Prostate cancer

InsightsIssue 8 | Summer 2016 Improving diagnosis The new tools to catch it earlier

Prostate cancer and me SIR MICHAEL PARKINSON

Teaching old drugs new tricks Making existing treatments work harder Insights | Summer 2016 1 Inbox Prostate cancer and me: Get in touch and Sir Michael Parkinson Editor’s 3 have your say 14 The former chat-show legend talks frankly about his brush with note Prostate cancer news prostate cancer Just six months after Latest research announcing our 10-year 4 developments strategy, we’re already The Manual making exciting progress Our tips for coping with on our pledges for better Three ways we’re 16 the fatigue of prostatep19 diagnosis and treatment improving diagnosis now cancer treatment of prostate cancer. 6 The new PSA guidelines, risk tool and mpMRI After the PROMIS trial

C ONTENTS roll out that’s changing Do your own announcement (p6), prostate cancer detection challenge walk we’re busily preparing 18 Ann Fraser reveals the to roll out mpMRI scans secrets of her successful before a first biopsy Speaking out for Isle of Wight walk across the UK, as well as Father’s Day developing our risk tool 8 Five stories of fatherly for GPs and encouraging conversations and advice Running across health professionals to from our supporters the Sahara make better use of the 19 Plus Top Dad and PSA test (p6). We’re also fundraising thank yous heavily involved in funding Prostate Cancer UK research that’s finding update all sorts of new uses for 9 All the latest from us Get involved drugs that are already Events for the rest of 2016 clinically approved, which 20 and five fundraising ideas means they could be Teaching old drugs swiftly given to men with new tricks prostate cancer if they are 10 How researchers are Our support effective (p10). finding new uses for and services old treatments 22 How we can help you Enjoy reading about that, as well as the remarkable stories of Sir Michael Parkinson (p14), Kevin Webber and Bob Wilson (p19). Then check out our new DIY walking kit (p18), which joins our other fundraising guides p14 for cycling and golf. Who knows, next time it could be you featuring in the pages of this magazine.

Editorial team Sophie Lutter Sarah Lines Nick Wright p10 Sonia Barbate Dominic Bates (Editor) 2 Insights | Summer 2016 Your praise INBOX for the Men Tell us what you think about the magazine. United March All feedback is welcome: we want to hear what you’ve got to say. Our Facebook page Dear Terry was full of tributes to Jeff Stelling, Russ Green and We’re glad that seeing his band of fellow marchers our pin-badge helps you after their 262-mile walk Dear Insights feel supported by others. Excellent research from Hartlepool to London, As a recent sufferer, I We know that you’re results [from the that’s now raised more would like to pass on not alone in finding the than £400k. Here are just a my sincere thanks to all badge reassuring and Stockholm-3 trial]. few of your responses: the football managers personally significant, and Let’s hope this and pundits who wear we’ll soon be releasing the Prostate Cancer UK a film that tells some of test can be rolled the amazing stories from pin-badge. It makes me Well done Jeff Stelling instantly humble and our supporters about out worldwide and what the badge means and everybody who took proud that these busy save unnecessary part in this epic walk. The people take time to to them. You may also like to know that you can biopsies and support of Jeff and others wear one. I completed at Sky Sports is admirable. my radiotherapy and I soon buy the pin-badge treatment, whilst from our online shop at We need more people am now on stomach in the public eye to raise injections to reduce my prostatecanceruk.org/ saving lives. Well shop, so hopefully you’ll awareness of this awful testosterone. So when I done Prostate disease. We’re still miles see a badge, it certainly be seeing many more of them on people’s lapels Cancer UK for behind breast cancer in helps me get through terms of awareness. it, knowing people are in future. funding the next thinking of us Steve E unlucky ones. stage of research. Terry Greenwood, Keep up the Thornton, Lancs good work Well done Jeff and Co. We had the pleasure of joining a cookbook ourselves, and its own cookbook. the march from Derby to but the Prostate Cancer We’d also recommend Burton. Fabulous day with Research Foundation Macmillan Cancer a great bunch of people part-funded Healthy Support’s range of online raising lots of money and Dear Insights Eating: The Prostate Care recipes tailored for people awareness for a really It would be a good Cookbook, by Margaret with cancer (search for good cause. move to get one of the Rayman, back in 2009, ‘recipes’ on their website), well-known chefs to put which is still available and there’s a more general Viki Myatt together a cookbook for on Amazon. Some of selection of equally healthy men with prostate cancer. the science behind the meal ideas on the NHS This would also raise ingredients it recommends Choices website awareness of the disease, may well have dated, but (nhs.uk/livewell). What fantastic memories and encourage discussion it is full of good healthy Bon appetit! we will all have. Would we of the subject. meal ideas. Nowadays, do it again? Yes we would! we often signpost people Jeff Willmot, via email Thank you Russ and Jeff to Penny Brohn UK’s for making day six a real Dear Jeff website (pennybrohn.org. treat for me. It’s an interesting idea! uk/nutrition), which has We’ve never produced well thought-out recipes Brian Harrison

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Insights | Summer 2016 3 PROSTATE CANCER NEWS Race is on to get new MRI diagnosis adopted in the UK after PROMIS of scans before biopsy revealed Preliminary results from the without having to take a cancers detected by itself. everything set up to do long-anticipated PROMIS tissue sample and risk But if urologists could use mpMRI right, then there’s trial – announced at the serious infection. the results of the MRI scan a chance that it could American Society of Clinical to help them accurately actually do more harm Oncology conference in The results still need to target where in the prostate than good. That’s why June – found that using a be confirmed in a peer- to aim the biopsy needles, we’ve been working with multiparametric magnetic reviewed publication, this might result in more radiologists, commissioners resonance imaging but this first glimpse aggressive cancers being and NHS to (mpMRI) scan before a first certainly looks exciting. diagnosed straight away. make sure the training, biopsy could allow many The research team, led by equipment and expertise men to avoid having the Professor Mark Emberton We want men to benefit are in place before invasive and often painful and Hashim Ahmed from from these findings and nationwide roll-out is done procedure. The researchers UCL, also found that having be spared unnecessary as speedily as possible. concluded that mpMRI was an mpMRI scan before a biopsies as soon as the You can read more about sufficient to safely rule out standard, random biopsy results have been peer- what we’ve been doing at the possibility of clinically- didn’t improve the number reviewed. But we know prostatecanceruk.org/ significant prostate cancer of aggressive prostate that unless hospitals have mpmri An innovator and unifier: in memory of our former trustee, Christopher Adams

