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

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…

Pausing or Quitting Prostate Cancer Treatment

How do you know when it might be right to pause your cancer treatment? And an even bigger question to follow: How do you know when it’s time to quit treatment altogether? Before I continue, let me just say for those whom this might concern, I’m not about to be packed off on a one-way trip to a hospice; well, not anytime soon, I hope.

Considering pausing treatment

Pausing cancer treatment has been on my mind. As of my writing this, there’s nothing to pause, as I’m currently not undergoing any therapy. Soon I’ll be having my next PSA test, which rolls around every six months. For around the last 18 months, my PSA has stood at a highly desirable 0.03 and long may it remain that way.

The reason mildly-anxious thoughts have been occupying my mind is that my last hormone injection was way back in August 2020, and little by little the side effects have started to depart. My interest in sex is back, the hot flashes have gone, and something like normal life is starting to return. And you know what? I like it!

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.

Speak Up About Your Mental Health

By the time you read this, Movember will have been in the rear-view mirror. Did you grow a mustache to raise money to help beat prostate or testicular cancer? The focus on ProstateCancer.net last Movember was not so much on physical ailments but rather on men’s mental health issues.

A whole slew of fellow correspondents wrote moving articles on this website about mental health issues. They took many themes, but if there was one overarching message, it was the importance of speaking up and telling people you have concerns about your mental health.

Difficulty talking about mental health

I’ve had various brushes with my mental health, which we will get to in a moment, but talking with my wife, she asked if my male friends and I ever discussed this topic among ourselves. She and her girlfriends regularly enquire and check up on each other’s health both mental and physical. I’m very open about my cancer, and my friends do ask me about it. But discussing our mental health is not high on the agenda when we get together.

Read on…

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…