as we know; catch cancer early and your chances of survival look a whole lot better.

Everyone in the UK over 55 is screened for bowel cancer every two years, but there’s no such screening for prostate cancer because detecting it is so problematic. The PSA test just isn’t accurate enough for national screening.

I’m a case in point, when I was diagnosed with a sizable tumor in my prostate with a Gleason score of 4+3=7, my PSA was still only 5.03 which is barely above normal. We need better tests and right now a lot of work is being put into a pre-biopsy MRI scan. Read on…

This Year I Finally Got a White Christmas

Posted in Cancer, Guy's Cancer Centre, Prostate Cancer1 Comment

It wasn’t just Bing Crosby who dreamt of a White Christmas. To this day my daughter bemoans the fact that as we live in the city center, we almost never get snow and have only ever seen two White Christmases.

I thought my prostate cancer recovery was going well

Even those of you who are entirely ‘Bah! Humbug’ about Christmas must admit that for about 30 minutes when the snowflakes fall a kind of magic happens and even the ugliest places are beautified. Admittedly after that half hour is up, the snow turns to a grimy slush, but I’ll settle for a few minutes of crystal white wonder, particularly on Christmas Day

Well, this year I got a White Christmas, but as the eagle-eyed among you will have spotted this sentence starts in the first person singular and not the third person plural — all will be explained.

Read on…

My number’s up

Posted in Cancer, Guy's Cancer Centre, NHS, Prostate Cancer, Radiotherapy2 Comments

Ok calm down I’m not about to peg out, but I’ve just discovered that my PSA reading is up rather than on the smooth glide path down that I was counting on. I was at my quarterly meeting with the oncologist at Guy’s Cancer Centre when I was given the unwelcome news that the Unwelcome Guest has made a slight return.

But let’s put this into some perspective. The PSA blood test is a notoriously crude measurement but just about the only means available to check the state of prostate cancer particularly post-prostatectomy or in my case post-radiotherapy.

When the Unwelcome Guest was first diagnosed, my PSA level stood at 5.03. I was then put on hormone therapy and the dive down started. Within a month my PSA stood at 2.61. Six months later, in June, it was 0.8. Following radiotherapy last Autumn, a test in December revealed my PSA to be virtually undetectable at 0.07.

For it to be entirely undetectable it has to fall to 0.03 or lower and that of course was what I was hoping for, but the Unwelcome Guest had other ideas. Now I’m told the little bugger has bounced back up ever so slightly to 0.1. In itself this may not be serious, and doctors recognise something called the PSA bounce, with the numbers fluctuating, following radiotherapy. Hopefully this will correct itself, but if it continues to climb and were it to reach 2.0 then other medical options would have to be explored.

I can’t deny this was something of a shock as I was pretty convinced that while still on hormone therapy and following radiotherapy to misquote Yazz and The Plastic Population ‘The only way was down.’ But that’s the Unwelcome Guest for you; full of little surprises.

Prostate cancer that comes back is called a recurrence and happens in 1 in 3 men after treatment for early prostate cancer, but we are a long way from that and anyway if those are the odds on the table I’ll take ‘em.

My next appointment at Guy’s cancer theme park is in September and as you might imagine I’ll be paying pretty close attention to the scores on the doors. In the meantime, I’ll be doing what I’ve learnt to do since Autumn 2017 when I was diagnosed and live in the moment. Nothing bad is going to happen to me in the short term, we have a wonderful holiday to look forward to and then come September we’ll take a look at the lay of the land.

The war on cancer

Last week the newspapers were back to declaring war on cancer. Let’s hope it’s more successful than the war on terror. But this was welcome news; a new cancer hub known as the Institute for Cancer Research (ICR) is set to be located in south London close to the Royal Marsden Hospital. Researchers there will look at new ways to stop cancer cells from evolving and resisting chemotherapy. One of their goals is to ‘herd’ cells together and stop them from flourishing much in the way that drugs now control HIV. They are calling it the world’s first Darwinian drug discovery programme.

Senior scientists at the ICR argue that the traditional use of ‘shock and awe’ chemotherapy against cancer has failed because too often it has helped fuel ‘survival of the nastiest’ competition and evolution among cancer cells.

Dr Olivia Rossanese, head of biology, said: “We’re especially excited by the potential of APOBEC inhibitors, to slow down evolutionary diversity and drug resistance, and ensure our existing cancer drugs work for patients for much longer.”

Inhibitors are being designed to stop the action of a molecule called APOBEC to reduce the rate of mutation in cancer cells, slow down evolution and delay resistance. These drugs should become available within the next ten years.

Loss of confidence

Posted in Cancer, Guy's Cancer Centre, NHS, Prostate Cancer, Radiotherapy, St Thomas' Hospital4 Comments

By nature, I normally combine brutal confidence with a sunny disposition and a relatively good perception of my strengths and faults. As the French say, I’m comfortable in my skin. (Though they generally say it in French)

Recently that confidence seems to have taken a hit and initially I blamed the Unwelcome Guest.

When people learn you’ve got cancer, they immediately think you’re going to die and even if you’re not headed straight to the departure lounge, they tend to assume you spend all your time thinking about your mortality or lack of it.