To say Christopher Adams the UK would be a gross treatments and innovative Action and The Prostate – who was diagnosed understatement. Chairman drug therapies. As Chair Cancer Charity to form with prostate cancer in of the Prostate Cancer of Prostate Action, he was Prostate Cancer UK 2003 and died on 13 Research Foundation from instrumental in the success in 2012, becoming a February 2016 – had an 2007, he was the obvious of a number of fundraising trustee of the UK’s largest impact on prostate cancer choice to steer the ship events and was the first to men’s health charity. research and treatment in following the merger in jump in and get involved. 2010 with Prostate UK to He was also an innovator form Prostate Action. Research was his passion and not afraid to take a risk and he was a massive for the cause. Sitting down His positive attitude to advocate of the Research with his friend, Kenney facing up to his own Forum – the biennial Jones – drummer with disease was evident in his meeting that brought the Small Faces and The efforts to help extend the the world’s top prostate Who – they pulled together lives of other men dealing cancer researchers and a plan to create a music with prostate cancer, clinicians under one roof to festival to raise money for focussing funding on compare notes and build prostate cancer. Those of groundbreaking collaborations. Genuinely you who have attended research into committed to bringing Rock ‘n’ Horsepower (now advances in all the prostate cancer in its third year) can attest charities together – to avoid to its success, and this duplication of effort and successful event is a fitting share experience and ideas tribute to a man who gave – he was instrumental in his all to help stop prostate the merger of Prostate cancer being a killer. New genetic test and drug set for clinical trials thanks to research grants from your donations Our new Translational made it possible for us to men have this mutation with hormone therapy, Research Programme fund two new grants worth before they start treatment, radiotherapy and radium- supports science that more than £800k. so that only those who 223. They will then move sits right at the leading are likely to benefit will be on to conduct a small- edge of patient care. The The first grant went to given the drug. scale clinical trial in men ambitious scheme has one Professor de Bono at with advanced prostate exciting aim: by the end of the Institute of Cancer The other grant will fund cancer, where he will test every grant, the research Research in London. His a research team working the drug in combination should be ready to enter team are developing a with a pharmaceutical with the traditional clinical trials for men with genetic test for aggressive company to develop a therapies to work out how prostate cancer. So it really prostate cancer to help drug they believe might much of the drug is safe to won’t be long before these assess which men will force treatment-resistant give to patients. grants are making a real- respond best to a certain prostate cancers to start life impact. treatment. They have responding to traditional Together, these two already shown that a drug therapies again. This projects represent new The hard work and called olaparib works drug has only just been approaches to treating determination of everyone best for men who have developed so it’s in the advanced prostate cancer who’s raised money a mutation in one of the very earliest stages of that could make a big for us – through events genes that controls how testing. The researchers difference to how well like Jeff Stelling’s Men cells repair broken DNA. will first carry out extensive these treatments work, United March and the So now they want to pre-clinical tests to and how long men can Distinguished Gentleman’s design a simple genetic see how well the drug expect to live with ride, in particular – has test to work out which works when combined the disease.

An update from Professor FROM THE LAB Charlotte Bevan With our £250k research grant, Professor Charlotte signature that can be used to classify tumours into Bevan and her team set out to understand how a family different sub-groups. of proteins called nuclear hormone receptors is turned on and off in different prostate cancers. The team are now looking at what happens when they change the level or activity of some of these proteins. They believe that the pattern of how these proteins They have so far found that the activity of one nuclear are expressed varies between cancers. They think this hormone receptor in particular can be altered using variation allows them to not only be categorised into a drug that’s currently in clinical trials for metabolic more or less aggressive tumours, but also to work out disease, and that this alteration appears which treatments might work best to combat them. The to affect how prostate cancer cells grow. idea builds on work already done in breast cancer, where this pattern of nuclear hormone receptor expression Over the next couple of years, they’ll already guides which treatments are given to women. analyse more tumour samples to make sure their protein expression Funded by the Movember Foundation and the Garfield signatures really are a useful indicator Weston Foundation, Professor Bevan and her team’s of the type of tumour it is and what work has already made tremendous progress in its first treatment is most suitable. At the year. So far, they’ve confirmed that there are high levels end of this grant, Professor Bevan of nuclear hormone receptors present in all prostate hopes to apply for additional funding cancers, and that certain protein family members tend to complete the pre-clinical work that towards being turned on or off at the same time as will be essential to move this into each other. This could form the basis of an expression clinical trials.

If you’d like to comment on this or other news stories, go to prostatecanceruk.org/news and join the conversation

Insights | Summer 2016 5 Three ways we’re improving diagnosis now

In the last six months, we’ve made exciting progress towards better and more consistent Preparing for UK roll out of mpMRI diagnosis of prostate cancer, with improved PSA Following the exciting early results of the PROMIS trial guidelines, a new risk tool for GPs in development (see p4), we’ve already started laying the groundwork and preparations for roll out of mpMRI across the to roll out multiparametric magnetic resonance imaging UK. Here’s a brief guide to what each one means (mpMRI) before a first biopsy across the UK. in practice. We’re working with the Royal College of Radiologists to pilot a training programme for its members that will New PSA guidelines agreed launch later this year. We’re also taking a first-of-its-kind We convened a powerful group of doctors, nurses, approach to assist the commissioning of this scanning consultants and their professional bodies to agree technology, working with a group of prominent Clinical radical new recommendations for using the PSA test Commissioning Groups to develop a ‘checklist’ of more effectively. The 13 ‘consensus statements’ build resources that need to be in place. on the current advice for PSA testing from Public Health England, but go much further, recommending that: NHS England has been invited to work with us and their new National Diagnostics Capacity Fund to understand • Health care professionals should discuss the PSA whether we already have enough scanners to make this test with men without symptoms from the age of diagnostic tool a reality for all men, or whether we need 45 who are at higher than average risk of the to campaign for more. We know we need to be realistic disease, including Black men and men with a family about this, and access for every man will not mean history of prostate cancer. prostate mpMRI scanners available in every hospital. So we need to work with men to establish what they • GPs should explore using the PSA test to provide consider to be a reasonable distance to travel. a ‘baseline’ for men in their 40s who are concerned about prostate cancer, to work out their risk of Finally, we’ll work with radiologists and radiographers getting prostate cancer later in life. who have already become experts in prostate mpMRI • If a man has no symptoms of a prostate problem and is clearly likely to live for less than 10 more years, his GP or practice nurse should advise him not to have a PSA test. HIGH Immediate referral The PSA test is controversial and notoriously RISK imprecise, but it’s the best thing we’ve got and we hope this expert guidance plugs the gaps in the Age official rules and brings some detail and clarity. It puts PSA test Repeat test soon advice agreed by hundreds of specialists at the GP’s Family history MEDIUM and/or probable fingertips. Men can now ask for a really informed Ethnicity RISK referral discussion with their doctor and consider getting PSA Other risk tested younger. factors No immediate LOW action, repeat RISK test in x years

