Mikael: Now I’m going to make the most of every moment
Maybe it was a common symptom of becoming an old man. This is what Mikael Lagström from Åland thought a couple of years ago when he began to have difficulty urinating.
Many of Mikael’s male peers had similar problems and prostatic hyperplasia. He thought he, too, was suffering from prostate enlargement and that he needed a resection operation. However, the problems were minor and did not cause any difficulties in everyday life. He felt energetic and fit.
Mikael, who had worked as a dentist for more than 40 years, had officially retired from his own dental clinic, where he worked together with his wife and partners. His long days at the office changed to a couple of on-call shifts a week.
The youngest of Mikael’s five children, a 28-year-old son and his wife, had graduated as dentists and started work in the family business, which also brought great joy. Now Mikael had more time for his beloved hobbies: sailing, gardening with his wife, and skiing up north. Life seemed to be in balance.
When his urination still seemed difficult in the spring of 2020, Mikael wondered whether he should see an occupational health doctor to get his prostate-specific antigen (PSA) value measured with a blood test. But then the COVID-19 pandemic hit and Finland was closed. It was a year before Mikael was able to schedule a blood test.
One restless night
The PSA was high, just as Mikael had suspected. It was spring 2021, and Mikael and his brother-in-law went skiing in Kajaani for a week.
“I skied 35 kilometres a day and I felt very good. I was troubled by the test result though,” he recalls.
Mikael had another PSA analysis performed after a couple of weeks, just to be on the safe side. The value had risen again. As a dentist, Mikael had a feeling that he might have prostate cancer.
“I stayed up one night, wondering which service provider I should choose: a municipal hospital or the private cancer centre Docrates?
Mikael had read articles about Docrates and had heard praise for the cancer centre’s activities and advanced treatments. On the other hand, he needed to look after his finances: where would he get the money for his treatment? Perhaps by selling his sailing boat?
Mikael’s good childhood friend was a Docrates customer due to prostate cancer at the time. He said the treatment was excellent. Access to treatment and its progress were also significantly faster than in the overloaded public sector.
“A friend who started his treatment path in another hospital said he would have come straight to Docrates if he could turn the clock back. This convinced me.”
Mikael asked his loved ones what they would think if he sold the sailing boat and spent the money and savings on cancer treatments. His family thought it was a good idea.
“In the end, it was not a difficult question: what would I do with the sailing boat or my money if I were dead?”
The shock came at night
At the end of April, Mikael emailed Docrates about access to treatment. Half an hour later, he received a detailed and thorough answer from the cancer centre. He was recommended an immediate examination and diagnosis.
“I first contacted Docrates on Thursday and, already on Monday morning, I was in Ruoholahti for diagnosis. My situation was reacted to very quickly, which made me confident in a difficult situation,” Mikael says, praising the staff.
The studies revealed that Mikael was suffering from aggressive prostate cancer that had spread to his bones. It was assessed to be a cancer with a high risk of progressing. Timo Joensuu, the founder of the cancer centre, who is a specialist in cancer and radiotherapy, told Mikael about the diagnosis when he was at home in Åland a few days later.
“I was optimistic that it couldn’t be that bad, because I was in such good physical condition. Of course, the fact that the cancer was aggressive stopped me.”
In the evening, Mikael went to bed with a peaceful mind, but he woke up afraid in the night.
“That’s when I had a shock. It’s the only time I’ve truly broken down since I got sick.” Fortunately, his anxiety was over by morning.
He felt relieved and consoled by the doctor’s precise and individual treatment plan, which they immediately reviewed together.
Final cleaning in progress
Mikael’s treatment started with hormonal therapy in early May, and only a couple of weeks later, he was switched to radionuclide therapy involving lutetium. This is an experimental but promising treatment method that was introduced at Docrates in 2016*.
“My treatments were already very advanced at Docrates when the appointment I had for the first consultation in the public sector was just coming up. I cancelled my appointment in the public sector with my mind at ease.”
According to the original plan, Mikael would receive lutetium treatment once a month, three to six times. In Mikael’s case, just one treatment was enough to achieve the goal of reducing his PSA from 60 to less than 1. Mikael was then given both external and interstitial radiotherapy, or HDR brachytherapy.
Mikael’s prostate cancer had spread extensively to his bones, but the metastases were relatively small.
“After the treatment, my bones were scanned again, and it was found that half of all the metastases had disappeared completely and the rest had clearly shrunk.”
Chemotherapy was not used at all, as it was not needed.
Now is the time for final cleaning. That is how Mikael describes the final stage, where he is given radium-223 radionuclide therapy targeted at his bones every four weeks.
“It is an easy mode of treatment for the patient in the sense that it involves very few side effects. My situation is now very good. It is possible that I will recover from cancer altogether.”
Mikael’s condition will continue to be monitored and controlled regularly every 3 months.
Svenska-klubben met in the waiting room
Travelling between Åland and Helsinki for treatment has not been difficult for Mikael.
“The journeys have not been very demanding for me since I’ve been so motivated. Besides, being at sea is always a pleasure for an old sailor.”
Mikael pops into Helsinki for just a few hours before returning to Åland on the same day. During the longer treatment periods in the summer, he stayed in Espoo as a housekeeper for a family of friends while they were away.
