Receiving a diagnosis of cancer is difficult for any man to come to terms with; when the news comes on the very day that your wife discovers she has breast cancer, it is a doubly hard blow.
Bill and Val Elliott received their respective diagnoses within an hour of each other on Thursday, 27 April. Both had undergone initial biopsies but didn't know quite what to expect. Their grown-up sons, Simon and James, had insisted on accompanying them to the clinics in Surrey that day.
'I was seen first in Frimley at around 12.10pm, and then Val went over to the breast clinic in Guildford where she was given the news 55 minutes later. We met up at an Italian restaurant and consumed several bottles of red wine,' recalled Bill. 'It was pretty hard for the boys and for us, well, it was simply mind-numbing.'
Walking along a deserted beach in Norfolk last week, the couple spoke of the remarkable twist their lives had taken. They came for a short holiday to stay at a friend's cottage before Val begins her radiotherapy treatment, when in fact they were due to be spending this summer taking it easy as Val retired last month after years of demanding work as a child protection expert.
But when it comes to adjusting to their diagnoses, the hardest part of all has been hitting a biggest brick wall within the National Health Service - the stark fact that different cancers are given very different funding priorities.
The truth is that some cancers are more equal than others, and campaigners know that a more vociferous and passionate group is likely to have more success at persuading governments, and the NHS, to fund their treatment than one that is less vocal.
Breast cancer currently enjoys 10 times more funding than prostate cancer. It has benefited from very glamorous campaigns, such as Ralph Lauren's initiative, Fashion Targets Breast Cancer, supported by models such as Kate Moss, Naomi Campbell and Giselle. Pictures of men in underpants highlighting prostate cancer do not have quite the same appeal as sexy women in white T-shirts.
Val, who turned 60 last month, was diagnosed after noticing a small dimple to the side of her left breast. She has already undergone a lumpectomy to remove the small tumour inside, and she has had to have some lymph glands removed to protect her from the risk of it spreading.
Her oncologist has put her on Arimidex, an expensive but highly successful drug given after surgery, which will give her the best possible chances of survival as it lowers the amount of the oestrogen hormone in the body. This week she will begin a course of radiotherapy to kill any surviving malignant cells.
For her husband, the story is different. Still working as The Observer's golfing correspondent, he has been turned down on cost grounds for the treatment which his consultant, Professor Stephen Langley, recommended for him - a relatively modern procedure known as brachytherapy. This involves planting around 100 radioactive seeds, about the size of rice grains, within the prostate gland in order to kill off the cancer through radiation.
The alternative is to have a radical prostatectomy, the surgical removal of the prostate which has a higher risk of two major side effects - impotence and incontinence.
'I had been having [prostate] tests for the last three years, just to make sure there was no risk,' Bill said. 'I'd been having the usual warning signs, such as getting up a lot in the night to have a pee. Although my PSA [prostate-specific antigen] count was relatively low, I had a biopsy which showed that there were malignant cells, and Professor Langley said he felt brachytherapy would be right for me.
'I had assumed everything would be fine, until the professor received a letter from the Primary Care Trust, saying they had turned down the request for the procedure. Given that Guildford is the major centre of excellence for cancer, and that Langley himself is an expert in brachytherapy it was surprising, to say the least.'
What angers Bill so much is that the PCT has refused to explain its decision for the rationing. 'They didn't even have the courtesy to write to me about why I couldn't have brachytherapy. They told me later that they never deal directly with patients. Why not? Is that because they want to remain unaccountable?'
The Prostate Cancer Charity is worried that covert rationing of treatment is starting to spread. Although it was originally Wales alone which refused to give brachytherapy, it is now hearing of cases in Nottingham and Bath. The charity's chief executive, John Neate, said: 'It is a disgrace and completely unacceptable that any man with prostate cancer for whom brachytherapy treatment is recommended, should be denied access to it.
'It is not an untested, experimental treatment - it's now recognised by a large body of research and can help men whose cancer has not spread. What it means is that patients can have a few short visits to the hospital, and post-treatment recovery time is minimised to a few days.
'And frankly, no one should have to battle with the bureaucracy and financial aspects of their treatment when they need all their energy to come to terms with their diagnosis.'
After many calls to the PCT, the answers that Bill has received are even more surprising. He asked one official what the clinical reasons were for turning him down for treatment and was told that they were not clinical, that the trust simply had a policy of not funding the treatment.
Given that brachytherapy costs just £2,000 more than the radical prostatectomy, and carries fewer side effects, he found this irrational. His home in Rowledge, near Farnham, is just 10 miles from the Guildford cancer centre. None of the doctors to whom the Elliotts have spoken, including their own GP, was aware of this decision having been taken.
