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The Silent Killer by Hamish Marett-Crosby

Published on BBC website “In Your Words” – – 12/12/2007

Hamish Marett-Crosby, Prostate Centre patient, was diagnosed with prostate cancer just before last Christmas. He looks back on a troubled year.

“This is surreal”, I thought. In another context it would be the stuff of fantasy, or one of those memoirs which seem to focus on what had been wished for, rather than what actually happened.

Let me explain. I was lying back, flat out, 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 around between my thighs. They were in fact attaching some leads to a rather strange machine which was going, and I quote, “to sort me out”.

It is too soon to be one hundred per cent sure, but I think I have been sorted out. All this was happening in the basement of the University College Hospital at the top of Tottenham Court Road and I was undergoing a relatively new procedure for dealing with an agressive prostate cancer.

It was new to me; I had first heard of it a few months prior to that day and when, while trying to find out more about the subject, I told my Cancer Back-Up group I was going to be given High Dose Rate Brachytherapy, they hadn’t heard of it either.


Not having heard of the PSA blood test, and only being vaguely aware of where the prostate was, and even less aware of what it did, the whole diagnostic and treatment regime was, quite frankly, a bit frightening. The down-to-earth approach at Cancer Back-Up and above all, the straightforward advice I received at The Prostate Centre in Wimpole Street, did much to alleviate the fear.

Of the various options for treating the disease, surgery and standard brachytherapy were out as I was too far down the road. The cancer had spread. As a result the HDR option was decided on, but that would be after a 9 month course of hormone blocking drugs to shrink and starve the main tumour, and reduce, down to nothing, 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 which brought me no sympathy from any woman over a certain age and it also made me very weepy. Corny sad films would have me in floods of tears.

But there is the other side, I was lucky. Luck had brought me to Dr Heather Payne, Consultant Oncologist at The Prostate Centre and University College Hospital. Unassuming and un-dramatic, as well as being a dab hand at sketching, she outlined, in a few horrendously graphic strokes, what she through was the best way to deal with my problem. And forget all this nonsense about dying with prostate cancer than from it, that is true once it is found – indeed if it is found, if a test is taken soon enough – and dealt with early enough in the process.

Don’t leave it too late

A month or two before I went to hospital, a contemporary of mine, a politician I had interviewed many times, had died of it and London was sprinkled with posters of the late Bob Monkhouse warning us not to follow his example and leave it too late.

Through ignorance I had very nearly left it too late. The cancer had spread, the time for operation was past but, as I said, I had found Dr Heather Payne; she was in the vanguard of developing HDR treatment in the UK, a process which would burn out the cancer and that would be followed by a mopping-up process, radiotherapy.

Given the success of the proposed HDR treatment, a shorter series of radiotherapy (at a lower dose) than would normally have been the case would then be needed to clear up the residue. Less chance therefore for what our friends in the US Air Force refer to all collateral damage.

“I can’t guarantee a cure Hamish”, Heather had said, “but it’s the best chance you are going to have”. As I said, simple, straightforward and direct, the best way to encourage confidence; a feeling augmented by the way her staff obviously view her as one who walks on water. She even made signing the consent form not too daunting. Why daunting?

Because these days every possible eventuality has to be spelt out; it’s all an element of the don’t-say-we-didn’t-warn-you syndrome that comes as part of our increasingly litigious society. The list of what could go wrong and what might happen is the stuff of nightmares. Don’t think about it.

Not unbearable

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 uncomfortable, very uncomfortable, but nothing if one considers the alternative.

The scales are very much loaded on the positive side. And on that positive side must also be noted the absolutely essential constructive support 24 hours a day. Someone to help you through those dark moments, when the natural reaction to the bald fact that you have cancer breaks through your defences and you feel low, very low. I have had, and have that support, I am lucky.

I also had the advantage of working in an environment which keeps the mind active and does not give you time to get involved in too much self-analysis. To those who can cope with the chaos, there is no better cure for introspection than working in a radio news room.

University College Hospital

And then there is University College Hospital itslef. A gleaming structure of steel and glass with the oncology ward on the 16th floor. Once I had progressed to shuffling-around-mode, I could move from side to side of the tower and pass the time looking across London and then down at the traffic on the Tottenham Court and Euston Roads; a pastime which gives one a god-like feeling of superiority and detachment.

Nor does one feel cut off; there is an acceptance that people will, and do, use their mobile phones and as a consequence much of the time was spent sending texts in answer to all the enquiries about my health – the shock of discovering how much than can cost for a Jersey Telecom customer in the UK is a story for another time and place.

“It looks good”, said Heather as I was discharged. “We’ve burnt out that tumour of yours, it has been a text book case. It looks beautiful”, said this remarkable woman who can see beauty in a prostate.

So it came about that I was one of the privileged. Privileged because, after 5 days in the oncology ward in a major London teaching hospital, I was walking away full of optimism; there were many left there, I left behind, who would never be in a position to feel anything similar.

All that’s left is to complete the radiotherapy course; with luck it will be, at worse, an inconvenience, nothing like the main procedure… and then? Well that’s the big question. Do I go back to as before, or do I re-assess what I do with the extra life I have now been offered?

Dr Heather Payne comment

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.

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