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 Where has all the colour gone?
That once dressed my life in finery,
And lifted my heart to sing.
Now all appears a sodden grey,
That sticks and clings,
Like cheap and dreary paint,
To the fabric of my existence,
So that joy and delight are faded memories.
I yearn for the days,
When colour was everywhere I looked,
At every turn a new delight.
But those days seem like some distant dream,
A life lived by some other,
That callously has left me behind,
To drift upon an ocean of drab and sickly grey,
A world of endless hopelessness.
 I have been vaguely aware of attempts to develop a vaccine for Prostate Cancer, but a recent article in the IrishTimes online seems to suggest that such a vaccine might be available sooner rather than later (article here).
Researchers at the Cork Cancer Research Centre at University College Cork claim to have developed a safe vaccine that prompts the immune system to attack the cancer cells. Apparently prostate cancer is more common in Ireland (I wonder why – could it be a dietary factor?).
The vaccine is intended to be used along conventional treatment such as surgery or radiotherapy, to ‘mop up’ remaining cancer cells and so would be particularly useful for metastatic cancer or hormone refractory cancer.
It certainly seems to be an exciting development that holds much promise and hope for prostate cancer patients whose cancer is resistant to treatment.
 There has been a lot of speculation about a link between cancer and suicide:
‘Cancer patients have a two to 2-1/2 times greater risk of committing suicide than the general population’ mcnbc
‘Studies indicate that the incidence of suicide in cancer patients can be …. up to 2 to 10 times as frequent [as in the general population]‘ National Cancer Institute
This week the ‘Business Week’ website reported on a US study into prostate cancer and suicide. It stated the obvious, namely that ‘a cancer diagnosis is an acutely distressful event’ (tell me about it!) and then went on to say that ‘men [in the study] diagnosed with prostate cancer had an overall 40 percent higher risk of suicide in the year after the diagnosis was made, and a 90 percent higher incidence over the first three months post-diagnosis.’
All a bit depressing really. The report authors implied that part of the blame for the suicides could be placed on the use of screening in the US (here we go again), but then went on to say:
‘The higher risk was seen in the years before widespread PSA screening was introduced. Since 1993, when PSA screening became commonplace, the risk of suicide after a prostate cancer diagnosis has not been above the ordinary.’
If you think about it, it is really a rather perverse aspect of human behaviour if when faced with a cancer diagnosis people turn to suicide. It doesn’t make any rational sense. A diagnosis of cancer makes one painfully aware of one’s mortality so the logical thing to do is to make the best of the time remaining. But of course people are not rational are they!
The problem is not suicide, but depression – the feeling that life isn’t worth living.
 The debate about screening goes on.
I was at a prostate cancer support group meeting on Monday at the Maggie’s Cancer Centre at Charing Cross hospital. A urologist was available to answer questions and the thorny issue of screening for prostate cancer was brought up. This issue is always contentious and has been high profile recently following a European study looking into the pros and cons of screening for prostate cancer (there is a good report on this study on the BBC website).
The problem is that the PSA test is not a reliable indicator in itself of cancer, as a raised PSA score could be indicative of other factors such as a benign growth., The European study reported that screening would cut deaths by 20%. However it also suggested that it would lead to lots of men undergoing treatment unnecessarily – the false positive effect. This issue was emphasised by the urologist at our meeting because of the unpleasantness of the treatment. The biopsy is not pleasant (probably the most unpleasant experience I have ever had) and surgery, which is the first option for contained prostate cancer has very unpleasant side effects, namely urinary incontinence and sexual dysfunction. The European report, based on evidence from Finland suggested that for every eight men screened one would turn out to be a false positive.
Well I find the arguments here false and made my feelings known to the urologist. In America, where there is regular screening, the survival rate for prostate cancer is much better. In the UK we only manage 5 year survival rates in the region of 60 to 70 percent whereas in the USA it is in the high 90s. The urologist agreed that in the UK prostate cancer was being reported later and as a consequence tumours were larger and metastasis much more common. The reality is that I would have been better off being born in the USA! Of course the urologist claimed that the cost of the much better survival rates for prostate cancer patients in the USA is at the cost of men undergoing unnecessary treatment.
But there is a false assumption being made her, namely that a raised PSA score inevitably leads to treatment. This surely need not be the case. If a man presents with a raised PSA score to a doctor then the doctor should perform a DRE. If the DRE proves suspicious then a biopsy should be considered, probably following a period of surveillance. Only when the biopsy returns a positive result, and only then, should treatment be considered (and there is evidence that latest MRI scanning techniques might replace the biopsy which would then do away with a painful procedure).
