Thankfully that outdated and bigoted viewpoint was firmly consigned to history within a decade of that. Around the same time, our American allies pursued a policy called “Don’t ask, don’t tell”, where it was fine to be a homosexual (or alphabet soup varieties thereof) so long as you never told anybody. So you could continue to serve your country, just as long as you stayed in the closet.

Over the last few years, as somebody with cancer, I’ve deliberately been extremely open about my status, my treatment, and how I was coping with my unwanted status. This blog is clearly a major part of that. That has led to an unexpected consequence, which is the number of conversations I’ve had that basically sum up to “how is yours going?” Now that should be absolutely fine - human beings naturally group together with others who have shared similar life experiences: I’ve loads of friends who are fellow aviators, fellow writers, fellow academics, and so-on. What’s not fine, is the extent to which I’ve realised that for a lot of these people I am one of a very small number of acquaintances they’ve told.

I’m not going to name anybody here, of-course. Secrets shared with me I hold sacred, at-least where I realise they’re a secret and they harm nobody else. But, I’m going to talk about a couple of disturbing examples.

There’s a professor I know but don’t work with. He has been living with prostate cancer for some years, and has engineered things so that nobody around him has any inkling that he has this burden in his life. It’s clear that he is seriously concerned that the university he works for will disadvantage his career if senior colleagues find out, and thus chooses to keep it secret. I’m glad that he felt that in me at-least, he had somebody with whom he could share that secret, and we’ve had some lengthy conversations about our shared issues. But, he really shouldn’t have to.

There’s a retired test pilot I have known for many years, who was diagnosed with prostate cancer a couple of years ago, and is still going through treatment. He’s retired, it really shouldn’t matter any more, but nonetheless he seems extremely reluctant to talk openly about it. He opened up to me when we were at a symposium together recently, but so far as I know, very few other colleagues know a thing.

There really seems to be a perception by many people that we’re in that territory of Don’t Ask, Don’t Tell. It’s important to them that they should keep their cancer secret, except from immediate family and fellow sufferers, and sometimes not even then.

It almost feels like I’m developing a cancer “gaydar” (“cadar” perhaps?) where I sense that somebody has cancer, and might need the opportunity to confidentially chat about it. On one level I’m honoured that people feel they can trust me, and glad to be able to help somebody to share their worries and experiences with somebody who understands. And, of-course, I do understand. At the same time, it distresses me that we’re still in a world where so many people find this necessary.

But they do. It took me thirty seconds of googling to find images and statistics showing that globally there is a stigma associated with having cancer, in very many people’s minds. It took me a little longer to investigate the subtleties of that. It’s clear that a great many people with cancer do not feel that they can be public about it. They feel judged, perhaps some way inadequate, or they feel concerned about the impact public knowledge will have on them.

Here are a few breadowns I discovered in my reading around the subject:-

• Prostate or Breast Cancer sufferers are concerned that because of the effects either the disease or the treatment will have on their bodies, they will be perceived as less masculine, or less feminine.

• Lung, or head and neck, cancer sufferers, because of decades of anti-smoking campaigns, will feel judged as having brought it upon themselves.

• Similarly with liver cancers and perceptions of alcoholism.

• Cervical cancer sufferers worry about being judged for perceived sexual promiscuity.

This isn’t totally universal. Campaigns have reduced the stigma associated with either prostate or breast cancer, and it seems that in high income countries with good healthcare systems, things are a bit better than otherwise.

This all horrifies me. I know first hand that living with cancer, and going through cancer treatment is distressing and gruelling. My own experience has been largely positive - maybe one or two people have been avoiding me, maybe one or two people at work were insufficiently respectful of what I was going through, but the vast majority of people around me have been totally supportive. I have on the other hand been often described as brave for my openness about my cancer - something I really don’t perceive myself as being. But at the very least I’ve not been as afraid as some people clearly are to be open about my position. But these conversations, and these descriptions, show our society in very poor light that we can’t always uncritically support people we know with such a serious medical condition.

I wish I had a moral to this little essay, but I really don’t. I can only say that I can see aspects of our society here that is broken, and unhealthy. Perhaps we can all, whether we suffering ourselves or not, just try and quietly and supportively move it in a healthier direction.

(P.S. Do consider buying my first novel, details here.)

Firstly, I’ve had the results of my latest 3-monthly blood tests. PSA remains undetectable, and everything else is apparently on an even keel. That is brilliant news, but actually came with something else that’s rather alarmed me. My oncologist said that at the end of two years, so about this coming Christmas, he’s going to propose taking me off the Darolutamide Androgen Receptor Blocker, the main part of my hormone therapy. Then a few days later when he copied me a letter to my GP about that he also proposed in that taking me off the 3-monthly Decapeptyl injections which block production of testosterone. That last might be a computer error, as that’s not what he said to me in person, and I’ll raise that with him - but I’m sure you can see why this alarmed me. These powerful (if expensive!, I estimate around £50,000 per year) drugs seem to have done a brilliant job of preventing any reappearance of my cancer. But I’d been originally led to believe that I’d be on them for perhaps five years, maybe indefinitely - so why suddenly are they talking about ceasing them after only two years? Is it because I’ve responded so well?, or because the science has changed (in which case, I can’t seem to find that in my own trawls of the literature), or very cynically are the oncology consultants being asked to reduce their prescribing of these very expensive drugs. I am confused right now, but as I’ve three months until my next blood test and phone call with Professor Hoskin, I’ve time to think about it.

At the same time, wouldn’t it be nice to be off them. Whilst I think that my symptoms seem to be much less severe than “enjoyed” by many, I really won’t miss the hot flushes, the emotional lows, the lack of energy, reduced libido, and the difficulties in controlling my weight. So if this is really going to happen, and is medically justifiable, hip-hip-hurrah.

At the same time - yes, this scares me. This incredible drug seems to be doing an amazing job of keeping the cancer firmly under wraps - and should. According to the very comprehensive Wikipedia page on it, it more than doubled time until reappearance of metastases versus a placebo in trials. So is it really justified taking me off it this soon? I will be asking lots of searching questions at my next meeting, and will probably send him a detailed letter before that, listing my concerns. At the same time I recognise that he’s a man at the top of his game, and if he’s recommending this, just like the rest of my treatment, I have confidence that he’ll have sound reasons for that.

In the meantime, I have some other news, and this is the real reason I’ve not had time to keep this blog up to date recently. I’ve had a new book come out, and this time it’s not an important but less than exciting textbook about my professional endeavours. I have written a novel!

This has had a very long gestation. I started writing it in 2019, had it half finished when Covid happened - gosh that feels so long ago. That caused me to avoid my laptop for anything but work for a couple of years. Then after Covid, I picked it up again, finished it, edited it. I wrote the sequel, edited that. I created the plot to the sequel - then was diagnosed with cancer, kicking just about everything else in my life into the proverbial long grass. Finally around a year ago I got it through a couple more edits, and commissioned a brilliant aviation artist, Matthew Emeny, to paint the cover. En-route I’ve learned a lot about publishing. That’s included creating my own one man (and for the moment, one book!) publishing house, Pateryx, using a chunk of my spare time publicising the book, and generally boring my wife silly about every machination of the process.

And the result, now out for a month, is my first novel: Wings on a Mountain. This is the first of what I plan to be a series of adventures of an ex-RAF engineer with great abilities and marginal judgement, called Dr David “Indy” Jones. Quite literally now available from all good bookshops, for about £8.99 for the paperback, or £3.49 for an eBook. And not a mention of cancer anywhere in it.

So if you like my writing, and wonder what I’ve got to say in fiction - please give it a go. The reviews on Amazon and elsewhere so far seem pretty enthusiastic, and I have to say, it’s been a brilliant distraction from all of the other problems I’ve had to tackle, not least the cancer, over the last few years.

You can buy it here.

More soon, I do have more to say, I just need to find time to say it.

Is this about cancer? Well partly. I am certain that my immune system is still badly compromised by the aftermath of chemotherapy, which finished about fifteen months ago, and speaking with my oncologist he agreed that the effects of that can last well beyond a year. Also it’s well documented, and definitely my lived experience, that androgen deprivation therapy (ADT, a.k.a. hormone therapy) does your emotional balance and control no favours at-all. So I’m afraid that my emotional response to illness and stress, and especially when I’m not able to exercise is not what it was two years ago. Exercise is my main mechanism for managing my mental health, and the seven weeks that I couldn’t exercise wreaked havoc with mine.

The good news is that I was well enough to start exercising again early April, although it’s been an incredibly slow build-up and I’m still not up to doing as much as I could in January. I have just, this week, managed to hit my previous target of three thousand calories of exercise in a week, and that feels absolutely amazing. Maybe soon I’ll be able to run more than about 3½ miles at a go as well, and if I can keep it up I’ll get rid of some of the excess fat I’ve built up this year, on top of the excess fat I built up last year! Let’s not share the numbers on that.

When am I going to get to the point? Well the point is that so much of going through a long term experience like cancer treatment is about starting over again. And again. And again. I talked about this a few times last year, but I think it’s becoming even more stark to me this year. As you go through this godawful journey, over and over again, you’ll hit potholes in the road. Chemo was a big pothole, radiotherapy another big one, the pneumonia that I had in February and March was an absolutely huge hole in the road. And every time you come back out of a pothole, you have two choices. The first choice is to dust yourself off, accept that you are at the bottom of the hill again and start that draining push to rebuild your health, your energy, and your emotional stability. The second choice is to finally say “fuck it”, and stop trying.

Clearly, the first of those two should always be the right choice. But from where I’m sat it gets tougher every time. I go back to a poorer state of fitness than last time, I hit a new emotional low, I take longer to get back to where I was before. This is causing me to re-assess how I deal with this, and I’m sure this must have happened to many thousands of people like me who thought they were superhuman, or at the very least able to keep going and do their jobs and hobbies. It is still massively baked into me that I don’t take sick leave, I stand up to my commitments to work, to my friends, and to my discretionary activities.

I’m clearly wrong aren’t I. I need to find the mechanisms to help everybody else to help me. To enable other people to step in and fill the Guy shaped gap when I am getting over the most recent shock to my system and frankly just need to sit in the garden, or go walk and eventually run in the woods, to give my mind, body and soul a chance to rebuild themselves.

But if only it was that easy. I lose track of the number of people who have said some variation upon “Guy, it’s really important that you reduce your workload and take it easy, but of course, my project is the most important thing and that’s the one you won’t be compromising on, will you.” I don’t think that people even realise they’re doing that - but they are. Playing fair, before I became a cancer patient myself, did I really recognise when other people were going through something similar? No, I probably didn’t, and that’s not to my credit.

And most of us have personal projects as well that matter to us emotionally: whether that’s writing a book, building a kit car, redecorating a bedroom, or just getting to the next level in a computer game. Life’s not just about existing, ESPECIALLY when you’ve been badly ill. Those personal projects are massively psychologically important. So, for many of us, is simply being useful.

And here’s a question. When you’re not up to doing something, and your colleagues don’t have the capacity to do it, so it either doesn’t get done, or gets done badly - just whose fault or liability is that? Answers on a postcard please!

Do I, dear reader, have a solution to all this? Nope, I really don’t. I think that anybody in long term medical treatment, or with a long term medical condition probably lives this delicate and painful balancing act. I’ve certainly seen it in people I cared about in the past, just never really believed that I’d ever have to live it myself.

