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Dear Readers: Yes, pen pal programs still exist in a digital world

CONCORD, N.H. (AP) — In 1985, a 13-year-old girl in New Zealand spotted a pair of purple, lip-shaped sunglasses in “Young Miss” magazine. In March, I traveled 9,000 miles from New Hampshire to deliver them to her, finally fulfilling my pen pal’s decades-old request.

International Youth Service, the agency that matched us up 40 years ago, has long since folded, but other pen pal programs have survived — or even began during — the internet age. And even though New Zealand’s postal system has reduced home delivery days, Denmark has stopped delivering letters altogether and Canada is moving in that direction, some see signs of a letter-writing resurgence.

“The hunger is there,” said Rachel Syme, a writer for The New Yorker magazine who created a pen pal program during the COVID-19 pandemic and later published a book encouraging others to take up handwritten correspondence.

More than 15,000 people signed up for Syme’s Penpalooza project in 2020, and she still gets hundreds of takers when she coordinates a new round of matchmaking every few months. She also gets requests for pen pals at book signings for “Syme’s Letter Writer – A Guide to Modern Correspondence,” and the stationery stores she frequents in New York City are always crowded with customers.

“People are very interested in physical, analog things right now,” she said. “I think it really has an appeal especially to a younger generation who grew up with a phone glued to their hand, to do something that’s more tactile, slower, more intentional, more mindful, but also just disconnected from the internet in every way.”

“Yours (hopefully)”

I was still 10 years away from connecting to the internet when I opened my first aerogramme from New Zealand, a sheet of pale blue paper that served as both writing surface and envelope adorned with a 45-cent stamp. That missive ended with a formal “Yours (hopefully) Molly Nunns,” but within a year, she was signing off with “Lots and lots of love” or “Your friend forever.”

In letter after letter, Molly drew little hearts on the tails of y’s in both of our first names, asked for updates on my middle school crushes and shared stories about her classmates and family. I could clearly picture her life, though it was hard in snowy New Hampshire to imagine celebrating Christmas during the summer.

“I am thinking of you heaps and I wonder what you are doing because you’re a SUPER pen friend and I hope that we never stop writing to each other and that one day we will get to meet each other,” she wrote in early 1986.

Julie Delbridge, 65, fostered similar friendships after joining International Pen Friends as a teenager in 1979. Writing to pen pals in more than a dozen countries from her home in Australia was such a positive experience that she began working for the organization as an adult and took over as its president in 2001. While she loved sharing photos, postcards and treats with her pen friends, it also was a therapeutic experience at a time when her parents were going through a bitter divorce.

“It was a pastime that I totally immersed myself into in a positive way and gained a lot of enjoyment from,” she said. “There was an abundance of non-judgmental friendship, fun and different perspectives.”

Over its 59-year history, IPF has provided pen pals to more than 2 million people ages 8 to 80+, she said. Membership peaked in the late 1990s but surged again during the pandemic, and this year, there’s been an increase in people ages 21-26 joining.

Pen pals in the classroom

In 2021, the U.S. Postal Service sent cards and envelopes to 25,000 elementary school classrooms for a pen pal project, but older students also are putting pen to paper.

In Texas, a group of medical students created an anonymous pen pal program to promote peer support and personal reflection. At Villanova University, professor Kamran Javadizadeh requires students to send letters to each other as part of a literature class called “Letters, Texts, Twitter” that examines different forms of epistolary communication in literature.

“I make them put pieces of paper in envelopes and take them to the post office and send them to each other even though they could just as easily hand it to the person in class,” he said. “Something is lost when you have instantaneous communication. So I’m interested in the relationship between synchronous kinds of intimacy and asynchronous forms of intimacy.”

Gordon Alley-Young, dean of communications at New York’s Kingsborough Community College, believes letters are like vinyl records — they’re coming back into fashion as young people explore a tangible medium from the past. He has both studied the history of letter writing and used it to teach students empathy.

In an interpersonal communication class, he noticed that students analyzing case studies about relationship problems offered matter-of-fact, almost insensitive diagnoses. But when he re-wrote the case studies in the form of letters from friends and had students respond in kind, they began sharing their own feelings and offering more open-ended advice.

“We really want students to connect to what they’re looking at,” he said. “And letter writing encourages that.”

Pen pals in the digital age

An app called Slowly seeks to combine modern technology with the old-fashioned anticipation inherent to the pen pal relationship. Users send messages digitally, but delivery is delayed from an hour to several days to mimic snail mail.

“This delay naturally encourages longer, more thoughtful messages because you wouldn’t just say ‘hi’ if you know you have to wait days for a reply,” said cofounder JoJo Chan.

Since 2017, the app has gained 10 million users in more than 160 countries, most in their 20s and 30s. One user said he was curious about pen pals after hearing about them from his grandparents, Chan said.

