For better or worse, my family and I have watched the” Simpson’s” since its inception. I think we were in a motel room outside LaGrange, Georgia on are about Thanksgiving day. The episode that night was about Santa’s little helper. A dog that came in last at dog race and was found by the Simpson family sulking around in the parking lot after the race, alone and discarded by his owner. We were hooked. The episode however that I want to tie into prostate cancer has to do with the time Bart switched his test with a very bright student and was sent to a special school, in error, for the gifted. The teacher asked Bart this question,”Bart, what are your thoughts on a country building up its military might and nuclear arsenal as a deterrent to war. The essence of what I am asking relates to having guns in order not having to use them.” Bart looking obviously troubled by the question, pauses and looks around at his brilliant classmates and them at him. “Well, in in this situation I guess you are damned if you do, and damned if you don’t.”
From “The Decision”
Prostate cancer is very different. Prostate cancer has several treatment options and almost all will result in some change in voiding and/or sexual function. In addition to the concerns of the patient about whether he’ll be cured or not, he has to worry about symptoms that are going to be caused by the treatment and not by the disease. The symptoms that can occur strike right at the heart of the male patient’s pride (if he has debilitating voiding symptoms) and his sexuality (if his erections worsen). To make matters worse, some patients have favorable parameters indicating the slow-growing type of prostate cancer and may be completely symptom-free, but they are still faced with a decision about whether to undergo treatment. This patient is the one most troubled by the decision because he has to walk the fine line of limiting risks versus getting cured. He doesn’t want to over-treat the cancer, subjecting himself to all the risks, but he doesn’t want it to come back either. Having prostate cancer, even low grade and low volume, is a lot like being a “little bit pregnant.” Once you know you’ve got it, you have to deal with it (even if dealing with it is to choose surveillance). It is understandable why so many newly diagnosed prostate cancer patients are frustrated by having to make the decision to pursue one treatment over another.
With the advent of screening, PSA, increase awareness of the male regarding prostate cancer and the need for rectal exams, prostate cancer is being detected earlier. Now that is the rub. Early detection in a disease that may not kill you. It would not be so much of an issue if it weren’t for all the bad stuff that happens to a male that is treated for prostate cancer. The potential for really messing up a male because of treating the prostate is real. So what to do? As Bart said, “You’re damned if you do and you damned if you don’t.” In time with genetic research and other markers, maybe one day we’ll know which cancer will kill when you choose surveillance and which one doesn’t. We don’t now, so the male needs to have the biopsy if there is a concern. Then you’ll know the Gleason score and the volume of the positive cores. Armed with this info you can make an informed decision. Its tough for the guy like me who had minimal disease and was looking at the incontinence and potency issues. I feel strongly that the notion that you don’t do the PSA or the biopsy because “all prostate cancers are the same” cannot be the rule of the day. As it is, if you are a male around forty you should get checked and if it results in a positive biopsy-an informed decision based on the specifics of the biopsy- can be made. For me, I could not live with the idea of doing nothing. I was an Admiral Farragut,” Damn the torpedos. Full speed ahead!)
PS- Without googling- what battle and what war did the Admiral say this? If you don’t know, it will surprise you.