I can only say that if you are living this, like me - or you have somebody in your personal or professional life, please try and deal with this consciously. Know that you are going to hit another health pothole sooner or later, and when you do, find ways to recover manageably. That will be frustrating, difficult, and as other people around you think that you should be doing more than you are, or handle things better, it will bring you into conflict with them. Which brings me back to those work problems again!

Until next time, look after yourselves.

I don’t have an answer for this. Honestly for my health and sanity I’d have been better just staying in bed for a couple of months, interspersed with light exercise in the fresh spring air. In the real world I have a job to do that I care about, and I tried to get back to work as soon as I could to get things done and interact with my colleagues, who are often also my friends. This didn’t go entirely well; I’m still trying to catch up on stuff - no organisation is so well staffed these days that they can just take up the slack when a key individual is under-strength for a while. So I’m stressed and still struggling, and it’s clearly impacted upon other people as well. We’ll repair the damage and move on, but it’s not always been pretty.

On a totally personal level I’ve still to pass 50% of the amount of exercise that I was doing before I got the chest infection. This matters a huge amount to me - the exercise levels I try to maintain are vital for my physical and mental health and wellbeing. Yet, it seems that everything that disrupts my life, puts me another step backwards, and I never seem to get back to where I was before any more. Whilst I’m at it, the lack of exercise and stress do my Body Mass Index no great favours either. This worries me a lot.

On the other hand, there have been wins. I’ve just had my latest blood test, and not only is the PSA marker still undetectable, but my haemoglobin count is now finally, if only just, above the threshold that indicates anaemia. Anaemia seems a common side effect of cancer treatments, and had concerned the aviation authorities - so hopefully that’ll stay healthy and the world can stop worrying about my iron levels. I’d also been worried that during the chest infection my body had finally succumbed to the treatment and I’d hit full-on erectile dysfunction - as happens to the majority of prostate cancer patients. Fortunately, if slowly, I’m emerging from that unhappy place, and hopefully will continue to as I slowly restore my fitness, and maybe even chip away at my obesity. Just maybe, the light at the end of the tunnel isn’t a train coming the other way.

Is there a point to this bit of self pity? Well, I hope so. I’ve known I have cancer for a little over a year and a half now, and it’s been an undeniable roller-coaster of a ride. But there’s clearly a bit of a difference between facing the short term threat, and the longer term impacts. Being told that you have cancer and need, in my case, chemotherapy and radiotherapy is scary as hell. However it’s also something substantial and can be faced down with courage, and the energy and fitness you went into this journey with.

A year later and people may be telling you that you were brave, looking good, and they’re very impressed - but you are also drained and depleted. You’ve less fitness, the chemotherapy messed with your immune system, the radiotherapy messed with your manhood, and the hormone therapy continues to mess with your emotions. Unless you were luckier than me, you’re also probably (more) overweight. So you are in a far worse place to handle, well, just about anything. Other illnesses, workplace stress, family problems, the challenges of dieting - or just the natural challenges of ageing.

(And there’s another challenge in itself - in two months I’ll turn 56. How do I tell if any one thing I notice in myself is due to my cancer, due to the cancer treatment, or down the fact that I’m just getting, frankly, old. Spoiler: I can’t know, just blame everything, and worry about everything.)

I’ve written before about the importance of keeping as fit and healthy as possible to be able to tackle what life throws at you next. This is advice I’ve given, and I’m trying to live up to, but it is very very hard. I can only keep trying my best, but post cancer, still in treatment, significantly post age 50, everything seems to be working against me now. I’m quite certain that I’m very far from alone in trying to fight this, and in being bewildered and frustrated by the battle.

So if this is you as well, keep trying to find the time, energy, and reserves to win this battle yourself. If this is somebody in your life, who have been through the core of cancer treatment and are now with frustration and bewilderment trying to make sense of the long term journey - please recognise that their big battle may be now over, but their war isn’t.

Take care everybody.

This has made me a bit philosophical about having a disease, or not - and how that flavours your mindset. For the last 19 months the presence, or risk of cancer has been permanently and distressingly in my mind. So when I started to suffer from these symptoms, all my initial thoughts basically summed up to “is this cancer related?” Yes I looked up androgen deprival therapy side effects, impact of my cancer treatment on my immune system, and anything else that I could think of. I got distracted. The answer is almost certainly very prosaic and that I needed to find treatment for a chest infection. And eventually, I did and hopefully I’ll recover soon.

But this got me thinking about 2020: a year that most of us would really rather forget. Late in 2019 the world started to learn a new phrase “Covid 19”. By March 2020, we started to suffer cancellations and lockdowns, and by July we were suffering from a massively complex changing ground medical advice, lifestyle and travel restrictions, and a massive level of paranoia. July 2020 is significant to me because it’s the month when I turned 50. (Also the deadline for the oldest you can apply to become a European Space Agency Astronaut, yes I applied, no I failed. A story for another day.) We were all badly distracted, most distracted of all were people who worked in medicine and public health. So, oddly enough, there were very few public health messages being sent out about anything but Covid, and those that were, were largely being ignored.

So, in the year that I turned 50, when some advice was out there saying that men passing 50 should get a PSA test as a first line of screening against Covid-19, in reality I was completely distracted. The entire globe was distracted, and the medical professions were particularly distracted. In 2021 there were actually quite a lot of articles and warnings about exactly this - this article from the BBC is a great example: https://www.bbc.co.uk/news/newsbeat-56362264 . And yet did any of us really listen and apply that warning to themselves? Not many of us. I never did open my ears to advice about routine cancer testing, and was only diagnosed after some symptoms, with stage 4 cancer, late in 2024.

The evidence of me, this month, worrying about cancer when I should have been worrying about all the evidence of a worsening chest infection, is that I still haven’t learned to properly horizon scan for new health risks. We’re all still incapable of seeing beyond the immediate threat. That is quite worrying really.

There’s a pretty obvious comparison here in another part of my life. I fly aeroplanes, and a major part of my mindset, and not a little experience, is about handling in-flight emergencies. So let’s put me forty minutes of flying time away from the nearest runway, and an engine decides to develop a nasty fault. At that point I need to do two things:-

(1) Deal with the emergency

(2) Keep flying the aeroplane, and be prepared for anything else that might go wrong between now, and when I safely land it. That could be weather, problems with the other engine, losing my situational awareness - pick your problem.

As a flying instructor, I’ll give any pilot who fixated solely on the immediate emergency without considering management of every other aspect of the aeroplane an extremely hard time. And yet here’s evidence that twice in six years I’ve failed to properly think about one major health threat, because I was fixated on another. Hopefully this second time I at least only wasted weeks, and not years, and the worst consequence is probably just a week or two off work. But, I’m still not impressed with myself.

Can I leave you with a life lesson here. Deal with the ongoing life threatening emergency: whether it’s cancer, covid, or an engine on fire. But never stop being aware of the risk of other things that might also come out of left field and threaten you. An overly narrow vision could just leave you vulnerable to, and unprepared for, the next big risk.

Of course, we’re far from unique in aviation. The first person to note that some professions showed greater incidences of cancer was an Italian, Bernardino Ramazzini, who around 1700 published a book showing that certain jobs, including dyers and chemical workers, miners, metal smelters and gas workers showed increased risk of cancer. He didn’t however come up with any theories as to why.

The first explanation of a specific causal relationship between occupation and cancer were made about two hundred and fifty years ago by an English surgeon called Sir Percivall Pott. He noticed that there was a significantly higher rate of scrotal cancer (or in the English of the time, “canker of the privities”) in chimney sweeps, and showed a connection between that and exposure to soot. Of course, in the callousness of that time, whilst nobody particularly disputed his conclusions, and a number of laws were enacted very quickly requiring better hygiene standards in chimney sweeps and *raising* the minimum age of British chimney sweeps to eight, in reality most of those were ignored. It took about a century before protection of British chimney sweeps from soot actually started to happen, and cancer rates dropped. In the USA I believe it was at-least as bad, not least as there chimney sweeps were mainly enslaved boys - for whom clearly workplace health and safety was something that happened to other people.

(Watercolour of chimney sweep’s cancer tumour, by Horace Henge Dobell.)

Various other links were made over the intervening years, but a massive breakthrough was made by two Japanese scientists, Katsusaburo Yamagiwa and Koichi Ichikawa, who published a paper in 1915 showing experimental work where they’d caused cancer in rabbits by exposing them to coal tar.

That all led to a whole raft of work, and our present understanding that by creating a toxic environment in a part of the body, what happens is that deformed cells are prevented from being instructed to self destruct by surrounding cells, and as a result they thrive when healthy cells may not. This has included understanding of the effects of asbestos, or coal dust, and even tobacco.

So we’ve learned some fundamental principles over the last 250 years. If you can identify the carcinogen, and eliminate it from the workplace, then you should be able to minimise the risk of cancer.

But, if only it were that simple. Back in the 18th century, Potts’ discovery of the mechanism of a link between scrotal cancer and soot exposure still took a century for real change to happen. That was basically because the people with the real power - employers and politicians, didn’t really want to do more than make token efforts. So how are we doing now on aircrew cancers?

The truth is, not as well as we should. It’s true that regular medical screening and generally motivated people with access to good healthcare support, means that actually mortality due to cancer is little different in aircrew and the background population. But, eliminating the radiation, which most people assume is causing that cancer, is much harder. We can’t help that aeroplanes fly well above the ground, nor that combat aircraft and airliners alike have big radars in the front creating ionizing radiation. Adding extensive radiation shielding would make aeroplanes problematically heavy. Probably the best that we can do is to limit duty hours, and to enhance medical screening - which unfortunately we haven’t generally done. There is a military oriented charity in the USA, Aces and Eights, who I have mentioned before, who are doing something - but in the rest of the world, not a lot.

(Aces and eights aircrew cancer checklist.)

There’s another characteristic of aircrew is that we all love to fly, it may well be our sole or primary income, and thus we’re actively dissuaded by the professional environment from reporting symptoms or getting tested. Speaking from personal experience, that was definitely a significant concern for me, although I’m glad to say that commonsense and benign marital pressure did make sure that I got tested.

Whatever occupation you’re in, it is worth knowing what the carcinogens are in your workplace, and doing your best to avoid them. Sometimes it’s easy - painters and mechanics can wear protective gloves, people in dusty environments can wear masks, anybody getting close to chemicals can use barriers and regularly launder clothes (those poor chimney sweeps back in the 1800s were probably going to bed at night not only in the same clothes they’d been sweeping chimneys in, but under blankets they’d been using to gather up soot!).

Being personal about this for a minute - do I believe that my own cancer was potentially caused by my being a pilot? No, actually I don’t - the statistical evidence is that prostate cancer isn’t one of the ones that’s more likely in aircrew. Also whilst I’ve a fair number of flying hours (for the record, two thousand four hundred and twenty eight hours and twenty one minutes, plus whatever passenger flying I’ve done over the years), the vast majority of that was under 5,000ft and in aeroplanes without a radar. Frankly, I just got unlucky - but that doesn’t mean that I don’t now think that aircrew cancer is a very big deal, and I, and my colleagues, should take this very seriously. So should you, whatever your own professional environment.

