prostate cancer guru or fool? please comment-where is he now?


The Prostate Lab www.prostatelab.com

Disclaimer : The following does not represent the opinion of Dr. Oppenheimer, the Prostate Lab, or any other potentially liable party. Sometimes you just have to take the responsibility yourself.

Lorenzo Q. Squarf Flamekeeper of Western Civilization

-Understanding the Game

-Playing the Game

-Two years later — [quavering voice] “I am still ALIVE!   Kaf, kaf!”

Message #1: UNDERSTANDING THE GAME:

Prostate cancer is the single greatest overrated disease in the history of civilization.
Forty thousand men, it is claimed, die from prostate cancer each year in this country.
Forgive me, but that number is not medically or socially significant. There are about
130,000,000 males in the United States. Forty thousand is but a whisker off the beard
of the testosterone contingent. The survival of the masculine gender in the United
States is in no way threatened by this trifling disease. Many more men die on the
highways of our beloved land each year from road rage, or have the life snuffed out
of them in marriages to the wrong women.

Hello, I am Lorenzo Q. Squarf and I have prostate cancer.

Well, I *probably* have prostate cancer. The probability is in the vicinity of 90%+.   I don’t
know for sure because I refused an “urgently recommended” biopsy. I have no intention
of allowing anyone to violate the integrity of my trouble-free reproductive organs with sharp
instruments so that scientific curiosity about my asymptomatic prostate gland, which seems
to have produced theoretically disturbing test results, can be hypothetically satisfied. Here
is my relevant medical history:

DREs: a slightly enlarged prostate gland was detected — it was declared to be normal and
suitable to my age which is 65. I have no urological symptoms whatsoever. No nighttime
wee-wees, no nothing. I pee vigorously, no dribbles, and not that often. I have an active and
highly appreciated sex life. I got my first PSA because I read about that test in a magazine
and thought that I would see how my new Medicare supplement worked — it was a freebie.
That is the only reason I requested the PSA test.

5/19/97 — PSA 7.4 — referred to a urologist by my GP.

5/27/97 — PSA 5.0 — urologist redo of the PSA test

6/21/97 — PSA 9.4 *and* 9.7 — another redo at the urging of the urologist; two labs, same blood
at my stipulation, *plus* some other tests

ProstAssure test results came in with a skull and crossbones stamped across them —   Zone Four,
indicating a 90%+ probability of prostate cancer. My free PSA was below 15% and caused scowls
and grimaces.

When my urologist, Dr. Doom, received the initial 9.4 PSA results, he adopted his funeral director’s
demeanor and informed me that he was scheduling me for a biopsy. I burst out laughing, mumbled
something about “under advisement,” wished him a good day, and walked out of his office, humming,
with a light step, and never returned. Dr. Doom promised me a horrible death from metastatic cancer
and subsequently sent me a registered, certified, return-receipt letter informing me that I was no longer
his patient and that he was no longer my urologist. He covered his ass. I chuckled and covered
Squishalie Doodlebug Provolone, my neurotically voluptuous girlfriend, with my biologically active
body and had a wonderful time. I do not have the slightest intention of ever allowing anyone to come
near my asymptomatic clangers with a meat hook, ice tongs or a chain saw.

I am writing this with a slight backache. It is either the usual backache of a 65 year old man — and I
have had them come and go all my life — or it is metastatic bone cancer. Yawn!  It has been bothering
me *slightly* for the past four to six weeks. I really do think, though, that it is a routine backache and
that my chiropractor, Captain Crunch, will be able crack something in the lower area of my spine and
that I will be able to boogie with the Force or with whatever comes along without the slightest difficulty.
I will ask him, though, to take an X-ray so that he and I can scan it and look for Swiss cheese holes or
some abberational nibbles in the pelvic bones and lower vertebrae. If things looks okay, I will let him
play snap, crackle and pop with me. If things don’t look okay, I will undergo some other non-invasive
diagnostic procedure to clarify the situation. It is useful to name things when they are part of you. As
they say in French, nishgaferlich. There is no sense in even attempting to chase down and slay the
dragon of metastatic bone cancer once it is on a rampage. The treatment is worse than the disease
and one can check out whenever things become truly intolerable. It is a philosophical issue, not a
medical one. Let’s be adult and realistic.