6 Insights | Summer 2016 before biopsy to develop guidelines for other health Overall, the researchers need to come up with the right professionals, so there are agreed technical standards balance of factors that give the most accurate picture and quality assurance levels to give men a positive of a man’s risk, but is still easy and quick to use within diagnostic experience. a normal GP appointment and is cost-effective for the NHS. Subject to how trials pan out, we hope that a large number of men will have access to the risk tool within Our new risk tool for GPs three years and it will be in the hands of all GPs within five. We’re developing a new risk assessment tool for GPs, which should indicate the presence of cancer far more accurately than the current PSA test alone. It will not only help men understand their risk of aggressive prostate cancer, but also what to do about it. The tool is straightforward, easy-to-use and will be It isn’t always built in to GPs’ existing computer systems. It will let them input information like – but not exclusively – age, easy for GPs ethnicity, family history and PSA level, and get back an indication of the patient’s individual risk of having to know what aggressive prostate cancer. to do with the But more than that, it will then give both the man results of PSA tests, or to spot and his doctor a clear idea of what they should do next, using a traffic-light system: red to go straight to all their patients who might be a urologist, green to go home and not worry about another test for years, or amber for something in at higher than average risk of between. The results can then be printed out for the man to keep or used as an opportunity to suggest prostate cancer. appropriate information resources for him. We’re caught between the fear of over-diagnosing harmless prostate cancers, which can lead to all But the first step is getting the calculation right. While sorts of complications further down the line, and fear PSA level, ethnicity, age and family history will doubtless of missing an aggressive prostate cancer. be key factors used by the tool, the researchers will also consider a long list of other possible risks. At the We desperately need a simple tool that can be easily same time, we’ll also be funding work to validate the adopted into ‘real-life’ primary care that will help us Stockholm-3 screening trial in the UK, which used a make better decisions with and for men at risk of panel of new tests for genetic and protein biomarkers prostate cancer. And that’s what Prostate Cancer alongside PSA. If the results are as promising here UK are planning to deliver. It could make a massive as they were in Sweden, the new tests could also be difference to us, and our patients. included in the risk tool. Dr Jon Rees, GP in Nailsea, North Somerset

HIGH HIGH ImmediateImmediate referral referral RISK RISK

Age Age PSA testPSA test RepeatRepeat test soon test soon FamilyFamily history history MEDIUMMEDIUM and/orand/or probable probable EthnicityEthnicity RISK RISK referralreferral Other Otherrisk risk factorsfactors No immediateNo immediate LOW LOW action,action, repeat repeat RISK RISK test intest x years in x years

Insights | Summer 2016 7 Speaking out for Father’s Day

On 19 June, we celebrated dads everywhere – weekend, which included regular screenings of our including those no longer with us – by asking advert during the Le Mans 24-hour race coverage. everyone to talk to their families about prostate cancer and share their favourite piece of fatherly “I’m supporting Prostate Cancer UK this weekend advice. Here are just a few of those who supported because I’m a bloke and we need to look after each our campaign with their stories. other,” says Drew. “We’re very bad at ignoring things and just walking away and thinking it’ll be alright. So Phill Griffith: my dad’s wise words having the details [of prostate cancer] thrust in front of “One of the things my dad said to us me has been pretty shocking and something I before he died was: boys, whatever won’t ignore.” you do, get a PSA test and make sure you’re in good health,” says father-of- Nigel Mansell: my dad’s two Phill, who lost his dad to prostate mixed advice cancer 15 years ago. “The worst piece of advice my dad ever gave me was to stay away “My dad also told me to always be myself. I can still from fast cars! So, that didn’t work hear his words ringing in my ears: ‘You can only be out,” the former Formula 1 and you and that’s who you are best at being. You are the IndyCar World Champion told star in your movie’. Like so many others, I relied on my us. “But his best advice, something I still live by, is to father to guide me through so many situations in life, always treat people with courtesy and how you would but I didn’t realise how much his wisdom and advice like to be treated. We all need to support each other. meant to me until he was gone.” “I know there are a lot of men who are on their own Brian White: my lifesaving journey with prostate cancer, and I think it helps if we’re family chat all more open about it and support one another – we’ll After reluctantly meeting with his only beat this disease if we stop ignoring it.” dad at a party for the first time in five years, Brian learnt of a family Ray Winstone: wants out of history of prostate cancer. The brief his diagnosis conversation led to the 42-year-old’s In our special short film, Father’s prostate cancer being caught early and helped him Day, Ray Winstone plays grieving rebuild a relationship with his father. car mechanic Joe, who wants to run away from his recent prostate cancer “It was like getting a winning lottery ticket that I found diagnosis and avoid talking to anyone out my father and uncle had prostate cancer when I about it. Made in 2013, and did,” says Brian. “ was going to send me also starring Charles Dance, away and get me to come back every six months. Tamzin Outhwaite and John In the words of my oncologist: ‘If we’d sent you Simm, the film’s themes of away, we’d have been dealing with metastatic opening up and knowing prostate cancer’.” your risk struck a chord with hundreds of visitors to our Drew Pritchard: blokes need to website this year. Watch it for look after each other yourself at prostatecanceruk. The presenter of TV’s Salvage org/fathersday Hunters joined his colleagues at Quest in supporting our channel takeover during the Father’s Day

For more about all of these stories and other dad-related articles, visit prostatecanceruk.org/fathersday