On New Year’s Eve last week, I got up and prepared to pick up an aeroplane I part own from maintenance, air test it, and deliver it back to our home base at White Waltham. That didn’t actually go to plan (nor did my chemotherapy a year before), but the day after, the fog around London had cleared and I managed to fly our baby back home. She was, I’m glad to say, flying very well and a new instrument we’d added to the panel working perfectly. (For my fellow aviation nerds, we’d replaced the mechanical DI with an AVCOM AV30 configured as an HSI.) That is quite a year’s journey.

A decent case could be made that 2025 was the most stressful of my life (maybe equal first with 1996 when some military flight test training went rather badly for me, but that was a long time ago, and I’m a very different person now.) It has left me feeling exhausted and fragile.

2025 has been a year of achievements for me. The minor ones are worth listing, as on a normal year any one of them would stand-out. I was elected a Fellow of the Higher Education Academy here in Britain, and of the Society of Flight Test Engineers in the USA. I was awarded the Jesualdo Martinez award for my work in flight test (it’s only awarded every two years, to a single flight tester in Europe), and the Royal Aeronautical Society written papers prize (for the second time). And of-course I got promoted to full Professor at Cranfield, which I’m very proud and pleased about. Looking at the spreadsheets where I track this stuff, I also flew just under 85 flying hours, ran 539 miles: an average of 10.4 miles a week, and was co-author of a couple of new research journal papers.

None of which is particularly front and centre in my consciousness. The only success that really matters for 2025 is beating prostate cancer. I’ve gone from somebody with stage 4 cancer, a deformed prostate and tumours right through my pelvis and torso, to somebody whose blood tests are coming back with the magic word “undetectable”. Nothing else really matters does it.

This should be a cause for a celebration, and indeed in October I invited a bunch of my family and friends (many friends came, and a few family) to a “Guy Kicked Cancer” party at my flying club. I really can’t overstate how psychologically important that was for me. At the end of a journey that was draining and and sometimes seemed never ending, letting my hair down with 40 people I really care about was an amazing and liberating experience. There were people who when this cancer journey started advised me to plan for events and rewards, and this was one I’d been thinking about for months. They were absolutely right - finding those psychological break points is really valuable. If you’re going through a similar journey, I can only commend this as excellent advice. If anybody you know is doing this, try and support them - even if that’s just turning up and drinking their beer.

On the day of the party, I also collaborated with two charities: Civil Air Support (which I’m a trustee of) and the Graham Fulford Charitable Trust, plus my flying club (West London Aero Club at White Waltham). We organised a PSA testing event that men could come to, including flying in - trying to take this message to the flying community who really need it. We got 50 men tested, one of whom has told me privately that he’s been referred since for an MRI scan. I really hope in his case it turns out to be benign, but if it’s not, well we may have saved a life there. There are plans to build on this for some bigger and better events, both at White Waltham, and other places this year and beyond.

There are a bunch of cancers, including prostate, that have a higher incidence in aircrew than the background population. There are several unproven theories about why that’s the case, including proximity to radiation emitting cockpit equipment, altitude, and chemicals. [If you want to read more on that, have a look at the website at https://www.acesand8s.org/ . The Aces and Eights Foundation are an American charity, borne out of a community in the US flying military who got together a few years ago and compared notes, with some concern, about their relative cancer rates.] Also they’ve been looking into the fact that male aircrew tend to have more daughters, but sadly having no children myself, I can only take that on advisement.

This starts to knock against an important question in my mind as I enter 2026. What is my mission now? Remember missions, very fashionable for organisations back in the 1990s, and still a concept that’s useful. I’ve never been somebody who just pitched up and did stuff for the money (if I was, I might make more money, have nicer aeroplanes and a nicer house, not that I’m actually complaining about any of those). So trying to get the cancer testing and awareness mission out to my fellow aviation professionals is definitely part of my personal mission going forwards. I didn’t know as much about cancer as I needed to when I got into this strange journey, and I’m absolutely certain nor do lots of other people. So let’s get this message out.

I’ve set myself a few other objectives as well. If you’re reading this, it’s probably quite obvious to you that I quite like to write. When I got derailed by the cancer, I was working on a third edition of my textbook Initial Airworthiness, which I last updated in 2018. I have restarted work on that with a view to getting it published this year. I’ve also pushed forward the throttle on publishing a novel I’ve been working on for the last six years, so hopefully this summer I’m going to see that hit the streets. You heard it here first, but I’ve written the first of what I hope will be a series of air accident investigation thrillers, starring my fictional protagonist Dr David “Indy” Jones. I hope that I can get that out in “all good bookshops” about May.

Is that enough? Well it really should be, but I absolutely MUST NOT stop supporting my inner man. I’ve decided to switch my exercise targets from a running-mileage target to an exercise-calories target of 3,000 per week, equivalent to running about 20 miles. Will I hit that? I don’t know, but I’m going to try.

And that, absolutely, is enough targets thank you very much. Two books, normal work stuff, promoting cancer testing for pilots, and 3,000 calories of exercise a week. If I show signs of setting myself any more targets than that between now and next Christmas then please, somebody, take me aside and tell me to just slow down. I do not need any more targets - I just want to reach 2027 sane, healthy, still employed and maybe with a couple more books on the shelf. It’s enough.

I’m a bit of a collector of professions. The first thing I ever qualified in that permitted me to earn money was as a lifeguard when I was 14. Since then I’ve added canoeing instructor - long lapsed now along with the Royal Lifesaving Society qualification. Then I got an Engineering degree when I was 22 and became a Chartered Engineer at 25. After that I’ve become a professional pilot, a qualified martial arts instructor, and a published author. I’ve been qualified to teach in universities for a few decades, and as I wrote last month I’m now a full Professor.

The one I’m most proud of however, is that I’m a Test Pilot. This is a profession rather misreported in the popular media and certainly anybody who behaved like Tom Cruise’s Pete “Maverick” Mitchell in the second Top Gun movie would not last five minutes. What we are is pilots with enough ability to safely fly an aeroplane, whilst also carrying out experiments or evaluations within the flight. That clearly did include quite a lot of specialist training and experience, and en-route I might have taken a few risks, but as far as possible, very carefully calculated and managed ones.

Like a lot of test pilots, I got into this with a personal subtext of hoping this could lead to what I really wanted to do - become an astronaut. When I was a student back in the 1980s and 1990s I already knew that this was my ambition, and I studied what at that time seemed to be needed. That was: stay fit and healthy, get an engineering or science first degree then a PhD in an experimental field, learn French and Russian, learn to fly, and ideally get experience of test flying. So, I set out to do all of those things - with variable success (I’ve pretty much forgotten all my Russian, but the French is still okay). Cutting to the punchline first, yes I did get one shot at applying for astronaut, with the European Space Agency in 2020; it took them, 9 months to reject me, so I can’t have been too bad, but nonetheless, I failed. Whilst I’m a bit grumpy about the failure (although in retrospect, if I’d got further through the astronaut selection, I suspect that the medicals would have picked up my cancer earlier, and booted me out anyhow), I have absolutely no regrets about the journey. Absolutely everything I’ve done en-route to this has been worthwhile and usually enjoyable.

Which brings me back to a story. My logbook says that the first flight I ever commanded as a test pilot was on September 29th 1998 when I was evaluating the stalling characteristics of an aeroplane type that had had an unexplained fatal accident. About three years later, I was accepted into the main “club” for Test Pilots, the California based Society of Experimental Test Pilots, or SETP. That’s a very big deal, as the Society’s entry requirements are independent and very exacting, also that it’s a club which is both prestigious and very supportive of its members. So I decided I was going to save up and get myself to SETP’s big annual conference in Los Angeles. That I did, and in September 2003 I attended for my first time the SETP Annual Symposium and Banquet in Anaheim.

I remember that conference very well, for many reasons - I got to talk to so many brilliant people from all over the world, and learned huge amounts. But one brief incident particularly sticks in my mind.

It was the start of day 2; the conference started with breakfast about 7:30 and I got there on time, and loaded up a plate with doughnuts and coffee (this was America after all!), then sat down at an empty table to enjoy that and take in what was going on. A few minutes later a middle aged American introduced himself as Rick, and asked if he could join me. I was glad of the company and were enjoying a chat about how the conference was going, and what were likely to be the most interesting sessions that day. He was obviously ex-military and knew quite a lot about spaceflight, but that described half the people in the room. We were basically two colleagues chewing the fat.

Then another middle aged American came and tapped my new friend on the shoulder. He turned around. 22 years later I remember every word of the next short conversation.

“Hello Bob, great to see you”.

(Turned to me)

“Guy, meet my old mate Bob Crippen, he commanded me on my first Shuttle mission”.

I was having breakfast with Captain Rick Hauck, pilot of one, and commander of two more Space Shuttle launches, and Bob Crippen, pilot of the first ever Space Shuttle launch, and commander of three more after that.

On April 14th 1981, aged ten, I had been sat cross-legged in a a primary school hall watching on our black and white “school television” the first ever launch into space of NASA’s Space Shuttle. Bob had been strapped into that space shuttle as the pilot (actually co-pilot, but astronauts would never admit to being a co-pilot, so they are commander and pilot, instead of pilot and co-pilot). I couldn’t bring myself to call him Bob. “Sir” seemed much more appropriate.

But let’s talk about inspiration. Those two men have inspired thousands of people to pursue their best selves, personally and professionally - it is of-course part of the job of an astronaut. I’m very privileged to have known them however briefly, and be inspired in person.

How about in Cancer? Well unlike being an astronaut, nobody applies to have Cancer. It’s totally understandable why anybody would just want to concentrate upon their treatment, and hopefully recovery and after that try and achieve a quiet life. I would never judge anybody adversely for that. Yet, at the same time there are people who have become incredibly inspiring in the way they’ve used their cancer diagnoses not just to change their own lives, but other people’s too. Look at what Sir Chris Hoy has done to turn the personal tragedy of his terminal prostate cancer diagnosis into an education mission, or the Princess of Wales to spread the word about the need for care and consideration towards people who have, or have had, cancer. And less well known people I’ve found at-least as inspiring: People like Tony Collier, runner, campaigner, terminal cancer patient, and administrator of a massively supportive Facebook group for prostate cancer patients and their families who has done a huge amount; Floella Benjamin, former children’s TV personality and now a campaigner for prostate cancer awareness in black men, and patron of Beating Bowel Cancer. People like this inspire me, and are inspiring many other people - and no space suit required.

So let me finish with a challenge to anybody reading this. Aside from all of the pressures on your own life, which are real, and which you have to deal with - do you do things, and live a life, that would inspire others? I think that the best test is to ask yourself: if teenage you could see adult you, would they have found you inspiring? Would they regard you as a role model? If they wouldn’t, there’s still time!

My deepest sympathies to the family and friends of Astronaut Rick Hauck, who died last month of Parkinsons Disease, at the age of 84.

P.S. Latest blood test results are “unremarkable”, PSA<0.01. I continue to fight the good fight. Weight loss? - less successful.

If you’ve had serious, life-saving medical treatment: for example major cancer treatment, somebody behind all that probably had the title of “Professor”. If you studied at University, whether that was medicine, like the physicians treating us, engineering like me, or pretty much anything else - then also at the top of the tree was somebody called “Professor”. When I was an undergraduate at Southampton University back when Pontius was still a Pilot, our head of department was Professor Robin East, a slightly severe, but ultimately incredibly knowledgeable and supportive figure who I always enjoyed interacting with and learning from. But did you ever wonder just what that means.

