I have prostate cancer. But I am happy | George Monbiot

The three principles that define a good life will protect me from despair, says Guardian columnist George Monbiot

It came, as these things often do, like a gunshot on a quiet street: shocking and disorienting. In early December, my urine turned brown. The following day I felt feverish and found it hard to pee. I soon realised I had a urinary tract infection. It was unpleasant, but seemed to be no big deal. Now I know that it might havesavedmy life.

The doctor told me this infection was unusual in a man of my age, and hinted at an underlying condition. So I had a blood test, which revealed that my prostate-specific antigen (PSA) levels were off the scale. An MRI scan and a mortifying biopsy confirmed my suspicions. Prostate cancer: all the smart young men have itthisseason.

On Monday, I go into surgery. The prostate gland is buried deep in the body, so removing it is a major operation: there are six entry points and it takes four hours. The procedure will hack at the roots of my manhood. Because of the damage that will be caused to the surrounding nerves, theres a high risk of permanent erectile dysfunction. Because the urethra needs to be cut and reattached to the bladder, I will almost certainly suffer urinary incontinence for a few months, and possibly permanently. Because the removal of part of the urethra retracts the penis, it appears to shrink, at least until it can be stretched back into shape.

I was offered a choice: radical surgery or brachytherapy. This means implanting radioactive seeds in the parts of the prostate affected by cancer. Brachytherapy has fewer side effects, and recovery is much faster. But theres a catch. If it fails to eliminate the cancer, theres nothing more that can be done. This treatment sticks the prostate gland to the bowel and bladder, making surgery extremely difficult. Once youve had one dose of radiation, they wont give you another. I was told that the chances of brachytherapy working in my case were between 70 and 80%. The odds were worse, in other words, than playing Russian roulette (which, with one bullet in a six-chambered revolver, gives you 83%). Though I have a tendency to embrace risk, this was not an attractive option.

It would be easy to curse my luck and start to ask, Why me? I have never smoked and hardly drink; I have a ridiculously healthy diet and follow a severe fitness regime. Im 20 or 30 years younger than most of the men I see in the waiting rooms. In other words, I would have had a lower risk of prostate cancer only if I had been female. And yet I am happy. In fact, Im happier than I was before my diagnosis. How can this be?

The reason is that Ive sought to apply the three principles which, I believe, sit at the heart of a good life. The first is the most important: imagine how much worse it could be, rather than how much better.

When you are diagnosed with prostate cancer, your condition is ranked on the Gleason Score, which measures its level of aggression. Mine is graded at seven out of 10. But this doesnt tell me where I stand in general. I needed another index to assess the severity of my condition, so I invented one: the Shitstorm Scale. How does my situation compare to those of people I know, who contend with other medical problems or family tragedies? How does it compare to what might have been, had the cancer not been caught while it was still apparently confined to the prostate gland? How does it compare to innumerable other disasters that could have befallen me?

When I completed the exercise, I realised that this bad luck, far from being a cause of woe, is a reminder of how lucky I am. I have the love of my family and friends. I have the support of those with whom I work. I have the NHS. My Shitstorm Score is a mere two out of 10.

The tragedy of our times is that, rather than apply the most useful of English proverbs cheer up, it could be worse we are constantly induced to imagine how much better things could be. The rich lists and power lists with which the newspapers are filled, our wall-to-wall celebrity culture, the invidious billions spent on marketing and advertising, create an infrastructure of comparison that ensures we see ourselves as deprived of what others possess. It is a formula for misery.

The second principle is this: change what you can change, accept what you cant. This is not a formula for passivity Ive spent my working life trying to alter outcomes that might have seemed immovable to other people. The theme of my latest book is that political failure is, at heart, a failure of imagination. But sometimes we simply have to accept an obstacle as insuperable. Fatalism in these circumstances is protective. I accept that my lap is in the lap of the gods.

So I will not rage against the morbidity this surgery might cause. I wont find myself following Groucho Marx who, at the age of 81, magnificently lamented: Im going to Iowa to collect an award. Then Im appearing at Carnegie Hall, its sold out. Then Im sailing to France to pick up an honour from the French government. Id give it all up for one erection. And today theres Viagra.

The third principle is this: do not let fear rule your life. Fear hems us in, stops us from thinking clearly, and prevents us from either challenging oppression or engaging calmly with the impersonal fates. When I was told that this operation had an 80% chance of success, my first thought was thats roughly the same as one of my kayaking trips. And about twice as good as the chance of emerging from those investigations in West Papua and the Amazon.