8 Insights | Summer 2016 Football to Let your Amsterdam legend live on Jeff Stelling was already passes £1m a favourite with football Now in its fourth year, the fans. So surely, after Football to Amsterdam 262 miles on the Men cycle saw 350 riders set United March, he can UPDATE off for the Dutch capital on now safely lay claim to 3 June from two different the title of legend. But starting points in London you don’t need to go to and . The biggest such extreme lengths to New Silverstone Classic ride in football is the become a legend, too. official end-of-season Just by supporting our partnership event for our partnership work through a gift in with the English Football your Will, you can take League, and more than your own legendary step 60 different footballs clubs towards helping us fight were represented, raising prostate cancer. more than £500k between them and taking the total This September, as part raised by the event since it of Remember a Charity started beyond £1m. Week, we’re celebrating and encouraging more people to meet with a Match-day solicitor and include Prostate Cancer UK in collections their Will. It needn’t be Prostate Cancer UK This year’s festival takes at the expense of friends has been appointed the place over the weekend top £72k and family, as you can Silverstone Classic’s of 29-31 July, with Thanks to our English provide for both the Official Charity Partner for 10,000 privately-owned Football League causes and people close the next three years. The classic cars on display partnership, we’re able to you, but every gift can world’s biggest classic and the Boomtown to hold match-day make a real difference – motor racing festival at Rats headlining the collections throughout no matter what the size. the Formula 1 race track music stage. the season, which are offers the perfect platform a great way of raising to reach more than Full details and both awareness among 100,000 visitors each year tickets are available at football fans and funds to with our message not to silverstoneclassic.com help us find better ways ignore prostate cancer. to diagnose, treat and To find out more, prevent prostate cancer. including our Free Will Scheme, just 350k people reached by our This year more than 500 email legacies@ volunteers took part in prostatecanceruk.org, awareness programme 63 collections, filling their call 020 3310 7275 or visit buckets with an incredible prostatecanceruk.org/rac Our awareness prostate cancer, events £72k. Thank you all of you: programme has exceeded have been held all across without your dedicated its target of reaching the UK in Rotary Clubs, support, we wouldn’t 350,000 people, four workplaces, army bases, be able to months ahead of our large sporting events, and have this kind three-year schedule. even prisons! of impact at football Delievered by our To book an Awareness stadiums talented volunteers, Talk near you, visit across the who speak about their prostatecanceruk.org/ country. own experiences with talks

Insights | Summer 2016 9 Teaching old drugs new tricks

One of the most important ways we can stop prostate cancer killing so many men is by learning the best way to use treatments that already exist. They’re already in the clinic and often already approved for other uses, so making these drugs work harder for us will save years of development time and millions of pounds. Dr Sophie Lutter explores some of the drugs already being given – and giving – a new lease of life for men with advanced prostate cancer.

Giving an old drug at a new time STAMPEDE The biggest trial to test these ideas so far is the The rules about drug development and testing mean STAMPEDE trial and the first results made quite a that all of the drugs we currently have to treat advanced splash when they were announced last year. prostate cancer – like abiraterone, enzalutamide, docetaxel or radium-223 – were developed as ‘end of They found that giving docetaxel – a type of life’ treatments; to give to a man whose cancer had chemotherapy – at the same time as hormone therapy become hormone resistant and had no other to men newly diagnosed with prostate cancer that options left. had spread around the body increased survival by an average of 15 months. Now researchers are asking if we hit the cancer harder earlier on in a man’s treatment (when he may also This is now routinely available to men newly diagnosed be feeling stronger), will the same drugs have a with metastatic prostate cancer earlier in the bigger effect? treatment pathway in England and Scotland. Formal commissioning hasn’t happened yet in Wales or Northern Ireland, but so far oncologists have still been able to prescribe docetaxel early on to patients who need it. We’re continuing to work with both countries to make sure a formal policy is in place as soon as possible.

Over the next few years, the STAMPEDE trial will also find out if hormone therapy with radiotherapy or abiraterone or abiraterone and enzalutamide combined also benefits men with advanced prostate cancer.

ADRRAD In the ADRRAD trial, researchers at Queen’s University Belfast are asking if a double whammy of radiation from the time a man is first diagnosed with advanced prostate cancer that’s spread to the bones can radically change his survival prospects.

As well as giving hormone therapy to stop the prostate tumour growing or even shrink it, the researchers will also zap it with radiotherapy and use radium-223 injections to kill cancer cells in the bone. If the combination of treatments proves both safe and effective enough, it will be rolled out into a large-scale clinical trial after only a couple of years.

At the same time, the research team is also working on the underlying science behind it to find out whether some men will be better suited to this treatment than others.

10 Insights | Summer 2016 Teaching old drugs new tricks

Giving an old drug, but only to the right men There are many genetic variations of advanced prostate cancer, which respond differently to treatment. So a one-size-fits-all approach means that some men do really well on a particular treatment, while others don’t benefit at all. Working out which men fit into which group is going to be the next big game-changer in treating advanced prostate cancer.

TO-PARP The TO-PARP trial, led by Professor Johann de Bono at the Institute of Cancer Research in London, looks at men who have a change in one of the genes responsible for repairing damaged DNA. This makes the cell more likely to become cancerous. But it also means that the cancer that develops is more likely to be controlled by a type of drug called a PARP inhibitor.

The team found that around 30 per cent of men with Dr Attard found that one of the ways it changes to advanced prostate cancer had this type of mutation, become resistant to hormone therapy also makes it and the same 30 per cent benefited from treatment resistant to treatment with abiraterone. The next stage with a PARP inhibitor called olaparib, which is currently is setting up a clinical trial to test whether men with this used to treat women whose ovarian cancers have this mutation, who are unlikely to respond to abiraterone, same mutation. Next, the trial will recruit only men with will instead respond better than usual to docetaxel a DNA damage repair mutation, and will assess exactly chemotherapy. This work should start later in 2016. what benefits in terms of delaying cancer progression and increasing survival olaparib can bring for these men. PTEN mutations PTEN is a gene that works by putting the brakes on For men who don’t have these mutations, we’re helping cell division so that cells don’t divide too quickly and to fund a number of research projects that are focused become cancerous. But for some reason, radiotherapy on understanding the differences between individuals’ doesn’t work well for men whose prostate cancers cancers and how this might affect the way they contain a mutation in PTEN. respond to treatment. One of our PhD students, Conor Hanna, found that Androgen receptor mutations although radiotherapy on its own wasn’t enough to kill Dr Gert Attard at the Institute of Cancer Research cancer cells that had a PTEN mutation, when it was identified mutations in the androgen receptor that stop combined with drugs designed to stop the cell repairing prostate cancer from responding to abiraterone. The damaged DNA, it became much more effective. androgen receptor is a protein that drives prostate Conor’s work was conducted in mice, but his lab cancer growth when it is ‘turned on’ by the hormone mates at Queen’s University Belfast have picked up the testosterone. During the course of the disease, it baton and are hoping to progress the post-graduate’s becomes permanently ‘switched on’ even without research into a full-blown clinical trial for men with testosterone – a situation known as hormone resistance. prostate cancer very soon.

