A Urologist’s tale

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The response to my recent blog entitled the PSA Clock has been highly gratifying. There seem to be many new subscribers to this blog and I welcome you and your comments. I have just attended a prostate cancer meeting (IPCU 2017) where a lot of great science was presented. I will share some of that in a future blog, and plan to do the same after the ASCO GU conference next month. However, I wanted to make you aware of a remarkable article (please click on that link and read it NOW) by one of the real leaders in prostate cancer research, Paul Schellhammer. Paul and I even shared authorship of an article…it’s a small world! Interestingly, in his article he used the same metaphor I used in that previous blog. He says, “I was entering the universe of the ticking PSA clock. The second PSA failure confirmed that I was in the story for the long haul.”

I don’t think I have ever read a more up-to-date, thoughtful, yet personal and empathetic scientific article about prostate cancer, or maybe even cancer in general. A possible exception is “When Breath Becomes Air” which I previously reviewed and still highly recommend. In Paul’s article, he describes in detail, with the latest advances carefully referenced, his approach to his own prostate cancer. He used the PSA clock to make decisions all along the way (as I do with my patients, and as many of you do). However, he also makes this observation: “War is energy depleting, resource consuming, and long wars all the more so. Prostate cancer is a disease of long natural history. Patients who enter into a daily battle with the disease forfeit the state of living well with their cancer. Mukherjee, in his biography of cancer, the Emperor of all Maladies, discussed his concern with the cancer war metaphor. He suggested that the war on cancer may have to be won by redefining the meaning of victory. For prostate cancer patients this may involve a state of negotiation whereby they learn to live well and hopefully long with their disease.”

Some of the great commentators on my “PSA Clock” blog felt that I may have been advocating not looking at the PSA or not fighting the war. As I responded, that is a highly personal decision and the patient and doctor should discuss things like how often to look at the PSA and what difference it might make to check in monthly versus annually, or not at all, depending on where in the “war” they are, and what the options are. What I hoped could be worthwhile thinking about was turning off the clock either temporarily or permanently in some situations – and that clearly is a psychological decision, not a medical one. As one commentator pointed out, we do the vital signs every time we see a patient because knowing that someone’s heart is beating and their blood pressure is OK is “vital”.

Another friend Dr. Aroop Mangalik has just published a book on dealing with your doctor regarding end-of-life choices. “Dealing with Doctors, Denial, and Death.” Hopefully that is not where you are at present, but if so, Aroop is another of those very thoughtful physicians who has much to offer. You can get a discount on his book here. Use a promotion code: RLFANDF30 at checkout. From Dr. Schellhammer, “For prostate cancer patients this may involve a state of negotiation whereby they learn to live well and hopefully long with their disease. The emphasis is on thrival as well as survival. This mindset has been described by others as when there are clouds on the horizon one learns to dance in the rain, or those patients do best who learn to dance with their disease. Again, as stated earlier, the appreciation of “today” is affirming and healing.”

It’s a lovely sunny day here in Colorado, and time to go skiing! Find your own groove and have a great time this weekend.