UPDATE - Issue 32 - Winter 2008
The Silent Killer
Hamish Marett-Crosby, who was diagnosed with prostate cancer just before Christmas 2006, looks back on a troubled 2007.
'This is surreal,' I thought. There I was lying back, looking up at the ceiling and - as I had missed both meals that day - munching a cheese roll. Further to the south, as it were, two young women were fiddling about between my thighs. In fact, they were attaching 22 leads linking me to a machine that was going to, and I quote: 'Sort me out.' All this was happening in the basement of the University College Hospital and I was undergoing a new procedure for dealing with aggressive prostate cancer. But I must start at the beginning.
'I have cancer,' I woke up saying to myself the day after the diagnosis came through. Cancer! Like winning the lottery, it's something that happens to other people.
'This is the time when support is essential
This is the time when support is essential because one can feel very, very low. I have that support. I am lucky.
I am also lucky in working in a radio news room. There are good jokes, bad jokes, scandalous gossip and the necessity of maintaining an on-air persona. All this is excellent therapy, you have neither the time nor the opportunity to feel sorry for yourself.
Of the various options for treating the disease, surgery and standard brachytherapy were out. It was too late, the cancer had spread. As a result High Dose Rate (HDR) brachytherapy was decided on, preceded by a nine-month course of hormone blocking drugs to shrink and starve the main tumour and minimise the other nodules that had spread from the prostate.
''Why are you crying'
The hormone treatment worked in reducing the cancer but also had two bizarre side effects. I would get the occasional hot flush (no sympathy from my older women friends) and it also made me very weepy. 'Why are you crying' my grand-daughter would ask as I struggled to the end of The Selfish Giant. 'Because it's sad,' I would reply brokenly as the tears rolled down.
Luck had brought me to consultant oncologist Dr. Heather Payne. She is in the vanguard of developing HDR treatment in the UK.
'I can't guarantee a cure, Hamish,' Heather said, 'but it's the best chance you are going to have.? Simple, straightforward and direct, the best way to encourage confidence.
Now to answer the obvious question. The treatment is invasive and unpleasant but not unbearable. Two days of lying down flat on your back with your legs propped up and with a load of needles in you is very uncomfortable, but nothing if one considers the alternative.
'We've burnt out that tumour of yours,' said Heather as I was discharged. It has been a text book case. It looks beautiful,' said this remarkable woman who can see beauty in a prostate.
It is too soon to be one hundred per cent sure, but I think I have been sorted out.
Hamish's brachytherapy explained
Dr Heather Payne writes: High Dose Rate (HDR) temporary brachytherapy is a form of high dose radiotherapy. It is different to low dose rate (LDR) iodine seed brachytherapy which is a treatment option for early, non aggressive prostate cancer and involves small radioactive seeds that are permanently inserted into the prostate gland.
HDR can be indicated for some men with locally advanced or high risk prostate cancer (Gleason Grade>8 or PSA>20) who may benefit most from these higher doses of radiation. HDR is often given as a boost in combination with 4 - 5 weeks of external beam irradiation in order to give higher doses of radiotherapy to the prostate and seminal vesicles than would be possible with external beam treatment alone and minimise the dose to the surrounding healthy tissues (bladder and bowel).
The procedure involves a stay in hospital for a few days. Hollow flexible needles are inserted into the prostate under anaesthetic. A computer controlled brachytherapy machine then pushes a single high dose rate radioactive iridium wire into the needles for a few minutes for two or three treatments. The treatments are given over one to two days. The iridium source is removed in between the therapies but the hollow needles stay inside the prostate until the last treatment session is completed. The patient is not radioactive. This treatment is generally well tolerated and the long term side effects are similar to external beam radiotherapy.