Joining OnFocus in this episode is Nigel Harris, a medical sales professional from Winchester who recently underwent HIFU treatment with Tim Dudderidge. He leads a very active sporting life, particularly on the ice where he both plays and coaches ice hockey – and following his prostate cancer diagnosis was intent on finding a treatment that wouldn’t compromise his lifestyle. As he describes as his personal motto, “there’s still much to do and see”. He’s joined me to discuss his experience.
Clare Delmar
Hello and welcome to On Focus brought to you by The Focal Therapy Clinic, where we connect you with issues facing men diagnosed with prostate cancer that are little known, less understood, often avoided or even ignored. Prostate cancer is now the most commonly diagnosed cancer amongst men in the UK with this sombre fact because a multitude of challenges and opportunities. I’m Clare Delmar. Joining me today is Nigel Harris, a medical sales professional from Winchester who recently underwent HIFU treatment with Tim Dudderidge. He leads a very active sporting life, particularly on the ice. He both plays and coaches ice hockey and following his prostate cancer diagnosis, he was intent on finding a treatment that wouldn’t compromise his lifestyle. As he describes as his personal motto, there’s still much to do and to see. He’s joined me today to discuss his experience. Nigel, thanks so much for joining me today. Welcome.
Nigel Harris
Thank you very much for having me on.
Clare Delmar
I’m very motivated by the wonderful photo you sent to me of you in full hockey gear on the ice, which I’m going to share with our listeners. First of all, congratulations and wonderful success on your treatment and on your big ice hockey success as well. How did you learn about HIFU? And tell us a little bit about your experience with that.
Nigel Harris
It was a bit of a surprise. And you’re probably going to be the only person you ever hear saying thank goodness for kidney stones because I was under treatment for kidney stones and after the last wash out I had, the consultant came back to me afterwards and said, I really would like to have you go through a full screen with some dye. So now with my background. So I’m a medical sales professional. I started as an operating theatre technician these days called ODPs, so I had a little bit of background and understanding and thought this does sound a little bit suspicious.
Clare Delmar
Yeah.
Nigel Harris
So the first thing I did was say “absolutely no problem at all.” So we went through the MRI scan. After that, there was a couple of weeks and I was phoned up by Rob Keen, the Macmillan nurse who himself has gone through prostate cancer, and he let me know that I had prostate cancer. It was lucky because it was early diagnosis. It confirmed what I’d already expected, but obviously you hope it’s not. And at that point, Rob gave me options for a treatment procedure. Post…Where where do we go from here? As you’ve said, I’ve got a fairly active life. Although I’m 68, I’m still working and enjoy the hockey, enjoy skiing and enjoy the diving and haven’t planned on giving up and clocking out yet. So I wanted to review everything. So he basically told me what was available from the ffull gland therapy, which didn’t sound too good. And what I do, I understand exactly what it is. And obviously I’ve seen gland therapy done the old fashioned way. Then it was going onto all brachytherapy, radiotherapy and all the others and all of them appeared to have significant drawbacks. Not that they don’t work. Of course they do work and it’s important that they do. And you have a fallback. But all of them appear to have significant issues in terms of what happens afterwards. And if you’re fit, you’re healthy and you’re looking to carry on pretty much as you did, you’ve got to consider things like HIFU. Once I was told about it, I did…. I Googled it, did a bit of research. I came up with a paper that Tim Dudderidge and his colleagues had written. Although my maths isn’t wonderful, I went through it and it seemed to me to give very much similar outcomes to full gland therapy, but without all of the issues that can potentially go with it. Now, not everyone has all of the issues that go with any procedure. But let’s be honest, there are potential procedures whenever you break the skin, which is why when I went back to see the consultant, my first thought was, well, if it is as they said it was, a Gleason three plus three. And the previous consultant had already suggested that it might be best for me if we just do active surveillance. And that was my first and best thought, active surveillance. That sounds good. Keep on giving a bit of blood every few months and we’ll see where it goes. However, Mr Dudderidge said, after I’d had the biopsy, which I forgot to mention, there were quite a significant lump on one side, although fortunately it was still contained, and a very small lesion on the other side. And his thoughts were it’s far better to be active and proactive on this, so. He said well and went through all of the options again, so I said, well, do you want time to think about it? And I said, no, I’ve made my mind up. I’m going to go for HIFU. And he said, no time at all to think?, no, I’ve made a decision. That’s the way I want to go. Because the other thing he said, which is also quite important and people really do need to consider is that it’s not a one off treatment. It can be repeated if things happen, if you get unlucky. So the reality is in almost every case, it’s a no brainer. Why would you go through an open procedure? Why would you have brachytherapy unless it was absolutely necessary when you can’t go and cuddle grandchildren for three months?