Please donate so we can continue this vital research work: prostatecanceruk.org/donate

Insights | Summer 2016 11 with this approach is that there are so many other Giving an old drug a new lease of life variables involved in cases like this that it’s really difficult We’ve already talked about how olaparib was first used to draw definitive conclusions about whether it’s the to treat women with ovarian cancer, so what other statins that are the decisive factor. drugs being used in other diseases could have a role to play in prostate cancer? Dr Hing Leung, at the University of Glasgow, is using a £463,460 Prostate Cancer UK research grant, funded by The Movember Foundation, to run a phase II clinical trial to test whether taking statins alongside hormone therapy can delay the time it takes for prostate cancer to become hormone resistant. If this proves the case, it could be an extremely quick and cheap way to help men live longer with prostate cancer.

Metformin Metformin – a diabetes treatment – is another drug that’s been whispered about without any solid clinical data behind the rumours. But as with statins, the speculation has built to a critical mass, and now various research projects and a few big clinical trials are looking to get to the bottom of what, if anything, metformin does in relation to prostate cancer.

One such trial is the Canadian-led MAST (Metformin in Active Surveillance Trial), where a randomly selected group of men on active surveillance are prescribed metformin to see if their cancer progresses more slowly. We’re expecting to hear the results of this trial in 2018. The STAMPEDE trial is adding a new arm to test Statins whether giving metformin alongside hormone therapy Statins were originally developed to help lower to men newly diagnosed with prostate cancer that has cholesterol in people at risk of coronary heart disease. spread outside the prostate will help them live longer. But there’s been a buzz of speculation around the benefits they may have for men with prostate cancer for Overall, the clinical and scientific jury is still out on a while now. metformin. But it’s a cheap and readily available treatment with minimal side effects, so any and all One research team found that testosterone competes evidence of benefit will be extremely welcome if and with statins to get inside the cancer cell. This means when it comes. that it may take longer for testosterone to build up in a prostate cancer cell and drive growth if a man is also Targeting areas of low oxygen taking statins. A group of researchers at our Belfast- Movember Centre of Excellence has developed a way However, all the clinical evidence for statins’ benefits to identify head and neck cancers that had particularly so far has been retrospective. That means that low oxygen levels, by looking at the genes that are researchers have looked back at what happened turned on in these tumours. Cancers with low oxygen to men who just so happened to be taking statins levels tend not to respond well to radiotherapy, but for another condition at the same time as they had doctors can sort this out fairly easily with drugs that hormone therapy for prostate cancer. The problem raise oxygen levels.

12 Insights | Summer 2016 Dr West and Dr Choudhary are now working to adapt proteins are turned on or off in his cancer. Depending this ‘low oxygen gene signature’ to identify men on the results, the man will be randomly assigned to whose prostate cancers have low oxygen levels, so either a normal best standard of care or to a tailored-to- that they can either be offered alternative treatment to his-cancer treatment arm of the trial. radiotherapy that might work better for them, or can be given drugs to raise the oxygen levels in his tumour so that the radiotherapy will work. Giving the right drug, at the right time, to the right man Eventually, through trials like these, To make really radical inroads into the number of men dying of this disease, we need to find a way to give men might outlive a diagnosis the right drug combination, to the right man, at the currently considered terminal right time. We need to be precise in the way we treat a man’s cancer, with treatment that’s accurately matched This will be really big deal and is likely to be expensive. to his cancer and the way it’s developing. Breast It’s also going to take years to pay off, but – and it’s a cancer is already treated like this, and now we have the big but – when it does, we’ll be a long way towards chance to do the same for prostate cancer. achieving our goal of halving the number of men dying from advanced prostate cancer each year. Eventually, That’s why we plan to fund a large-scale precision through trials like these, men might be able to outlive a medicine clinical trial. So far we’ve brought together diagnosis that’s currently considered terminal. the researchers, clinicians and statisticians we think we need. This includes some of the key people who were With the exception of the STAMPEDE, TO- instrumental in running the STAMPEDE trial, as well as PARP and MAST trials, whose scientific teams those who have already helped set up similar trials for we collaborate with closely, all the research lung and colorectal cancer. mentioned in this article is funded by us with It’s still a work in progress, but the basic idea will be to support from the Movember Foundation. recruit men as soon as possible after a diagnosis with For more about all our research work, please visit advanced prostate cancer, then analyse the initial blood prostatecanceruk.org/research or biopsy sample to work out what genes or

Insights | Summer 2016 13 PROSTATE CANCER AND ME Sir Michael Parkinson

The legendary former How did you react when talk show host, who you were given your interviewed everyone diagnosis? during his 50 years on TV – from It wasn’t a surprise. to Rod Hull and his My doctor had been infamous emu – had monitoring my levels and prostate cancer for I’d been doing charity two years before his work for prostate cancer doctors gave him the so knew what could all clear last summer. happen. I just thought: The 81-year-old miner’s ‘how can I deal with this?’ son and die-hard And the answer is by FC fan tells getting good doctors and us how he felt about good support and having being diagnosed, the the mindset that you’re unpleasant side effects going to get through of his treatment, this. My wife has also and why he thinks been wonderful. football is the perfect vehicle to raise awareness.

How did you first learn about your risk of prostate Thankfully my cancer? cancer was Luckily for me, my doctor made picked up at me aware of the potential threat an early stage my prostate posed and I was to me long before I was diagnosed with successfully prostate cancer. Being in television, I had to treated have a medical before every new show for What was your insurance purposes. So I treatment like? would have three or four a year and always had my I had radiotherapy PSA checked. Thankfully and the reactions my cancer was picked weren’t pleasant. You up at an early stage and I think: ‘well, this is easy’, was successfully treated. and then a month later

14 Insights | Summer 2016 Sir Michael Parkinson

you start getting after- Have you talked to your effects. Even when they own family about their got rid of the cancer, the prostate cancer risk? effects lingered on in the bowel and the bladder. Absolutely – my three It’s a difficult thing to deal sons know all about it. with, but you deal with it Only my oldest boy is over better if people tell you 50, but they all get their about it and tell you what PSA checked regularly. It’s to do. a simple blood test and if they do find something, Is it important celebrities the new treatments like you talk about coming from the genetic the realities of having research that’s going on prostate cancer? now are really wonderful. Sir Michael joining other celebrity readers at our The only way you can You’ve been a great Carols by Candlelight event in 2014 justify fame, which is a supporter of us for many daft thing really, is by using years. What’s most pray to God that it won’t, it to promote awareness impressed you about but I have regular monthly of things like this. I asked our work? checks to try to keep it cricket commentator under control. The fact of Jonathan Agnew on the I think that the awareness the matter is that I feel well radio last year about campaign around football I think that now – a lot better – and I prostate cancer and is terrific. It’s the audience can work and write again whether he’d been to see we need to reach: the the awareness and do telly if I wanted to. a doctor. He said no and ordinary and younger So even if it’s only bought I called him an idiot and guys on the terraces. campaign me five extra years, it’s told him to go immediately I know because I was around football been worth it in my view. – which he did. But that’s one of them. But there In another year or so I feel the crusade we should are so many other things is terrific I’ll be back somewhere all be on. Because some to take their attention near the kind of health I men are reluctant to go nowadays, so we’ve got How is your health now? was enjoying before I had to the doctors still and we to keep at them all the the cancer. I just want to must persuade them that time and football is the All the tests show that live to see Barnsley win it doesn’t hurt and it could ideal vehicle. I love the the cancer has gone. the European Cup. save your life. If not for pin-badge, too – it’s You can’t say it will never themselves, they should really stylish. come back and you just go for their families.