There are several ways to define the meaning and role of a professor. Once upon a time it was basically anybody who taught in any of the world’s tiny number of universities, and the title came because they “professed” their knowledge. Then universities multiplied and became larger, they became the most senior academics and various additional grades of academic were appointed beneath them. This is still by and large the case, although internationally there are two main scales. In Britain we have…

Lecturer —> Senior Lecturer —> Reader —> Professor.

Whilst our American colleagues, often copied around the world and this is actually also taking hold in Britain have a different scale:-

Assistant Professor —> Associate Professor —> Professor.

Ignoring the fairly trivial point that American universities have three grades to cover the British four, the main point is that a Professor has reached a point of distinguished conduct in their personal knowledge, their research, and their ability (usually, not always) to teach their subject. In medicine this has become particularly closely linked with clinical practice, so many of the most distinguished clinicians are also actively involved in researching new and improved medical treatments, and equally involved in training the next generations of medical professionals - and quite right too. Hence my medical treatment has been led by Professor Peter Hoskins at Mount Vernon Cancer Centre, for which I am very grateful - looking him up, he is clearly one of the thought leaders in the UK in best practices in cancer treatment, and I’m fortunate to be treated by such a man.

Fiction has provided us as well with some great Professors - here are a few of my favourites, in their chroniclers words. These are from a favourite author of my childhood, Norman Hunter:-

Professor Branestawm, like all great men, had simple tastes. He wore simple trousers with two simple legs. His coat was simply fastened with safety pins because the buttons had simply fallen off. His head was simply bald, and it simply shone like anything when the light caught it.

It was a wonderful head was the Professor’s. He had a high forehead to make room for all the pairs of glasses he wore. A pair for reading by. A pair for writing by. A pair for out of doors. A pair for looking at you over the top of and another pair to look for the others when he mislaid them, which was often. For although the Professor was so clever, or perhaps because he was so clever, he was very absentminded. He was so busy thinking of wonderful things like new diseases or new moons that he simply hadn’t time to think of ordinary things like old spectacles.

Or for a less wholesome Professor, we can have one from Sir Arthur Conan Doyle…

He is the Napoleon of crime, Watson. He is the organizer of half that is evil and of nearly all that is undetected in this great city. He is a genius, a philosopher, an abstract thinker. He has a brain of the first order. He sits motionless, like a spider in the centre of its web, but that web has a thousand radiations, and he knows well every quiver of each of them. He does little himself. He only plans. But his agents are numerous and splendidly organized. Is there a crime to be done, a paper to be abstracted, we will say, a house to be rifled, a man to be removed—the word is passed to the Professor, the matter is organized and carried out. The agent may be caught. In that case money is found for his bail or his defence. But the central power which uses the agent is never caught—never so much as suspected. This was the organization which I deduced, Watson, and which I devoted my whole energy to exposing and breaking up.

If your tastes in literature are more recent, of course you can go to JK Rowling…

Nothing like this man had ever been seen on Privet Drive. He was tall, thin, and very old, judging by the silver of his hair and beard, which were both long enough to tuck into his belt. He was wearing long robes, a purple cloak that swept the ground, and high-heeled, buckled boots. His blue eyes were light, bright, and sparkling behind half-moon spectacles and his nose was very long and crooked, as though it had been broken at least twice. This man’s name was Albus Dumbledore.

So why am I rambling on about professors, real and fictional? Well, once upon a time I had the title of Professor - I was at the time Head of Airborne Science at the National Centre for Atmospheric Science, and Cranfield University, where we were based, granted me the role and title of Visiting Professor. Basically it meant that they wanted to keep me onside, but weren’t actually paying me anything. Our Head Office decided to make me redundant in 2019, leading by a slightly circuitous route to my coming over to Cranfield to work properly, but not as a Professor - I was firstly an internal consultant on a fixed term contract, then I took a permanent role as Associate Professor of Aviation and the Environment. (Don’t feel sorry for me, it actually came with a significant payrise compared to what I’d had at NCAS.) That’s a job I’ve thoroughly enjoyed for the last five years or so, and hopefully done some good. But I’d decided in the middle of 2024 I was going to bite the bullet and put my application together to full Professor. That was coming along slowly, but in what I hoped was the right timescale, when almost exactly a year ago I received my diagnosis of stage 4 prostate cancer.

Clearly, like anybody with any sense, I prioritised my cancer treatment - but I also decided that I was NOT going to be derailed from this particular ambition. So whilst going through chemotherapy, I slowly and painfully put together my application: covering the papers I’d published, the PhD students I’d supervised, the small amount of teaching I’d done, and (very important these days) how much my work had changed the world, and how much money I’d brought into the university. That went in in March. Then early in June, just after finishing radiotherapy, I was interviewed by a board chaired by Professor Dame Karen Holford, Cranfield’s Vice Chancellor (the head of the university in other words), and the following day got a call from her Deputy, Professor Dame Helen Atkinson giving me the good news that I’d passed - but telling me to keep it quiet for a while.

Six weeks later the bombshell hit - a letter from HR saying that my promotion would be effective on August 1st, or when I became a Fellow of the Higher Education Academy - something I’d not pursued because the university hadn’t run the process for it for over a a year, I’d been really rather busy with my cancer treatment, and frankly I hardly did any teaching - my job was all about research. Putting myself under a lot of stress though, I dropped as much as I could and threw all my efforts into getting the elusive FHEA.

Well, two weeks ago, I had my final oral interview for it, and the same day passed and was appointed a fellow of Advance Higher Education (same thing, it’s a bit confused over its own name). The same day, my promotion was effective.

I thus present myself as Professor Guy Gratton PhD FRAeS FIMechE FSFTE FHEA AFSETP.

And still, Guy with Cancer. I’ll also continue to try and uphold the standards of bow-tie wearing, tweed jacketed, professorial eccentricity for which the profession is famed, and aim to keep making the world a better place through it.

I did, jointly with a colleague who is a breast cancer survivor, contact HR at the university about tying to contact other people who have similar experiences around Cranfield and forming a support group of some sort - even if it’s just a monthly hour of coffee and war stories. That sadly seems to have fallen into the “too difficult” camp for now, mostly I think because they’re in the middle of a pretty horrendous restructuring right now (read: redundancies). Thankfully that seems to be passing me over, but not all of my friends and colleagues, although there’s an element of procedurality about it too. I’m sure we’ll find a way to do it, but it might take a while.

No, the reason I’m not posting so much is that I’m, after a fashion, piecing my life back together. Going to meetings, restarted work on several books I was busy writing before I got diagnosed (any agents out there interested in taking on a series of aviation centred adventure novels?), working on a bunch of work and charity projects, running a slowly increasing rate. I am aware that I’m still exploring what my capacity is, as I really don’t know, and not always finding the right balance. So posting my thoughts on Substack is a casualty.

However, there’s something I really do want to talk about, which is the new report just presented to parliament by Prostate Cancer Research. If you’re not seen it, here’s the link: https://www.prostate-cancer-research.org.uk/screening-report/ .

It was presented by a team that included former Prime Minister Rishi Sunak, and current Deputy Prime Minister David Lammy, as well as a bunch of very clever and motivated people from the charity and medical sectors. I’ve read the report so you don’t have to (although it’s worth it), and I’ll tell you - it’s a brilliant piece of work. What it does is show, with a lot of evidence that a targeted screening programme is extremely affordable, so much so that the case for doing it is almost inarguable. The specifics are a bit complex, but basically they’re arguing for:-

- Screening that uses a combination of PSA testing, MRI scans and biopsies

- Targeted at two groups of people: black men aged 45-69, and all men in the same age group with a family history of prostate cancer in men, or related cancers in women.

They break down the costs, show how many new people of what professions in the NHS need to be trained and qualified to support it, and overall show something really worthwhile, affordable, and achievable. Whilst I’m not a medic, I am a scientist and can absolutely see what was done here and it is really really impressive.

—

It’s clear that the team behind this report don’t want to stop at that position. They want to screen all men from 50-69 as well, and to expand screening as the technologies come online to include an expanding range of ways of detecting prostate cancer including AI, and several new blood tests that are being evaluated at the moment.

—

On some levels, I really don’t want to agree with this report, for the very emotive reason that under the proposed initial testing regime I would never have been tested. I would still not have had my own cancer picked up until it was nearly too late, and maybe not at-all. But, it is absolutely right that the methods and groups that it wants to target are those whose lives are most likely to be improved and saved - I was an outlier and not in the same bracket.

So I really hope that our MPs listened to this, and who knows, a few of these busy folks, might even read this report past the too-brief executive summary…

It is clear that the intention is not to stop at this initial introduction. It is to start there, and as quickly as possible expand the testing regime both into more people, and better technologies. And clearly the fact that this targeted regime exists will help encourage others to get screened as well - perhaps somebody else like me at, or even before their 50th birthday.

So well done to everybody who was involved in this brilliant piece of work. It absolutely deserves to succeed, and if the job is done right won’t be an end point, it’ll be a starting point.

I hold professional pilot licences in three places:-

- Britain, with the Civil Aviation Authority

- the USA, with the Federal Aviation Administration

- the EU, with the Irish Aviation Authority.

All three applications were made at once by my AME (that’s Authorised Medical Examiner to you), and then I sat back to see what happened.

The first to respond, as I described four weeks ago was he IAA, who asked for a history of my blood test results - totally reasonably, and also a letter from my oncologist detailing my future treatment plans. This last was interesting because it concentrated my mind on the fact that the oncology team hadn’t clearly told me that as well - so I asked them for that. And I’m still waiting; I’ll chase that again sometime soon.

The second was our own dear Civil Aviation Authority who surprised me with a massive level of helpfulness. They actually phoned me up first for a chat about my needs, then almost immediately sent me a letter and, joy of joys, A MEDICAL CERTIFICATE. In this case a class 2, not a class 1. In reality that’s all I need, but they are amenable to my getting a class 1 back eventually. It’s really interesting to me to see how the CAA did this: basically they seem to have thrown my full medical history into some form of statistical model, and concluded that my “risk of incapacitation” is presently elevated by the medication to the point where it’s above a magic threshold of 0.1% (0.1% per what? - year / flight / decade / ever? They didn’t explain that). That means I can have a class 2 but not, yet, a class 1. What the hell, that’s a brilliant result, allowing me to return to the full range of all the flying I’d actually been doing.

For interest they aren’t just doing that however - I’ve been given a list of things I have to do to keep this: a PSA test every three months, an iron level test annually, an oncology report at-least once a year, and a cardiology review, including an exercise ECG every two years. Now that’s not trivial, but in reality it’s not much more than I was doing anyhow - so thank you so much CAA, you’re still on my Christmas Card List.

Next up has been our friends in the USA. I have a very formal and pompously worded letter from the Office of Aerospace Medicine at the American Federal Aviation Administration in Oklahoma City. They don’t seem to have taken much longer than the British to come to a decision - the real delay was in the letter making its way across the Atlantic (American officialdom really doesn’t do emails!). Pomposity aside, it was also spectacularly helpful - they have gone straight to the class 1 I asked for, albeit initially only for six months. By the end of six months I have to provide them with their own requested sets of reports - PSA tests, blood count tests, calcium (no idea why, nobody else seems to have ever taken an interest in that), and basically anything else that they think the oncologists might find interesting. So thanks to you also Uncle Sam.

