Survivor: David Livingstone, from Northern Ireland, who had dynamic cancer treatment

THE PATIENT

For nearly 20 years, I was a motorcycle traffic officer with the police, but I retired in my mid-40s on medical grounds.

I had injured my back quite badly in two major motorcycle accidents in the line of duty and so have spent much of the past couple of decades in pain.

But it was nothing compared with the agony I woke up to one morning in May 2016. The pain in my back was so bad that I could not get out of bed.

Eventually, with the help of my wife, Phyllis, I managed to get upright and, after taking a couple of painkillers, the worst of it subsided.

However, the next morning, the same thing happened. At first, I blamed my old injuries but, when the pain persisted, I went to my GP. He suspected that it might be a kidney stone and told me to go to A&E, where I was put on intravenous morphine.

The following morning, I had a CT scan and blood samples were taken.

Later that day, a doctor explained that these showed I had a very aggressive prostate tumour that had spread to my spine and lymph nodes. I didn’t have kidney stones after all.

My levels of prostate specific antigen (PSA) — a protein that increases when cancer cells are present — were off the scale. A healthy reading is up to around 4ng/ml. Mine was 3,495 — one of the highest that my doctors had ever seen.

I was told that there was no point removing the prostate because the tumour cells had already spread.

I was one of the unlucky ones who’d had no symptoms at all until it was at an advanced stage. And my cancer was terminal.

I was dumbstruck — I hadn’t even considered cancer.

After I got home, I broke the news to Phyllis, who was deeply shocked. We had a brief cry and then told our elder daughter, Victoria, 30. Our younger daughter, Andrea, 27, a doctor, was with me when I got my diagnosis.

I was given roughly a year to live, even with treatment to slow the spread of the cancer.

Within a few days, I had my first of four weekly doses of hormone therapy — to suppress my levels of testosterone, which the cancer uses to grow. I also started a six-month course of chemotherapy.

'I was told that there was no point removing the prostate because the tumour cells had already spread. And my cancer was terminal,' he says of his initial diagnosis

The hormone therapy did have some nasty side-effects, including extreme fatigue, hot flushes and weight gain, and I lost my hair due to the chemotherapy. I was just well enough to walk Victoria down the aisle in October 2016. It was one of the proudest days of my life.

Yet I knew it was probably only a matter of months before I would finally succumb to the cancer.

Then, one night, on the local news, I saw a television report about researchers looking for volunteers for a new treatment being trialled for men with advanced prostate cancer at the Northern Ireland Cancer Centre in Belfast — just 35 miles from where I live.

I contacted them the next day — with an estimated six months to live, I had nothing to lose.

Researchers explained that it involved a ‘double whammy’ of radiotherapy, where they would blast my prostate with radiation from outside my body, but also inject tumour-seeking radioactive drugs, to hunt down malignant cells internally. They said that, while this would not cure my cancer, it could bring it under control enough for me to live a fairly normal and extended life.

In December 2016, I had the first of 37 daily radiotherapy sessions. I also had six injections, each a month apart, of a tumour-seeking drug called Xofigo.

Apparently, both techniques are already used on the NHS, but no one had tried them together in advanced prostate cancer.

I experienced some vomiting and diarrhoea and was very low in energy.

Gender imbalance: Prostate cancer affects around 47,000 men a year in the UK and it is now a bigger killer than breast cancer — 11,800 men a year, versus 11,400 women

My bones have also been weakened by the cancer, so I need to take a calcium supplement daily, and I still have regular hormone therapy injections.

But, more than two-and-a-half years after my diagnosis, scans show I’m clear of cancer, apart from one small patch in my spine. And my PSA is virtually zero.

I should have been dead 18 months ago, so the fact that I’m still here is nothing short of a miracle — all thanks to the doctors doing this vital research.

THE SPECIALIST

Professor Joe O’Sullivan is a consultant in clinical oncology at the Northern Ireland Cancer Centre at Belfast City Hospital.

Prostate cancer affects around 47,000 men a year in the UK and it is now a bigger killer than breast cancer — 11,800 men a year, versus 11,400 women.

If it’s caught before it spreads beyond the prostate, there is a good chance of survival.

But, in around 10 per cent of cases, it has already spread to other organs — what we call advanced prostate cancer — and the chances of living more than two years are very slim.

WHAT ARE THE RISKS? External radiotherapy for prostate cancer can cause inflammation of the bladder, soreness around the back passage, erectile dysfunction and tiredness. Radium 223 injections may trigger a drop in blood cells, which can increase the risk of infection, shortness of breath, nausea and diarrhoea. Dr Jeanette Dickson, vice-president for clinical oncology at The Royal College of Radiologists, says: ‘We know that using radium 223 helps patients with very advanced prostate cancer live longer and feel better. ‘This trial is looking at using it alongside external radiotherapy and hormone therapy and, hopefully, more patients will benefit.’ Advertisement

There is no cure for advanced prostate cancer — treatment involves controlling the tumour growth with chemotherapy and hormone therapy, in which drugs are injected to reduce the amount of testosterone, the hormone prostate cancer needs to grow.

This can control the cancer for a while but, eventually, it nearly always stops working.

The next step is often radium 223, or Xofigo — a radioactive liquid that is injected into a vein and circulates throughout the body. It targets cancer cells that have spread to the bones.

But we wanted to see if giving radium 223 at the same time as external radiotherapy and hormone therapy could have a more powerful effect.

External radiotherapy is not normally used to treat prostate cancer that has spread. In fact, it’s thought to be largely pointless, given that harmful cells have already migrated.

But we know from other cancer types, including breast cancer, that treating the area where the disease started can be helpful.

We have tested the treatment on 28 men as part of a pilot study. So far, the results have been very promising and we now hope to do a bigger trial involving hundreds more.

The hope is that combining the two forms of radiotherapy will be more effective than existing hormone treatment on its own and will extend the life expectancy of men whose treatment options are otherwise limited.

I’m very hopeful this research, partly funded by the men’s health charity Movember Foundation and Prostate Cancer UK, will lead to improved survival rates and turn some cases of advanced prostate cancer into a chronic illness that can be controlled with treatment, rather than a death sentence.

A course of radiotherapy costs around £3,000, while six-monthly injections of radium 223 are about £12,000, so the combined cost per patient would be around £15,000.