There are, I believe, three steps to overcoming fear: name it, normalise it, socialise it. For too long, cancer has been locked in the drawer labelled Things We Dont Talk About. When we call it the Big C, it becomes, as the term suggests, not smaller, but larger in our minds. He Who Must Not Be Named is diminished by being identified, and diminished further when he becomes a topic of daily conversation.

The super-volunteer Jeanne Chattoe, whom I interviewed recently for another column, reminded me that, just 25 years ago, breast cancer was a taboo subject. Thanks to the amazing advocacy of its victims, this is almost impossible to imagine today. Now we need to do the same for other cancers. Let there be no moreterriblesecrets.

So I have sought to discuss my prostate cancer as I would discuss any other issue. I make no apologies for subjecting you to the grisly details: the more familiar they become, the less horrifying. In doing so, I socialise my condition. Last month, I discussed the remarkable evidence suggesting that a caring community enhances recovery and reduces mortality. In talking about my cancer with family and friends, I feel the love that I know will get me through this. The old strategy of suffering in silence could not have been more misguided.

I had intended to use this column to urge men to get themselves tested. But since my diagnosis, weve discovered two things. The first is that prostate cancer has overtaken breast cancer to become the third biggest cancer killer in the UK. The second is that the standard assessment (the PSA blood test) is of limited use. As prostate cancer in its early stages is likely to produce no symptoms, its hard to see what men can do to protect themselves. That urinary tract infection was a remarkably lucky break.

Instead, I urge you to support the efforts led by Prostate Cancer UK to develop a better test. Breast cancer has attracted twice as much money and research as prostate cancer, not because (as the Daily Mail suggests) men are the victims of injustice, but because womens advocacy has been so effective. Campaigns such as Men United and the Movember Foundation have sought to bridge this gap, but theres a long way to go. Prostate cancer is discriminatory: for reasons unknown, black men are twice as likely to suffer it as white men. Finding better tests and treatments is a matter of both urgencyand equity.

I will ride this out. I will own this disease, but I wont be defined by it: I will not be prostrated by my prostate. I will be gone for a few weeks but when I return, I do solemnly swear I will still be the argumentative old git with whom you are familiar.

George Monbiot is a Guardian columnist

Prostate Cancer UK can be contacted on 0800 0748383

Read more: https://www.theguardian.com/commentisfree/2018/mar/13/prostate-cancer-happy-diagnosis-operation

Trial finds combination of pancreatic cancer drugs extends survival

Campaigners hail monumental leap forward in treatment of most lethal form of cancer, which kills 8,800 Britons each year

Cancer campaigners are hailing a monumental leap forward in pancreatic cancer treatment after a new drug trial significantly extended survival from what is the most lethal form of the disease.

The clinical trial found that 29% of patients given a combination of two chemotherapy drugs lived for at least five years compared with 16% who received the one chemotherapy drug that is still the NHSs standard treatment.

The results are important because they could lead to an improvement in the prospects for people who develop pancreatic cancer, which has the lowest survival rates among the 21 most common forms of the disease and kills 8,800 Britons a year. Only one in 100 people survive for 10 or more years after their diagnosis.

These results are a monumental leap forward in pancreatic cancer treatment. We believe this could herald a true step change in the treatment of this tough cancer, offering substantially more patients who have had surgery the chance to live for longer and, crucially, without significant added side-effects, said Leanne Reynolds, head of research at the charity Pancreatic Cancer UK.

About 10,000 people are diagnosed with pancreatic cancer each year in the UK. However, the apparent breakthrough may only benefit the 800 who have surgery. The cancer is too advanced in most of the other 9,200 cases for surgery to be worthwhile.

Four in five patients are only diagnosed when the cancer has reached an advanced stage, and in 46% of cases only after they have presented as an emergency at an A&E unit. Survival rates have barely improved for 40 years, in contrast to some other forms of the disease. It is the fifth most common cause of cancer death in the UK.

The ESPAC-4 (European study group for pancreatic cancer) trial involved 732 patients from 92 hospitals in England, Scotland, Wales, Germany, France and Sweden. Of those given both gemcitabine and capecitabine, 28.8% survived for at least five years, compared with just 16.3% who received only gemcitabine.

Pancreatic Cancer UK and the researchers behind the findings are now urging the NHS to replace gemcitabine with the combination as the standard treatment for the one in 12 sufferers of the disease who undergo a resection of their pancreas.

