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"You're not going to die from this"

For Nick Keller, 2019 was supposed to be about the joyous celebration of new life. But the reality was far scarier. Read the sports industry entrepreneur's powerful first person piece recalling the moment he received the news everyone dreads.

Knees bent, lying on my side, a tear creeping out of my eye...

For some reason, I had always imagined a prostate examination was 'little pinkie' rather than the whole hand.

Half way through I really felt that Dr Ken was rummaging around for some lost car keys using my buttocks as the pillows in the sofa. I could sense that Dr Ken understood my shock as what, for me, had always been a one-way street was soon to be more like the M25.

The man in the white coat tried to comfort me by chirpily proclaiming that I had a “tight arse” – small solace for the diagnosis to come.

So, here I was: 48 years old; prostate cancer; new baby due in two weeks; and the prospect of Brexit, which I had taken quite personally. 2019: what a fucking start.

Next time I found myself opposite Ken, still unable quite to look him in the eye after our particularly rough first date, he opened with the line: “Here’s the good news, you’re not going to die from this.”

Surely, in all the English language, no words more accurately signal the arrival of a shit sandwich.

With my nearly nine month-pregnant wife Ainsley sitting next to me, I listened as Dr Ken explained that I had prostate cancer.

He talked through some of the alternatives – radical prostectomy; radiotherapy; and something relatively new, called HIFU.

Ken, who had been so confident on that first date, no longer seemed so cocksure: “You have to see everyone to weigh up the options and the side effects.”

Side effects? These are not your usual side effects. They are a full-on bombardment of your youth and masculinity.

So what would you do, Ken? “Don’t ask me, I’m a surgeon. I remove things”

In my head, I drew a Venn diagram of expectant dads and guys with prostate cancer. I figured the overlap was small – maybe seven out of 7.6 billion on the planet.

The next weeks were a whirlwind of research, doctors’ appointments and tough calls with close family. I became an expert, and without going crazy, I went about finding out all I could about this disease.

Here’s what I learned: every man gets it and dies with it, but not many die from it.

It didn’t take me long to realise that I was very young to be diagnosed. It also become clear that the medical fraternity push you towards a radical approach – treat the cancer not the side effects.

But what about those side effects? Incontinence and erectile dysfunction. A four-to-five-hour operation, five robotic arms, Co2 to expand your body, four to five weeks off work. The surgeons talk about pumps, Viagra and pads like they are viable options. “If you don’t want prostate cancer again, remove the prostate.”

For a man who has suffered some serious obsessive worry around decision-making, this was the sort of conundrum that could have sent me into a severely anxious and depressive mess.

It didn’t. I was surprised.

It helped that I didn’t engage in chatrooms. I lost the appetite after my first experience. Prostate Chat Room guy had left this message: “I had the RP 16 months ago and I have lost 1.5 to 2 inches off my dick". I turned to my wife and said, "That's a whole penis". I never went on chatrooms again.

I had to rationalise and my brain was telling me: go light with HIFU – they boil the cancer using ultra sound waves going through the rectum wall. It’s pretty new stuff, and was only accepted by the US FDA in 2016.

It also so happened that the guy who did my biopsy is one of the pioneers in prostate treatment. But then, of course, the cancer can come back.

Family history suggested I might have hereditary issues; my dad and uncle had both had the same diagnosis, albeit when they were 20 years older.

Round and round the whole scenario kept revolving in my head.

In the end, I made my gene tests the deal-breaker, rationalising that my kids don’t give a shit if I cannot get hard, though they do care if I’m dead.

If my gene tests were normal, I would go HIFU, if not the radical proctectomy. Radiotherapy was out as I would not be able to hold my new baby for six months.

Baby due 4th February; gene results due end February. Excellent – nothing to decide for three weeks. Best get on and have a baby.

Nick and Ainsley with Rosa

Due date…….