Prostate cancer is a delight as compared to all other life-threatening afflictions. Think about it: PCa
is a conversation-laden disease and nobody has a definitive fix on *exactly* what ought to be done.
And no matter what is done, there are no guarantees… except, of course, that the moment anyone
submits to *any* invasive diagnostic or therapeutic procedure, he becomes a miserable wretch and
a professional PCa patient, the latter for the rest of his life… and sometimes the former. I,
personally, refuse to watch my prostate gland like a flute player watches a cobra. If it aggravates me
sufficiently, I will destroy it. It has been informed. I, meanwhile, am grooving right along and enjoying
things.

Consider a sudden and crippling stroke. Now there is a real catastrophe! No warning. No conversation.
BLAM! Paralyzed and drooling. Your affairs are in a total mess and there is nothing that you can do
about them. I would rather have PCa and join in the endless small talk about it, whenever I want to, as I
go about the game of life with gusto.

How about a massive coronary? No warning. No conversation. BLAM! Tubes coming and going into
and out of every orifice in your body. Your personal affairs are in total chaos as you lie there like a
potato latke as they shuffle bedpans beneath you. No, thank you. I would rather have the kind of PCa
that I have and its related luxuries, not the least of which is that my phenomenological health is
splendid and my activities are utterly unaffected by it.

Gentlemen, we Watchful Waiters are extremely fortunate.

My next message about this heretofore confusing subject will be a thunderbolt of clarity. I shall
stipulate — fearlessly, I might add — what I believe *everyone* ought to do in light of his test results
and symptoms. If Einstein had the courage to successfully tackle gravity, the least I can do is punt PCa.

Have a nice day.

-Squarf

Message #2: PLAYING THE GAME:

My backache was not the result of metastatic cancer ravaging
my pelvis and spine thank you for your good wishes. It was
caused by misaligned vertebrae. The X-ray was refreshingly
clear about that. Captain Crunch did his stuff. My backache is gone.
My prostate cancer and I seem to be ignoring each other. My pelvic
bones look lovely — no Swiss cheese holes from cancerous rats and
no nibbles from cancerous mice. So much for the dire warnings
of the Dr. Dooms of this world. Freud said that a cigar was
sometimes just a cigar. Well, a backache is sometimes just a
backache.

Here is the Squarfian Analytical Matrix for dealing with
the hysteria of prostate cancer. This is not medical
advice; this is advice about living. All disclaimers known
to man are hereby invoked. If you are an attorney, I suggest
that you ignore my advice and get a radical prostatectomy
without delay, anaesthesia or compelling reasons. Everybody
else, here we go:

1) If you have *no* symptoms, but have an elevated PSA do
nothing. NOTHING! Never mind the doom-and-gloomers.
If everything is functioning normally as far as you are
concerned, then forget it. No exceptions. Do not, under
such circumstances, allow a biopsy. The odds are wonderful
that, by doing nothing, you will eventually anguish and die
from something altogether different than prostate cancer.
There. Feel better? Good. Me, too. I shall never have
another DRE or PSA and screw biopsies, altogether. A death
wish? Nope. Quite the contrary. Read on.

2) If you have no symptoms, but a DRE indicates an irregularity,
get a couple of PSAs down the road, and a couple of follow up
DREs to see if a) the PSA is climbing *significantly*, and b)
if the irregularity has changed *significantly*. If not, and
if you continue to have no symptoms, get it checked once a year.
Don’t let anyone panic you into anything. Do *not* get a biopsy.
Don’t worry. Enjoy life. When and if something is wrong, you
will be the first to know. In the meantime, forget it because
you will probably die of something else first. So? So cheer up!