For more information about living with prostate cancer visit prostatecanceruk.org/living

Insights | Summer 2016 15 THE MANUAL Your questions answered about controlling prostate cancer-related fatigue

Getting fatigue and how it affects you depends on a number of things, like how fit and well you are, the stage of your cancer, and the type of treatment you have. Men who’ve had a radical prostatectomy tend to feel fatigued for a while afterwards. While men on hormone therapy and radiotherapy may notice their fatigue lasts throughout their treatment, and either improves or lingers on after it finishes.

What can I do about it? Fatigue is one of the most common side effects of Don’t beat yourself up. It’s not a sign of weakness cancer, but it’s also one of and it’s important to give yourself time to recover. the hardest to beat. Our When you feel up to it, there are things you can try Specialist Nurse, Meg, offers which can make a real difference. The first is to talk to some ways to manage it – your GP or someone in your medical team. They can including our fatigue support find out what’s causing your tiredness – the cancer, service – to make the most treatment, or something else, like anaemia – and of the energy you do have, suggest ways to treat it. so you can keep doing the Next, organise your day so you can do the things things that matter to you. most important to you when you feel most energetic (read more about this below). Try to stay active with some gentle exercise – even if it’s just a walk around I feel tired a lot, do I have fatigue? the block. Light exercise can lift your mood and help you feel more energised and awake, but always talk to Fatigue is more than tiredness but everyone’s your medical team before starting a new exercise plan. experience of it is unique. Some compare it to the Eating healthy foods can help you feel more energetic kind of exhaustion you feel if you’re recovering from throughout the day, too. the flu. Men often tell us their fatigue is unpredictable and, unlike normal tiredness, it often doesn’t get better Try setting some goals for yourself. It helps to have a with rest. For some it can be hard just to get out of reason or purpose to take control of your fatigue – like bed, affecting work, relationships and hobbies, and – getting back to work, or spending more time with the ultimately – how you see yourself. Whether your fatigue kids or grandkids. And keep up the things that you is mild or has a bigger impact on your life, there are enjoy doing as this will spur you on, too. ways to improve it.

When I’m feeling tired, should I rest or try Why do men with prostate cancer get fatigue? carrying on regardless?

Fatigue is a very normal part of living with any type It’s all about balance. It’s good to have some of cancer, and can be the result of the cancer itself periods of rest, but doing nothing all day can make or your treatment. Just the stress and worry can leave you feel more tired and less motivated. So it’s important you feeling exhausted, but it doesn’t mean your cancer to have some periods of activity in your day, even if is getting worse or your treatment isn’t working. you don’t really feel like it. Some treatments, such as

16 Insights | Summer 2016 hormone therapy, can make you feel tired and cause These are just a couple of positive comments from you to lose some muscle strength. Resting completely men who have used the Fatigue support service: can make this worse. It helps to get a good night’s sleep, too. Relaxation techniques and dealing with any worries that keep you awake can help, or you can speak to your GP about possible medications.

I’ve got activities I need to keep up, how can If I feel tiredness coming on, I’m a I do this? lot clearer in my own head about

Planning your days around when you feel most saying I’m not going to do that and active and when you need to rest can help – take control, rather than keeping keeping a diary may help you spot patterns. Make a list of the things you want to do and decide what’s most going until I fall over. important, what can wait, and what you can get help with. Then plan to do the most important things when you know you’ll have more energy. Remember to give yourself time to relax, too.

You can also change the way you do things rather than It gave me back enthusiasm for life give up what you enjoy. If you played golf every day, and stimulated me to not loll about try once a week or nine holes instead of 18. If fatigue makes doing your job difficult, speak to your employer and feel sorry for myself. about flexible working to change your hours or duties. You may be able to take extra breaks or work To try the service, call our Specialist Nurses shorter days. on 0800 074 8383 or fill in our online form at prostatecanceruk.org/fatigue Who can help me deal with my fatigue?

Feeling worried or down can make you feel more tired, and feeling tired can make you feel more worried or down. It’s a vicious circle. Getting some support to unload what’s going on in your head can help. You can join a local support group or our online community (see p22 for details) to swap stories and ideas with other people who’ve been there.

Or there’s our 10-week Fatigue support service, led over the phone by our Specialist Nurses. Lots of men have enrolled over the past year and found it a real benefit. As well as monitoring their fatigue levels over the course of the programme, we followed up a couple of months later to find out how they were getting on. Most found their fatigue levels had improved and they had increased motivation. But it was having their experience acknowledged and knowing many other men felt the same that helped the most.

Find out more about dealing with fatigue and our Fatigue support service on our webiste at prostatecanceruk.org/fatigue

Insights | Summer 2016 17 DO YOUR OWN CHALLENGE WALK Stepping up to the fight against prostate cancer

When Ann’s husband, John, was diagnosed with prostate cancer in 2002, they knew they wanted to do something to help. Living on the Isle of Wight, with its beautiful coastline and country footpaths, they struck on the idea of a sponsored walk. After This year’s walk is the first I’ve the eighth Wear Your Pants on the Outside walk in aid of us last April, Ann shares some of the secrets done without John. It was tough behind the event’s success. but I’m glad we did it We first planned our fundraising activities about eight If someone is thinking about doing a walk for Prostate or nine years ago. John wanted to do something that Cancer UK I’d say go for it. Make a big list of your would attract men so he could talk to them about the friends and family and start with them, as they’ll always importance of being aware of your risk and getting checked. be most generous. But asking everyone who takes part to pay £5 is a great way to raise money. His first idea was to offer a shoe-shining service to raise money and contact men, but he soon realised that not Get as much publicity out there as you can in your local many men have their shoes shined anymore. So we papers. Use social media because it really does work thought about what else we could do and as we live on – people share things and you get a lot of interest from the Isle of Wight – which is a big walking place – a walk places you never even thought you would. And have seemed like the perfect thing to do. a good poster made, too, and put them out to attract local people. We decided to organise a walk which was challenging but not too difficult so people of all ages and all levels Before this year’s walk started, we’d raised about of fitness could enjoy it. Our walk is eight miles around £3,000 online. On the day itself, we carried buckets West Wight, from Yarmouth to Totland, Freshwater and and collection tins with us and collected a lot too. I’d back to Yarmouth. It’s a circular walk, so we start and be surprised if we don’t do £5,000 on this year’s walk finish in the same place and we all end up in the pub. when all the sponsorship money finally comes in.