This is one of the biggest ever breakthroughs prolonging survival for pancreatic cancer patients, said Prof John Neoptolemos of Liverpool University, who lead the team of researchers.

When this combination becomes the new standard of care it will give many patients living with the disease valuable months and even years. The two drugs taken together extend median overall survival from 25 and a half months for those on gemcitabine alone to 28 months, according to the study, which has been published in the Lancet.

Cancer survival rates in England and Wales

The difference in short-term survival may seem modest, but improvement in long-term survival is substantial for this type of cancer, added Neoptolemos.

Meanwhile, separate research has also brought good news about lung cancer, which has the second worst survival rates among the commonest forms of cancer.

The number of people surviving for at least a year after diagnosis rose from 31% to 38% between 2010-2015, according to the NHSs latest audit of the quality of care patients receive. Experts in the disease welcomed the increase, which is mainly the result of earlier diagnosis.

Ian Woolhouse, the audits senior clinical lead, said it was very encouraging that one-year survival had improved in what is the UKs second most common form of cancer after breast cancer.

His team noted other progress too in how the NHS treats patients, including the fact that 60% of patients now receive some for of anti-cancer treatment. They analysed the records of 43,000 people diagnosed with lung cancer in 2015.

However, they voiced concern about the persistent wide and unacceptable variation in standards of care provided by NHS trusts and boards across England, Wales, Scotland and Guernsey. Only 57% of patients are seen by a specialist lung cancer nurse, for example, even though the target for that is 90%.

Dr Jesme Fox, medical director of the Roy Castle Lung Cancer Foundation, said: We are pleased to see this encouraging increase in patient survival. However, there is much still to do to ensure that lung cancer patients are diagnosed as early as possible and are able to access best practice treatment and care.

Read more: https://www.theguardian.com/science/2017/jan/25/pancreatic-cancer-drugs-trial-combination-extends-survival

What it’s like to survive cancer, by those who have done it | Guardian readers and Sarah Marsh

As research shows more people than ever are alive decades after diagnosis, we speak to five people about life after treatment

The chances of surviving cancer are much greater than ever before. In a study published by the charity Macmillan Cancer Support it was found that people are now twice as likely to live at least 10 years after being diagnosed than they were 35 years ago.

Five people shared with us their cancer remission stories and what they learned from the experience.

Stephen Evans, 63, Abu Dhabi: Having come so close to death, I now realise life is short

Stephen
Stephen Evans in 2012

I was surprised by how accepting I was when told I had cancer in 2011. The diagnosis came only a couple of years after my father had suddenly succumbed to lung cancer. At one point I came very close to death as a consequence of leukopoenia, a reduction in the number of white cells in the blood, rather than the cancer itself. Having come so close to losing my life, I now realise life is short and nothing is certain.

My first dose of chemotherapy was dreadful. The oncologist and nurses warned me it would be, but it was still a shock. I felt hot, and nauseous and thrashed about in pain. I wouldve fallen off the bed if the nurses hadnt been hanging on to me. However, after that one episode, ongoing chemotherapy caused me no further problems. In fact, the whole treatment programme was so well managed that eventually I just went back to work and pretty much lived normally.

Ive been in remission since 2014 and I feel pretty good. The cancer may return one day, but Im ready for it I know the symptoms and Im confident prompt treatment will see me OK once more.

Finding out my cancer was gone was not the dramatic moment one might imagine because I could feel I was getting back to normal. I have a clinical background and so I viewed the whole thing quite analytically. When my oncologist told me I now needed only annual check-ups I just went back to normal living like it was no big deal. Its funny really.

Rebecca Palmer, 36, Colchester: One minute I was looking for baby clothing and the next wigs

Becky
Photograph: Becky Palmer

Id gone from being pregnant to having cancer in the space of a matter of weeks one minute I was looking for baby clothing online and the next wigs. I simply didnt have time to be ill and it was a mighty inconvenience to my lovely life.

I had a molar pregnancy a type of gestational trophoblastic tumour that happens when the normal fertilisation of an egg goes wrong. To get cancer as a result of a miscarriage seemed so surreal to me, it actually made the whole thing seem like a very bizarre dream.

Six months of chemo followed and with the help of my husband and incredible nurses and doctors I got through it. My cancer has a very high survival rate, so I wasnt hugely surprised to go into remission. It was the only outcome I expected and I simply wanted to get back to my normal life.

Becky

Im not sure the whole experience taught me anything. I rather suspect Im supposed to say something poignant about life and I am bloody grateful to be here but cancer itself is just a bad bit of my past and has no particular impact on my present. I now have three children and I dont have the time or inclination to give cancer any more of my life.

