I went to see Dr P yesterday and received some mixed news. The bad: the PSA is now 24, up from 16.The good: he emphasised that I looked “fantastic”, and that the disease is not causing radiological progression. (This will be tested the next time I see him in 4 weeks, by which time I will have had my three-monthly CT and PET scans.) I asked him if he was happy with me and he replied he was “happy with everything”.

Obviously an increase in the PSA is no cause for celebration. However

• the reading hasn’t doubled (Dr P’s criterion for intervention);
• one should remember that this is an increase recorded over two months, i.e. double the usual obervation period; and
• the PSA itself is just a marker of the underlying disease. It is therefore a mistake to fetishise it. It’s not the quantum of the PSA, but the trajectory of the increases that is important. As long as I feel well and can do the things I want to do — both of which are the case — the number can be what it likes. (Short of point #1 above.)

So where do birthdays come in? This morning as I was trying to get back to sleep, I had the following thought. You know how after you’ve had a birthday, you think “Actually, I don’t feel different from when I was a year younger”? A monthly PSA score is a bit like having a different age each month. I was 16 in April, and 24 now in May. Something is happening, but I’m still the same person.

Dr P and I were both away in April (hence the two-month gap between consultations), he in Rome, we in Singapore. Below are some brief impressions from our five nights there:

• Getting on the plane was a bit ugly (a one hour queue at Tullamarine for seat allocation). We learned later that Singapore Airlines had oversold premium economy. Also, my beloved and I were both affected by an annoying issue about our tickets. The form of name appearing in our passports was different to that on our tickets, the passports bearing our middle names, the tickets not. We had asked then travel agent specifically if that would be a problem, to which she replied “No”. Unfortunately she was wrong. This meant we couldn’t use the automated kiosk for seat allocation, because it couldn’t reconcile the two forms of our names, and we had to find a human to resolve this — who were in short supply.
• The flight over was OK, and the hotel (the Shangri-La) was fantastic. My left ankle had gotten quite sore from all the standing at the airport, but I bought a (very expensive) sports elastic bandage for it, which made walking around a lot easier. The hotel is in 11 hectares of beautiful grounds, so we had a couple of tentative wanders around there.
• The weather was very hot and humid — even the locals said so. So it was a bit too hot to walk around outside any distance. Fortunately the hotel had a shuttle bus to the CBD, and taxis were readily available — both air-conditioned.
• The highlight of the trip was a visit to the Peranakan Museum , a tribute to a particular aspect of Singapore’s multicultural heritage. Fortunately this had a lift! All very fascinating with lots of personal stories.
• The flight back was on a newer aircraft (Airbus A830), with better entertainment facilities and quieter. We had been to Singapore about 11 years previously, so knew what to expect. It is a very painless and tidied-up bit of SE Asia, redolent with shopping malls, great food, and tous les conforts modernes.