(Yes I did sign it just after taking this photo.)

I find it interesting to compare the approaches of the three authorities, who theoretically are operating under basically the same rulebook, with local variations.

UK - we’ll run a computer model of your health, and if the statistics come out okay, you’re good, subject to ongoing tests to allow us to keep our model up to date.

Ireland - we need to tick all the boxes in our procedures.

USA - If your AME is happy, we’re happy, but you need keeping an eye on.

I’m not suggesting that any of them are less than professional in what they’re doing, or at-all unhelpful, but it’s really interesting to observe that there are at least three different ways to skin this particular cat.

So, anyhow - I got most of the results I wanted, and I’m a happy airman. It does show you can come through this wretched cancer malarky, and return to the things that really matter to you, despite it all. If anybody involved in getting my medicals back is reading this- thank you, and I won’t let you down.

But let’s talk about my cancer, and a few related things. I’ve had a couple of recent blood tests which, infuriatingly I didn’t get the results for at once, but last week I finally got. The important number, as we all know, is PSA, or Prostate Specific Antigen, and with what I learned I let my inner Engineer have a play and plotted it all on a graph.

The result is wonderfully stark - my PSA reading is now under 0.01 ng/L, which the medical profession declare to be effectively “undetectable”.

I’m also very glad to say that I’m continuing to manage to run a bit over ten miles a week, and the last few weeks there’s been a marked change in my pace - not massively faster so much as that I can now run pretty much my whole favourite 5¼ mile cross country run without needing to regularly stop and walk for a patch. On the cooler days at least. I’ll admit I’m not handling the hotter days well, but frankly that may be just well, that it’s too damned hot and I don’t really need to find an excuse for that. I’d like to get my mileage up more, and I think I will now, if gradually.

I’m clearly happy and relieved by the undetectable PSA, although I’m a bit surprised not to be as overjoyed as I thought I might be. I’ve tried to pick apart why that is. I think basically it’s because I never really believed that this cancer could kill me (and so far I’m right!), and that the big issue in my life has been the discomfort and disruption. So my sense, whilst massively grateful not only to the nurses and physicians who have treated me, but to the generations of researchers who created these treatments is one of relief, accompanied with “so can I get on with my life now?”. Something that’s not quite so easy as you’d hope - I saw a quote from Catherine, Princess of Wales recently that summed this up:-

“You put on a sort of brave face, stoicism through treatment, treatment's done - then it's like 'I can crack on, get back to normal'. But actually the phase afterwards is really difficult, you're not necessarily under the clinical team any longer, but you're not able to function normally at home as you perhaps once used to”

I agree with her completely. And there’s not just a single thing you want to pick up. There’s all the things that I wasn’t able to fully concentrate upon at work, there’s the amount of exercise I want to do, getting my weight back down (getting there, just really really slowly), and of course my flying. I’m still flying, thanks to a collection of carefully managed loopholes in the regulations (for those in the game, I have a UK ANO CPL/IR as well as my part FCL CPL, which allows me to instruct up to PPL level with a PMD on aeroplanes up to 2000kg, and exercise my IMC rating, but not my IR), but am still a bit restricted. So I need to get my full medical certificates back again. This took me early last week, armed with a 15 point report from my oncologist, to an office on Wimpole Street in London the consulting rooms of Centreline Aviation Medical Services, and the enjoyably competent Dr Christopher King and his team. Because I have pilots licences in three countries - the UK, the USA and Ireland (the last covering the 31 countries of the European Union Aviation Safety Agency, or EASA) I went to him as he’s one of the few AMEs (Authorised Medical Examiners) I can find with the triple qualification, and thus I could have one examination and get all three of my “class 1” professional pilot medicals back. Do I actually need these right now? - no, I don’t, but I’m electing to try and reset the clock on all three in one go, so that any interesting flying that comes my way I can hopefully just go and do. So I took the train there last Tuesday, and spent an entertaining, if expensive, three hours doing a lot of paperwork, most of me being examined once, my eyes about three times in subtly different ways, and then sat down with Dr King for a bit longer with growing piles of paper on his desk.

The conclusion is what I’d hoped for - in his expert opinion I am indeed fit to hold a professional pilot medical again. Yippee, this for me feels like a bigger win than the “PSA undetectable” from my oncologists. However, it’s not quite that simple (is it ever?). So Dr King has now sent reports to all three national authorities, and the next stage is for them to make their decisions - and we do know that with aviation authorities who are quite rightly very risk averse, but also sometimes more than a little bureaucratic, this may well comprise of more questions and investigations.

And so a new process begins. First off the mark, unsurprisingly as they’re always particularly slick and professional, have been the Irish Aviation Authority, who came back to us within 24 hours with some questions. They wanted the results of my original MRI and PSMA PET/CT scans, as well as my most recent PSA tests. All totally reasonable, and easy to answer, so I did. Then they asked another question which was very interesting. They want a written summary of the plan for my care into the future. Well that’s a very interesting question, as frankly, I’d like to know that as well and whilst I’ve been given indications verbally, it’s actually all been quite vague. So I had a conversation with one of the specialist nurses at Mount Vernon Cancer Centre, who was also only able to give me a fairly vague answer - but agreed that it is totally reasonable for the IAA (and me!) to want that in writing, so she’s undertaken to request that for me in a letter that I can then scan and pass on to our friends in Dublin.

This process is going to go on for a bit I think, which does emphasise why I don’t feel like partying just yet. As Princess Catherine said, it doesn’t all just go back to normal, and the journey from cancer treatment back towards some kind of “new normal” isn’t instant, and isn’t straightforward. We may not even really know what the new normal looks like. But, we’re getting there, and I’ll talk about the ongoing journey, and things that I learn en-route, as I travel it.

Finally, my friend and fellow pilot and engineer Kev, who posts on Substack as “Harry off dock” having been through urgent chemo and MDRT had his operation for oesophageal cancer a few days ago and is now in recovery. What he’s gone through has sounded an order of magnitude more brutal than most of my own experiences, but he’s a warrior and I wish him the very best. You’ll beat this mate. We both will.

I’m feeling quite upbeat this week, not least because Sunday night was a bit of a landmark night - no I’m not talking about my sex life again - I’ll spare you that, but about the fact that for the first time in probably months I slept right through the night without once needing to get up to service an irritable bladder. Of late I’ve been drinking virtually no alcohol (not that I was ever a heavy drinker, but I enjoy the taste very much), and my hot drinks are primarily free of caffeine, and those do seem to have helped. But despite being 6 weeks now since the end of radiotherapy, I’ve been still suffering - a little, but just enough to need a pee a few times in the night. I don’t know if that is permanently over (probably not until I’ve lost some more weight!), but it felt like a massive landmark when I woke up at 7 this morning, before the alarm, having slept since about 11:30 last night, and particularly refreshed. Exercise I’m sure is helping (current average 9.97 miles/week over the year, and 13.5 miles this week at an average of about 15 minutes/mile), as doubtless is simple passage of time to heal. Ultimately, it feels like I’m getting there

Last (Monday) night not quite so good, but only one trip for a pee in the middle of the night, so it continues to all head in the right direction.

A few points on drinks by the way. I’ve become increasingly an aficionado of zero(ish) alcohol drinks, so here are a few of my favourites:-

From the left:-

Guinness zero, almost indistinguishable from the original, the can widget does a great job of making it genuinely taste off-draught. I prefer it at room temperature, although if you prefer still perfectly drinkable out of the fridge (as that’s where my flying club’s bar keeps it!)

Leffe zero - a decent continental lager, nicest ice cold.

Adnams Ghost Ship 0.5%, not a bad IPA, best in my opinion chilled.

Thatchers Zero%. One of the best of an increasing range of low alcohol ciders, although equally is good is Sainsbury’s own-brand half percent cider.

An honourable mention, but I don’t have a bottle in the house at the moment is Erdinger Alkoholfrei, which is a pretty honest continental wheat beer, also in my opinion best chilled.

Tea-wise, most decaf green teas taste about the same, but one enhancement I like is to add (in a tea infuser) half a teaspoon of dessicated coconut, to give a decaf version of a favourite daytime drink of mine, Heath and Heather’s organic green tea and coconut.

(Just in passing, and absolutely nothing to do with my cancer, I discovered several years ago that tannins give me heartburn, so I don’t drink black teas any more, nor red wines made from grapes. Pleasingly my own red wines made from blackberries seem to be absolutely fine but those are distinctly NOT alcohol free.)

After that of course, particularly in the hot weather we’ve been having lately, nothing beats chilled filtered Chiltern tapwater. I’m lucky to live in an area where our tapwater needs very little treatment when it came out of the local aquifers and tastes wonderful.

Prior to all this kicking off, I’d regularly enjoy a small glass with dinner of my own home-brewed beer or wine, and I’ve not touched much of that lately. I have idly read up on how to remove alcohol from your own homebrew: apparently I need to heat it up to about 80°C to boil off the ethanol, then after cooling it down again add CO2 to restore the fizz. I can’t say I’m massively optimistic about the likely outcomes of that, but at some point I’ll have a play. I’ve an awful feeling I’ll end up with something like Kaliber, which of course was groundbreaking in being, when it was launched in 1986, one of the first widely available alcohol free beers in Britain but was also, quite frankly, horrible.

Is this part of my new normal? It probably should be. Although I’ve never been a heavy drinker, all advice is that reduced alcohol intake is highly advisable to avoid cancer recurring, even once my microwaved bladder stops being so irritable. I will miss being able to make and drink my own wine and beer though, so perhaps I will find a halfway house of much reduced, but not zero alcohol intake, and keep enjoying a regular Guinness Zero.

————

Anyhow, I had two medical appointments yesterday. One was supposed to be on the phone, the other in person. Due to a rather shambolic set of very-NHS last minute rescheduling then canceling of appointments that turned into a short chat on the phone, a longer chat in a corridor with somebody who didn’t think he had an appointment with me, and a blood test.

Upshot - I’ve been given another month’s worth of Daralutamide, the androgen receptor inhibitor which I believe is aiming to starve to death any residual cancer cells that the other treatments didn’t kill off (thus statistically increasing my chances of seeing a ripe old age by about a third), and paperwork for the next two blood tests. Hopefully in the next few days I’ll find out my latest PSA result - that I am looking forward to reading. Hopefully a very small number indeed.

————

Finally time for one of my routine reminders.

- Blokes over 50 (45 if you’re black or have a family prostate cancer history) get a PSA test every 2 years or so.

- EVERYBODY, your own major health issue could hit you any time, so make sure you’re continuously fit enough to handle it when it comes.

- If your job relies upon your health and fitness, consider getting critical illness insurance cover. I am somewhat lucky that teaching flying is only my “hobby job” and not my main income, or I’d be stuffed.

They’d taken off from Cape Canaveral on 16 July 1969, exactly one year later I was born, and my parents attributed the moon landing and what it said to them about a bright future as one of the reasons to start a family. As I was the first result of that decision, I can only say I’m very grateful.