3.30pm – “I have some back pain but nothing serious. See you after work,” says Ainsley

4.15pm – Arrive home to find wife in labour

4.16pm - Download contractions app

5.00pm - Wife making lots of noise – I try and remain calm using my “Keep calm and measure contractions” app

6.00pm - Hospital tells us to not call again until wife is having three contractions every 10 minutes

6.30pm - Wife has urge to push and I realise I have been measuring the contraptions from end not beginning of contractions. Stop using the app.

6.45pm - Wife wondering whether there are in fact any benefits of marrying a man 13 years her senior with two kids and a funky prostate .

7.03pm - Wife goes into labour in hospital reception while waiting for lift. She is 10cm and no drugs available at this stage. Shit balls!

7.10 - We find ourselves in a small room / cupboard

7.11pm - We meet Helen, Head Maternity Nurse at UCH, and – along with my gladiator wife – the heroine of the next 3 hours, 11 minutes.

10.02pm Baby’s head is out but not moving any further. Student nurse faints. Wife sits on baby’s head. Helen is coaching student nurse while using every tool in the “get the baby out of there” tool box and my wife offers hyperventilating student nurse a snack. Like I said, she’s a gladiator – a thoughtful one.

10.15pm I sense the baby is thinking: “How will I fit in that tiny room? Someone has to leave before I come out.”

10.22 Rosa Charlotte Keller born. I have PTSD. It was a small room with no where to hide.

Paternity flies. Baby and mum are wonderful. Work goes frantic. Finance Director resigns. New business falls away and Brexit snaps at the confidence, as does the old man’s disease I have. It ekes away at my youthful mindset.

Ten genes most associated with prostate - all normal. Pet scan – normal except for the prostate.

Great relief, but still the voice in my head is saying: “Treat cancer as effectively as possible – leave no chances”. I had almost come to terms with it.

Arrange to see my GP to discuss options, convinced that he will back up every other medical person – radical intervention.

“This is easy,” he says, before I have even sat down. “Is it?,” I think.

“There is under no circumstance that you can have this surgery – you are too young, the cancer is encased and can be eradiated by HIFU. Why on earth would you risk your erection”

He was adamant. “Get your wife on Facetime.” He explains that, with 7,500 patients, he has seen a lot of prostate cancer.

He says: “In most, if not all of my patients that have had a radical proctectomy, the consequence has been a lifetime of anguish.” Straight talking and experience. I walk out with my mind resolved. HIFU it is.

After much thought, time to tell the kids. I wanted to wait till I knew my treatment and until after my son’s Bar Mitzvah – I forgot to mention the parallel challenge of organising a party for 90 and bringing my family and friends together with my ex-wife’s to celebrate my 13 year-old’s passing into religious independence.

Nick with his family's newest recruit, baby Rosa

Boys 10 and 13 ask great questions. They both process well and there is a brief discussion over whether they can call me “Nick no Dick”. I appreciate the banter and know they will be fine.

Cut to three weeks later - 26th March, 8.20am: “The cancer has been obliterated”

In the realm of cancer, I am a lucky boy. Within two months of diagnosis, I am treated. It seems unbelievable.

Professor Emberton describes it as a boring day at work.

I reckon an enema, having your prostate boiled through your rectum and a catheter seems like a pretty interesting day. I apologise to Prof for his having to see my ugly arshole. He does not laugh.

I do.

I am telling this story for myself and for those who do not know what a PSA Test is and who need to know.

If you’re a guy over 40 – get your PSA score. It only takes 5 minutes.

I and my wife experienced the best of the NHS at UCH with their extraordinary mix of maternity nurses from across the world. You were remarkable.

I also experienced the best of private health care – I recognise the privilege but cannot tell you how brilliant Vitality Cancer Unit were from the start to the end of my treatment.

Thank you to all those that have dealt with my bravado; the graphic detail and toilet humour. Family, friends and work colleagues will know it’s my way through tough situations. Roll on 2019…

Nick Keller is CEO of Benchmark.

Beyond Sport UK takes place at the Tottenham Hotspur Stadium on June 25th, 2019.

Listen to the full conversation with Nick on the latest Unofficial Partner podcast.

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