Robert Barden, 58, Portland: Im still on the road to remission, but feeling positive helps

Robert
Photograph: Robert Barden

I found out that I had lung cancer in the summer of 2011. I was terrified when I heard the news as my stepfather and grandmother both died of it. After the initial shock, I went into a state of denial. Then, I felt determined: I was not going to let my wife and daughters watch me die from this.

Surgery started just a couple weeks after my diagnosis. My lung was collapsed, and there was no time to waste. They removed the lower lobe of my left lung. That was followed by a month of daily radiation treatments, due to a positive test on one of the lymph nodes. It was emotionally draining to realise that I was not out of the woods with surgery alone, but this prepared me for the battle to come. The following two years were met with recurrent tumours requiring the inevitable chemo treatments and more surgery, the last two-and-a-half years ago.

Im still on the road to remission. Ive recently graduated to six month scans, as opposed to three monthly ones, so the prognosis is cautiously optimistic until I reach the five-year mark. But Im halfway there and feel great about it.

Ive learned that a positive attitude and sense of humour is sometimes the only thing that will get you through the day. There were many times when all we could do was laugh or cry, and we most often chose to laugh.

Tom, 43, Hertfordshire: The surgeon said removing my testicle was like getting a Malteser out of the bag

Id known I had testicular cancer before the diagnosis. The lump had been there for months, stubbornly refusing to go away and, by the time I actually mustered the courage to take it to the doctor, the testicle was at least twice normal size. There were only so many possibilities in terms of what was wrong with me and blind optimism has never been my strong point. It was almost a relief to have it confirmed. I had a weekend between diagnosis on the Friday and finding out that the cancer hadnt spread. I spent most of it drunk.

You either learn to laugh at humiliating situations or youll have to crawl under a rock and die of shame somewhere. Before my operation, I had an entire class of medical students have a feel of my diseased nut so that theyd recognise it in future. I dont know how anyone cant see the funny side of that.

I had an orchidectomy, a surgical procedure to remove one testicle. I made the surgeon write on my left leg which ball I was having off, complete with an arrow pointing at the offending gonad. She was the same woman who had charmingly told me what a simple operation it was, like getting the last Malteser out of the bag.

After that, I had the option of one big dose of chemo to be sure. I took it, as I figured it would give me peace of mind. If Id known how it felt, I might not have done. At the risk of stating the obvious, chemo is not pleasant.

Its been over 10 years since I was diagnosed. My life has changed in lots of ways and I wonder if the cancer had something to do with it. I became far more reckless afterwards. Im not sure whether that was as a sort of life is short reaction to what happened. Whatever caused it, that period led to the break-up of my relationship. I cant blame the cancer, but it feels like it was a catalyst. Or it might just be a convenient excuse for my own bloody awful behaviour.

Either way, Ive remarried now and I hardly ever think about the cancer any more. Its still good for the odd comic anecdote here and there, but thats about it.

Kathy, 65, Lancashire: Remission felt like the end of a journey I never thought Id complete

Radiologist
When the cancer came back 12 years later, I opted for a bilateral mastectomy. Photograph: Rui Vieira/PA

The first time I heard the words I wanted to run away rather than face up to what was happening. The doctor was cold, clinical and didnt seem to understand why I was so terrified the nurse tried to tell me that people did survive but nothing made any sense at that point. I just thought, Im going to die.

My bloke, my sister and best friend got me through it. When the cancer came back 12 years later, I opted for a bilateral mastectomy and had both breasts removed. I had bilateral reconstruction with muscle taken from my abdomen during a nine-hour operation. Unfortunately, I haemorrhaged in the recovery room and it took a further two hours to control the bleeding. The reconstruction was wrecked from that point on. Following surgery I had six rounds of chemotherapy, followed by radiotherapy.

When I found out I was in remission it felt like I had finally got to the end of a journey I never thought Id complete. I felt a huge mix of relief and exhaustion. My experience taught me that there are so many brilliant, kind, supportive people in my life, and out there generally. As time goes by Ive realised that if youre here, there may be reasons for that. It sounds like a cliche, but I believe people should live for the moment. Do what you want to do, be where you want to be, and spend time with those who matter to you.

  • Some names have been changed.

Read more: https://www.theguardian.com/commentisfree/2016/aug/03/what-its-like-to-survive-cancer-by-those-who-have-been-given-the-all-clear