Talking of being grateful for my existence, how’s my treatment going? Well, it’s coming up on five weeks since the end of my Martian Death Ray Treatment, and there are definitely a few side effects still with me. I was warned that the fatigue would build over a couple of weeks after the MDRT finished and without doubt that has been true. I’ve continued trying to maintain my fitness, mostly with my usual habit of cross country running. And I am, but by god it’s been a struggle at times. I’m not yet back to the energy levels I was at the end of chemo, still needing to take breaks every mile or so for a short walk to get my breath back, and not always being able to run the steeper uphill portions. However, that is definitely coming to an end, and I am getting closer and closer to being able to run my standard 5¼ mile / 8½ kilometer + 180 push-ups cross country run without any walk-breaks. A few weeks ago I was taking several days to get over the aches and exhaustion from a run, and now that’s down to about a day. This week I’ve managed to run 15 miles in total, the first time I’ve managed that sort of distance since mid May.

How about the elephant in the room? Sex ! I talked in my last post, “The orgasm conspiracy” about my upset and frustration about the lack of prior information on this, and my own researches. I’m no less upset about the lack of information, but am getting a better understanding of my own position and I’d say it’s two out of three. I’m happy and relieved to say that whilst I do need more and longer foreplay to get there, I don’t have erectile dysfunction. I am also able to enjoy an orgasm: maybe longer whilst less intense than before, but it’s there and still thoroughly enjoyable. Both do need me to be content and relaxed (so not the same day as a five mile run when I’m still aching), but to a fair extent that’s true of all good sex isn’t it. Ejaculation on the other hand - no I seem to be completely dry, not a drop to be had. Perhaps this is more aesthetic than anything else: I’m now 55 (my birthday was last week, as you probably already worked out) with sadly no children and pretty obviously by this stage never likely to - but the lack of warning of that still smarts, as does its likely permanence. (I say likely, but I’m not totally convinced that the research I’ve managed to find on that point is authoritative, so I’ll hang on to a shred of optimism and see what can be done with exercise, healthy living and practice).

The other thing is my weight. I put 8kg on through chemo, and have been trying moderately hard to shift that (and being honest that I was already overweight when all this shenanigans started). Success has not been great: I’ve got rid of about 2kg of that and can fit into a flying suit again - perhaps indicating I’m turning some fat into muscle, but the rest is refusing to go, so I think that I need to try harder. I’ll say that it’s not my highest priority: I did buy myself a few new pairs of trousers in the spirit of acknowledging reality, and as I’ve said quite a few times, it’s better to be fat than dead. Hopefully as I get my mileage up, and find more willpower over portion control, I will have more success. However, it is a bit frustrating.

Anyhow, whilst I’m here, let’s talk a bit more about death rays. The use of ionizing radiation, such as X-Rays to cure things was a passion of perhaps too many medics at first. After X-rays were discovered by Wilhelm Rontgen in 1895, very quickly they were being used for all sorts of things, many of which probably caused rather than cured cancer due to lack of understanding at that time. However after WW2 machines called teletherapy units, that used cobalt-60 to emit high energy gamma rays started to be used. Those could penetrate a body much better than X-rays, and be focused on a tumour, giving a much better chance of destroying it.

This started to come together with other work, including that of a brilliant British engineer called James Watson-Watt. In 1935 he was passed intelligence reports that the Germans had developed a real death-ray capable of destroying whole towns. Investigating that for the British Air Ministry he was also tasked with creating a ray gun that could shoot down aircraft. Quickly he showed that this was physically impossible, but he did show that instead you could use radio waves to detect aircraft. That was the start of RADAR (RAdio Direction And Ranging) and by the beginning of WW2 Britain had nineteen RADAR stations, increasing to fifty by the beginning of the Battle of Britain. These huge, valve driven machines were massively important in achieving Britain’s success in WW2.

All that work on controlling, focusing and sensing radiation in the meantime though, could also be used medically. This led to the invention of the “Linac” which is a machine capable of generating, focusing and directing radiation onto a small volume - like my prostate. The first Linac machine was built and installed at Hammersmith Hospital in 1952 by Metropolitan-Vickers (with whom my father would shortly start as an apprentice in 1957, albeit he was building then designing jet fighters in Swindon, not medical machines in London.)

I’m pretty certain that my treatment used even more advanced machines called “Linac Scanners” or “MR Linac” which can both scan and zap the patient (referencing the little tattooed dots), permitting extremely accurate treatment. This directs the beams of radiation onto a small area, whilst rotating around the patient’s body to minimise the total radiation received by any other tissue, and simultaneously scans it to try and get the radiation in exactly the right place. Clearly however there are limitations: however well focused the radiation is, it still needs to pass through the rest of the body to the area being treated, the beam does inevitably fan out, and a portion will pass out again the other side. That explains the irritation I’ve had in my bladder (not severe, and it’s receding - particularly with the avoidance of caffeine and alcohol, but it’s been there - alcohol free beers and ciders are thankfully massively better than ever before, although decaffeinated teas remain a bit uninspiring) and the fact that likely my whole prostate has been effectively microwaved, not just the diseased bits (hence probably the anejaculation I keep whingeing about.)

(If you think that this diagram is rubbish by the way, and it is, you should have seen the ones I rejected. I love chatGPT and use it for all sorts of things, but I don’t think that it’s about to put any medical illustrators out of a job just yet.)

So anyhow, I’m where I am. Definitely not dead, in reality very grateful for all this technology despite the side effects and sometimes poor communication, and coping increasingly well with the demands of work as I try to come properly back up to speed.

More another day.

In the meantime, some symptoms in myself have caused me to go looking up some information about sexual function post radiotherapy. This is the point where if you’re of a tender disposition you might want to stop reading and wait for my next blog.

If you’re still with me then… if you read the websites of organisations like the NHS, Prostate Cancer UK, or Cancer Research UK, the advice on long term effects of external beam radiotherapy or EBRT they do warn you that a proportion of men can suffer from erectile dysfunction, then direct you to advice on treatments for that. They also suggest that if you’re still hoping to father children you should consider sperm banking as the radiation can effect the health of your sperm. That’s honest enough, and so far as I can tell the advice offered is sound.

However some of my own different symptoms caused me to start having a deep dive into the scientific literature on the long term effects after EBRT (MDRT to you!) which amongst others brought me to a paper: the snappily titled "Ejaculatory performance after radiotherapy for prostate cancer: a systematic review and meta-analysis”, by a team of mainly Californian medical researchers who summarised seventeen studies covering over two thousand patients. Their conclusions are stark and rather painful…

- 85% of men who have had EBRT have suffered a reduction in the amount they ejaculate

- 18% of men who have had EBRT suffer a complete end of ejaculation.

- An unquantified but large proportion of men who have had EBRT also suffer a changed or reduce sensation of orgasm during sex.

The authors conclude their paper with a very straightforward statement: “Patients receiving radiation treatment may experience significant changes in their ejaculation, such as the absence of ejaculation, reduced ejaculatory volume, and ejaculatory discomfort. It is important to counsel them about these potential side effects.”

(Here it is if you have the appetite to read the whole thing: https://pubmed.ncbi.nlm.nih.gov/39277705/ )

This is probably the most recent paper I can find on this but I found others with similar conclusions going back ten years or so, so this isn’t new knowledge.

Was I counselled on this? - not one tiny bit. Worse than that, it appears that none of the usual UK trusted sources of advice for cancer patients mention anorgasmia or anejaculation at-all.

Our friends across the Atlantic seem to be very ahead of us Brits on this, this page from the American Cancer Society is a lot more up-front about the risks, saying pretty much what I summarised above:-

https://www.cancer.org/cancer/managing-cancer/side-effects/sexual-side-effects/ejaculation-and-treatment.html

Needless to say, I only recently found that, and not before my treatment started.

So where does this leave me, or anybody like me? Frankly quite angry and upset. Without going into too much personal detail, there are issues here that we’ve only just found out about, which Mrs.G and I need to process and handle, probably for the rest of our lives. That would have been a whole lot easier as an emotional task if we were warned up front. The obvious question here is just why did this happen - why did not a single person amongst the many who have treated me, or who have authored documents and websites supporting prostate cancer patients in the UK think that this massive issue wasn’t worth mentioning?

I’m going to go out on a limb here and guess. I think that the British medical establishment just don’t think it’s good for us to know. They’re aware that a lot of men are so embarrassed or uncomfortable about the idea of any interference with their nether regions that they simply won’t have even the simple digital test, let alone beyond that. So information is withheld from us, for our own good, to make sure we don’t back down from the treatment that’ll hopefully cure us of cancer. And then afterwards, so many of us probably think it’s “just me”, and because it’s so personal, just don’t talk about it.

I find that arrogant and annoying. If you want us to do the right thing, appeal to our rationality, appeal to our masculine sense of doing what’s right irrespective of the consequences, explain the full realities - or if you’re busy, and you probably are, point us at full and truthful sources we can digest in our own time. Don’t lie to us, and don’t withhold information - because the next time a physician recommends to me what the right treatment should be for me I’m likely to be a lot less trusting, and use a lot more of their time up understanding what I’m really up against. Frankly, you should be too.

The treatment was much the same as the previous five except that they peeled off and threw away the transparent plasters protecting the very faint aiming-mark tattoos, and then at the end they handed me a letter…

Hurrah! I feel somewhat now like I did when I handed in my PhD thesis in 2004 - this treatment has dominated my life for so long (okay, only about 8 months, compared to the 8 years of my PhD, but it feels like forever), I’m now seriously wondering what to do now.

Of course, the answer to that is obvious - I need to get my life back on track. Before I talk about that though - there’s a word in this letter I keep seeing and I thought that I should look up exactly what it means. It’s “radical”; so we’ve seen terms like radical prostatectomy, radical mastectomy, and so-on. I must admit I thought that it simply meant “big and irreversible”, but it turns out not. In this specific medical context, the word derives from the Latin “radix” or root and it actually means to eliminate the root cause of the disease. So my radical radiotherapy is intended to permanently eliminate my cancer. Good, that is what we need - but I hadn’t got curious enough about the term before to properly understand it.

Of course, this isn’t the end of my treatment, but we are I hope now into the end game: even if that’s going to be a long one. I still need to keep on with the hormone treatment (this is to try and starve of testosterone any residual cells that escaped both chemo and radio), I need to get rid of a load of excess weight (depending upon your baseline at-least 6kg, but ideally 11kg), and I’d like to get my fitness back up where I like it again, both for general health and wellbeing, and just as importantly, to minimise the risk of my cancer coming back. I’m actually pretty happy about having maintained a 10 miles/week cross-country running average through this year of treatment, but would like to double that for the second half of the year if I can, and maybe get close to or pass my 14 mile average from 2024 by the end of the year. This isn’t just my ego (although it is a bit) but I really do firmly believe that this level of fitness is vital to my survival through this whole process, and for that matter has been why my journey so far - however much I’ve hated it - has been much less painful than many other people’s. This is also part of my message to the whole world from my cancer journey; even if you are hopefully totally cancer and other disease free right now, one day you might not be, and you may not get any warning of that (I definitely didn’t). So are you ensuring you have a body with enough reserves to keep you going through both the disease, and the treatment? It turned out that I did, and I’m really glad of that. Now to rebuild my reserves both for ongoing healing, and against anything else that life might throw at me without warning.

And to start to devote myself more full time to my work again. I absolutely love and believe in my work at Cranfield, and my managers and colleagues have been brilliant through all this - but it’s inevitably been neglected since my diagnosis in November, because of treatment times, because of fatigue, and sometimes because my mind was simply elsewhere. I’d like to get back to where I am, and repay their support. Let’s be realistic though, that’s going to take a month or three.

