Apologies if that seems a bit abrupt. I do though, apparently, have cancer. It got me but hopefully not finally. It’s such a strange illness. We are so very afraid of hearing that we have cancer and yet that very point when we find out is, for so many people, a life saving – not just a life changing – moment. Yet we dread it. More of that later. I turned 60 a few short months ago and though I cannot claim that everything has turned to shit it does seem like quite a lot of me is starting to fail. If a similar set of ailments had beset me last year I might not have seen it in such portentous terms but the fact remains that since April 19th my blood pressure has increased, my ears have filled with wax and I have developed cancer. As I type this I can see what abject nonsense it is. The wax has been building in my ears for years, I just neglected to do anything about it. I have been on mild medication for my blood pressure for well over 10 years now and those cells don’t wait for you to get free prescriptions before they go rogue. Time may be notionally marked by the number of days we have been alive but it’s marks are visible in the decay and decline of our bodies. Ironically I am actually fitter than I have been for many years. I have lost a lot of weight and I do a daily yoga practice. I do breathing exercises – I even tape my mouth shut at night to ensure I breath correctly (through my nose) whilst I am asleep. I am told repeatedly that I don’t look anything like 60 and could easily claim to be a good 10 years younger (if you don’t look too closely!). The body, they say, keeps the score and I am starting to feel like I am losing. Perhaps I will make it to penalties after a rather drab period of extra time. But the big C, seriously?
I should of course have expected such a diagnosis at some point. My mother survived breast cancer earlier in her life but, like her mother before her, died after her second bout metastasised. Her brother fatally succumbed to the same cancer that befell my own father. Dad survived his cancer but died of pneumonia following a short stay in a care home as a result of his developing both vascular dementia and Alzheimers. Something else that I might be in line for – thanks Dad. We are constantly being told that roughly 50% of us – one in every two is how they put it, like we can’t do the maths – will get cancer at some point in our lives. Anne recently had a very rare form of cancer so I rather hoped that might balance out my family history. Perhaps those one-in-a-million cancers don’t fit the standard statistical models. Statistics, though, are abstract cancer is very, very subjective. You either get it or you don’t but when you do it is very much you that does.
In as much as anything can be genetically predictable I was always going to get some sort of cancer. Throw in my history of smoking and periods of relatively heavy drinking I should probably be grateful I have made it this far. I suspect that by now you are either trying to work out which one I have or you have managed to guess based on the evidence presented. There have been a number of well-known people who have died from cancer in recent years. Two Davids come to mind – Bowie and Myers (hairy biker) – neither of whom disclosed what type of cancer they had. I was never quite sure why this was but having just Googled it. It appears we did know that Bowie had liver cancer though he wasn’t aware it was terminal until a couple of months before he died. Myers on the other hand steadfastly refused to name his cancer because he thought everyone would, er Google it (see what I mean) and draw conclusions regarding the state of his health, or rather his lifestyle choices I should imagine. That’s what we do isn’t it? We hear someone has, for instance, liver cancer and we immediately think they must have been a drinker so we ask Dr Google what causes liver cancer and then we worry that we might be next. I haven’t just done that and I don’t know what causes that particular version of the disease (it is drink isn’t it?). We all know the correlation between lung cancer and smoking sufficiently well enough to condemn most people with it as having made their choices and being a drain on the health system because they didn’t have the will power to quit the fags. Here’s the thing though, lots of people get lung cancer and don’t smoke. It really can be very arbitrary. I smoked and didn’t get it. My brother smoked a hell of a lot more than me and, despite losing his leg due to his arteries clogging up, he didn’t get it either. Roy Castle, on the other hand, never smoked a single cigarette in his life and he got lung cancer in his early 60s and died shortly after. When I say he ‘got’ cancer I should really describe it differently. Cancer, unlike many diseases isn’t ‘out there’ waiting for us to come along and get infected by it. Cancerous cells form inside our bodies alongside perfectly healthy cells and whilst doctors are able to identify what are the likely causes for these cells to go rogue and behave in the way they do they cannot, with any great certainty, predict who, when, where or how they will. It could be you. It is me. The point is this is a process that starts in your body and develops in your body. You don’t know when it begins, if you are lucky you might find out early enough to do something about it. Sadly, many people don’t discover what is going on until it is too late.