Cancer changes people’s perception. Someone once said we all carry three words in our head to describe people we know. Whatever those three words are when people think of me, I’m pretty sure one of them is now cancer. I suspect this leads some to think I’m diminished in some way and unlikely to perform my job as effectively or be a generally high-functioning member of society. Cancer also coshes humour, stuffs it in a burlap sack and throws it overboard.

I’ve been too blessed in my life ever to be a victim and I’ll be damned if cancer is going to make me one now, but dealing with cancer is odd for those who’ve contracted it and for those who come into contact with it who are mostly thinking, thank God it’s not me. Cancer can be like water on limestone, a slow drip-drip of confidence erosion.

Part of my job is to get on my hind legs and talk to groups of people who then benefit from my enormous wisdom. Lucky sods. Unlike Mrs Preen who hates giving talks, I quite like it. If you haven’t already guessed, I’m a bit of a show-off.

Part of my cancer treatment is getting quarterly hormone shots which gives me a small insight as to what menopausal women have to endure. In short, I get hot flushes, flashes and sweats. A week or so after my first shot I was at a meeting at the Natural History Museum when suddenly, out of nowhere, I’m in a muck sweat. High temperatures seem to trigger these events and the summer is definitely worse but whatever the ambient temperature, I start leaking at least five times a day.

This is uncomfortable, unpleasant, but as I’ve said elsewhere if this is what it takes to boot out the Unwelcome Guest then so be it. No sweat you might say, but it’s not so great when it happens when giving a presentation to clients. Suddenly I’m melting in front of their eyes and I can see it’s as uncomfortable for them as it is for me. They’re thinking Jim’s either as nervous as a first date or having a heart attack, whatever their thoughts, dripping sweat from the eyebrows is not a great look.

On a more banal level, I’m also a bit Mutt & Jeff – too much loud rock & roll from a young age is the culprit there. Being hard of hearing also tends to sap one’s confidence, as if you don’t catch what people say, you just appear thick.

Don’t get me wrong this loss of confidence is by no means terminal and most days I’m just as arrogant, self-assured and opinionated as ever, but it does tend to gnaw.

As much as I’d like to blame the Unwelcome Guest for this intermittent confidence outage it might be as much about old age as cancer. I hit 65 this year, which in a peculiar way I’m quite looking forward to. My last socially significant birthday was 21 and that’s 44 years ago. Here comes retirement age, though I have absolutely no intention of retiring as I’ve always associated retirement with death. My Dad retired at 60 and was dead in eighteen months.

I may not be able to run as fast as I could, getting up from kneeling down requires a herculean effort and my prostate is shot, but I’m taking comfort in the words of PJ O’ Rourke: ‘Age and guile beat youth, innocence, and a bad haircut.’

Unwelcome Guest in arse kicking sensation

Posted in Cancer, Guy's Cancer Centre, NHS, Prostate Cancer, Radiotherapy, St Thomas' Hospital, Tomotherapy7 Comments

The Brexit box-set psychodrama seems to be reaching the season finale, but let’s forget about that and concentrate on good news. I am now officially the James Bond of prostate cancer – my PSA level is 0.07.

Yesterday’s appointment with the oncologist, following two months of radiotherapy and a year on hormone therapy, revealed my PSA level to be ‘virtually undetectable’. Take that Unwelcome Guest, you now almost don’t exist.

To complete the Unwelcome Guest arse-booting contest my PSA level needs to be 0.03 or lower. Then it is undetectable and, for a while at least, I join the NED club. (No evidence of disease)

Now I know the Guest might already be planning a come-back tour but right now the NHS seems to have bested the little bastard. So first a big PHEW from me and then a huge thank you to all the wonderful urologists, oncologists, radiotherapists, GPs and nurses who have nursed me through this horrible twelve months. Without exception they have been splendid, caring and often funny. Who can forget the time I told a doctor that cancer had come as a shock as both my parents had died from heart disease, only for him to reply: ‘Don’t worry Jim, you’re still way more likely to die from a heart attack’. Such comfort.

So what now? I still have two years of unlovely hormone therapy to endure. I’m aware that some find this therapy truly horrible, and while I’m not crazy about it, if this is what it takes to be rid of the Guest then I’m in. I’ll see the oncologist every four months and hopefully my PSA level will decline still further. If it were to rise above two, that would be a cause for concern and would require further treatment.

I’m aware this game isn’t over, but neither is it game over. With one bound Jim was free to fight another day. I’m seriously considering having a couple of light ales this evening.

Prostate Cancer UK

Anybody reading this blog in the UK who has prostate cancer will almost certainly know about Prostate Cancer UK. This is their mission statement:

‘Prostate Cancer UK has a simple ambition – to stop men dying from prostate cancer. Through shifting the science over the next 10 years to focus on radical improvements in diagnosis, treatment, prevention, and support, we will stop prostate cancer being a killer.’

I’ve just been doing some copy editing for their website, which is an excellent resource that answers many of the questions both sufferers and their families may have about this pernicious disease. You can get your Man of Men charity pin from them too. Check out the website, if you haven’t already, and support a worthy cause.