3) If you have distressful symptoms, that is another story, but
remain clam. CLAM! Getting up once or twice a night to make
a wee-wee is not the end of the world. If that is your only
problem, or if your problems are of such a trifling
nature, why, disqualify such slight inconveniences from
inclusion in the “distressful symptom” catagory. Nervous?
Can’t stand to do nothing? Okay. Buy a book on nutrition
and consume prostate-specific nutrients. They won’t hurt,
they might do some good, and you will feel rather purposeful;
besides, this is a much less traumatic approach than turning
your life over to the dice-and-slice crowd for a bit of exploratory
mayhem. And a slightly or moderately enlarged prostate whose
only disadvantage is a weak stream or the semi-frequent need to
pee is not sufficient justification to allow anyone to use a meat
hook on your prostate gland merely to see what sample chunks look
like under a microscope.

4) If you have *seriously* distressful symptoms — and this would
include the inability to pee, whizzing blood, loss of bladder
control, severe groin pain, or other highly suspicious
dissatisfactions, then you have to do whatever is required
to find out what is causing the situation so that you can take
appropriate action. And this *might* require a biopsy. Your
ass may well be grass, but you really do not have the choice of
*ignoring* things. You do, however, have a number of options as
to which therapeutic modality or combinations thereof are available.
Learn what they are. Check them out. Pick the least intrusive
and distasteful alternative and go with it. Goodbye and good luck.
You have just left the Watchful Waiting Club. And I am grateful, by
the way, that you are in such a teensy-weensy, downright minuscule
minority. Nothing personal, mind you, it *could* happen to any of
us… although it is so *damned unlikely* as to make Watchful Waiting
a fairly pleasant, boring, but supremely sane game.

5) OVERVIEW: We can find *anything* that we *really* look for:
the accuracy of Nostrodamus’ predictions, UFOs, God, or abberant
cells in any organ of our bodies. We just have to search hard
enough, long enough and destructively enough. Frankly, there are
some things which I do not wish to find. And if those things want
to find me, well, they know where I am, and they know how to get my
attention.

What did men do before there was a PSA test? They lived until
they died, and it was usually from something other than prostate
cancer. Check the stats. You will smile. Check the stats more
closely and you will grin from ear to ear because a lot of men died
*with*, and not *because* of, prostate cancer. It just never bothered
them while they were alive. They had no idea! There is a moral in here
somewhere which suggests that an awful lot of men over a certain age have
prostate cancer percolating amongst their clangers, but that, and in the
normal course of events, it never managed to brew a troublesome cup of
coffee. Got it? Good. Have a cup of tea.

If something seems to be functioning well, then leave it alone.

Do not fix what is not broken.

Gentlemen, there are no survivors on planet earth. Prostate
cancer has no real cure and no pleasant treatment. Let me quote
from a man who has much more experience than I. His name is Tom
Feeney. He is 83 years old and he has prostate cancer. Tom writes:

“There is currently no treatment available that has been proven capable
of providing a cure, capable of extending life, or of doing more good
than harm. In addition, all treatments have undesirable side effects
that can seriously detract from the patient’s quality of life for the
rest of his days.”
— from Tom Feeney, on this website, recommended reading

If you *really* research the subject, you will probably discover that
many urologists would *not* — repeat NOT — follow the advice for
*themselves* that they are providing to many of their patients. Read
the previous sentence again. And again. It is not only true, it is
terribly important and revealing.

So? So I have decided to not make a career out of my asymptomatic
prostate cancer. No more DREs, no more PSAs. To hell with my
ominous test results. If I get an ouchie, I will seek a fixie, but
not a moment before then and as non-radical as possible. And yes, I
will use my own decision-making analytical matrix which I have outlined
above.

All I know now, and all I want to know, is that I have a fully
functioning and trouble-free prostate gland which performs magnificently!
Watchful Waiting? No. I am neither watching nor waiting. I am living.
There is a big difference. I recommend it to everyone. Frankly, I
consider the odds stacked heavily in my favor.

-Lorenzo Q. Squarf

MESSAGE #3:  TWO YEARS LATER  [“I am still ALIVE!  Kaf, kaf!”]