I have found out early that I have prostate cancer (PC). I am writing this 6 weeks after going to the doctor for my annual blood checks and asking them to check for the possibility of PC due to some urgency developing around my nocturnal calls of nature whilst we were away in the van. In that time I have had an rectal examination, an MRI scan and a local anaesthetic transperineal prostate biopsy (LATP). Most recently I saw on my medical records the letter sent from the urologist to my GP detailing my particular cancer status and I am scheduled to discuss my treatment options with said urologist tomorrow morning. I have deliberately written this today because, whilst I am aware of the various routes I could take next on my Cancer Pathway (as it is called), I need to talk them through with someone who knows what they are talking about. I have shared some details (but, trust me, spared you some of the more harrowing ones) along the way with my family and friends and I have found a good source of solace and support on the PC board in a forum of my fellow supporters of Manchester City FC. In there many men have shared something of their own ‘journey’ and it has been good to know that I am not alone in this, not that I ever really felt I was. It is ultimately, though, my prostate that has some cancerous growth in it and it will be my decision how I deal with it.
A common response to a cancer diagnosis is to come out fighting. We go into battle, we don’t let it defeat us. But what are we supposed to be fighting? This is part of me, not a part I necessarily want but it is still me. I haven’t been invaded. I was genetically disposed to some mutation or other occurring at some point and it has. I’m not angry – where would I go with that? Do I blame my parents? God? I don’t think so, my parents had no idea this would happen (it hasn’t happened to either of my older siblings btw) and even if God existed I doubt he would be terribly arsed about my prostate. So if I’m not getting angry and fighting what am I doing? Surrendering? Accepting? Brokering some kind of peace? Yes, all of the above really. I have this bit of me that if left unchecked could kill me but it isn’t unchecked. It has my attention but not all of it. I am already making accommodations for it, I am dealing with the fact that I have cancer the best way I am able given the information I have. Tomorrow I will have more information and I will be better able to deal with it. If I ultimately knew everything there is to know about what this type of cancer does in a man of my age I would still not know precisely what my cancer is doing to me.
Does knowing more actually help me here? I have recently been told that, based on my lifestyle and certain markers in my blood and biology, I have a 10.4% chance that, in the next 10 years, I might suffer some sort of heart related condition that might not kill me but probably will present me with a (potentially) life changing impairment. Because the number is 10.4 and not 9.9 I am being offered some medical intervention that might reduce my chances (below 10). This is certainly information but I am struggling to understand its importance. Of course, I don’t want to die prematurely and I don’t want to live my final years struggling with a serious, or indeed any, disability. I especially don’t want to have brought these possibilities about because I chose to negligence over intervention. But what am I actually being offered here? I might be able to reduce my chances of possibly suffering something sometime in the future. I cannot entirely eliminate the risk. I get that, short of terminating myself, there are no guarantees, but the level of risk seems fairly low now and I might just make it a little lower. And at the same time I have cancer. It could almost be described as AI – artificial information. Life comes with the inherent certainty that it will end. Knowing that end will almost certainly come rather sooner if I step in front of a bus is easier to understand, and avoid, than the potential risk that I might kill myself in 10 years if I over-butter my crumpet. I don’t blame them for telling me but I don’t want to be made to feel guilty if I ignore them, given the rather scant nature of the information.
All of which brings me back to my cancer. I started writing this some weeks ago and I have now had my consultants appointment and I have been made aware of the options that present themselves given the profile of my specific ‘malignant tumour of prostate’ (as my health record describes it). Basically, I have 3 potential courses of ‘action’. I could have a radical prostatectomy, radical radiotherapy of active surveillance. The first two ‘radical’ treatments do offer a potentially cancer free future. The tumour is localised in my prostate still so its removal should be the end of it. Similarly if I elected to zap it away with radiation that should also see me rid of it. Both treatments, however, are not without their potential side effects, none of which sound particularly pleasant.
I have decided to live with this and gone on active surveillance. It is curious I chose the only option that isn’t described as radical and yet when I tell people it feels like I am regarded as a bit extreme and revolutionary. Of course, in a medical sense, this refers to the latin derivation of radical as ‘root’ and the removal of the prostate (in this case) is akin to removing, in a gardening context, both the weed and it’s roots to ensure it doesn’t grow back again.
The next step is a blood test in December and then, depending on the results, nothing more for another 3 months or a scan, biopsy etc. and more decisions. I have been told that some people start out on the same path as me but then find that the knowledge that they have cancer in their bodies becomes overwhelming and they select one of the treatments. I might well end up doing the same but it doesn’t feel like that now. I feel content to live with my cancer and to see how it develops and how, in turn, I am changed by its presence. We are all of us constantly changing and it is a source of both pleasure and pain, but mostly indifference. Impermanence is, ironically, baked into our experience of life. I didn’t have cancer and now I do and I may well get more or rid myself of what I have. My blood pressure will rise and fall, my cholesterol will probably get worse. My muscles will start to fail as could my mind. I will decay and I will decline but, for now, I will just get on with things and try not to think too much about it.