Cancer is a very frightening word. It’s a very frightening disease but I think the word is worse. It conjures up images of people with scarves on their heads, pale and thin, bulbous tumors and growths, and ultimately death.
But it probably shouldn’t.
I recently finished a book, The Emperor of All Maladies: A Biography of Cancer, which describes how cancer was initially treated, how scientists made revolutionary discoveries, expanded understanding, endured crippling setbacks all the while remaining compassionate, and understandable.
Cancer has been with us for a very long time, even before we knew what it was. In the book it describes the rise of “Cancer societies” and their transformation from being science lead to market lead organizations. In a recent PCa support meeting the presenter gave the history of brachytherapy which echoed the books reports of doctors performing drastic procedures to test potential treatments, often without patient consent or understanding.
What reminded me of all this was a recent post by my urologist Dr. Singal on twitter to an article about prostate cancer screening. The article was a response to another article about health care and whether or not prostate cancer is worth testing for.
Now obviously I am biased given my present situation, but it would seem to me the issue isn’t with testing, the issue lies with treatment. And our fear of cancer is what drives treatment. Saying we shouldn’t test for prostate cancer because it leads to over treatment which is non-cost efficient and does more harm than good is stupid. It’s jumping a step in cause and effect. It’s not the testing that makes it non-cost effective and harmful, it’s the over treatment.
So let’s look at over-treatment…
When my mother got lung cancer, she went through surgery, chemo and radiation. And after she had exhausted all options, she turned to alternative treatments including some radical ones. Treatments like 7-14-X which do not have sufficient clinical trials to validate their effectiveness. However when you have nothing to lose, and you are driven by fear of course you will over-treat. Cancer will kill you…
…sometimes.
If you have options, and you have time then you can make more sensible choices, and sometimes that choice is to just wait. Active surveillance is a viable treatment for prostate cancer, and who knows maybe I just writing this to try and convince myself but it would seem to me that if we could get past the “holy shit, did he just say I have cancer?” moment and take a deep breath then we’d be able to approach this with a clear head.
Prostate cancer research and testing is definitely headed that way. Every day more articles on active surveillance come out and more urologists seem to be accepting it as a form of treatment.
For me, I am glad I got tested. Knowledge is power. I am equally glad I was diagnosed at a time when aggressive treatment isn’t the only option. Impotence and incontinence are horrific consequences to live with at 70 years of age let alone 40 years! I feel lucky to be in this position, I am aware of my disease, in a position to monitor it, and don’t have to live with the side effects of treatment. Not to mention that every day that passes without treatment better solutions are developed. Who knows, maybe by the time I need to deal my cancer a treatment will have been developed without side effects.
The question of “to test or not to test” is missing the real issue. The real issue is what to do afterwards and sometimes the best response is to do nothing at all.