To me there is no issue. All men over a certain age (probably 45 but certainly 50) should be automatically screened using the PSA test. This does not however mean that it will automatically lead to invasive treatment. While we continue without regular screening the mortality rates for prostate cancer will never improve.
I love Far Side cartoons. Gary Larson somehow manages to hit the spot with his wacky view of life, often pointing out our deepest human frailties, our pettiness, pomposity and our quirks. This is one of my favourites -
There is something deeply reassuring about people’s failures and incompetence. A lot of sit-coms are based on incompetence – “some mother’s do ‘ave ‘em”, “only fools and horses”. etc.
The fact that the scientists in the cartoon can’t even make a straight rocket is hilarious but also points out that failure is a part of human nature. To err is human. We seem to have forgotten that simple fact in our modern culture. We are not gods and never will be. We are not infallible. When things go wrong our temptation is always to try to allocate blame, but perhaps it was no-body’s fault!
If we can’t blame individuals then were are perhaps tempted to imagine amazing conspiracies. My experience of life is that when things go wrong it is much more likely the fault of basic human incompetence rather than people getting together to try to hatch evil plans. Apart from anything thing else its too much hard work for most people.
I believe our blame culture is unhelpful and deeply psychologically harmful. We would like to think that humans get progressively better and better but they don’t. Technology may progress but people don’t. We are no different from our hunter gatherer ancestors who lived on the African plain or swung from the tress. We just have better technology.
  Abraham Maslow (1908-1970) and specifically the hierarchy of needs, that he developed, is well know in educational circles. His insight was to realise that not all human needs were equal. If you are starving then you are unlikely to be worried about whether you are loved – you just want food! And if you feel your security is threatened then you’re unlikely to be overly concerned about your self esteem.
The hierarchy is organised so that the most important needs form the base of the pyramid, and in this way physiological needs are paramount and must be satisfied first. Then follows the need for security – feeling safe. Then love and esteem next. The implication for teachers is that children (and adults) wont learn if their physical needs are not catered for (if they are sitting in a cold dark classroom), or if they feel threatened, or without a sense of belonging and positive self esteem.
Maslow then went on to suggest that as well as all these needs, people had a need for what he called ’self-actualisation’. This is shown by the top two slices on the hierarchy pyramid in the diagram above. Self-actualisation is about realising potential.
I think that people diagnosed with cancer often hit a kind of self actualisation wall. They will quite commonly ask the question - ‘what have I achieved?’ – I know I have. When life suddenly seems finite one is forced to ask difficult questions; what could I have become?, what difference have I made?, have I squandered my life on frivolities?
Of course many people will never ask these kind of questions. When life feels like it will go on forever there is always the temptation to just ‘drift along’. After all there can appear to be plenty of time to catch up with one’s ambitions and the dreams of youth. The trouble is, cancer or not, life is not infinite and dreams can just end up being dreams!
In a way, this is a gift of cancer – it makes you ask these kind of questions, even if they are challenging and worrying questions to ask.
 A number of mental ‘laws’ have been identified that help to describe how the sub-conscious works. Depending on who or what you read there can be anything from 6 to 12 of these laws. The following eight laws are based on a hypno-therapy course I recently attended:
1. Law Of Desire
This is perhaps the most obvious law. It simply states that to make a change in our life we must desire the outcome. Although this seems too obvious to mention, the reality is that we can often be afraid of achieving what we desire. We make claims to want something but actually are frightened of the possible consequences of achieving our desire. It is worthwhile spending some time considering what we TRULY want and if there are any consequences that we are scared of.
2. Law Of Harmonious Attraction
This law is based on the fact that the more we are able to visualise achieving our goal the more likely it is that we will achieve it. This is well known in sports circles where athletes will imagine themselves winning a race before the actual event. The process of visualisation has been proved to be very effective in meeting persoanl goals and improving the healing process. However it is important to eliminate negative thoughts and images as these will have the opposite effect, because the application of the law works both ways – if you constantly imagine yourself failing then you will.
3. Law of Expectancy
Belief leads to success. The old adage is of ’seeing is believing’ is wrong – it should be ‘believing is seeing’. If you really BELIEVE you will achieve something and have EXPECTATIONS of success you are far more likely to be successful. This also works in the opposite way – if you believe you will fail, you probably will!
4. Law Of Relaxation
This is sometimes called the law of opposite effort. Normally we feel we have to put a lot of effort into achieving something. Although this is true of physical work, with mental work the opposite is true – we must relax. Only when the mind and body are relaxed is it possible to access and communicate with the sub-conscious.