Clare Delmar
Indeed
Nigel Harris
Although this year has been slightly different, let’s be honest. But normally that’s not an issue.
Clare Delmar
How long did it take between your initial decision and consultation with Tim to actually undergo the procedure?
Nigel Harris
Well, I’m guessing I was very lucky because I learnt of the procedure, it was I think about the 1st of May and had the procedure on the 1st of June.
Clare Delmar
OK, so that was relatively fast.
Nigel Harris
Yeah, it was very fast. What I didn’t tell him, of course, was, was that I planned on playing ice hockey 12 days afterwards.
Clare Delmar
And did you?
Nigel Harris
Yes. What was funny about being a coach, I coached medical students from Southampton University along with other students, and one of the medical students just happened to be on Tim Dudderidge’s team.
Clare Delmar
Oh wow, that’s funny.
Nigel Harris
And she was chatting to me about it because she knew who I was, but she grassed me out.
Clare Delmar
Wow. Bad boy out on the ice.
Nigel Harris
Fortunately he said, well, if he feels fit enough that’s OK by me. And it’s not like it’s an open procedure.
Clare Delmar
Yeah.
Nigel Harris
If it had been an open procedure or anything else, it would have been absolutely no chance of me playing.
Clare Delmar
Yeah, no. I think that leads to be to sort of another question about your own experience and expertise in medical technology that gives you, I guess, sort of a specialist knowledge and perspective on both the risks and the benefits of new technologies in health care. So I’m wondering how that informed your decision and how you would describe these to men considering HIFU treatment. What are the risks and benefits that you based on your own personal experience and your professional experience, understand well and would like to share.
Nigel Harris
Obviously, technology is improving all the time. I mean, when I left the health service in nineteen eighty three, it was just to give you an idea, cataracts. People used to lie in bed for six days and not move. Now they walk in and out.
Clare Delmar
Yeah.
Nigel Harris
So significant strides have been made with all forms of technology. And the fact that you can now do…. Well, using ultrasound to ablate tissue is incredibly well thought out because you’re not going to be damaging the patient per say. The sound energy is focussed on exactly what needs to be done. And clearly, when you see the advantage of all types of ultrasound now, I mean, when my first son was born, you could barely make out a skeleton with the ultrasound. Now you can see a full body. And the advances are absolutely amazing. So what you’ve got to consider, I think, is what’s a survival rate, five years? Is it as good as you’re looking at with the full gland treatment? So if it is, if it’s something that you feel that is appropriate for you and I can say it for me, it is appropriate, but it may not be for other people. They don’t want to look at the advantages or they’ve got other issues that they want to consider. But, you know, just using heat from outside the body, not entering the body itself, it’s got to be the way forward. And it’s offering a high survival rate. If you’re a younger person and let’s be honest, 60 these days isn’t old and the working age is now being put up to 67 for most people. So that’s another two years on. So you really do want to to stay as active as you possibly can. And I’m fairly certain that even in ten years time, this procedure will be significantly advanced from where it is now.
