Incurable Prostate Cancer: Alan King tells his story. In May 2008, my GP gave me a digital rectal examination, and reported that, while my prostate was enlarged, this was not unusual for a man of 57. While this did not indicate an immediate cause for concern, she requested that I have a PSA test before leaving the surgery. Within 24 hours, I received a call at work, requesting that I return to the surgery at the earliest opportunity. Upon my return, my worst fears were confirmed. My PSA was 325 and I was referred to a cancer specialist as a matter of urgency. At the first consultation, I was informed that my PSA had risen to 375 and I should have a biopsy. At the second consultation I was told I had advanced prostate cancer with a Gleason score of 5+5 (the Gleason score estimates the prognosis of men with prostate cancer on the basis of the appearance of the cancer cells in the biopsy). My score of 5+5 was about as bad as it could get. The consultant urologist declared in his inimitable fashion that the condition was inoperable: “I’ve removed more prostates than anybody else in the South East and if I thought there was any point in removing yours, I’d have no hesitation in doing so”. He went on to suggest that neither chemotherapy or radiotherapy were viable options and that palliative care was my only realistic future prospect, with a daily dosage of the prostate drug, Casodex 150, helping to maintain quality of life — for the three to five years that he estimated I could expect to remain alive! I expressed surprise that radiotherapy was not an option and he reiterated that he did not consider it beneficial to me, while adding that as I had contended maintaining quality of life was a fundamental consideration, “He had never heard of a man that was capable of an erection following radiotherapy!” To add insult to injury, as he walked away, he shook his head and I heard him whisper, “poor chap”. CT and MRI scans were arranged. When none of these tests demonstrated cancer spread, it was apparent that the urologist was shocked, if not overtly pleased. His parting comment was that he was one of the most experienced in his field and saw no reason to change either his prognosis or treatment pathway, adding only that he would “not be offended if I wanted a second opinion” MOVING FORWARD At this point my emotional and psychological state were such that I was inclined to accept the opinion of this experienced individual and did not proactively seek a second opinion. I had resigned myself to my fate. However, a couple of weeks later, I was advised that a consultant clinical oncologist (Dr Henry Taylor) had expressed an interest in my case. At the consultation with Dr Taylor, he confirmed that the 375 PSA count and 5+5 Gleason score ostensibly painted a very grim picture. However, he also noted that my tumour was not typical as it had spread laterally within the gland. Further, he said that if the Casodex 150 reduced my PSA to 75, he would strongly recommend an intensive course of radiotherapy. Thankfully, by late October 2008, my PSA had fallen to around the 75 mark and Dr Taylor detailed both the potential benefits and risks associated with the radiotherapy regime he was proposing. Given that the risks included double incontinence, while also offering no guarantee of longevity, I must confess that my initial thoughts were to decline radiotherapy, believing that in doing so I may jeopardise the hope of maintaining a reasonable quality of life prior to shuffling off this mortal coil. However, in Dr Taylor I had found someone who was manifestly caring, willing to take on an apparently lost cause, and indeed, not prepared to write me off in such a cavalier manner. He even dared to state that his ultimate goal would be to actually cure me of this horrible condition. This served to rekindle my fighting spirit and I duly agreed to proceed with radiotherapy, completing my course on Christmas Eve, 2008. Thankfully, I did not suffer any significant side effects and, following radiotherapy, my PSA levels dropped steeply over the next few months. However, I was to remain on Casodex 150 and, while it had few side effects, those that I had were quite severe. Most disturbing was the condition colloquially known as ‘mind fog’. I was unable to concentrate or focus and suffered severe short-term memory loss. This was accompanied by a strange sense of detachment, as if I was standing on one side of a veil or obscure screen, while the rest of the world existed on the other side. I was struggling to function normally and was very conscious that my condition prevented me from properly fulfilling my duties at work, effectively rendering me unfit for purpose. This added to my feeling of depression and low self-esteem. I attributed this malaise entirely to Casodex 150 (although I concede that the psychological effect of being told I was inoperable and incurable also had a part to play) and was desperate to come off it. In November 2010 (and much to the consternation of my wife), Dr Taylor agreed to withdraw it, subject to monthly PSA checks and my commitment to its reinstatement if my PSA levels started to rise. INTO THE FUTURE I have now been medication-free for over five years, my PSA checks are quarterly, and my PSA levels are consistently low. While things are much better than I would dare to have dreamed, and I am officially in remission, nobody has yet been able to tell me that I am cured: until they do so, I will continue to categorise myself as living with cancer, rather than as a cancer survivor. The awareness of having cancer never quite goes away, and although I am largely able to consign it to the further recesses of my mind, it insidiously creeps back into my conscious as the date for my next PSA test approaches. But the tests are now only quarterly, I am very much alive and happy. I live life to the full and I remain optimistic that the dark cloud of cancer may yet reveal its silver lining. And finally, I shall finish on a footnote for my favourite consultant urologist: never say never! POSTSCRIPT In April 2016, 8 years after being given a death sentence, Alan ran the London Marathon on behalf of the Prostate Cancer Research Centre, raising over £3500 for research to develop new and better therapy for men with advanced prostate cancer.