Prostate Cancer Choices
One year ago today, I had surgery for Prostate Cancer that had been diagnosed two months earlier. I remember the wave of emotions that swept over me, the confusion about treatment, choosing robotic surgery and my recovery. I recall hearing my doctor tell me the next day that the surgery was successful. Since then all of my PSA tests are perfect and I have made a thorough and complete recovery. Indeed, two months post-surgery I took a 10 day bike trip through southern Italy with my family and in September I completed my first Century (a one day 100 mile bike ride).
But almost as soon as I had surgery (in fact, the very week), reports began to question the value of routine prostate cancer screening. First, two studies indicated that routine screening save only one life out of every 50 men who were treated. More recently, the American Cancer Society developed new guidelines that may have created even more confusion. FOX saw the guidelines “casting doubt” on PSA screening, CNN thought the guidelines would “let men decide” while the LA Times understood them as a call for more “education.” Finally, yesterday the man who discovered the PSA antigen called routine PSA testing “a hugely expensive public health disaster” and suggested that profit plays a role in screening and treatment.
I understand the statistics underlying these new reports. I realize that many men have prostate cancer, never know it, and live happily. But, death rates have gone don in the last 20 years because we now catch many tumors early. The problem is that we don’t know which tumors are aggressive but that hardly seems a reason not to screen at all. And, digging through the new Cancer Society guidelines reveals that most men over 50 and many over 40 should still be screened.
Yet, even this analysis ignores the human beings involved. The question that I asked myself and that I would ask myself today is: do you want to be the guy who dies from cancer? Do you want to be one of the nearly 30K men in the United States who die every year from prostate cancer? If not, what chance are you willing to take to avoid being that guy?
The individual’s decision has to be made in the context of his life. I have been married for over 35 years to the love of my life. My four children are all young adults just starting their own lives. I love my job and I am having the time of my life doing it. I haven’t run a marathon yet and I have many more places to visit in the years ahead. I took all of that into consideration last year when I chose surgery. Today, I would come out in exactly the same place. Last year, I risked treatment’s personal side effects to preserve the things that mattered most to me. It’s no different this year.
I know that some will say this is an overreaction to a fearsome risk or it is like betting on a long shot at the racetrack. But, at some point, that 50-1 longshot surprises everyone. Last year I went with the safe bet. I’d do the same today.