Last week, when the PCT became aware that The Observer was looking into Bill's experience, the trust told Bill that it would start to look at the treatment on a 'case-by-case basis'. Bill had a conversation with Nicola Chandler, the PCT's associate director of recovery and reform, who told him that part of the problem was that doctors kept 'raising patients' expectations' by suggesting treatments that were not necessarily available.
Bill's case will come up for consideration before a specially-convened panel within the next fortnight. There is no cancer specialist among this group. Instead, a GP and public health doctor provide the clinical input.
Bill asked Chandler if he could attend the meeting so that he could explain the situation from the patient's perspective, but was told that this would be impossible as it would be a 'virtual meeting'. He still doesn't know what that means.
As for Val, she has to stand by and watch her husband live with all the uncertainty and fear that his dilemma brings with it.
'I'm so angry about it,' she said. 'I've worked for a PCT for the past seven years, and we've always been huge supporters of the NHS. I'll defend it to the death, because it is a system that works, and I've always felt that it doesn't discriminate between the haves and the have-nots, but suddenly you find yourself dealing with a lottery. You also find yourself trying to get some sense out of administrators who are unaccountable and who will make decisions that will change our lives.'
Bill knows that if he paid £11,000 and went private he could have the brachytherapy tomorrow. 'It's a two-tier service we have now,' he remarked. 'In an area like Guildford, there are probably quite a few middle-class guys who would have savings and simply pay up.
'But what about all the other men I sit next to when I go to the clinic? Are they even told that their treatment has been denied to them? It seems to me that men don't kick up a fuss about healthcare because they are scared of talking about illness. But it shouldn't be up to us to kick up a fuss, should it? This is a treatment which the government's own experts have said should be available. Why, then, am I having to fight tooth and nail for it?'
Brachytherapy is a treatment first developed 20 years ago, but which has been slow to come to the NHS. Radioactive seeds of iodine-125 are inserted within the prostate gland, where they slowly release their radiation over a period of three months.
By delivering localised radiation, doctors avoid damaging nearby organs such as the rectum or the bladder, and thus reduce the potential side effects such as incontinence which can come with surgery.
The treatment is most suitable for men whose tumours are not large, and where the cancer is thought unlikely to have spread. For those whose disease may have spread, the alternatives after surgery may be external beam radiotherapy and a higher dose of brachytherapy.
The National Institute for Health and Clinical Excellence gave brachytherapy its approval in 2005. The funding for it, however, is up to individual PCTs which commission care from hospitals. Many of them are facing large deficits, and are under pressure to curb hospital spending as they have other cost pressures.
The Guildford and Waverley PCT denied to The Observer that it had a blanket ban on funding brachytherapy, and said that it had always looked at it on a case-by-case basis.
'Certainly we will investigate why this gentleman's treatment was turned down,' said a spokeswoman. She declined, however, to talk about his case in detail, saying that this would constitute a breach of patient confidentiality.
As Bill and Val walk out over the sands near Cromer, their closeness is obvious. They retain a strong sense of humour, managing to laugh about the unique nature of their situation.
'We will come through this together, although the timing of it all is a bit bizarre,' said Bill. 'Our lives have been changed forever.'
Two cancers compared
Prostate cancer
Nearly 32,000 men are diagnosed with prostate cancer in the UK each year. It kills around 10,000 sufferers a year.
Part of men's reproductive system, the prostate is a walnut-sized gland at the base of the bladder.
Treatment options include radical prostatectomy, the surgical removal of the prostate through the abdomen; cryotherapy, a method of killing cancer cells by freezing them; hormone therapy, a way of shrinking the tumour by reducing the amount of testosterone in the body; and radiotherapy, including brachytherapy.
On the web: the Prostate Cancer Charity www.prostate-cancer.org.uk the Prostate Cancer Support Association www.prostatecancersupport.co.uk set up by a group of men suffering from the disease in 1995.
Celebrity backers: Ricky Gervais, Ray Winstone, Benjamin Zephaniah and Desmond Tutu.
Breast cancer
Almost 42,000 women a year are diagnosed with breast cancer in the UK. It is the country's commonest cancer. Around 15,000 women a year die from it.
The younger a woman is when she has her first child, the lower her risk of the disease developing.
Treatment options include removing a whole breast (mastectomy) or just the tumour (lumpectomy). Diagnosed early, it is potentially curable. Radiotherapy is given to patients who have had conservative surgery, or are at high risk of a local recurrence. Some receive chemotherapy before surgery to shrink the tumour, allowing less radical operations.
On the web: Breast Cancer Care UK www.breastcancercare.org.uk and Breakthrough Breast Cancer www.breakthrough.org.uk
Celebrity backers: Nicole Kidman, Jerry Hall, Yasmin le Bon, Claudia Schiffer and Kate Moss.
Hear Bill and Al tell their story and join the debate here.
