Highlighted excerpts on Amazon’s Kindle about prostate cancer nuances from “The Decision” are revealing….

First of all…how does Amazon know when an individual who has a Kindle marks something as a highlight? I saw these highlights today for the first time on the Kindle page for my book. I go there from time to time to read comments and check ratings. I want to comment on the highlights. Before I do, I’ll share with you a conversation I had with my wife after my discovery.

“You know how sometimes you are reading a book and you read something you like…you’ll take a pencil or a yellow highlighter and underline a passage or sentence. That’s what they are doing, they are highlighting but on their Kindle.”

My wife who is a traditionalist when it comes to reading and books and doesn’t get why anyone would prefer a Kindle to a book says, ” How does Amazon know when someone highlights something? I don’t like that. I don’t want Amazon knowing what I am doing with my book. This is odd John.”

I read the “Popular highlights” explanation three times. I guess Amazon is wirelessly searching you Kindle when you download the next book. Did you know they could do that? It is a bit ” Orwellian.”

Anyway, most of the quotes from my book have to do with radiation issues. I mentioned in another post that my most negative comment on Amazon had to do with me, a urologist surgeon, being biased toward surgery. On the surface and on one’s initial impression, based on the following highlights, I’d agree. But there is more…and this is the truth and how it happened.

What has impressed me over the years in figuring out why certain patients decided to do what they did about their prostate cancer was how little they knew of the potential “down the road” side effects of radiation. In making those “effects” know in great detail comes across to some as being against radiation. Nothing is further from the truth. Radiation wasn’t for me, but for the guy who is afraid of surgery and the complications, the patient whose life can’t tolerate the recovery of surgery, etc etc….radiation is a wonderful alternative.

But…that guy that brags to me and his friends that he’s smarter than the next guy because he has been on the internet and “cure his cancer without surgery” not knowing the full ramifications of radiation…well it bothers me a little. Or the guy that from the get go feels that the urologist who diagnosed his cancer will recommend surgery because he’s “out to get a buck,” I just feel there needs to be some clarification. As I say in the book, ” When it comes to prostate cancer treatment decisions, you pick your poison. There is no free ride.”

If I had a nickel for the times that a patient who has radiation complained of urinary irritative symptoms or sexual dysfunction after radiation and indicated that it was a surprise to him…well I’d be a rich man. Somebody did not tell them the whole story, or they were so “clever by half” they did not listen. “Someboddy got some splaining to do,” as Ricky Ricardo used to tell Lucy. So…It ain’t biased, these highlights ain’t biased….they are making known to the radiation type patient (whether seeds, external beam or yes even Proton) what you are get”in to.

So…read the following with that grain of salt…. if the risks and benefits of radiation (after a knowledgeable review) trump surgery…or vice versa…go for it………

I ain’t trying to talk you out of nothin….I just want you to know…….

Popular Highlights from Kindle readers who have purchased “The Decision”

 (What’s this?)

Once you have chosen radiation, you have limited surgical options to correct any worsening of your ability to void. You are” attached at the hip” with it, both from the standpoint of surgical intervention of any urinary symptoms that occur as well as for curative measures if your PSA rises, indicating return of the cancer.

In my opinion, the fear of total incontinence resulting from removal of the prostate should not be viewed as the major issue in the decision.

(You can do radiation after surgery, but it is difficult to do surgery after radiation.)You

This differs dramatically from radiation, in which baseline function is not affected initially but deteriorates to an unknown level over time and stays at that level.

Highlighted by 4 Kindle users

If you choose radiation treatment, your surgical options for dealing with any of the complications associated with radiation, particularly obstructive voiding symptoms, are also limited, which will be discussed in more detail later. These factors, more than the ability to cure, are the caveats of radiation therapy that I feel are most often overlooked by patients choosing seed therapy.

As I inquired more about seeds, I was advised that the quality of the placement of the seeds was paramount to getting an adequate treatment and hence cure. There was room for error. It concerned me that if I did not have a procedure with good placement, then my cancer was likely to return due to my young age at diagnosis and my years at risk.

Regardless of the treatment you choose, you will have one or more of the following voiding issues. How long they will last or how severe they will be for you is an unknown.

If a patient makes a decision without careful consideration of his underlying voiding pattern and how it will potentially be affected, neither he nor the doctor has done his due diligence.

I felt then as I do now, that surgical removal assures that all the cancer in the prostate will be gone; radiation of the prostate cannot assure you that all the cancer in the gland will be killed.

Ask intelligently, “What was your Gleason’s score, baseline erectile function, how old are you, what is your current voiding pattern and what are your other medical conditions?”