General Discussion

My PSA was flat at just under 4 for about 6 years. It had reached that level slowly over a decade. In four months it went from just under 4 to nearly 7

In medschool we were taught that, starting age 40, one's (if one is White; although that caveat not mentioned at the time) risk of having prostate cancer was essentially a decadal equivalent if a prostate was fully sectioned and carefully examined.

That is, if one is 40, the risk of prostate cancer being found was 40%, if 60 then 60% and so on. My urologist tells me that really is not all that wrong. He also says that it is still true that most men with prostate cancer will die with it, not from it.

However, "most" is not all.

If it is the bones (either from local invasion, or as distant metastasis) it is very likely to bring a grim and painful death unless there is the involvement of a dedicated team willing to work closely with patient and family. Methods of "local control" (destroying individual tumor mets) have advanced greatly. Pain control has made less of an advance.

For people with bony involvement (or any metastatic disease), early referral for a palliative care consult (this does not mean immediately going into a facility to die!) seems to give better quality of life no matter at what stage the treatment might be presently.

The concept of "battling the cancer" is now being shown (as some of us had long suspected) to perhaps do more harm than good to quality of remaining life for some people as it can lead to feelings of anxiety or guilt for "not fighting hard enough".

This paradigm can, in a sense, absolve the healthcare providers of responsibility for treatment failure. Yes, I've seen this more than once.

If the prognosis (medically based best estimate) is correct and the cancer is terminal then the "battle" must eventually be lost which some patients find devastating. It seems to go better if one can recognize and accept that this life has a beginning, and also has an end.

An end of some sort. Various faith traditions interpret this in different ways. Relief from fear, comfort from loss are two things which most traditions attempt to provide.