Meanwhile, there’s been a few interesting interventions in the news recently, not least from former British Prime Minister, Rishi Sunak…

So Mr Sunak, since he got booted out as PM last year by a fed-up electorate, has signed up as an ambassador for Prostate Cancer UK, and is actively campaigning on their behalf, including for a national prostate cancer screening programme. Initially through the use of PSA testing, but ultimately one hopes through better technologies, of which there are quite a few on the horizon.

I can see a few people around on social media rather cynical about this - saying that he should have done something about this when he was Chancellor or Prime Minister, or that he’s doing it because he sees financial advantage for himself in it. Personally I think that’s deeply churlish, and that the people saying such things are wrong (and for the record I did think he was a pretty mediocre PM, so I’m far from a fan of his otherwise). He’s run the country (a rather busy job!) and unlikely to get a chance to do so again, and he’s rich as Croesus, so really has nothing to gain personally from this. There may be some personal connection with the disease that we don’t know about: I suspect that there is, but ultimately, he seems to me to be doing good things for pure reasons. He wants us all to get tested and treated as early as possible if we have this bloody disease. So do I, and I sincerely hope that his intervention helps Prostate Cancer UK achieve their objectives.

(Photo gratuitously stolen from Mr Sunak’s constituency party webpage. Looks like he enjoys needles as much as I do!)

Incidentally PSA testing is criticised by some for being a poor test of whether somebody has prostate cancer itself, often providing false positives. In that they are technically correct, but I think it’s still an invalid argument because PSA readings aren’t used to trigger treatment, they are used to trigger further testing. In my case that was an MRI scan, the infamous digital test (finger up your bottom), a biopsy (which is no fun at-all but absolutely confirmed that I had cancer and how aggressive it was: the infamous “Gleason Score”), and after that a bone scan, and a PET/CT scan to help design the treatment. From what I can tell, if the PSA had given a false positive, those would have told us that and I’d not have had treatment inappropriately.

Yes, there are technologies that could do a better job, and they need developing - but without doubt the UK (and most other countries) needs a screening programme NOW, with the best medical technology available. Let’s start with PSA, then we can transition to other technologies as they’re perfected.

More soon. I want to talk about how radiotherapy works sometime, amongst quite a few other things. Ye gods I’ve already written 39,000 words of this blog, that’s about half a decent novel - thank you for continuing to read it. I hope it’s giving you value.

I have been advised about some tricks like pushing gently on my bladder, or pouring warm water over the head of my penis, but thankfully that’s not been necessary.

I had a bit of a professional triumph, which is that I was awarded something called the Jesualdo Martinez Award in Flight Testing. One of my professions is that I’m a Flight Test Engineer (the other half of the crew with the Test Pilot who run the assessment of new and modified aircraft), and this is awarded every two years by the European Chapter of the Society of Flight Test Engineers to “reward special dedication and remarkable accomplishment or inspirational work in the area of Flight Testing. ” That’s a big honour, particularly as I knew Jesualdo, who died in an A400M flight test crash near Madrid in 2015. The award that I get to keep is a copy of a painting called Empty Desk, that symbolises the flight test professional who went out on a flight, to do their job, and didn’t make it back. It’s powerful stuff, and can’t help make any of us think about our mortality in the middle of trying to function and thrive - very much where any cancer patient is.

Anyhow, enough about me, let’s have a bit of a history lesson. I got curious about how chemotherapy came about; I’ve looking into and talked about before how it works - but not where it came from. So that’s what I’ve done this week.

It seems that the idea of chemotherapy starts with World War 1, and in particular one of the nastiest ever forms of warfare - poison gas, specifically mustard gas (actually an aerosol, not a gas). Nitrogen Mustard and Sulphur mustard are deeply evil concoctions with no known cure, which can blister and destroy the skin and lungs of people exposed to it. Whilst banned by a range of treaties, these things keep cropping up again including during WW2 and the Iran-Iraq war. Doubtless there are still stockpiles of it, or lost and forgotten weapons buried in bunkers, around the world. My late father told me about, in the 1940s or 1950s, having a schoolteacher with half a lung, often wheezing or suffering coughing fits, because he’d been one of the 185,000 British and Imperial servicemen gassed in the trenches of WW1. Used in war, it’s awful stuff.

(“Gassed” painted by John Singer Sargent, owned by the Imperial War Museum)

From as early as WW1, autopsies of people killed by mustard gas showed reduced white blood cell counts, and a general slowing of cell division in the body. Medical scientists got involved, quickly abandoning sulphur mustard as too volatile, but starting to experiment with nitrogen mustard. Researchers in the USA started using this in cancer patients from 1942, and this led to the creation of the world’s first chemotherapy drug, Chlormethine (it has a bunch of other names including mechlorethamine, mustine, HN2, and mustargen). This stuff is nasty, very poisonous, and under some circumstances also explosive, but it does seem to be more poisonous to some cancer cells, including prostate cancer, than it is to the rest of the body. Early experiments did definitely show extended life in cancer patients, and it is still occasionally used today.

Building on this after WW2 other scientists, given this clue that cancer could be poisoned, started looking for other ways to do it. Some other American researchers in the 1940s realised that folic acid could make some cancers worse, especially leukemia, so they started looking for chemicals that could have the opposite effect. These drugs, called Aminopterin and Amethopterin countered the effects of folic acid within the body, and could indeed counter the effects of leukemia. Incredibly, many people thought this was a bad thing, as leukemia in children especially was regarded as incurable and nobody should be extending death or giving false hopes. Thankfully the medical researchers continued their work, and in the 1950s similar chemicals were being used to attack solid tumours - such as in breast cancer, as well as leukemia (which is in bone marrow).

By the mid 1950s then, the medical scientists had the bit between their teeth and were out looking for any chemicals that could poison cancers: and they were finding them. Then in the mid 1960s some bright sparks realised that there was an even better way to do this, and they could use combination chemotherapy - multiple chemicals, with different mechanisms, working together. This proved revolutionary not least in making many childhood leukemias curable. Somewhere this became also known as polychemotherapy.

Just think about that - in fifteen years the world went from “we shouldn’t try to cure childhood leukemia, it’s incurable and this will just extending suffering”, to “yes, we can cure childhood leukemia”. That is quite amazing.

Then the chemicals came thick and fast. Antimalarial drugs being tested from the 1950s, Taxanes, from yew trees developed between the 60s and 80s (this is what I’ve been treated with), Camptothecin - from a Chinese tree, platinum basic chemicals in the 60s and 70s. And more, that I’ve only found passing mentions of but are doubtless important in a range of niche cancer fighting applications.

At the same time nobody ever lost track of the fact that pretty much all of these chemicals are poisons, so other medical scientists were actively developing ways to keep people alive in ways that let the chemotherapy doses be applied, or even increased to best effect. This included anti-emetics (stopping vomiting), red blood cell infusions, broad spectrum antibiotics - or even removing bone marrow, treating it with what would otherwise be lethal doses of chemotherapy drugs, then putting the treated bone marrow back into the body. The ingenuity is amazing, and (speaking as a cancer patient here) deeply appreciated.

It looks like all this research continues - with ever more clever and carefully targeted chemicals, and we should all be grateful for it. This corner of medicine, a little over a century old, is mindblowingly impressive.

And it all started with a weapon of war.

Basically, it feels like I’m getting better, and my guess that the once a week radiotherapy for six weeks should hopefully give more benign side-effects seems so far about right. After next week’s treatment (on a Tuesday this time, it seems that Martians take bank holidays off as well) I’ll hopefully be back towards a relatively normal working week. Well, three days of it, but it’s a start. I do have a lot to catch up on, and the world keeps moving on, but I’m optimistic. I’d also like to get back to some personal writing projects - a textbook I’ve a contract for, and an unpublished hobby novel that I broke off halfway editing.

In the meantime it gives me a chance to talk about something that I think is rather important, even if you’d never thought about it. Literature reviews and open access publishing. Let me explain.

If you’re like me you probably don’t have to imagine this, but let’s say you or a close friend or family member has just been diagnosed with some serious disease that you didn’t really know much about. It could be prostate cancer, it could be something much more obscure. So, as it’s 2025 what are you going to do?, well very likely you’re going to look it up online, using whatever is your favourite search tool. Lots of people use Google, I often use DuckDuckGo, but loads of others exist. One thing that should find you is the websites of the main charities trying to support people with the same disease, and generally they’re going to be really helpful - but possibly not all that detailed if you really want to burrow down into the details of specific risks, treatments and so-on. One tool I use a lot is Google Scholar, which is set up for academics like me; it’s here: https://scholar.google.co.uk/ this is a really really useful tool because it’ll find you the documents which are written by and for research professionals: for example all the lecturers and professors in the world’s medical schools.

So picking a search I’ve done myself, you could search on “comparing different regimes of radiotherapy for metastatic prostate cancer”. That will bring up a whole list of papers that you want. Your results may be different because the algorithms keep changing, or you might make a slightly different search to me, but I just did that and got this…

So this is the top four papers it came up with, and there are various things this can tell you about the papers. Clearly their titles are useful clues, but you can also see the years these were published - the more recent it is, the more up to date the research should be. Another really interesting metric is down the bottom of each entry where it says “Cited by nnn”. That’s really informative because a paper that’s been cited lots of times, has been used by other medical researchers in their own publications. So down the bottom there, that “Cited by 987” tells you that the authors of nearly a thousand other papers have found that Lancet paper useful enough to include themselves as a reference. On the other hand, that paper was published in 1999: 26 years ago, so it’s likely not as up to date as we might wish. Worth reading perhaps, but there’s probably been a huge amount of new research since then.

What you can do is click the “since year” bits on the left of the screen, and that’ll help you only get the most recent papers. So if I do that, let’s say click on “since 2021” for the same search I get this:-

(And loads more papers underneath). I’m quite interested in that fourth paper. 73 citations in only 4 years is impressive, and a review of radiotherapy treatments is the sort of thing I want to know about. However I see a word that’s completely new to me “oligometastatic”. What the hell does that mean? So, Google Scholar assumes you understand the jargon in any individual paper even if you don’t; however, we have other tools at our disposal so let’s go to another favourite of mine, ChatGPT. If I ask it: “what does oligometastatic mean in the context of prostate cancer?” what does it tell me, as ChatGPT much prefers to talk in plain English. Well it gave me this:-

Ooh, now that’s really interesting as basically it describes my own cancer. So now I’ve used two tools to start to find out things of real importance to me, but this really is only the start of trying to understand what the research is really telling us. It’s a slow process, and you’ll hit a load more long words you won’t know unless you have a medical degree and possibly not even then. Use AI, or find a medical dictionary to help you through those, and make lots of notes - it’s a slow process of learning.

I’ll point out something else really helpful about that last paper - it’s what is called a “review paper” (the clue’s easily found - the world “review” in the title!). Those are gold dust when you are trying to understand something as complex as cancer treatment - they search many other research papers and try to bring all their conclusions together in one place. In this case it brought together the results of 56 different studies: so you only hopefully need to read this one, and not search out and read all 56! (I’ve written a few review papers myself in my own field, which is non-medical, hence why I understand the landscape.)

