Apologies everyone. I published this yesterday, but as a page, not a post. So no-one saw it.

I saw Pat Bowden, the radiation oncologist, this morning. The news was, as has been previously, neither the best nor the worst. The takeout: I have to have androgen deprivation therapy (ADT).

In more detail:

1. the last PSA test was 7.2, more than double the one previous to that, which was 3.4. So just over double in three months means it is obviously heading in the wrong direction.
2. I will be referred to one of two medical oncologists for the ADT. (Pat thinks they are equally good and experienced with prostate cancer. So it will be whichever of them is available first.)
3. ADT has been around for about forty years, so is a well established treatment.
4. ADT works by depriving the cancer of androgen, which is what feeds it. It is basically chemical castration.
5. ADT is known to have side effects, so I may experience one or more of these:
   1. hot sweats
   2. weight gain (most patients gain 2-3 kilos)
   3. aches and pains
   4. feeling weaker and less energetic
   5. decline in mood
6. It is delivered in the specialist’s rooms by means of an implant. The implant lasts three months.
7. ADT gives a median control time of four years until the next treatment. I asked what “control time” meant. It means the cancer being under control, i.e. not changing; see Managing cancer . So with four years being the median, this is the middle value in the range from shortest to longest control time. (Apologies if I have committed a statistical indignity here.)
8. Should it become uncontrolled, other treatments will be embarked on. As well as the existing treatment options, I could possibly participate in a trial of one or another emerging treatments, should they be suitable.
9. Cancers which are new to ADT are referred to as “castration naive” (or variations on that). They can then become “castration resistant”, “ADT refractory”, or other jargon that refers to the ADT becoming ineffective.
10. I was under the impression that this progression (from naive to resistant) was inevitable. However, only a small percentage of castration naive cancers become castration resistant.
11. New treatments are being developed all the time. As well as this, combinations of existing treatments are being tried very actively, to see if they work better together than singly. One that is potentially relevant for me is ADT in combination with a drug called abiraterone. (Pat, unsurprisingly, knew about this, and had had dinner with the author. See Osterwell, 2017 . You may be asked to register with the site. If so, I can send you a scan of the paper.) This combo has been found to give an absolute (not relative) increase in control of 8% over ADT by itself.
12. Pat was pretty positive about ADT and my cancer, saying (words to this effect) “It’ll stop it”. In my experience, specialists are not usually so forthright. (You will note he did not use the “C” word. I will settle for stopping it, though!)
13. I asked Pat what were the three things he would like me to take from the consult. His reply:
    1. We can control cancer for many years;
    2. ADT comes with side effects; and
    3. the treatment paradigm is very dynamic. So there will be new treatments available in a few years not currently available.

I will be going for the most aggressive option that the specialist recommends. Pat’s rooms are going to call both oncologists and see who is available first; I should hear from them in a few days. I still feel fine and intend to go on exercising, socialising, and all the other things I get up to. As my beloved correctly pointed out, it would be advantageous for me to lose a few kilos before starting the treatment, in case it does cause weigh gain. I will give it a go! Generally, I feel slightly daunted, but relieved, oddly, that I have a clear treatment path to follow.