Hearing the words “you have cancer” changes everything. In my role as clinical nurse specialist in a busy prostate clinic, I see the effects of these three words on men and their families every day. The shock and disbelief, the fear and confusion as most men feel perfectly well with no symptoms at all. Many men want to do something about this NOW, the same day if possible. Of course it’s not possible, nor is it necessary for most men. Prostate cancer is generally slow growing and for most men, not a lethal cancer; the aphorism “men die with prostate cancer not of prostate cancer” is mentioned in patient-education material and by urologists and radiation oncologists all the time.
But our Western way of thinking is to get rid of cancer as soon as possible, anyway and anyhow. This is appropriate in many kinds of cancer, but prostate cancer is for the most part, different. I have overheard some of my colleagues saying to patients that prostate cancer is the “good” cancer and that prostate cancer “gives the gift of time.” I shudder when I hear these platitudes; for the newly diagnosed person, there is no “good” cancer and the only “gift of time” that anyone wants is a long and healthy life, a life free of cancer and its attendant worries.
Some men are content to wait a while before they have active treatment. Some of my patients are farmers and their willingness to undergo treatment and the subsequent interruption to the seasons of their work dictate when they want to have surgery or start radiation. Others are “snow birds” and delay their treatment until they return from their winter sojourn in Texas or Florida. We support these decisions where possible based on the stage, grade, and volume of their disease.
Some men demand treatment NOW, and if the surgeon or radiation oncologist can’t provide the treatment on their timetable, the man may choose to go elsewhere. This may mean an expensive few days in another city, perhaps in Canada or even in the United States. Canadians are used to waiting for treatment when necessary, but for some, any wait at all — for an MRI or CT scan or radical prostatectomy — is too long, and they pay out of pocket to get it done elsewhere. But this is not about the U.S. health care system versus the Canadian one; this is about men newly diagnosed with cancer and the pressures they face. We welcome those who choose to be treated elsewhere back after they have had their treatment and provide follow-up care, just as we would for our patients who have been treated by the medical specialists who work in our clinic.
It can be difficult to try to explain to most patients why there is no urgency to start their treatment from a medical perspective. It makes sense to them to get it done as soon as possible. Their family members and friends are often unable to understand why there is a “delay,” and they may pressure the man to find another physician who will start treatment faster and sooner. There is some evidence that not having immediate surgery does not result in adverse effects. A study concluded that in men with localized prostate cancer, delaying surgery for more than 60 days is not associated with adverse pathological outcomes or with worse biochemical recurrence-free survival.
But this is of little use to the patient who wants the cancer out NOW.
Rationalizations and statistics do little to persuade the man who is terrified and who is struggling to live with the knowledge that he has cancer in his body. On the other hand, I have had the experience of working with patients who went to the U.S. for an “executive physical” and were diagnosed with prostate cancer on the same day; PSA in the morning, biopsy in the afternoon, and surgery booked for three days later.
One particular man was so anxious that he did not remember any of his pre-surgical teaching and on returning to his home in Canada two days after surgery, called me and another nurse 10 separate times for information. This continued for three weeks — multiple phone calls for help problem solving and understanding what he was feeling and experiencing. We provided the information each and every time but it was obvious to us that for this man, having surgery NOW was not necessarily the best choice. He had little time to process the information that I am sure was provided to him, and the rapidity of the timeline from screening to diagnosis to treatment did little to control his anxiety that, in turn, influenced his understanding of what was to come.
There are, I’m sure, other men who have negotiated this rapid cycle with comprehension and few, if any, problems. Perhaps I only see the ones who don’t.
Anne Katz is a certified sexually counselor and a clinical nurse specialist at a large, regional cancer center in Canada who blogs at ASCO Connection, where this post originally appeared. She can be reached on her self-titled site, Dr. Anne Katz.
