Excellent article. I can add nothing to the medical angle, but there are other angles to consider too.
Let’s use President Biden as an example. I believe he’s 82. If he were totally cured of his cancer, that doesn’t really solve the problem given his age. If he was totally cured of one thing, that’s really just setting the stage for the next problem.
My Dad died of prostrate cancer, but he went pretty quick, so there was no hospital horror show. My Mom died of Parkinsons, which can be brutal over an extended period of time, 15 years in her case.
What I’m trying to get at here is that it seems difficult to analyze the desired course of action in these cases unless we have some basis of comparison. Where does President Biden think he’s going after this life? He seems to be a serious Catholic, so that gives us a clue, but perhaps none of us REALLY know what we believe until the end?
Many seniors suffer enormously as they reach the end of their lives. Some giant percent of all health care spending occurs in the last year of life.
Assuming a person is 80+ years of age, I would propose that serious illness at that age is not really a medical issue, but a philosophical one. How one would approach treatment would seem to depend a lot on what one considers the alternative to treatment to be.
The medical community has the best of intentions. But to the degree they push advanced treatments which may come with many ugly side effects, they are unintentionally sending a dark philosophical message.
“As bad as your current situation is, the alternative is even worse”
While that may indeed be true, it seems important to make clear that this is not a science based assumption, because there is no proof of that statement’s validity.
We might be wary of looking to the medical community for advice on matters which, so far at least, really have nothing to do with science.
I hear you. All too often in the US we often medicalize the aging process. To me, the question of how to handle a tough diagnosis (at any age) isn't *should you pursue aggressive versus conservative care*, but rather it's two questions 1) what are your goals and core values and 2) what tradeoffs are you willing to accept given the hard decisions you are facing. In other words, you center the patient not the diagnosis
We aren't doctors at our house, but my wife is an AVID wildlife rehabber who spends hours every day trying to keep her patients healthy and alive so they can be released back to the life they were designed to live. She's been doing this for 20 years.
Point being, when that process is your daily life for years, it can be difficult to switch gears and choose death as the best option in a situation. Part of what complicates it is that she sees the death of a patient as her personal defeat. Living in a wildlife hospital does make me sympathetic to the demands we place on health care providers. We expect them to be laser focused on making us well, and then turn on a dime and go in the other direction at the exact right moment. I couldn't handle those demands myself.
As you've seen, my concerns are really more philosophical than strictly medical.
When a vast medical system with great scientific authority (and the rest of society too) fights desperately to keep us alive, an unspoken and unintended message being sent is that where ever it is we are going after this life is to be avoided at all costs.
It makes me wonder whether that dark message is one of the things that makes us sick.
We're sailing across the ocean on a ship, and we've been told that the ship is definitely going to sink at some point, and then everything we fear the most will happen. How are we supposed to have a good vacation? :-)
Harvard researchers followed 1000+ men with early-stage prostate cancer for several years. Compared with men who rarely ate eggs, men who ate even less than a single egg a day appeared to have twice the risk of prostate cancer progression. The only thing worse for prostate cancer than eggs was poultry: Men with more aggressive cancer who regularly ate chicken had up to four times the progression risk. A single daily serving of cruciferous vegetables such as broccoli, brussels sprouts, cabbage, cauliflower, or kale may cut the risk of cancer progression by more than half.
A 2015 meta-analysis found that high intakes of dairy products—milk, low-fat milk, and cheese, but not nondairy sources of calcium—appear to increase total prostate cancer risk.
I know someone with exactly this diagnosis who died of squamous prostate cancer. Diagnosed with prostate cancer, Gleason Score 9, had spread to the bones, hormone treatment. Clear of cancer from October to March when he felt hideous pain all over. Died early June of the very rare squamous cell prostate cancer. Any thoughts?
You may want to add that the PSA scores are adjusted by age due to age related enlargement of the prostate. You may also want to add that there are two kinds of prostate biopsies available. Someone with two elevated PSA scores with no other likely cause * and a history of sepsis * may want to request an MRI before any biopsy. If a biopsy is still then needed, a transperineal biopsy carries less risk of infection and a recurrence of sepsis than a transrectal biopsy.
This is a clear, detailed, and helpful article that answers major concerns men would have about this situation. I am 81 and have had BPH problems but would now feel more comfortable about discussing this type of cancer more fully with my urologist when I have a regular check-up. Thank you for all that you do for us.
Excellent article. I can add nothing to the medical angle, but there are other angles to consider too.
