A Prostate Cancer Case Study: Part 2

Jim Flood discovered he had an aggressive form of prostate cancer in 2008. In his series, "You’re Only As Good As Your Last PSA," he details his journey from being diagnosed to receiving treatment to coping with side effects. Read A Prostate Cancer Case Study: Part 1.

An operation, then a rising PSA

After the radical prostatectomy operation, I was monitored at 6 weeks, then 3 months, then 6 months. Monitoring was through the PSA test, which perversely becomes a more reliable indicator when the gland itself has gone.

At 6 weeks, the PSA had come down from 9 to 0.08 – "undetectable." At 3 months, it was the same. But at 6 months, nearly a year since diagnosis, it had gone up to 0.12, a rise the consultant described memorably as, "small but probably significant."

The relapse was underway. For all the non-nerve sparing, it had not been a totally clean sweep. Something had escaped and was on the go again.

Re-thinking my treatment decision

For the consultant and his team, this meant a recommendation to proceed to the fall-back option: radiotherapy.

For me, since the surgical "big bang" solution had failed, it meant a complete re-think. I had put my faith in the men in white coats, but they had delivered the costs of treatment without the benefit.

Maybe it was time I started to take a hand myself. In the year since the operation, I had not exactly buried my head in the sand, but nor had I taken much interest in finding out about my condition. Maybe I didn’t want to know. What little research I had done just depressed me, and it was depressing enough learning to cope with my new-found incontinence and impotence.

Feeling resentful

Now I came to understand the consultant’s care in distinguishing between what he could do and what he could promise. What he could do, and had done, had been presented as the best option, but it came with no guarantee.

I was resentful at the damage done to me for, it was now clear, no gain. It was easy at that moment to forget that the real enemy was the disease, not the people who spend their lives fighting it. My GP once described cancer to me as "crafty."

A personal campaign

Fighting it calls for all hands, so what, I suddenly wondered belatedly, was I doing sitting on mine? I have spent most of my life working for causes that had little to do with me personally. This campaign was going to be very personal.

Throughout these 12 months, I had been blessed with the company, advice, and practical help of my partner. I don’t know how I would have fared without her.

We looked online. The first book we found was Jane Plant’s "Understand, Prevent and Overcome Prostate Cancer." That seemed to fit the bill. It came, and the reading started. It was indeed a good book to start with. I shall always remember the most vivid chapter heading: "Milk is a four-letter word."

Reading books on cancer

Over the next few years, I read little else but books on cancer; sad, but necessary. They were on the whole readable, knowledgeable, and persuasive, although for a non-scientist it was not always easy to judge their authenticity.

There was naturally a wide variation in detail but a convergence on the core issues. One consensus that emerged was for a plant-based diet. Going dairy-free turned out to be just the start.

Watching my PSA levels

Meanwhile, the PSA continued to rise slowly (now 0.15), and a month’s radiotherapy was scheduled for November 2009.

On weekdays for 4 weeks, we went to the hospital, where I was zapped from 4 angles. The target was the prostate bed, although, without an actual prostate gland to aim at, this seemed to me a bit hit-and-miss. After the thorough scraping by the surgeon, who could say where the malignant morsel might be?

A sliver of hope

I had already started to give up all dairy products, and I arranged an extra PSA test just before the radiotherapy to see if a month’s dairy-freedom had made any difference. At first, it seemed as if it might: the PSA was 0.14. We clutched at this straw, but 0.01 is well within the margin of error.

Besides, we had hardly begun to realize how widespread dairy is in our food, and naively believed that paying off the milkman was all there was to it. We slowly learned a new kind of shopping, where you put your reading glasses on to scrutinize the label of every tin and packet.

Worsening symptoms

On the 20th and last day of the radiotherapy, a strange thing happened. I had been warned to expect fatigue and even burn marks, but neither happened.

Instead, on this last Friday, I had a new and not very pleasant feeling. It got worse over the weekend, and other symptoms developed: blurred vision, unsteadiness, constant hiccups.

I went to the GP, who ordered a blood test. Later that evening, as I lay half asleep and feeling sorry for myself, I got a call from the Out of Hours Service to say I should go to A&E immediately. A&E – OMG! – couldn’t it wait till morning? "If I were you," came the firm reply, "I would go now."

An unexpected diagnosis

We went. After the customary 4 hours, I was admitted. All I remember of the next 24 hours was the drip attached to my arm, which seemed to be more of a waterfall than a drip. After a few days came the diagnosis: Addison’s Disease. This is a failure of the adrenal glands resulting in the leaching of salt from the body.

My GP told me later that my sodium level had been "on the floor" and I had had an "Addisonian crisis" that could have been fatal. The condition is rare – the GP had never seen a case – but apparently, I share it with Bin Laden, JFK, and probably Jane Austen. The answer these days is hydrocortisone, daily forever.

A mystery

I felt relieved that at least the symptoms had been recognized and the condition labeled, but was there a link with the cancer or the radiotherapy? It did seem a remarkable coincidence.

The medics doubted a direct causal connection but thought it possible that the stress of the treatment might have allowed a long-suppressed condition to emerge. As with many diseases, causation is a mystery. All good things come in threes, so I wondered what might drop in next.