This year will be the eighth year we’ve done it. Sadly, I know Prostate Cancer UK is a brilliant charity and John passed away from prostate cancer in they’ll use their money wisely. I think the research 2015, so this year’s walk is also into future cures is hugely valuable, as well as the the first I’ve done without him information and support service they provide. Hopefully by my side. Making the decision one day it won’t be 1 in 8 men who get prostate to hold the walk again without cancer, it’ll be 1 in 100, and then one day we’ll be able him was tough, but it’s been well to get rid of it altogether. attended so I’m glad we did it. Do what you love with Men United this summer and organise your own walk. For advice and merchandise, visit prostatecanceruk.org/walk, email [email protected] or call 0800 082 1616.

Top left: Ann and John Fraser in 2012. Left: Participants on this year’s Wear Your Pants on the Outside walk.

18 Insights | Summer 2016 In the SPOTLIGHT THANK Kevin Webber from “One day I’d run about Epsom, Surrey 20 miles up sand dunes and mountains and had YOU In the 20 months since no energy left. It was 45 he was diagnosed with degrees, I’d drunk all my advanced prostate cancer, water and I couldn’t go £400k father-of-three Kevin has on. But I thought: if I don’t To Jeff Stelling and raised more than £30k finish then the charity everyone who joined him for us through sponsored won’t be able to use me on the Men United March, running events. But in as an example for other cancer. It was so emotional walking 10 marathons in April, he fulfilled a life-long men in bad situations with and several times we’d 10 days from Hartlepool dream of competing in the prostate cancer. So I kept end up crying together. to Wembley. The epic, 156-mile Marathon pushing myself to go on. When I finished the race, awareness you raised de Sables across the coming 566th out of 1,254 was immeasurable. Sahara Desert. “Seeing the Prostate runners, I was worried I’d Cancer UK flag on my enter a real black hole. So “It was physically backpack, people would shortly after swearing I’d exhausting,” says Kevin. come up to me when I was never do it again, my wife £4,000 running and share their and I agreed I should sign To Colin Clarke, who family stories of prostate up for next year.” tackled the Inca Trail trek in Peru. That’s despite recovering from surgery “I couldn’t be prouder of “Keeping my emotions in to remove his prostate, TOP my dad. He’s shown so check was not easy! I can’t having been diagnosed much dedication to being wait to come and cheer with prostate cancer in 2014. healthier, taking on the him over the finish-line at DAD Grand Depart shows just Utah Beach. I will be the how far he has come. loudest, proudest spectator there – and possibly the “I ran every mile of the most emotional. 5,895 marathon for him – having To Lara Hughes, who his support kept me “I don’t want anyone to climbed the 5,985 metres going. One of my hardest hear the words ‘I have to summit Mount training runs was done in cancer’. I’d like to think Kilimanjaro, raising more France, running towards that our hard work and than £6,000 in memory of After Bob Wilson was Mont Saint-Michel, where determination will make her grandfather. diagnosed with prostate my dad’s cycle will start. a difference cancer in 2014, he to future and his daughter Beth “He cycled the 20 treatments, £22,230 decided to raise money miles with me, studies and To Irene McGowen, who for us to help other men mostly sheltering – one day – has raised this incredible with the disease. While me from the a cure.” sum through a variety of Beth signed up to the wind and events over the years, London Marathon, Bob rain. including dinner-and-dance had taken up cycling as events, tea parties and even a way of losing weight a pop up charity shop. and improving fitness before and during his treatment. It soon became his obsession, so Beth suggested he sign up for our Grand Depart Classic in France. Together they’ve raised more than £2,000.

19 GET INVOLVED Five ways to get your mates together and raise money for us as Men United

Be like Jeff on your Take on the Classic own challenge walk Three Peaks Challenge All year round Until 31 October Inspired by Jeff Stelling’s money for us and help Climb the home nation’s trip. Contact events@ Men United March? Or beat prostate cancer. It’s highest peaks – Ben Nevis, prostatecanceruk.org or perhaps you’re looking easy and we’ll be with Scafell Pike and Snowdon call 020 3310 7153 to find to challenge yourself in you every step of the way, – in a 24-hour endurance out more. memory of a loved one getting in touch to help as race against time and or for someone currently soon as you sign up to do the elements. This gritty facing the disease? your walk at challenge requires a good Whatever your reason, prostatecanceruk.org/ level of fitness, but you’ll organising your own walk walking be professionally led and is a great way to raise supported for the whole Organise your Chipping In own cycle ride All year round All year round Whether you’re a budding money and awareness Even if you’re golfing game shot and ball out of bounds Bradley Wiggins or it’s in the fight against is more is a fineable offence, with been a few years out of prostate cancer. Get than Rory McIlroy, you the whole pot donated the saddle, organising in touch at events@ and your mates can still to us at the end to help your own cycle challenge prostatecanceruk.org or raise money for us when save lives. Sign up at with a buddy or two as call 020 3310 7153 and you hit the greens this prostatecanceruk.org/ part of Men United is an let us help you put your summer. With our Chipping golf to receive our special excellent way to raise wheels in motion. In challenge, every bunker scorecards to keep tabs. Donate Your Day All year round Whether you’re planning know what you’ve got a birthday or wedding, planned, and we’ll let you donating your day to know how we can support Prostate Cancer UK is your event. We’d love to fantastic way to mark the celebrate with you. occasion. We know your Visit prostatecanceruk. day is special so let us org/donate-your-day

