prostate diaries question: do urologists recommend active surveillance for prostate cancer? well….hell yea!

One of my heroes of all time is Will Rogers. If you have not read a book about him….do it. He is the best. He was a Rush Limbaugh of sorts in the early 1900’s. My son, Sam is an Eagle Scout, and he and I hiked for two weeks in New Mexico at Philmont. Waite Phillips donated the land to the scouts many years ago and as such “doing Philmont” is a rite of passage so to speak in scouting. Phillips made his money in oil and was one of the first men to utilize the concept of a “gas station.” Phillips 66 doted Route 66 in its heyday. We went to Waite Phillips house near the beginning point of the house and in the basement was a picture of Waite Phillips and Will Rogers. Rogers had stopped off at Phillip’s place 0n his way to somewhere else.I would like to think that I am a kindred spirit with Will Rogers. He died in a plane crash with Wiley Post at a far away place in Alaska. In his pocket it is reported that he had a lucky wooden nickel, and a set of jacks. I get it.

By the way…in the news this week was a story about how a video of college students having sex on a rooftop at USC going viral. Guess what the building’s name was? Waite Phillips Hall.

Many of you reading this are thinking or Roy Rogers…I am speaking of Will. I have read several books about him and even went to New York to see “Will Roger Follies.” He began his career as a cowboy and had a talent of playing with ropes and making them do tricks, a rope lariat, not poet lariat. He traveled about and as I recall he got on a boat with a circus and refined his lariat skills. He made his way to New York was in Zigfeld Follies. So finally I am to the point I want to tell.

When Roger’s performed he did not talk. He just did rope tricks and did that for hundreds of performances. One day he messed up a trick and the rope fell to the ground not in keeping with the intended trick. He looked up and said, ” I guess I can’t do rope tricks and chew gum at the same time.” He walked over to side of the stage and took the gum out of his mouth and stuck it on the wall. The audience roared in laughter. It was such a hit that he decided he’d drop the rope and mess up the trick on purpose so that he could use the line again. With each successive show he added more lines and in time his show was more talking than roping.

Then he became his own show. He’d have a newspaper and he’d read a story and then comment on it in an informative yet funny way. Rogers quotes are now well-known and timeless. “All I know, I’ve read in a newspaper.” “I am of  no particular or organized party…I am a democrat.” Being from North Georgia and home of moonshining and stills, I like this one, “Nothing helped improve the roads in America like prohibition did.” Think Dawsonville’s Bill Elliott.

He had a daily spot in the newspaper with just a short thought or comment. Again….Rush Limbaugh has used his technique. Read a story, or play a sound bite of stuff that is reported and then comment on it in a funny way. Rogers became the highest paid performer in america. He was an advocate of commercial air travel and his travelling by plane did more to promote the public’s acceptance of it as being safe..somewhat ironic seeing how he died in a plane. But that is a whole nother story. Wiley Post.”Let’s go flying Will!”

My mother loved telling this on Will Rogers and she loved telling me to be “big about it.” This is where the following came from. Will Rogers would be asked to be the featured performer at Presidential functions. Numerous presidents  from both parties had him as a performer. He’d go and make fun of them and their party in a clever way. Someone asked him one time how was it that the most powerful men in the world would invite someone who they knew would be making fun of them and their policies. He replied….” Because…they are big people.”

So. When I was summoned to retrieve my son Sam from the University of Oklahoma and drive him and his car back from there to Georgia, I was delightfully surprised to end up in front of my hero…Will Rogers and the Will Rogers International Airport. An airport that did not have my baggage from Atlanta. No problem. I got it the next day. My son was an issue as well. ” Dad. Can’t come pick you just yet. My battery is dead in my car. I am working on borrowing a car. I’ll let you know. I’ll call.”

No baggage, nobody there to  pick  me up, but I was in Oklahoma with a statue of Will Rogers. Really….I wasn’t working….It could be said that, ” It don’t get no better that this.”

Now it is a beautiful Sunday afternoon in Northeast Georgia and my wife is at the beach with my daughter Bess. I am “home alone” and that really is not good. I like being alone for about 23 hours then I don’t like it. I thought I’d like it, but then I miss all that my wife” brings to the table.” I have the dogs and “their” issues to deal with. Then it came to me. My son, Sam, who is in Savannah, let me borrow  his friend’s mother’s Flip, and it dawns on me that I could do an Amazon video for Author Central using the friend’s mother’s Flip…and I do it. So…..without further a deau…..is that the way you say or spell that….it’s okay…I am from the south and we southerner’s don’t know the sophisticated ways of the north…..and bla bla bla

Oh I forgot…surveillance. I just finished one of the requirements for the Board of Urology, it’s called MOC, or maintenance of certification. I had several disease options to choose from and you guessed it…I chose prostate cancer. The whole thing, and obviously what the board members thought was important to its member urologists, was about being sure that all the options for the treatment of prostate are given to the patient along with the risks and benefits of each. Active surveillance was listed as one of the treatment options to be offered and documented as having been discussed. (This should make those of you who think that all surgeons want to do is remove your prostate feel maybe a little bit better.)

I mention in my book that active surveillance is a bit dicey for the guy less than 60 and it is an option for a certain type of mindset. An anxious person will not go this route. I personally considered it but my mind wasn’t good with it. I had a guy “give in” to doing something (abandoned surveillance) because he knew did not want radiation and if  the disease progressed, he’d rather deal with surgery at his current age than 3-5 years down the road.

In my practice for my patients that choose surveillance, I do what they do at Johns Hopkins and that is a PSA twice a year and a biopsy yearly. The patients that I follow this way are very pleased and usually feel very comfortable with their decision.

I spent way too long on this post…but when I saw the picture of Will Rogers with Waite Phillips in the basement of Phillips’ home at Philmont and I had been hiking with kids for two weeks straight…well it did me good to remember all that and how it felt to be done and to think I was standing in a place where Rogers once was as a guest. History does me that way. It intriques me but frustrates me…I want to feel it but it is a tease…and that keeps me reading.