Clare Delmar
I mean, one of the things you mentioned earlier in informing your decision were the side effects or the lack thereof that this treatment would afford you. One of the things that I find with our patients is that the very fact that they’re having this conversation or this discussion with the doctor about HIFU usually means that they address the so-called taboos of prostate cancer like sexual dysfunction and urinary dysfunction. And I’m wondering how that played out in your discussions with Tim and with family members. Did it make it easier to talk about the whole situation you were in with your prostate cancer diagnosis and why this treatment was preferable?
Nigel Harris
Well, as I said before, I’m still working. I enjoy my job. I’ve been out today down to a hospital in Wales to look at some opportunities down there and came back. If you consider, let’s forget the sexual side of it at the moment. Let’s just consider the continence side of it. If you have a degree of incontinence, it can be managed. But it’s not great. I understand that, you know, you can use leg bags if you have a degree of incontinence, but it’s something that’s going to play on your mind and there’s no question about it. If you’ve got faecal incontinence, that’s even worse because you’ve got to wear nappies. OK, you’re still alive, but you’ve got to look at your quality of life. And that’s where for me, I like to dive, I like to ski, I like to muck around on the ice with my students and try and coach them some ice hockey. I like to ride motorcycles. All of these things would be much less easy if you have the incontinence and however good the surgeon is, there is still far more of a chance that you will get some of these side effects because it’s a very innovative area. You know, and I’m not saying any surgeon is going to turn round to you and say, no, I can do this without or… They have to be pragmatic about it. There is a there’s a fairly high chance if you’re going for full gland therapy, that you will end up with one or maybe more of the side effects.
Clare Delmar
Yeah
Nigel Harris
and I think with full gland therapy, I didn’t actually go around and look at the statistics. But if you do want anything of a sex life, then you are very likely not to be able to maintain an erection.
Clare Delmar
Yeah
Nigel Harris
I’m not sure whether you could manage it with Pfizer’s miracle drug or not.
Clare Delmar
Yeah
Nigel Harris
but you have to consider it. I mean, my guess is that you’ve really got to see where you are. I mean with three plus three or even a three plus four Gleason, you’ve got far more options to consider than maybe you know, when I was in theatre, you know, they were probably very few options and maybe caesium seeds, radiotherapy and full gland therapy. That may well have been it. Then of course, with that, you’ve got the issues of the hormone therapy afterwards. And that friend of mine went through that. He was diagnosed in 2007 and he actually had to stop his hormone therapy because, as he said, it’s turning him into a very ugly woman…Didn’t really… I mean, fortunately, he’s still alive now and he’s OK. But even so, he went through that and it was a very unpleasant time for him. I’ve also got to say that my company was very, very supportive. I had a colleague that went through bowel cancer and he was great to talk with, to be honest with you. So that was helpful. My children, I got three boys, I’ll say three boys.
Clare Delmar
Three young men.
Nigel Harris
Yeah, well yeah. Forty, thirty six and thirty five. Yeah. The important thing for me to them was to let them know that they’re now they, they have to be more vigilant, with someone in the family, it’s something that they need to be aware of. And in fact their grandfather, not my father, but my wife’s father had prostate cancer. So it seems to be quite a number of people I’ve heard of now that are willing to say they’ve had it or we know they’ve had it. As you rightly say it’s a very, very prolific cancer and that clearly needs to be discussed more. There’s a lot of it around. And you see people wearing the little men badges. Yes. Which is also good to know that people are wearing those so you can talk with them.
Clare Delmar
Yeah, I mean, one of the things that I found interesting in talking to you earlier was how well you understand the costs and the benefits of HIFU treatment to individuals. And you’ve discussed quite openly about the side effects and the options that men would have, especially if they have early stage like you did. But I’m also wondering, again, sort of wearing your professional hat, if you can comment on how you see some of those costs and benefits playing out in the health care system. I mean, do you see this as a long term economic advantage for the NHS or other health providers, given that….?
Nigel Harris
There has to be. There has to be. With cataracts, 30, 40 years ago, you were lying on your back for six days.
Clare Delmar
Yeah.