Let me stop there, as my intention here wasn’t to lead you through the hours of searching I’ve already done preparatory to satisfying myself that I was being good advice and making the right decisions about my treatment. Those were largely personal to me, and your mileage, as they say, will be different. No, my objective was to show you that you can do the same, for the aspects of your own medical concerns, or those of your friends and family. This may not be a cancer, it could be any other condition, but the basic approach to searching and interpreting information is the same. In a nutshell:-

- Use an academic search tool like Google Scholar, along with the right keywords to find the best papers about your illness.

- Use artificial intelligence (such as ChatGPT, Grok, etc.) or a medical dictionary to interpret the language you don’t understand.

- Keep burrowing down until you’ve found the answers you need.

- Keep taking detailed notes, as no normal human being can keep all this in their head.

A couple of important cautions though. Firstly not everything you want to know is actually known. For example I spent a lot of time looking for information about the side effects of the two different radiotherapy regimes I’d been offered. I simply couldn’t find any answers, so I then asked one of the oncologists looking after me - and they confirmed that nobody really knows. So I had to give it my best guess, and so far it’s turned out to be a good guess, but I’m being honest with myself that it was a guess.

A second caution, and a slightly political one. It happens that on this particular search all of those papers were available online, which was really helpful. They aren’t always - a lot of journals, including medical (and other academic) journals bury these papers behind expensive paywalls. That is really disturbing when you think about it: imagine you’re a bright enough person but poor, and your child, or your mother, has a rare disease. The physicians are too busy to spend as much time as you really need to explain it or look into the symptoms and treatments - so you go and do the sort of search I’ve been describing. Then you find that a lot of the papers are buried behind paywalls, at £25 a go just to read through and see if they’re useful or not. You just can’t afford to do that. Fortunately a lot of governments and charities have increasingly been refusing to fund research unless the resultant papers are placed online in what’s called “open access”. That is hugely impactful, but it’s still got a way to go. If you do find that you want to read those papers, there are a few tricks to getting to read them. I have a great add-on on my web browser, called Unpaywall that will often find drafts on university and laboratory archives that have been archived for just this reason, or you can talk nicely to somebody you know who works in a university with a medical school who can find a copy via their university library, or if you’re really desperate email one of the authors and ask nicely.

You might never need this, but if you’re reading this blog you obviously think you might - so I hope this might be useful to you.

In the meantime, a last thought. This week we learned that two people I’ve a lot of respect for have advanced prostate cancer. President Joe Biden, and cartoonist Scott Adams (the man who created Dilbert). It sounds very much like both found out much later than they should have done, and I’ve massive sympathy for them and their families about that. I’m sure each had their own reasons for not being tested earlier or more routinely, and I’m sure both are deeply regretting that now - but fundamentally you know what I’m going to say at this point. GET A **** PSA TEST if you are in the zone and haven’t had one in the last two years.

I’d expected 1-2 months between the end of my last cycle of chemotherapy, and the start of MDRT. Frankly I was looking forward to that break. The five months since I was formally diagnosed with cancer have been physically unpleasant at times: the fatigue and weight gain especially, but above all absolutely mentally and emotionally exhausting. I’ve no regrets about the fact that I’ve continued working, my bosses and colleagues have been amazing in their practical support and sympathy, and Mrs.G has been wonderful - but I’d reached a point of really just wanting to crawl into a hole and ignore the world for a bit, just emerging once or twice a day to go for a run, or go to a pub.

The NHS had different ideas, and after calling me in during my last week of my last chemo cycle, and tattooing my hips and stomach, scheduled me for six weeks of MDRT starting this Monday. So that was just one week between chemical warfare and nuclear warfare - isn’t that against the Geneva Convention or something? A family member who was away abroad, had generously offered Mrs.G and I use of their beautiful house in a small village in Dorset for a couple of weeks, and I really wanted to go and hang out there for a few weeks, catching up on some urgent online work and meetings, but where possible chilling, reading, enjoying the Dorset countryside. Basically, trying to get our stress levels back down to the normal “high” of a couple of busy academics. Yeah, right, as if that was going to happen.

So we’ve both got non-negotiable (and hard to fully delegate) work deadlines, we’ve accepted the kind offer of the loan of a house for a couple of weeks, and then the NHS (who whilst really very good at making sick people better, firmly do it at their convenience, not yours) schedule my first MDRT for Monday morning. Okay, let’s just roll with the blows and make this work out.

We tried our best to have a decent weekend at home, including the amazing annual village fete and classic car show (no BBMF flypast this week, they were all a bit busy with VE day events I think), a bit of gardening, and packed a week’s worth of clothes and food in the car, then tried without success to get an early night. Up early, Mrs.G drove me down to Mount Vernon, where after a bit of random getting lost in hospital corridors then asking directions from a very helpful passing nurse, I finally checked in at the radiotherapy unit. This seems to be divided into little sub-units, each with a changing room, a waiting room, and an enormous chamber where they keep the Martian Death Ray Machine…

Having checked myself in using a bar code, I found the right machine, and sat and waited in the waiting room, chatting to a lovely man who was there with his elderly mother - at the time having her own MDRT. A few minutes later a nurse came in, introduced herself, checked I was who I thought I was, confirmed I’d brought a dressing gown with me and had emptied my bladder and bowels, then ushered me into the changing room where I stripped down to my underwear then - surrounded by all this technology put my clothes into (I’m not joking) a plastic supermarket shopping basket. A few minutes later my co-op basket was stowed along one wall in the Death Ray room, with my dressing gown on top of it, and I was lying down on the bench with some green laser lines across me. Oh by the way, nobody told me but my blue crosses just turned out to be magic marker and at some point in the last few days most of it had rubbed off, leaving me with the three regulation tattoo dots after all.

The brief then was really simple - a bit of shuffling back and forth until my feet and head were in the right places, covered my nether regions with a big sheet of paper and asked me to pull my briefs down, then “we’re going to adjust your position, don’t try to help us”. So I didn’t - they shuffled and twisted me sideways a bit, very politely, then withdrew out of sight somewhere - I think the other side of the foot thick door and left me to be zapped with high energy photons (I asked!).

The next fifteen minutes were, to be honest, a bit of a non-event. With some fairly benign whirring noises the big grey machine (why grey?, all these big medical machines seem to be grey) moved up and down and around me, spun around a bit, with big flat plates pointed generally in the direction of my prostate. Then it all went quiet and the very pleasant and efficient experts came back in, and said I was done and could go. Really that was it !

So Mrs.G and I got to the car and headed West to sunny Dorset where we arrived in good time for a pleasant afternoon, and we could after a fashion, decompress.

So what are the side effects? Well, basically, so far as I can tell, absolutely none. I think that I am still suffering from the after effects of chemo, combined with the withdrawal from steroids, which is still ongoing, but those are increasingly manageable. My energy levels are okay, my fat levels are not, and after a week of struggling, I managed this morning a not-too-embarrassing four mile run. And, I’m finding it easier to reduce my eating at last so hopefully between those two my weight will start to creep down. I have suffered a bit of a skin rash on my arms and neck, which doesn’t seem to fit any known side effects of anything, which started a day or two before the MDRT, but now has largely gone. I rather suspect it’s down to a mixture of stress and fat. Mentally I’m still struggling to decompress, not helped by some very real work reporting deadlines I’m still trying to hit - but those are starting to sort themselves out, whilst I’m getting a bit better at just stopping, enjoying the view, or reading a book. Ish. I need another week and apart from the 2nd MDRT next Monday, hopefully I’ll actually get that.

So, basically, nuclear warfare against my body is about a hundred times less hard work, so far, than chemical warfare. But the psychological warfare goes on, and may be the worst of all.

More soon.

This last cycle has been a little odd as well. Whilst I’ve been incredibly upbeat about it emotionally - knowing I don’t have another week 1 to look forward to again has had me very cheerful, at the same time my body has suffered worse fatigue than any previous cycle. Today, day 21 of my sixth cycle, I finally managed a slow and clunky 5¼ mile run and I feel great about that, but it has taken so long even to get to this point, and I suspect that I’ve got some weeks to go yet until I run that distance with any sense of ease. However, the good news is that nobody’s going to stick a needle in my arm again tomorrow so hopefully I finally have that time coming up to make myself fitter.

The other thing by the way troubling me right now is my weight. I went into chemo an overweight but acceptably fit 88kg. Four months later, I’m now 96kg; I think that’s down to a number of things. Above all the steroids I’ve had before each infusion, then in lower doses daily, secondly the fact that I’ve been eating breakfast every day to buffer those steroids: something I don’t normally do; third, a lot less exercise due to the fatigue, and finally the chemo-induced protein cravings and the calories that came with servicing those. All of this I’m now trying to fix, but it’s going to take a while. I’d like to be under 84kg (“normal weight” would be rather lower than that, but let’s be realistic, 84kg might just be achievable and sustainable, albeit not quickly), and fitness is more important than weight so if I can get back to at-least last year’s 14 miles a week (presently around 9 on average this year which I’m actually pretty happy about) and in an ideal world at least 20, which I haven’t done consistently for a few years.

A bit of good news about that by the way, one of my medical team realised when I was having a telephone consultation that they’d forgotten to start easing me off these steroids, so I’ve been given verbal instructors of how to ease me off them. I’ve been doing that for the last week so I’m now down from the 10mg/day I was on, via 5mg/day to now 2.5mg/day until they run out in a couple of weeks. Another thing I don’t anticipate missing once they’re over.

However, some more news. I had anticipated a couple of months before the radiotherapy started - however from now I’ve actually just got a week. On May 12th I have my first of six weekly doses of radiotherapy, much earlier than I expected. Last week I had my pre-RT scan as a result of which I’ve now got my first ever tattoos! Not, frankly, the most impressive tattoos in the history of the art: three blue crosses, one on each hip and one just above my groin. I’m not sure how permanent they are, but presumably they’re designed to last at-least a couple of months. Mrs G thinks that with a bit of imagination they could possibly be turned into small aeroplanes - I’m holding on to that idea, it might bear exploring further. For now however, my last radio session will be on June 16th, and what particularly makes me happy is that that starts the clock on my last stage towards getting my professional flying medicals back, hopefully eight weeks after that. So that could be the end of August. Fingers crossed. In the meantime hopefully my immune system is now in recovery, and I can start to stop being too paranoid about infections.

Tattoo above, my largest (right hip) at around 4cm across, the magic scanner below, with in the edge of shot a very pleasant and competent radiographer who I was chatting to about whether she could or should do a PhD to follow up her existing Master’s Degree. I’m a big believer in research degrees and that’s a conversation I always enjoy, albeit perhaps an unusual time and place to have it.

One more scan coming up apparently - a second MRI scan on my prostate to baseline what it is like post chemo, so that if in the future my PSA goes up again (last checked it was a very happily low 0.06) then can re-scan it and have something to compare against. I don’t know when yet.

Everybody tells me that the side effects from radiotherapy (or as I prefer to call it - Martian Death Ray Treatment, or MDRT) should be significantly less than I’ve had from chemotherapy: likely just some mild fatigue and easily managed dehydration, but we’ll see. Just don’t know until I get there. I can’t deny being nervous, nor that I’d rather hoped for at least a month’s break before the next stage, to work on my fitness, my weight, and my stress levels. At the same time, the sooner the MDRT fully zaps every last unwelcome cancerous cell left in my prostate, the better.

So bring it on, and I’ll deal with everything else when it comes.