I’ve spent my entire professional life practicing medicine, guiding patients through uncertainty, and translating complex science into actionable information that could be clearly understood. I thought I had a solid grasp on what it meant to face illness. I thought I knew how to navigate the medical maze and interpret all the jargon.
Nothing prepared me for the moment when I became a patient.
The diagnosis was prostate cancer.
Suddenly, I wasn’t the physician with the commanding vantage point. I was a person trying to make sense of a diagnosis that felt both familiar and foreign. And the deeper I went into the world of prostate cancer management, the more I realized how much I didn’t know.
The paralysis of choice
The first shock was the sheer number of therapeutic choices: active surveillance, surgery, radiation, focal therapies, and genomic classifiers.
These were all tools and terms I had heard for years, but I had never considered them from a personal perspective.
As physicians, we sometimes take for granted how overwhelming our own vocabulary can be. Sitting on the other side of the desk, I felt this acutely. Every option came with a footnote, a caveat, a statement of uncertainty.
Then came the next layer of complexity: genomic prognostic testing.
Understanding the score
My oncologist introduced me to a genomic test designed to estimate the likelihood that my prostate cancer might eventually become metastatic. These tests analyze tumor genetics to generate a risk score, aiming to provide a clearer picture of the cancer’s biological behavior. For instance, a lower risk score could lead to a decision to delay treatments like radiation therapy, opting instead for active surveillance to monitor the cancer over time.
It sounded like the kind of clarity every patient should expect.
When my results came back on the lower end, I felt a surge of relief. A low score suggested a lower chance of metastasis. For a moment, it felt like someone had cracked open a window in a very dark room.
But that relief carried a hidden danger. A low score can whisper, “You’re fine. You don’t need to take immediate action.”
My oncologist walked me through the science behind the score. He explained the pathways, the models, and the algorithms. He was patient with me and brilliant in his explanation. And yet, ironically, I left more bewildered than when I walked in.
This was not because of any shortcoming on his part, but because genomics science is still evolving. Even as a physician, I struggled to translate that promise into something actionable for my own situation.
Was I supposed to relax? Was this supposed to allay my worries? Should I worry differently?
The trap of complacency
A low genomic risk score would bring peace, I thought. Instead, it brought a strange mix of relief and discomfort. Part of me wanted to celebrate. Another part shouted not to become complacent.
Because a low score does not eliminate risk, it does not replace careful monitoring. It does not allow one to take one’s foot off the gas.
And yet, I felt myself drifting toward that temptation: checking my PSA less urgently, interpreting small rises as “probably nothing,” convincing myself that the test had already told me the ending of the story.
Looking back, I realize how dangerous that mindset was.
According to a 2023 survey published in a medical journal, patients and doctors often face challenges with genomic testing, including difficulty understanding the results and uncertainty about how to use the data to make decisions. And certainly not permission to be complacent.
The cost of uncertainty
There’s another truth we don’t talk about enough: These tests are expensive. And insurance companies, skeptical of their still-emerging clinical significance, often refuse to cover them. This financial burden creates a significant ethical dilemma for both clinicians and payers.
Thousands of dollars for a test that may, or may not, change management. A genomic test may yield uncertain results when predicting the future. As a physician, I understood why patients might hesitate, especially given that factors such as age, income, and insurance type can influence access to these tests. As a patient, it felt like another burden added to an already heavy load.
A shared vulnerability
Not long after my own testing, a dear coworker, someone I’ve known for years, someone whose resilience I’ve always admired, came to my office and quietly closed the door behind her.
Her voice trembled as she asked, “Can you help me understand what I’m supposed to do with this?”
In that moment, I saw myself in her. The fear behind the clinical language. The hope tangled with dread. The longing for certainty in a field that offers probabilities at best.
She wasn’t asking for statistics. She wasn’t asking for a lecture on molecular biology. She was asking for something far more human: reassurance that she wasn’t alone in the confusion.
And I realized I couldn’t give her the clarity she wanted, because I didn’t have it for myself.
So, I sat with her. I listened. I acknowledged how heavy those few pages of genomic data could feel. And for the first time, I understood that genomic testing doesn’t just generate numbers; it generates emotional weight. It creates a new kind of vulnerability, one that patients often carry in silence.
Her tears that day reminded me that even the strongest among us can be brought down by uncertainty. And that, sometimes, the most meaningful thing we can offer isn’t an answer, but emotional support and active listening.
Lessons from the other side of the desk
Facing prostate cancer taught me humility.
Genomic prognostic testing taught me vulnerability.
My coworker taught me compassion.
I learned that even “good” results can lull you into lowering your guard. Even physicians can feel lost in the genomic era. Even the most advanced tools can’t replace human guidance, empathy, and shared decision-making.
And even when science gives us probabilities, our hearts still crave certainty.
My low genomic risk score gave me hope, but it also tempted me to let my guard down. That temptation could have led me to monitor my PSA less closely and to assume that biology would behave exactly as predicted. And that would have been a mistake.
If there’s one lesson I carry forward, it’s this: Numbers can guide us, but they can’t replace vigilance. They can inform us, but they can’t remove active management of our health conditions. And they certainly don’t tell the whole story.
If sharing my experience helps another clinician understand what their patients feel, or helps another patient avoid the quiet danger of complacency, then this story has done its job.
And if it helps even one person feel less alone when they stare at a genomic report they never asked for, then all this uncertainty has meaning after all.
Francisco M. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine and can be reached at Florida Spine Institute and Wellness.
Dr. Torres was born in Spain and grew up in Puerto Rico. He graduated from the University of Puerto Rico School of Medicine. Dr. Torres performed his physical medicine and rehabilitation residency at the Veterans Administration Hospital in San Juan before completing a musculoskeletal fellowship at Louisiana State University Medical Center in New Orleans. He served three years as a clinical instructor of medicine and assistant professor at LSU before joining Florida Spine Institute in Clearwater, Florida, where he is the medical director of the Wellness Program.
Dr. Torres is an interventional physiatrist specializing in diagnosing and treating patients with spine-related pain syndromes. He is certified by the American Board of Physical Medicine and Rehabilitation and the American Board of Pain Medicine. He is a prolific writer and primarily interested in preventative medicine. He works with all of his patients to promote overall wellness.