Hello there.  I am now 67 years old.  My last two years were vibrant with
across-the-board good health.  Something occurred a month or so ago
which might interest you.  First, I must inform you that I have not seen a
doctor nor have I had an exam or test of any kind during the past couple
of years… with the exception noted below.  And I have not modified my
lifestyle which includes unmoderated red meat, cognac and cigars.
In a gesture of New Age preciousness I tried tofu, but gagged on it.  It
reminded me of dragon snot and is barred from my home.  Now to the
recent occurrance:

A friend, who is a well-known and highly respected PCa pathologist —
a uropatholgist — gave me an unsolicited freebie PSA as a social
gesture in June 1999.  The PSA came in at 5.2.  FIVE POINT TWO!
Down from an untreated 9.7 of two doctor- and intervention-free years
ago.  It looks as though my Dr. Doom will die of sclerosis of his personality
long before I will platz from anything.  My first reaction to the new PSA
test (which, in my opinion, approximates age-adjusted normal)?  Wow, I
don’t have prostate cancer after all!  My second reaction to that test?
Yes, I probably *do* have prostate cancer.  BFD.

In my humble opinion, I believe that that mature and maturing males
enable the development of PCa, but that their very maturation renders
it moot… provided that they leave it alone.  Very probably.  I *guarantee*
anguish to anyone who lets the medical profession take an aggressive
whack at his clangers.  Remember, when the only tool a man has is a
hammer, why, everything looks like a nail in need of being slammed.
Think of your urologist.  All is not lost.  Read on.

We need to face up to some realities: 1) we are all going to die
eventually and from something; 2) nothing has *ever* been proven
to lengthen the life of a PCa patient; 3) Virtually *everything* that is
done to interfere with real or imaginary PCa has horrific side effects
… and if they don’t, then they are truly extraordinary exceptions.
Horror stories abound.  Pollyanna tales of innocuous treatment,
cures and lovely life are rare enough to be considered mythology.
And, yes, some chaps have aggressive PCa which really does
require serious intervention in order to reduce the situation to
semi-manageable proportions.  Sorry about that.  It happens.  But
it happens a lot less frequently than the medical profession is able
to identify and stipulate with any degree of credible science to support
it.  Let me put it differently: some prostate cancers are not meaningful
and are best *totally* ignored; others are dangerous, but no one can
differentiate the baddies from the goodies.  So?  So a lot of guys get
wrung out when, in fact, they might have the innocuous variety of PCa.

I am not a Luddite.  Let me clarify my go/no-go criteria for hurling
yourself into the great maw of urological mayhem:

If you are in your 50s, avoid biopsies until and unless you have
negative urological symptoms which clearly indicated the need
for a biopsy to determine what might be going on.  If you have a
suspicious DRE that does not clear up you fall into this catagory.
If your PSAs are beginning to sequentially rocket upward you fall
into this catagory.  Absent these criteria, avoid urological
procedures.

If you are in your 60s, the same criteria apply.

If you are in your 70s, ditto, but be *very* fussy about what constitutes
negative symptoms.  If they are not all that distressful consider
treating the symptoms.  Think amelioration of discomfort rather than
aggressive intervention, but, if ordinary stuff can’t supress your
discomfort, why, discuss your particulars, and especially your
personal values, with a urologist who listens carefully,  and who
seems to care more about you than his theories of aggressive
intervention.

If you are in your 80s don’t play the therapy game.  Period.  No.  Don’t
do it.  It will destroy the rest of your life.  Ameliorate negative symptoms
with medication.  You can probably do this in an agreeable manner for
a longer time than you might imagine.  Smile.  You have won.

But, if you are like many folks, you will cruise and schmooz around
the PCa conferences like a moth around a flame.  Please pay particular
attention to all the definitions and descriptions and procedures that are
bandied about with such seeming authority.  Definitions are not
meanings.  They are too antiseptic.  It is one thing to talk about changing
your own catheter or urine collection bag or diaper, and quite another
thing to actually have to do it.  And never mind sitting in a bathtub full of
hot water, weeping, because you are unable to make a pee-pee.  Question:
Was it *really* necessary to wind up that way in the first place?  *Really*
honest to God necessary?  How do you know?  How do the doctors know?
Know as in KNOW!  Just because a profession knows *how* to do
something with a knife doesn’t mean that it makes sense to do it… without
a really persuasive reason.  Get the picture?

