I told my son I have cancer. It was the hardest conversation I have ever had

Telegraph

a day ago

In June this year, Paul Henderson received test results showing elevated PSA (prostate-specific antigen) levels. In this weekly diary, he will be sharing what life is like in the weeks that follow: the tests, the scans, the fear and what it's like when you have to sit down with your loved ones to discuss the possibility of cancer.
It was a warm, sunny day in the middle of June, just after 2.30 pm, and I was sitting with my wife, Marilyn, in a generically nondescript doctor's office at Whipps Cross Hospital. Having spent the previous two months undergoing tests, scans, and biopsies for suspected prostate cancer, we were almost certain the news would be bad. But no matter how prepared we thought we were to hear the words, the formal diagnosis hit us both hard.
After the initial shock, I tried to gather as much information as I could. Armed with a notepad and pen, I asked what I hoped were the right questions and tried to process what was coming back. In quick succession, Dr Chowdhury told me I had adenocarcinoma, the most common type of prostate cancer; that it was mid-stage, or stage 2, meaning it had spread beyond the prostate gland but not to the lymph nodes or beyond; and that my Gleason score was 7 (4+3), indicating a medium to high risk of the cancer spreading.
'Your cancer definitely looks treatable, but we will need to book you in for a bone scan to make sure it hasn't metastasised,' Dr Chowdhury said. 'It looks unlikely, but we need to be sure.' And if it has spread to the bones, I asked. 'That makes things more […] complicated.'
The conversation lasted only about ten minutes, yet it felt both inconsequential and monumental in equal measure. Undoubtedly, this consultation was one of many the doctor would have, but in that moment, for Marilyn and I, it meant everything. We walked to the car park in silence, then held each other tightly. After all the waiting and anticipation, we finally had the news we had feared. And now I had to face the moment I had been dreading since April – telling our children.
Despite living with the possibility of a cancer diagnosis for two months, we decided not to tell Nyah (22) and Fox (19) until we knew what we were dealing with. Nyah was living at home after graduating the previous summer, while Fox was in Durham studying for his first-year university exams, and we didn't want to distract him from his studies. We also felt it was important to break the news to them together. It was the hardest conversation I have ever had.
The day after he came home, we sat them both down, and I told them the bad news. When it came to saying the words 'I have cancer', the C-word caught in my throat. After the initial shock, we all ended up in tears. Fox hugged me like his life depended on it. At 6ft 3in and with broad shoulders, he is bigger than his old man, but at that moment he was a little boy again. I held him closer than I had in years. Then it was Nyah's turn; she buried her head in my shoulder and squeezed hard. They then both took turns cuddling Marilyn. I felt incredibly proud of them all for being so brave.
Once the initial shock had subsided, we talked. I explained the situation as best I could and tried to be as positive as possible. I didn't sugarcoat it, but I also wanted them to feel optimistic. Although the tumours in my prostate were fairly large, especially on the left side, the prognosis for stage 2 cancer is very good. Most patients, over 97 per cent, survive at least five years, and it is highly treatable. I am relatively young (56), fit, and healthy, so there was no need to panic, I reassured them.
They then asked the same question: what happens next? That was a little harder to answer. At the end of my consultation, when the doctor had informed me I had cancer, he explained that I had two options for treatment. I would have to choose between surgery to remove the prostate or radiotherapy to try to kill the cancer cells. To help make that decision, he referred me to St Bartholomew's Hospital, where I would meet specialists from both areas to discuss the best way forward.
In the meantime, while I waited for my appointment, there was the small matter of the bone scan that might just change everything…
Frequently asked questions
Answered by Prostate Cancer UK specialist nurses
1. What are the different types of prostate cancer and is there one type that's 'worse'?
Most men diagnosed with prostate cancer have a type known as adenocarcinoma. There are, however, several much rarer forms of the disease. Because these are uncommon, they have not been studied as extensively, and we know far less about them. Some of these rare cancers can be more aggressive, meaning they may grow faster and are more likely to spread to other parts of the body. In many cases, men with a rare form of prostate cancer also have some adenocarcinoma present at the same time.
Rare types of prostate cancer include:
Neuroendocrine tumours (small cell or large cell)
Glandular tumours (ductal, mucinous, or signet ring cell)
Basal cell carcinoma
Transitional cell carcinoma
Prostate sarcoma
Some of these rare cancers do not cause a rise in PSA levels. As a result, they may not be detected through a routine PSA blood test. Diagnosis may therefore only occur once the cancer has already spread outside the prostate, often following a biopsy.
2. What's a Gleason score?
After a prostate biopsy, the tissue samples are examined under a microscope by a specialist doctor called a histopathologist. They check for the presence of cancer cells and describe their findings in a pathology report.
Cancer cells in the prostate can look different depending on how likely they are to grow and spread. This appearance is given a Gleason grade, which ranges from 1 to 5. Grades 1 and 2 resemble normal prostate cells and are not usually reported. Prostate cancer is generally graded as Gleason 3, 4, or 5, the higher the number, the more aggressive the cancer is likely to be.
The Gleason score is made up of two numbers:
The most common grade seen in all the samples.
The highest other grade found in the samples.
These two numbers are added together, with the most common grade listed first. For example:
If most cancer cells are pattern 4 and the highest other pattern is 3, the score is 4+3 = 7.
A score of 3+3 = 6 usually indicates very slow-growing cancer.
A score of 7 suggests faster-growing cancer, with 4+3 generally being more aggressive than 3+4.
Scores of 8, 9, or 10 indicate faster-growing, more aggressive cancer that is more likely to spread.
3. What does it mean if cancer has metastasised?
You might hear the terms metastasised, metastatic or advanced prostate cancer. These all mean the same thing – that the cancer has spread from the prostate to other parts of the body. This occurs when cancer cells travel through the blood or lymphatic system, so the cancer is no longer contained within the prostate.
When this happens, prostate cancer is no longer curable, but treatments can be offered to help shrink the cancer and slow its growth or prevent further spread, such as hormone therapy. In recent years, research has developed a number of new treatments for advanced prostate cancer, meaning men are thankfully living longer than ever before.
Metastatic prostate cancer can sometimes cause symptoms in the areas it has affected, for example bone pain, anaemia, or issues passing urine. At this stage, additional treatments may be required to address these symptoms, rather than the cancer itself, to improve quality of life and keep the patient as comfortable as possible.