Fighting Stage 4

When I was first diagnosed with aggressive, advanced, Stage IV prostate cancer, I was told it was incurable but that we should be able to managed it as a chronic disease for years (but not decades).

I didn’t really know what that meant, but I am beginning to get an insight and I thought I would start sketching out some of my insights as part of my approach to dealing with this.

I still think of myself as young (44 at diagnosis, 45 at time of writing) but more importantly I have two young children (2 and 7, now 3 and 8). Perhaps it’s denial but my bucket list doesn’t contain items that I can tick off in years, but involve things I need to be around for decades.

My work have been amazing, fully supportive and with their support and there is no pressure from them as to what my return to work should look like. I can’t at the moment commit to running client’s cases, which is where a major part of my job satisfaction comes from, because my short term treatments are in a state of flux. I hope to get back to involvement in client facing work in one role or another if things stabilise and the reality is everyone has uncertainty – none of us are getting out of this alive. But I would like to give Anna some years of retirement with me, in due course.

I have done a lot of self-analysis over the last year and realised I have incurable ambition. It’s not about money (although that helps) or about pressure from anyone else, but I have an obsessive, compulsive desire to push myself to achieve milestones when I see logic in them. I even broached the “equity” discussion, ahead of my diagnosis and can’t quite put that dream to bed.

But for now, while I get monthly blood test anxiety, scanxiety when the blood tests trigger those, and play radiotherapy whack-a-mole, despite loving seeing the kids craft, learn new skills (watching Oliver have his first ski lesson was amazing and I always take a moment to admire Emma’s swimming even if she thinks I’m glued to my phone) there is a helpful sense of satisfaction and achievement from progressing work things in a way that I hadn’t always imagined when I was focused on building my own practice – I am excited by the exponential growth and developments in our London office and UK based team, and by networking opportunities I am developing such as Restructuring & Insolvency Runners, TRISS Cycling Club – Turnaround, Restructuring, Insolvency, Special Situations and Cycling and LIIARC – London International Investigations and Asset Recovery Conference.

So, what does “dealing with stage IV Cancer as a chronic illness” entail for me?

None of this is medical advice, but a reflection of some of my journey. All cancers are different and people’s bodies (and minds) respond in different ways. No-one should feel they have to respond in a certain way, every cancer patient should find their own way and those around them should support them in their decisions. Gently probe, offer resources if you have them, but unsolicited advice can offend and add to a mental load you may not understand. If you want to discuss how to help a friend or family member, or if you are yourself interested in any of these approaches, please do reach out and connect and I can suggest professionals who will be able to properly assist, but always happy to discuss my own personal approach.

My approach is:

• Follow the best available medical science. Science is my religion and the cornerstone of my approach to life (although I am grateful to anyone who prays for me);
• Add low-risk, evidence-informed marginal gains. The marginal gains philosophy of the British Cycling Team has inspired me in a number of areas of my life, and the compounding effect can make a material difference to the odds (I don’t mind being shown the odds! They’re something to beat);
• Avoid anything that is clearly irrational or harmful (although overtime the potential benefit/harm equation may change, I can’t see myself injecting bleach into my prostate anytime soon).

The “active treatment” of chemotherapy and radiotherapy last year (with a little marginal gains) reduced my prostate specific antigen (PSA) from 186 to 0.03 for a time. Here’s a bit of an introduction to the “chronic part”.

This is therefore part of how I am “managing Stage IV Prostate Cancer as a chronic disease”. It will evolve as I learn.