Slightly unexpectedly, he also discovered the social side of the treatment visits after getting to know other prostate cancer patients in the waiting room, who often had their appointments at the same time.
A group of five men began to call themselves Svenska-klubben, because three of them came from Sweden and, in addition to Mikael, there was another Finnish-Swedish man from Åland.
“There was plenty of discussion in the waiting room every time. As time went by, everyone started to arrive earlier than necessary, and after the treatments, we stayed even longer to talk.”
Peer support was very important. Mikael felt relieved to be able to discuss the matter with people with the same illness.
“I became a close friend with one of them, and we still keep in touch.”
Safe at all times
Reliable, empathetic, meticulous. The professionalism of the Docrates staff is warmly appreciated by Mikael.
“All this time, I’ve felt safe and well cared for. Everything has gone very well, without any hiccups.”
He particularly appreciates the individuality of treatment: that the treatment methods are very precisely tailored for the disease and its characteristics.
“In my opinion, academic medicine is often too patterned, and those who suffer from a certain disease are easily lumped together with the same treatment plan. Equality and similarity have been mixed up in a way. I’m pleased that Docrates is spearheading the development of personalised and effective treatment.”
Mikael has never regretted his decision to go to Docrates for treatment. He’s not even bothered about losing his sailing boat.
“I have a lot of friends who love sailing and I’m always welcome on their boats,” he says gratefully.
Anyone can get cancer
It is hard to believe that Mikael, who is cheerfully chatting away and laughing, still seemed uncertain about his future last spring.
“I’ve always eaten healthy and avoided unnecessary carbohydrates. During radiotherapy, I lost some weight, but everything has come back since. My appetite is very good. The spare tyres disappeared for a moment, but eventually came back,” he says, laughing and patting his belly.
Mikael takes care of his condition by being physically active. Throughout his illness, he has practised Nordic walking, running shorter distances at a slow pace at first, before having brisk walks of more than an hour long.
Mikael says that anyone can get cancer, regardless of their healthy lifestyle. In the case of Mikael, the cancer was probably caused by the hereditary BRCA gene, as his mother died of ovarian cancer. The same gene causes prostate cancer in men.
“As a dentist, I should have been more vigilant, but I thought I was in such good shape that it wouldn’t concern me. Now my children are also regularly screened.”
The support of his family and partners has been extremely important for Mikael during his illness.
“It’s a blessing that I have been able to pass on my life’s work to people who are as passionate about the profession as I am.”
For Mikael’s wife, her husband becoming seriously ill was a hard place, but thanks to successful treatments, she too is confident about the future.
“We’ve been getting closer since I got sick, and we talk more than before.”
Cherishing every minute
After the serious diagnosis, Mikael began to reflect on the meaning and content of life.
“I value every minute in a completely different way than I used to. I was on my way to this mindset before, but a little too slowly. Now I’m going to make the most of every moment.”
His loved ones have become more important than ever.
“Previously, it was easy for me to ask too much of myself and others, but today I’m more tolerant of everything. I’m not angry or upset about basically anything anymore.”
Right now, Mikael enjoys his life with his family, good friends, and hobbies. He enjoys choral music, and he is the chairman of the Mariehamns kvartetten choir, while also a member of the Freemasons.
Mikael is often asked whether his hobbies have made it easier for him to get his mind off the cancer and its treatment during his illness. He shakes his head.
“I’ve had no need to distract myself. My thoughts have always been constructive and positive, and I didn’t need a way to escape reality. I’ve had strong confidence in my doctors and the treatments I’ve received.”
Of course, the importance and communality of social relations have become more apparent as some restrictions placed due to the COVID-19 have been lifted.
“And since the average age in the choir is quite high, I’m not the only one with my ailments and experiences. We can talk about personal matters in a very liberated way,” he says with a glint in his eye.
Recovery may be possible
Mikael has a very clear message for everyone thinking about coming to Docrates for treatment:
“Do it now. I’ve wanted to be very open about my own illness, as I hope to help others by sharing my story. I also think that investing my money here will contribute to the development of cancer treatment.”
Right now, Mikael is planning a new ski trip to Lapland. He thinks he can ski distances as long as he did a year ago: 20 kilometres should be easy.
He never ceases to feel awed about the effectiveness of the help and care he received.
“At first, I was looking for more years in my life. It now appears that even full recovery may be possible. I can’t believe how great it feels.”
Even if the disease does recur, Mikael says that the methods and treatments are evolving every year.
“I believe and trust that everything will be all right. My basic principle is that I intend to stay alive for a long time,” he says, smiling.
*Lutetium-PSMA is an experimental mode of pharmacotherapy under special permission for compassionate use from Fimea. International randomised controlled trials of lutetium-PSMA treatment are in their third phase, after which official and more detailed Current Care Guidelines can probably be issued for the cancer cases selected for treatment. However, some results were already presented at October’s ESMO2018 conference, according to which the dose escalation study had shown that even a dose three times larger than the one that proved effective at Docrates was found safe and well tolerated without the appearance of the toxicity that restricts the dosage. The VISION study results** were presented in ESMO2021 conference: the results showed that treatment with 177-lutetium-PSMA significantly improved overall survival (OS) in patients with PSMA-positive metastatic castration-resistant prostate cancer.
**Publiced in NEJM September 2021