Cancer like a silence grows. That’s why I like to talk about it, even to the point of oversharing. Last July I wrote about the first anniversary of my diagnosis and now the second anniversary is upon me. They say the sequel is never as good as the original, but it has been another great year despite the odd setback. This time last summer I felt I’d found a kind of equilibrium. I was still dealing with side effects: tiredness and bone pain, low-level background anxiety, chemo-induced neuropathy, brain fog. And the side effects from the hormone therapy, physical and emotional changes. But leaving these aside, I felt positive. My working life was coming to an end. I had more time to spend with my wife Dini and our grandkids, and we took some great trips, including our first visit to Ireland as Irish citizens. I was finding it easier to take pleasure in small achievements. In August a wee girl fell in the pond in our local park unseen by anyone else, and as I waded in to rescue her I had a fleeting thought: maybe I’ve been spared to do this one thing. The butterfly effect.
At the end of September I retired from the University of Glasgow after 30 years. I had no regrets about retiring, especially now that I was settling into a routine and had a good fitness regime going, something I could never have done while I was working. I spoke to a senior colleague many years ago who talked about ‘stopping distance’, and how you have to slow down in the months and years leading up to retirement – advice he never took himself – but this condition has made it easy for me to let go of my working life.
Among the first fruits of my retirement was a trip to Spain with my brother John. We had talked for years about making a visit to Salamanca, where our father was imprisoned in 1937 after his capture at the Battle of Jarama while fighting with the International Brigades. The trip would never have happened if it hadn’t been for the cancer lighting a fire under me and the burden of work being lifted off my shoulders.
In November I embarked on a course at Maggie’s cancer care centre called ‘Where Now?’ designed to provide guidance on next steps after treatment, aspects such as emotional well-being and managing side-effects, healthy nutrition and exercise. It was another thing I couldn’t have done while working, as it involved a regular commitment over a six-week period. The expert input from Maggie’s staff proved invaluable but what resonated most with me was the chance to share experiences with my new cancer comrades, my Maggie’s mates. By the time the course finished I felt ready for whatever lay ahead. Which was just as well.
On the 26th of November, I had what I thought was a routine telephone appointment lined up with the oncologist, but at the last minute I was told to attend in person. I was on my own, and that felt odd, because usually Dini accompanied me to in-person appointments. The oncologist asked me how I felt, and I gave my standard reply: ‘Fantastic!’ It was an honest answer, because at that time I was relatively pain-free, mobile, eating well, sleeping well, and exercising every day, doing weight training to ward off the risk of osteoporosis and fractures that comes from being on ADT (Androgen Deprivation Treatment). The doctor’s response was ‘I’m surprised to hear that.’ My recent blood tests, he said, had raised concerns about a discrepancy between the successful suppression of my testosterone by the ADT, and a steady rise in my PSA (Prostate Specific Antigen). This was likely to mean that the cancer was spreading. My PSA was actually doubling, albeit from a relatively low starting point in the wake of the chemo and hormone therapy. Maybe it was psychosomatic, but right after that appointment I started to feel pains in my back.
If clutching at straws was an Olympic event I’d win the Gold Medal. After that appointment I clung to a couple of things that could have some bearing on the upward trend in my PSA. When I’d seen the oncologist I was just two days away from my new 3-monthly ADT injection, so I was at the end of the last cycle; maybe this could explain the hike. And I was using a topical steroid cream to alleviate a skin problem. I’d read somewhere that such creams could raise PSA. I mentioned these things to the oncologist. He shook his head. I was lined up for some urgent scans and tests: a nuclear medicine bone scan, a CT scan, and further blood tests. Once all the results were in I was given an appointment for Christmas Eve.
While this was going on, Beatson physiotherapist Katie Booth put me in touch with Medical Illustration Services at Glasgow Royal Infirmary. She had suggested me as a narrator for a new public information film entitled ‘Physical Activity and Strength Training Whilst on Hormone Therapy for Prostate Cancer’. It was a welcome diversion, and I was glad to be making a small contribution to wider awareness of the disease and its treatment.
Early in December I read Chris Hoy’s brilliant book, All That Matters, about his first year with metastatic prostate cancer. He was diagnosed at the same time as me with the same form of the disease – stage 4, incurable, inoperable, terminal – and the same prognosis – 3 or 4 years. It turns out we went through chemo at the same time, finishing that course of treatment in March of last year. There the comparison ends, of course. Chris Hoy, Olympic gold medallist, was only 47 when diagnosed and has two young children, so his story has a particular poignancy and intensity. I appreciated his directness and the details of his thoughts and feelings after the diagnosis, how difficult he found it to tell people – much harder for him of course, as he had to tell his kids too, as well as the public eventually.
The most compelling aspect of Hoy’s memoir for me was the message of hope, and his stress on the value of living in the here-and-now. I’d recommend his book to anyone facing cancer or chemotherapy, or with family and friends facing it, though I’d caution against letting his alarming account of chemo instil trepidation. Every cancer is different, and as Hoy himself acknowledges, ‘Chemotherapy is different for every single person who goes through it.’ I sailed through my chemo, and I watched others do the same, chatting, reading, listening to music, looking out the window, one person even doing their business on the phone. I was lucky in that respect.
On Christmas Eve I went along to the Beatson to get the results of my various scans, with Dini at my side to take notes. The fears raised a few weeks earlier were confirmed: the treatment had failed, and the cancer had spread to my left arm, pelvis, and another part of my spine. This wasn’t the Christmas present I was hoping for. The treatment that had failed – ‘Triplet Therapy’, the gold standard for my condition – was supposed to buy me 3 or 4 years. My cancer had become ‘castration-resistant’, much more quickly than expected. I didn’t know whether to be proud or ashamed. Me and my cancer – Captain Howdy – had been co-habiting for a couple of years. We had a deal, an accommodation. Our little arrangement was that he’d hang around my spine and bide his time and I’d get on with my life as best I could, but he’d reneged on the deal.
January brought better news as I was thrown another lifeline. I had a call from the oncologist to say that the application for a new drug had been approved. I was to be offered a treatment even more pioneering than the last, called Lutetium-177 (aka Pluvicto), a radioactive isotope that targets the cancer cells directly, more so than the chemo. Some people call it ‘that treatment the guy from Duran Duran got’, in reference to John Taylor, who hailed it as a miracle. This trailblazing treatment would be delivered in six sessions over a seven- or eight-month period.
On Thursday the 13th of February I gave a short talk at the West of Scotland Cancer Prehabilitation Education & Engagement Event. The venue was the Sir Chris Hoy Velodrome/Emirates Arena. I spoke about my own experience and the challenges I faced, and about the benefits of exercise, specifically weight training. While I was talking there was an image on the screen behind me that had been left up by the previous speaker, Katie Booth. I had no idea this slide was about me till I zoomed in later on a photograph someone had taken at the time and saw that it was a graphic summary of my case notes from the previous February, and contained medical information that was news to me. The HPC (History of Presenting Complaint) laid out the bones of my skeletal metastasis in medical shorthand: ‘63yo male with T4 N1 M1b high risk high burden Gleason 5+5=10 carcinoma of prostate with bone mets (eg. Thoracic and Lumbar spine, sternum, proximal left humerus, sacrum, innominate bones and proximal left femur).’