And note the career-building that is going on in the PCa conferences.
Endless chit-chat.  The same guys.  Year after year.  How come nobody
gets better?  Oh, one or two report that they are cured, but they are truly
rare exceptions and might never have had the bad kind of PCa in the first
place. Most of the participants have full-time jobs as PCa patients and
“survivors” — sounds noble, huh?  I have even seen the word “heroic” used.
I can’t see any nobility or heroism in dragging one’s ass around in treatment-
induced diapers or other assorted indignities, including moaning and
groaning — my personal values are peeking through here.  Yours may be
different.  Some guys are dealt a really lousy hand of cards by The Dealer —
and if it wasn’t prostate cancer for them maybe it would be have been
cancer of the lungs, pancreas, brain or liver — now those things kill;
prostate cancer, for the most part, seems to cause endless conversations
and second careers.  To be fair, in some — but far from all — cases of PCa,
nothing short of massive intervention is indicated.  And there is usually no
question about it.  And the unlucky chap really doesn’t have much of a
medical choice in the matter.

Extraordinary interventions require extraordinary justifications.
An asymptomatic man — a phenomenologically healthy fellow —
(qualified by the criteria noted above) who submits to *any*
destructive diagnostic or therapeutic interventions deserves (not
really) the lousy consequences, not the least among them is becoming
an amateur urologist who, despite intensive study and mastery of
language and procedures and theories, still doesn’t know what is the
best course of action.  Hello, there!  Will a real authority please stand up?
There are none.  Read the previous sentence again.

When you get over your relief or nausea, and if you feel like it, why, drop
me a note and a brief summary of your urological facts.  I am accumulating
statistics.  They keep validating my position.

-Squarf
From Squarf’s suggested reading list: A letter from a former President of the British Urological Association

For a broader view of the Squarfian approach to
prostate cancer and the rest of world, you may
access http://www.squarf.com/ I went to the site…no longer there…are you thinking what I’m thinking?

8 Replies to “prostate cancer guru or fool? please comment-where is he now?”

  1. Dear Dr. McHugh:

    Can you please advise me of the genealogical relationships between Thomas Feaney (a good friend of mine some years ago), Lorenzo Q. Squarf, Richard Albin, PhD, and Robert Albin?

    I now understand the genealogical situation regarding the last-mentioned pair (and am about to practice merciless plagiarism), but maybe there is something I am missing here.

    :O)

    Like

    1. First of all I admire the diligence with which you review the prostate news daily and how respectful you are to all. You have been more than gracious to me. I respond to your genealogy question with today’s post. Regarding Mr. Feeney, I obviously did not know him, but I love him. I spent about an hour on his site. I, however, do not agree with some of his sentiments and I am not sure he understood some of the nuances of prostate cancer or his particular disease. I say this respectfully, and purely from a objective review. I saw the picture of him with the bottle, his love of life, and felt his upbeat attitude and personality in his words.

      Like

  2. There was a time (back in about 1995-6) when Tom Feeney and I used to suspect we were the only two people on the Net who were prepared to state that any form of monitoring (active surveillance, watchful waiting, expectant management, call it what you will) was actually a viable method of managing selected prostate cancer patients. Of course I knew Gerry Chodak thought that too — but it had derailed his academic career!

    Then Terry Herbert (who runs the Yananow site) joined the club. (It’s been all downhill since then, of course!)

    :O)

    Thank you for the kind remarks.

    Mike

    Like

    1. Today I did a biopsy on a retired CEO who began surveillance with me and then enrolled in the John’s Hopkins study. He personally knows Patrick Walsh. He bought the first book that was sold of mine. ” Dr. McHugh, I liked your book but it is very weak on surveillance. It needs to be looked at as an active decision, not as something in which nothing is done. You need to work on that chapter.” So…. I think yall were ahead of your time.

      Like

  3. I am alive and well. My urologicals are totally splendid, as is the rest of my health. I am now 78 and fully functional and as iconoclastic and obstreperous as ever. Let the good times roll!

    Like

    1. I am honored to hear from you. I love your name and delighted you are well. Indeed….let the good times roll. I believe that was a Cars song circa 1975 or so. Absolutely love that second word….. obsta what? Does it mean to deliver a baby. Thanks so much for the update. JM ps….. uh oh….now I need to go back and see what I wrote about you.

      Like

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