Nigel Harris
And now you walk in and out. So let’s look at the same thing. I was in hospital overnight. There is a cost to every bed. I don’t know what that cost is, but I know it’s not cheap. And if you have to go into an intensive care unit bed, it is magnified by a factor of 10 to 20.
Clare Delmar
Yeah.
Nigel Harris
So every day that you’re in hospital is a massive drain on the NHS, so day procedures or overnight at most has to be the way forward. And the major way to do that is to try and not go through the skin. If you can do something without going through the skin, you are not breaching the main body’s defences to infection and anything like that. And there’s no bleeding. There’s no stitching to be worried about. This is a massive advantage. However, you know, when we start looking at open procedures, even keyhole procedures, there’s always a potential for something to go wrong. There’s always a potential for infection. Now, obviously, everything is done to mitigate that risk. We know that. I know that, I deal with machines that decontaminate and reprocess these instruments. But there’s always some kind of a risk. And you’ve got to be in a position to then look at if you’re going to go for an open procedure, which is fine, if that’s what you want to do and it has without question, it’s the highest benefit that you can go for. You have to look at your recovery. It’s not going to be as quick as it is with something like HIFU. So if you’re working person and let’s be honest, you don’t have to be that old to have a prostate cancer, it can get younger people. So if you want to be working, your working life will be extended significantly if you go for the radiotherapy or brachytherapy, the keyhole surgery, whereas HIFU apart from a day or so to recover. I did have a week off work, in all fairness, that the boss insisted, but I could really have gone back a couple of days afterwards.
Clare Delmar
Yeah.
Nigel Harris
It was not something that you need to consider, that’s going to be an issue. So the quicker you’re in and out of hospital, the quicker your recovery. There’s a massive, massive reduction in cost to everyone, not just the health service, but yourself, your family, of course, family.
Clare Delmar
Now, I definitely think that’s a big advantage. And you’re sort of the living embodiment of that, really. And, you know, as a sort of a final point, what advice would you give to men who are newly diagnosed with prostate cancer and on how they might explore their treatment options?
Nigel Harris
Right. It’s an interesting one. My first thought is this. I’m a great Douglas Adams fan. Don’t panic. OK. I had a fair idea of what was going through for me, but if I’d not had that background, obviously the first thing you’re going to do is start thinking I’ve got cancer. How long have I got? So don’t panic. Start using your resources and research the options. I know that’s probably easier said than done. And obviously I’ve got some background in looking into research, but, you know, talk to the Macmillan nurses, talk to your doctors, your family doctors, use the research, read the papers they offer you. That is important to understand all types of therapy that are there. Then I mean, I’m going to get this sounds very trite, but yeah. Make a personal risk assessment. What do you feel is the most risk and how do you feel that you would be affected by it? So if you’re very risk averse and you’re very concerned about everything, you might well say, OK, I want the whole gland out. I’m done with it. Get rid of it. If you are prepared to have a slightly less risk, a slightly more risk, rather, and I say it’s only very slightly, then HIFU is the way forward, will have to be the way forward. And as we said before, it can be repeated. It’s not a one off. That’s the great thing about it.
Clare Delmar
Yeah, very important point. Very important point. Nigel, I just want to thank you very much for coming along and speaking with me. Some of the things you said I think will be extremely helpful to men and to their families. And thanks again very much and congratulations on your success.
Nigel Harris
Thank you very much. As my last point I was going to make, I don’t know whether it will help anyone, but yes, you can play in an ice hockey match twelve days post procedure with HIFU. I’m not promising you’ll be able to skate…
Clare Delmar
Your photos living proof of that, so look forward to people’s comments on that. Thanks very much again.
Nigel Harris
My pleasure.
Clare Delmar
Further information on HIFU treatment is available on our website, along with a transcript of this interview and additional interviews and stories about living with prostate cancer. Please visit www.thefocaltherapyclinic.co.uk, and follow us on Twitter and Facebook at The Focal Therapy Clinic. Thanks for listening and from me, Clare Delmar, see you next time.