'It's odd to be told that I have prostate cancer because I still feel

How do you tell friends you have cancer? How do you face the possibility of death? By keeping your sense of perspective and sense of humour, says crime novelist David Armstrong

LIKE many of us, I tend to present myself at the doctor's surgery when I've accrued two or three minor ailments.

On the list in May was the fact that sleeping through the night had become history: I'd been getting up to visit the lavatory for as long as I could remember. Pub "research" suggested that almost all the men around my age (mid-fifties) did the same. But I thought I'd better mention it.

My GP sent me for a blood test.

And that was it: I was into the system. When my result came back, it was "just the wrong side" of "high-normal". I had a rectal examination. My GP could feel nothing untoward. "But ..." - there's always a "but" - "let's make an appointment for another blood test."

A week after that test, I received the letter that no one wants: even in this short time, my PSA (or prostate specific antigen - an indicator of cancer) had risen again. An appointment was made for me to have a biopsy.

I think you know instinctively if you're ill, and I felt confident that the biopsy would reveal cancer.

The weekend before I got the results, I skulked around the health shelves in Waterstone's feeling like a dirty mac looking for salacious reading. There was very little there. An ominous gap between piles and psychosis. I picked up a jaunty-looking tome on cancer in general. The sales assistant flicked up his eyes as he weighed up my sombre reading, then looked away.

My partner came with me for the biopsy results and consultation. In general, I feel well, so it was odd to be told that I have a lifethreatening illness.

Yes, I get tired, and often have a nap in the afternoon, but then writing is both tiring and passive. I don't fall asleep if I'm sawing wood or painting a wall.

The consultant outlined the treatment options: surgery, radiotherapy and/or hormone therapy. The so-called "gold standard" is surgery: but this gold lacks lustre and afterwards the risks of incontinence and impotence are high.

I could have six weeks of radiotherapy or a couple of days as an inpatient for "brachytherapy". This relatively new treatment involves "planting" radioactive "seeds" into the gland which slowly "detonate". Clinical data is hard to come by, but success rates look promising and sideeffects are less grim than those that accompany radiotherapy.

The consultant suggested further tests, a scan and an appointment with a radiotherapist. All of this, of course (added to holidays and normal patient backlog delays), takes weeks. And the weeks roll into months. All the time, one is mindful of the refrain that if you suspect cancer, you are advised to act quickly. I started to act in May.

It is now November and I can't help wondering whether the cancer is now taking an excursion around my bloodstream and turning a serious situation into a grave one.

The good news is that my health authority is going to pay for me to have the brachytherapy, which isn't widely available, in a hospital 100 miles from where I live because no one nearer offers it.

"Yes," I tell friends, "I am concerned." But no, I don't think about the illness all the time, probably because, apart from some back pain and a debilitating lack of good sleep, I don't feel too bad - not yet. I veer between facing up to the worst-case scenario and the knowledge that this is one of the more treatable cancers. Still, I can't help wondering whether my new book will be my last.

I've told only a few people. My partner knows, of course, and my two grownup children. At first, I needed time to reflect. If someone asks how I am, I might say "OK in myself, but apparently I've got cancer" and then give them a brief story-so-far. The trouble is, of course, this information can be very powerful and has the potential to be a very controlling thing. I thought, briefly, of writing to all those people who have wronged me down the years, and telling them, "I'm ill; I'm possibly going to die."

But then they might write back and say: "Oh, good." I haven't told the guys I have a drink with, feeling that even with their gallows humour they might find it difficult to respond appropriately to the news. Also, I've got used to the level of misinformation that surrounds the subject, and to correct misapprehensions by trotting out mortality rates - half the men who get prostate cancer die from it - can look rather bad form.

PERHAPS the best way to break the news is the way it went with my oldest chum, Steve. He telephoned one evening.

It was after dinner and it was clear he'd had a couple of glasses of wine.

"How are you, David?" he bellowed. "I'm all right, Steve, apart from the fact they think I've got prostate cancer."

Expletives from Steve, followed by a good deal of blokeishphilosophicaljoshing chat. After we'd discussed the football and rubbished United, he said: "So, what's the next move?" I tell him I have an appointment with the radiotherapist on Wednesday.

On the Tuesday evening, I am touched that he phones before my appointment the following day.

"How are you?" he asks.

"Well, I'm all right apart from the cancer," I say, apologetically.

"What cancer?" he says. "God, I'm so sorry, Dave, I'd completely forgotten."

Until I get the treatment, laughter is, quite possibly, the best medicine.

David Armstrong's latest book, Small Vices, is published on 19 November (Allison and Busby, 17.99).

The Prostate Cancer Charity: 0845 300 8383.

'Seek advice quickly'

PROSTATE cancer kills more than 10,000 men each year in the UK. One in 12 will get it, and half of those will die from it.

Blood tests can measure for prostate specific antigen, which is one of the key indicators of the presence of prostate cancer. Men aren't routinely tested for PSA because of certain contraindications: of 100 men with raised PSA, only 30 will have cancer in the prostate and as many as one third of men with normal levels of PSA will have cancer cells present. Despite the statistics, prostate cancer is perceived as less serious than many other cancers - partly because the symptoms are commonplace. Many men need to get up urgently in the night to urinate, then find they cannot pass water easily, but the reason for this is as likely to be an enlarged prostate gland as it is a malignant tumour. Most men in their seventies and eighties have prostate cancer, but by this age it develops so slowly that few will die from it. In younger men, the disease is more virulent and, if untreated, is almost certain to spread to the bones and other parts of the body.

"Don't accept these things as a natural consequence of ageing," says Chris Hiley of The Prostate Cancer Charity.

"Seek advice quickly."

Copyright 2001
Provided by ProQuest Information and Learning Company. All rights Reserved.