20 Insights | Summer 2016 18 Edinburgh 21 and 26 SeptemberNight Ride Prostate Cancer UKSee Golf the city’s famous EVENTS Championships landmarks, like Arthur’s Our first regional CALENDAR golf competitions July – December 2016 contested by the winners of your golf 10-11 Thames Path days (held before JULY Challenge 29-31 Silverstone An epic endurance walk 31 July): the North Classic Weekend from Putney over 25, 50 tournament is at Prostate Cancer UK is or 100km, following the Lymm Golf Club on coming to the world’s Thames Path National biggest classic motor Trail to Henley. 21 September; the racing festival, in the 11 Great North Run South tournament first of a three-year Run the world’s most promotional partnership. is at Sandy Lodge popular half marathon for us and join 60,000 on 26 September. AUGUST others from Newcastle to South Shields. 25 Loch Ness 9 Royal Parks 19-23 Prostate Cancer Marathon Foundation Half UK Scottish Senior 18 Challenge Cancer – Based at Fort Augustus Marathon Open 2016 Cycle Trans Pennine on the famously scenic Passing through the Join us at the stunning Choose the 60-mile loch, there’s a 5km fun capital’s most famous Archerfield Links course route from Manchester run and 10km course and august green near Berwick for the to Leeds or double it as well as the big one spaces, you can tick 50+ tournament. there-and-back. to tempt you to lace up off all of London’s your trainers and have a landmarks on this well- SEPTEMBER 18 Scottish Half go at running for us supported race. Marathon in Scotland. 4 Paris to Geneva Cycle The largely flat and A spectacular six-day picturesque route NOVEMBER ride across the French- around Edinburgh also OCTOBER 1-30 Movember Swiss border through offers a 10km option. 2 Great Scottish Run Are you ready Mo Bros the Jura Mountains, join Take on the 10km or and Mo Sistas? The our team and take in the 25 Challenge Cancer – the half marathon at annual month-long famous Champagne and London 2 Brighton Glasgow and look out moustache-growing, Burgundy wine regions Cycle from the capital for our supporter zone fundraising extravaganza and the hair-pin bends to the south coast once cheering you on as you will be back, bigger and of the Col de la Faucille or there-and-back, on a go past. bushier than ever. before finishing at 60- or 120-mile ride. Register mid-September Lake Geneva. 25 Berlin Marathon at movember.com Starting and finishing at the Brandenburg Gate, if you’re going to run a half marathon for us, why not make it one of the world’s finest and fastest?

Check out full details and sign up to all these events – plus many more – at prostatecanceruk.org/get-involvedprostatecanceruk.org/events

Insights | Summer 2016 21 Our services

Specialist Nurses Information on Regional services The blue men on this map 0800 074 8383 prostate cancer To find out what local represent the locations of support and services are support groups who have (Mon to Fri 9am-6pm, 0800 074 8383 available in your area visit asked to be listed on our Wed 10am-8pm) We provide free information prostatecanceruk.org/ website. Find a group near Our Specialist Nurses on prostate cancer and find-local-support you at prostatecanceruk. have the time to listen and prostate disease. Order org/supportgroups answer your questions or download copies from on anything to do with the publications section Live chat Please note that some prostate cancer and groups run meetings in of our website or call our Our Specialist Nurses are prostate disease. more locations than the Specialist Nurses for help available online to answer one listed. choosing the publications your questions and help One-to-one you need. you find the information telephone support you need. 0800 074 8383 Talk things over with someone who’s been there. We match callers with trained volunteers who’ve I now have had a similar experience. a realistic Online community expectation of Join the community online what I can and talk to others who know what you’re going through. achieve and, if I You can ask questions, pace myself, I do post information and share your ups and downs. make progress community. Fatigue support user prostatecanceruk.org Fatigue support Prostate cancer 0800 074 8383 support groups If you have prostate cancer Meet and talk to other and you’re struggling with people affected by fatigue, our Fatigue support prostate cancer who service is designed to understand what you’re help you manage your going through. There are tiredness so you can do more than 70 independent the things you want to do. groups across the UK.

Find out more about our services at prostatecanceruk.org/get-support

22 Insights | Summer 2016 Other useful organisations New support for men Bladder and Bowel Macmillan Foundation Cancer Support www.bladderandbowel www.macmillan.org.uk and their loved ones foundation.org 0808 808 0000 0845 345 0165 (Mon-Fri, 9am-8pm) confronting death Information and support Provides practical, financial for all types of bladder and and emotional support for bowel problems. people with cancer, their family and friends. British Association for Counselling & Maggie’s Centres Psychotherapy www.maggiescentres.org www.itsgoodtotalk. 0300 123 1801 org.uk Provide information and 01455 883 300 support to anyone affected Provides information about by cancer. Their website counselling and details of holds a list of centres therapists in your area. across the UK and has an online support group. Cancer Black Care We’ve launched a new section on our website full of cancerblackcare.org.uk NHS Choices practical tips and personal stories to help men with 020 8961 4151 www.nhs.uk advanced prostate cancer – and the people closest to Provides information and Provides information to them – to prepare for the end of their life. support to people from support you in making Black and minority ethnic health decisions, including “My husband planned ahead so I didn’t have to communities who are an A-Z of treatments make difficult decisions about his care when he was affected by cancer. and conditions, and nearing the end,” says Mo (pictured above), one of the information on NHS health contributors to the new section, whose husband Mick Cancer Research UK services in your local area. died in 2014. “It was one of the kindest and most cancer researchuk.org considerate things a dying man could have done.” 0808 800 4040 Penny Brohn Provides information Cancer Care Among the tips she shares for other people in her about living with cancer. www.pennybrohn position is to always have a close family member or cancercare.org friend on-call in case you need someone to be with Complementary and 0845 123 2310 you in the final hours of the man’s life, and to talk to Natural Healthcare Offers support using others with experience about what to expect. Council complementary therapies www.cnhc.org.uk and self-help techniques. “I was so worried about Mick being in pain or that I 020 7653 1971 Working hand-in-hand wouldn’t know what to do. But in the end, Mick’s death Details of complementary with medical treatment. was very peaceful,” she recalls. “Talking to the doctors therapy practitioners who and nurses and knowing what to expect was essential.” meet national standards of Relate competence and practice. www.relate.org.uk For more stories and tips like Mo’s, visit 0300 100 1234 prostatecanceruk.org/dying-from-prostate-cancer Health with Pride Relationship counselling www.healthwithpride. and sex therapy for Follow-up after prostate We’ve newly updated our nhs.uk individuals and couples. cancer treatment Information on cancer What happens next? booklet: Follow-up after issues and erectile Sexual Advice prostate cancer treatment: dysfunction for gay and Association What happens next? bisexual patients. www.sda.uk.net Order or download it now at 020 7486 7262 prostatecanceruk.org/ Provides a helpline service publications for advice and information about erectile dysfunction.

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Insights | Summer 2016 23 IGNORING PROSTATE CANCER WON’T BEAT IT. Join the fight. menunited.org

24 Prostate Cancer UK is a registered charity inInsights England and Wales | Summer (1005541) and in2016 Scotland (SC039332). Registered company number 02653887. 4007