1. 12 weekly injections: Prostate Cancer is primarily driven by testosterone. I therefore have 12-weekly injections (Zoladex) to reduce my testosterone to pre-pubescent levels. This apparently induces the male menopause and makes me more prone to muscle loss, fat gain (maybe I’ve been on these all my life?!) and osteoparosis;
2. Daily chemo pills. Because we still produce some testosterone, I also have androgen deprivation treatment in the form of Darolutamide twice a day. These aim to block the androgen receptors in my cancer cells and therefore provide a second level to reduce the main driver of the cancer.
3. I am fortunate to have private medical care through work. They insist on a monthly blood test to make sure I am healthy enough to continue my medication. This gives early warnings on my PSA, as the cancer will eventually become castrate resistant (i.e. driven by factors other than the testosterone). This allowed us to catch some patches in my spine and hip early and we are whacking them with targeted radiotherapy.
4. Radiotherapy Whack-a-mole: My main radiotherapy toasted my prostate, which was the source of my cancer. If you catch prostate cancer early enough it is still just within the prostate and is curable with various forms of treatment. Get a regular PSA test particularly if you are black or have a family history of prostate cancer – the recommendation is from 45 but I was 44 and had neither risk factor. Mine had already spread but we nuked the prostate as the source. That seems to have been successful but various micro-metastases lie undetected, waiting to ambush me again. When they do, we will hit them with radiotherapy – currently an intense schedule on my spine and hip, which should eradicate those sites and hopefully avoid the need for more systemic treatment in the short term.
5. Supplements: we start moving out of mainstream medicine here, where oncologists are reluctant to tread because of the lack of clinical trials. I take various supplements either to (a) put my body in as good a situation to cope with treatment and to fight disease as possible; or (b) that may metabolically stress my cancer cells so that they are more susceptible to treatment and/or my immune system.
6. Diet: supplements are arguably a capitalist approach to healthy eating. They can help get nutrients that may be difficult to obtain and in more intense levels, but there is a question if the body can really absorb those. A healthy diet is of key benefit to us and there are many foods that contain bioactive compounds (e.g. sulforaphane, polyphenols, isoflavones, caotenoids and others). Too long to list in this post, but I try to maintain a diet high (and varied) in these elements.
7. Manner of eating: it’s not just about what you eat (and drink), but about how you do it. Various cancers are fuelled by a mix of glucose, saturated fats and amino acids. This can create a minefield, but order of eating and the timing of food (it doesn’t need the fancy label of intermittent fasting) can make a real difference to how your body processes food and consequent inflammation or immune responses. I try to have 12-14 hour windows of not eating and do a monthly 72 hour water only fast to metabolically stress my cancer cells.
8. Exercise: studies show a drastic increase in mortality from, and recurrence of, cancer. It can also boost your mood, reduce fatigue and give a positivity and illusion of control that the cancer deprives you of. Anna and I are currently training for the London marathon (our sponsorship page is here: Jeremy Snead is fundraising for PROSTATE CANCER UK) and other challenges, and this has helped reduce my risk of other cause mortality. Resistance training also reduces the consequences from my medication.
9. Heat therapy: cold or heat shock proteins can make cancer cells more stressed than regular cells, and therefore potentially more vulnerable to the treatments that target them. I started with ice-baths (in part to teach myself how to cope with the chemo cold cap), enjoyed the endorphins from contrast therapy (switching between a sauna and an ice-bath) but I’m leaning more towards longer straight sauna sessions when I feel mentally week.
10. Hyperbaric Oxygen Chambers: cancers thrive in anaerobic environments. Flooding them with oxygen is thought to metabolically stress them – this can make them more sensitive to radiotherapy and other treatments that stress them. A hyperbaric oxygen chamber puts you under pressure (like diving) meaning the oxygen bubbles are smaller, then you breath condensed oxygenated air (up to 95% oxygen). This oxygenates your blood and plasma more quickly, delivering a more oxygen rich environment. In theory this makes the cancer cells more vulnerable to the treatment but even if not it makes your healthy cells recover from exercise, enriches sleep and gives you a sense of positivity.

I am grateful to a friend (I won’t shout him out without his consent) who opened my eyes to the potential to looking into ancillary areas.

I don’t know which of these things will ultimately matter the most, but doing nothing beyond standard treatment doesn’t sit well with me. Maybe the fundraising will help to change it to curable but a lot of the above seems sensible for most of life.

Some people don’t like cancer analogies about fighting, but I’m a litigator and I’m doing this the same way I litigate – methodically, curiously, with a view to the long term and aiming to beat any odds put in front of me!

If this is helpful to anyone navigating something similar, I’m always open to an exchange.