Living with... cancer

If the cancer is confined to the prostate gland, it can be removed and the patient is usually cured of the disease. In my case, it had spread through my body, possibly to my lungs. Surgery was no longer an option, but I was determined to try any treatment that would halt the spread of the disease. I was healthy, did not feel any side-affects from my condition and was willing to give anything a go.

My strategy was to keep the cancer at bay until one of the many new treatments being developed (mainly in America) became available. Prostate cancer is one of the biggest killers of men in the US and Britain. Billions are being spent on research and there is every prospect of a major breakthrough in the coming decade. A cure is probably some way off, but it is likely that men with prostate cancer will be able to live longer and healthier lives.

What my doctor had offered me was the standard treatment for patients in my condition, namely hormone therapy. Hormones are injected into the body to prevent the production of testosterone. This starves the tumour of what it needs to grow. The treatment is essentially a chemical castration (until recently in some countries the treatment was a real castration). Your sex life is ruined, but so, too, is the source of what feeds the cancer.

Unfortunately, the treatment works for only a limited period. While the cancer may recede at first, as it did with me, it usually comes back within two to three years. I wanted a much more aggressive approach, which brings me back to my consultation four years ago. When I walked out of my consultant’s office after his blunt response, I knew that I would have to find a doctor who shared my outlook.

At this point I need to make clear that when I say “I”, I really mean my wife, Natasha. I used to have an old-fashioned approach to medicine: you accept the doctor you are given, do not question his or her judgment, nod politely and think about your illness as little as possible. (Even after I received the diagnosis, I still went on assignment to Iraq and Afghanistan and tried as much as possible not to let the cancer affect my life. I found covering conflicts for The Times hugely therapeutic. It is difficult to feel sorry for yourself when you are confronted every day with people battling much greater tragedies with stoicism and courage.) Natasha did not share this approach. From the outset she has done all the heavy lifting emotionally and medically. She scours the internet for new treatments, e-mails doctors in California with queries about their findings, writes down the names of long and unpronounceable new drugs, with which she then confronts my doctors. It makes consultations far more lively.

What Natasha grasped is that the doctor-patient relationship has changed for ever, thanks to the internet. Though she has no formal medical qualifications and does not pretend to be a doctor, she is up to date on drugs, often still in the testing phase. She rightly believes that a consultation should be a conversation between doctor and patient. A good oncologist should know what new therapies and treatments are coming on stream and be prepared to explain why they are, or are not, appropriate for a particular individual.

That is why, when we left the consultant’s office, we embarked on an important journey of discovery. By my last calculation, I have seen nine consultants in three countries, exploring every possible treatment. It turns out that my original consultant was right, in one sense. Hormone therapy was the correct treatment for my disease. But he was wrong to suggest it was the only treatment. We discovered that dealing with cancer is more of an art than a science. Specialists offered widely varying advice. Since every case is different, the key for the patient is to find the doctor who shares his or her approach to treatment. Never be afraid to take a second, third or fourth opinion.

When I went to New York to see a top prostate cancer specialist, he gave exactly the opposite advice to that given to me in London. “Look, you’re young, you’re healthy, you have a positive attitude,” he said. “I would throw everything you can at this. If you don’t, a few years from now, when your condition may be more advanced, you will always wonder whether you did everything possible to fight the cancer. Go for it.”

With his encouragement, I found a like-minded consultant in London prepared to offer a very different approach. In addition to the hormone treatment, he put me on a course of chemotherapy in December 2007 and then a course of radiation therapy. I will not conceal that the treatments were unpleasant and tiring, but I kept working throughout and by the end of the treatments in 2008 my PSA had dropped below one. There was even a small chance that I might be cured.

I was clear of cancer for the best part of two years, but it did come back in 2010. This time, again on advice from my American doctor, I managed to get on a US trial drug available in Britain. It worked very effectively, bringing down my PSA level again to below one.

Unfortunately, as many cancer patients know, you may win a battle but the war is rarely over. Soon after I celebrated the success of my new treatment I felt a pain in my chest and a quickness of breath. A biopsy in November showed that the cancer had returned with one 5cm tumour in my right lung. The prostate cancer had mutated and was no longer giving out PSA readings, making it much harder to detect. It was no longer responding to the trial drug or hormone therapy.

So here I am back on chemotherapy, wearing a cold cap to preserve my hair, and waiting to see if the cancer will respond again to the poison being fed into my body. Whatever the outcome, a host of new treatments is becoming available, which I am confident will help me to beat the disease.

My main regret is that I can’t be in the Middle East to witness the great story unfolding there. Maybe next time.