That was a lot to take in, and I was glad to be getting another chance to lighten the burden. On the 31st of March my new treatment started. The radioactive isotope is administered intravenously. I was kept in overnight at the Beatson for monitoring after the first infusion, but will get the remaining doses as a day patient in the Nuclear Medicine Department at Gartnavel Hospital. The staff there are wonderful. There are no significant side effects so far. I have to shield after each session as it makes me radioactive, but COVID has made that kind of social distancing manageable. After each session a Geiger counter measures my radioactivity, then I get a bone scan during which I usually nod off. Bliss. For a week or so after the injection Dini and I need to sleep separately and keep a metre apart at all times. I can’t be in the presence of the grandchildren during that period, which is hard. And I have a letter of explanation in case I set off alarms if I go through airport scanners.

Lutetium-177 is given rarely, and currently only to those who have already gone through chemo and whose cancer has become castration-resistant. I feel lucky to have been given another chance. I’m calling it the lock-in after last orders at the bar, or maybe it’s the second wind that runners get, or, to use another sporting analogy, I am into Fergie Time. I’m hoping that this new treatment will give me another year, or three, or four, or more.

At the end of March I got an email from a friend who’d had a PSA test at my urging, one of several men I’ve sent to the doctors, some of whose checkups have resulted in ‘watch and wait’ guidance, or radiology, or in one case a prostatectomy. The writer of this email had got an amber light at an early stage, and was grateful to me for nudging him towards the doctor. He ended his message with. ‘So, maybe I’m another little girl you saved from drowning.’
In May I gave a short presentation at Cameron House, Loch Lomond, as part of a fundraising event for Maggie’s. That place has been a vital resource, giving me a boost of strength and support whenever I’ve needed it, as well as laughter during our fitness classes as we dance along to classics like ‘Kentucky Fried Chicken and a Pizza Hut’. Fast food is not part of my cancer-busting diet, but that daft song gave me an idea then for a fundraising event, a sponsored marathon disco called ‘Cancer Ya Dancer!’, which I’m told may well happen.

They say there are four stages to Stage 4 cancer: diagnosis, denial, defiance and death. I’m still at the defiance stage, and I realise denial never goes away. We can’t imagine our own death, even if we try to mimic it like kids do, lying on a mat and trying not to breathe. I was talking to someone recently who mentioned that he taught ‘death yoga’ and that struck a chord. The term was new to me, but as he spoke about what this activity entailed I realised I’d actually been practising it for the past two years. ‘Shavasana’, or Corpse Pose, a posture that stretches back to the fifteenth century, has been part of my daily routine since my diagnosis. I lie flat on my back, arms outstretched, and contemplate my own death, slowly letting go of any fears I might have, and embracing the silence. I may study for a black belt.