5. Law Of Visualization
Visualisation is the key to making positive changes but for visualization to work it must pass through the critical aspect of the mind. It must therefore be believable or the normal critical function of the mind should be depressed by for example deep relaxation.
6. Law of Substitution
The mind can only hold one thought at a time, so it is important to choose positive images over negative ones. If we can substitute positive images for negative ones we can overcome barriers to self achievement. It is not enough just to identify negative self talk for example. Such thoughts must be substituted with more appropriate and helpful thoughts.
7. Law of Repetition
The more we do something or think in a certain way the more ingrained our behaviour becomes. To overcome obstacles in the mind we need to practise, practise, practise. Habits are made and broken in a span of 21 to 30 days as a rule. Repetition for that length of time can greatly increase the odds of making permanent change.
8. Law of Self Concept
To make changes we must develop and maintain positive self images. All feelings of inadequacy or inferiority must be replaced with positive characteristics. Only by building our self esteem can we be truly empowered to take responsibility for our own development and healing.
These ‘laws’ can provide a powerful tool for gaining some control over our mental processes and supporting healing throughout the body.
No matter what, I want to continue living
with the awareness that I will die.
Without that, I am not alive.
This is what makes the life I have now possible.
I happened across this quote the other day, which comes from ’The Kitchen’, a book written by a female Japanese writer called Banana Yoshimoto.
I have never read anything by her but it is difficult not to warm to someone whose first name is a piece of fruit! It turns out that her real name is Yoshimoto Mahoko and she chose to be known as Banana Yoshimata, which I think shows a remarkable, one might almost say obsessional devotion to food. Indeed food is the common themes across all her books and although not well known in the West they are very well known in Japan.
 She has her own website but unfortunately it is all in Japanese, so not very assessable for Europeans. There is a very good interview with her on a website that goes by the rather alarming title of bookslut!
I came across the quote, not in one of Banana’s book but in a completely different book by another author. However the quote resonated with me straight away. Cancer can often seem and feel like a curse and I would certainly not wish cancer on any friend of mine, but it is also true to say that a diagnosis of cancer certainly helps to focus oneself on priorities, and Yoshimoto’s implicit suggestion that it is only possible to really be alive if you acknowledge death as a reality is I think likely to be true.
The soldier on the battlefield, whose life could be taken in a moment, probably feels alive in a way that many of us will never experience. Adrenalin junkies purposefully put their lives at risk, presumably because it somehow makes them feel more alive. It is certainly a conundrum to consider that people may feel more alive the closer they are to imminent death.
 Following on neatly from my last post regarding the value of intermittent hormone therapy in delaying the onset of resistance, an article in the e-magazine ‘eCanadaNow’ reports that research by Charles L. Sawyers in New York, on a new drug, with the very exciting title of MDV3100, is providing some hope in the treatment of refractory prostate cancer.
Traditional hormone therapy works by making the body stop producing testosterone so starving the tumour. This new drug works by blocking receptors on the tumour itself so that it cannot use the hormone even if present. The reason that tumours become resistant is unknown but the main area of research is now drugs to block testosterone in the tumour itself rather than at source.
The problem with all of these reports is that there is often a very long lead time from a drug being successful in the lab to becoming a standard treatment. However the article claims that ’stage III clinical studies will be taking place soon’ which is encouraging.
 There is quite a debate about the value of intermittent hormone therapy as opposed to continuous hormone therapy. Currently the only treatment I have for my prostate cancer is hormone therapy which consists of a three monthly injection of Zoladex. Zoladex blocks the production of testosterone which is needed by the cancer to grow. Hormone therapy suppresses the growth of the cancer but it doesn’t cure it.
Hormone therapy is relatively noninvasive and so is a common and favoured approach to managing prostate cancer. For myself, hormone therapy is being used as the cancer has metastasized into the lymph glands. Hormone therapy is a systemic treatment and so can influence the growth of the cancer throughout the body but unlike chemotherapy is much less toxic.
The problem with hormone therapy is that it will eventually fail. In all cases the cancer seems to become immune to the effective of the hormone manipulation after a whole and starts regrowing rapidly. Intermittent hormone therapy is intended to lengthen the time before the cancer becomes resistant (refractory is the medical term). Intermittent therapy consists of hormone injections for a period, followed by withdrawn of therapy whilst the activity of the cancer is monitored via the PSA test. When the PSA score starts to rise then hormone therapy is re initiated and so on.
There is evidence that this approach is more effective (and provides better quality of life) than continuous therapy (see this recent article).
At my next clinical meeting I will need to discuss where we are going with my hormone therapy routine with my consultant.
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