“Slowly offers a convenient way and a modern way for them to try that experience,” she said.

Syme, however, is all about the tangible aspects of letter writing. Her book includes advice on paper and pens plus all kinds of goodies that can be tucked into envelopes.

“There is joy to be had once you fully embrace the medium’s outdated extravagance,” she writes.

But letter writing, she said in an interview, is like a swimming pool, both shiny and deep. The frippery and embellishments don’t matter in comparison to what you actually put on the page.

“That’s where I think it can get very real, very quickly,” she said.

A special connection

Molly and I had been writing for 15 years by the time we met in person, spending a day together in New York when she toured the U.S. in May 2000. We crossed paths in London a few years later, and in 2018, she and her family visited New Hampshire.

“Who would have thought when we started writing in 1985 that one day you’d be sitting here? It’s quite amazing,” she said during my recent visit. “We’ll always have a special connection, I’m sure.”

In addition to the sunglasses, I also gave Molly a bound book of 200 pages of her letters that I scanned and printed. At age 13, I never could have imagined that someday I’d have searchable PDFs of our teenage scribblings that could be summarized in 10 seconds by artificial intelligence. But what amazes me more is the depth of the connection I felt during our tearful airport goodbye.

We will for sure meet again. Until then, lots and lots of love, Holly.

When you have advanced prostate cancer: What living with the disease looks like

(CNN) — “How long do I have to live ?”When I tell a patient he has prostate cancer, this is usually what he asks me first.With early-stage or low-grade prostate cancer, I can offer strong reassurance: Your life expectancy is good — expect a five-year relative survival rate of greater than 99% with treatment. Simply put, most men will not die from low-grade prostate cancer.However, once the cancer has spread outside the prostate to the bones and other organs the answer becomes more difficult. Treatment has changed dramatically over the past decade for advanced prostate cancer. New drugs, better imaging and the earlier use of combined therapies are helping men live longer.In a video released July 15, former President Joe Biden gave an update on his prostate cancer, saying he was receiving treatments that have been going well. In May 2025, Biden officially announced that he had an aggressive form of prostate cancer that had spread to his bones. Since then, based on official updates, he has continued hormone therapy, completed a course of radiation and maintained a public presence.His diagnosis brought renewed attention to prostate cancer screening and treatment. Now, more than a year later, his cancer journey offers an opportunity to examine what has changed in the treatment of advanced prostate cancer — and the hope these offer men living with the disease.I recently saw a patient who was diagnosed three years ago with cancer that had already spread to multiple areas in his bones. Since then, he has taken cruises, traveled with his family and spent weekends babysitting his grandchildren.He gets tired and cannot garden the way he once did. But he is still alive and considers every day a blessing. His experience, and what we see with Biden, shows what living with metastatic prostate cancer can look like today.Understanding survival ratesIf they haven’t asked their doctor already, many patients go online and find five-year survival rates, but every number they may find online comes with a huge asterisk.The American Cancer Society reports five-year relative survival of greater than 99% when prostate cancer is found in or near the prostate. The figure drops to 38% when it has reached distant parts of the body.But that number is based on large groups of men treated years ago. It does not fully reflect the impact of newer treatments — or account for an individual man’s age, overall health and response to therapy.Survival statistics describe groups of patients but do not predict what will happen to one person. That is why the 38% figure cannot tell us how long Biden — or any individual patient — will live. These patients’ outlook depends on details of their cancer and how they are responding to treatments.It’s treated more aggressively nowA man diagnosed with metastatic prostate cancer a decade ago and a man diagnosed today would not receive the same treatment. The thinking now is to use our best treatments early instead of holding back.For years, doctors began with hormone therapy — usually injections that lower testosterone — and saved other treatments until the cancer stopped responding.Today, those injections are often combined from the start with a newer hormone-blocking drug and/or chemotherapy. These combinations have helped men live longer and are one of the biggest shifts of the past decade.What Biden’s diagnosis told usThere are three details about Biden’s cancer that help doctors like me understand how aggressive it is and how to manage it effectively. Official statements highlighted that his cancer had a Gleason score of 9. The cancer had spread to his bones, and it was labeled as hormone-sensitive.The Gleason score is assigned after a pathologist examines biopsy samples. Scores typically range from 6 to 10, with higher numbers indicating more aggressive cancer. A score of 9 falls into the most aggressive category. However, the score alone cannot tell us whether the cancer has spread outside the prostate.When prostate cancer spreads, the most common destination is the bones — particularly the spine, pelvis and ribs. It can also reach organs such as the lungs or liver. Once it has reached distant parts of the body, it is generally not curable, but treatment can put a brake on it for years.Prostate cancer can also be hormone-sensitive or hormone-resistant. Because it typically relies on testosterone to grow, lowering the hormone or blocking its effects can help control the cancer. Hormone-sensitive means it still