Let’s use President Biden as an example. I believe he’s 82. If he were totally cured of his cancer, that doesn’t really solve the problem given his age. If he was totally cured of one thing, that’s really just setting the stage for the next problem.
My Dad died of prostrate cancer, but he went pretty quick, so there was no hospital horror show. My Mom died of Parkinsons, which can be brutal over an extended period of time, 15 years in her case.
What I’m trying to get at here is that it seems difficult to analyze the desired course of action in these cases unless we have some basis of comparison. Where does President Biden think he’s going after this life? He seems to be a serious Catholic, so that gives us a clue, but perhaps none of us REALLY know what we believe until the end?
Many seniors suffer enormously as they reach the end of their lives. Some giant percent of all health care spending occurs in the last year of life.
Assuming a person is 80+ years of age, I would propose that serious illness at that age is not really a medical issue, but a philosophical one. How one would approach treatment would seem to depend a lot on what one considers the alternative to treatment to be.
The medical community has the best of intentions. But to the degree they push advanced treatments which may come with many ugly side effects, they are unintentionally sending a dark philosophical message.
“As bad as your current situation is, the alternative is even worse”
While that may indeed be true, it seems important to make clear that this is not a science based assumption, because there is no proof of that statement’s validity.
We might be wary of looking to the medical community for advice on matters which, so far at least, really have nothing to do with science.
I hear you. All too often in the US we often medicalize the aging process. To me, the question of how to handle a tough diagnosis (at any age) isn't *should you pursue aggressive versus conservative care*, but rather it's two questions 1) what are your goals and core values and 2) what tradeoffs are you willing to accept given the hard decisions you are facing. In other words, you center the patient not the diagnosis
Thanks for your reply appreciated.
We aren't doctors at our house, but my wife is an AVID wildlife rehabber who spends hours every day trying to keep her patients healthy and alive so they can be released back to the life they were designed to live. She's been doing this for 20 years.
Point being, when that process is your daily life for years, it can be difficult to switch gears and choose death as the best option in a situation. Part of what complicates it is that she sees the death of a patient as her personal defeat. Living in a wildlife hospital does make me sympathetic to the demands we place on health care providers. We expect them to be laser focused on making us well, and then turn on a dime and go in the other direction at the exact right moment. I couldn't handle those demands myself.
As you've seen, my concerns are really more philosophical than strictly medical.
When a vast medical system with great scientific authority (and the rest of society too) fights desperately to keep us alive, an unspoken and unintended message being sent is that where ever it is we are going after this life is to be avoided at all costs.
It makes me wonder whether that dark message is one of the things that makes us sick.
We're sailing across the ocean on a ship, and we've been told that the ship is definitely going to sink at some point, and then everything we fear the most will happen. How are we supposed to have a good vacation? :-)
Harvard researchers followed 1000+ men with early-stage prostate cancer for several years. Compared with men who rarely ate eggs, men who ate even less than a single egg a day appeared to have twice the risk of prostate cancer progression. The only thing worse for prostate cancer than eggs was poultry: Men with more aggressive cancer who regularly ate chicken had up to four times the progression risk. A single daily serving of cruciferous vegetables such as broccoli, brussels sprouts, cabbage, cauliflower, or kale may cut the risk of cancer progression by more than half.
A 2015 meta-analysis found that high intakes of dairy products—milk, low-fat milk, and cheese, but not nondairy sources of calcium—appear to increase total prostate cancer risk.
I know someone with exactly this diagnosis who died of squamous prostate cancer. Diagnosed with prostate cancer, Gleason Score 9, had spread to the bones, hormone treatment. Clear of cancer from October to March when he felt hideous pain all over. Died early June of the very rare squamous cell prostate cancer. Any thoughts?
So sad.
So theoretically, Biden’s doc may have followed the guidelines not to screen at his age, and here we are….?
Possibly .. it just seems unlikely that the POTUS didn’t get aggressive screenings
You may want to add that the PSA scores are adjusted by age due to age related enlargement of the prostate. You may also want to add that there are two kinds of prostate biopsies available. Someone with two elevated PSA scores with no other likely cause * and a history of sepsis * may want to request an MRI before any biopsy. If a biopsy is still then needed, a transperineal biopsy carries less risk of infection and a recurrence of sepsis than a transrectal biopsy.
great point - thanks for raising it
This is a clear, detailed, and helpful article that answers major concerns men would have about this situation. I am 81 and have had BPH problems but would now feel more comfortable about discussing this type of cancer more fully with my urologist when I have a regular check-up. Thank you for all that you do for us.
Thank you for reading!