responds to these treatments.Over time, most advanced or metastatic prostate cancers find ways to grow despite low testosterone levels, which mean they are now hormone-resistant. Lowering testosterone alone is no longer enough to control the cancer, so doctors have to turn to additional therapies.Knowing if the cancer has spreadThe most sensitive imaging test available today is a PSMA PET scan. It uses a radioactive tracer that seeks out a protein found on the surface of prostate cancer cells. Areas containing cancer may appear as bright spots, helping identify where the cancer has spread. The American Urological Association supports using this imaging test to determine whether high-risk prostate cancer has spread and to help establish its stage.A traditional bone scan, used for decades, highlights areas where bone is reacting to injury or disease. It remains an alternative imaging option, but PSMA PET is increasingly replacing its use.What areas light up and where matter when deciding on treatments. A single spot in the spine and cancer that has spread to the liver are both called stage 4, but they are not the same disease and may not be treated the same way.Doctors also consider how much cancer has spread. We label it as “low-volume” disease when the cancer has reached a limited number of areas. High volume is when the spread is more widespread or has reached other organs such as the liver or lungs.Both require treatment that works throughout the body. Treatment for metastatic disease generally includes therapy that works throughout the body. For men with low-volume disease, adding radiation to the prostate may also help them live longer.Biden has completed a course of radiation, but his team has not disclosed what area was treated or enough detail to determine whether his cancer would be considered low- or high-volume.Treatment has become more preciseBeyond starting more treatments earlier, doctors can increasingly tailor therapy to the biology of an individual man’s cancer. We can now test both the tumor and a patient’s own DNA for mutations that help guide treatment.Roughly 1 in 10 men with metastatic prostate cancer carries an inherited mutation affecting the body’s ability to repair DNA. The best known are BRCA1 and BRCA2, the same genes linked to some breast and ovarian cancers.Certain mutations found in the tumor or inherited DNA may make targeted drugs called PARP inhibitors an option. If a mutation is inherited, it also gives family members information they can act on through genetic counseling, testing and earlier screening.Another advance is radioligand therapy. If a scan shows that cancer cells carry a protein called PSMA, doctors can attach radiation to a molecule that seeks out that protein. Delivered through an IV, it targets cancer cells throughout the body. This approach was expanded last year to more men whose cancer had become hormone resistant.Living longer can come with costsEvery treatment can cause side effects. With hormone therapy, one of the first is often hot flashes, similar to what women experience during menopause. These are not dangerous, but they can affect a man’s quality of life.Fatigue is also common. Testosterone helps maintain muscle, so lowering it can reduce strength and energy. Regular walking and resistance training can help preserve muscle and reduce fatigue.The side effect almost no one talks about is loss of sex drive or low libido. At diagnosis, most men are thinking about staying alive, not their libido. But months later, it often matters. It is worth discussing with your care team and your partner rather than assuming it is simply the price of treatment.The side effect I worry about most is weaker bones. Low testosterone reduces bone density, while cancer deposits can weaken the bone’s structure. Follow-up care should include exercise, a bone-density scan, and ensuring adequate levels of calcium and vitamin D. For men with hormone-resistant cancer that has spread to bone, bone-protecting drugs can reduce the risk of fractures and other complications.New or worsening back pain, especially with leg weakness, numbness or trouble controlling the bladder or bowels? These could mean the cancer is pressing on the spinal cord. It is a true medical emergency that requires immediate attention.Cancer care requires a team approachIdeally, several doctors work together to coordinate a patient’s care. The urologist is often the starting point. A medical oncologist manages treatments that work throughout the body, while a radiation oncologist targets specific areas, whether that is the prostate itself or a painful bone lesion. The primary care doctor helps protect the patient’s heart and bones and looks after the person’s overall health.A man’s age, other medical conditions, ability to tolerate side effects and goals for treatment all shape treatment plans. Two men with nearly identical test results may be offered — or choose — different paths based on their health and priorities.Good communication among doctors is essential, but gaps can happen. Being your own advocate means knowing who is on your care team, asking questions and understanding your options.I also recommend bringing someone you trust to important visits for support and to take notes and help you remember what was discussed.More treatments, better testing offer hopeFor men worried about prostate cancer, talk with your health care provider about the benefits and risks of PSA testing. Black men and those with a strong family history should begin that conversation in their 40s. New urinary symptoms are often not cancer, but they still deserve attention, as does blood in the urine or semen, unexplained weight loss and/or persistent back or bone pain.For men living with advanced prostate cancer, there is reason for hope. There are more treatments and better testing than there were a decade ago, and good care pays attention to how a man feels, not just to what his scans show.The-CNN-Wire™ & © 2026 Cable News Network, Inc., a Warner Bros. Discovery Company. All rights reserved.
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