With the fast-growing number of options for treating prostate cancer, our decision about which to choose has become increasingly difficult. In the old old old days when it was surgery or a likely premature death, the limited list of options made the choice a little clearer. Unless there was good reason to expect a quick departure from this world for reasons other than cancer, I suppose we’d probably find a good surgeon with a sharp scalpel and hope for the best.
Nowadays our prospects are bright, but we must make a much more complex choice between conventional surgery, robotic surgery, cryosurgery, x-ray/photon radiation (IMRT), brachytherapy, hormone therapy, chemotherapy, gene therapy, HIFU, and (my personal favorite) proton therapy, to name just a few. We must also consider various intensities, frequencies, and combinations of the above, further increasing the number of line items before us.
It’s as daunting as making a selection from the 19-page menu at The Cheesecake Factory.
Choices abound. How in the world can we make sense of it all and make a good decision? It’s tough, and everyone will want to offer their two cents worth. And whether curing our cancer or our hunger, the influencers operate in surprisingly similar fashion. Our challenge is to understand and remember the motives behind all this well-intentioned advice so we can keep it in the proper perspective.
Let’s consider three areas of influence you’ll encounter as a customer at The Cheesecake Factory or as a prostate cancer newbie.
The server’s favorite
You walk into The Cheesecake Factory (TCF). The server welcomes you and delivers their massive menu, possibly in a wheelbarrow. After some serious perusal of the options, you decide to go with the Bistro Shrimp Pasta from page 8. Your server then excitedly declares, “Wow! Good choice! That’s my favorite dish!” Similarly, a more aggressive server might initially hand you the menu, turn to page 8, point, tap three times, and proudly proclaim, “This one’s my personal favorite. You should try it!”
This happens to me quite often, and each time my unspoken reaction is, “Well, hey, that’s cool, but why should your favorite matter to me?” My favorite flavors might be entirely different than the server’s. I might even be allergic to shrimp. Is there any reason to think the server’s reasons for preferring the Bistro Shrimp Pasta apply to me at all? Unless I had asked for an opinion, the unsolicited comment seems totally subjective and irrelevant.
In the prostate cancer world, the urologist is often the one who presents the menu of treatment options, and you should not be surprised if you detect a not-so-subtle server-like bias. “My personal preference,” you might be told, “is surgery. It’s the gold standard. If I were you, it would be my choice. I highly recommend it.”
Regardless of the urologist’s reason for this preference—and urologists are certainly entitled to have one—it is just one person’s opinion. And although your request for the doctor’s professional opinion is implicit, the prudent response is to research and explore the other options thoroughly on your own. Surgery might indeed be the right choice for you, but you can’t know this until you’ve given the rest of the menu equal consideration.
There are as many flavors of prostate cancer therapy as cheesecake, and you will eventually develop your own very personal reasons for preferring one over the others. Once you do, run with it and don’t look back.
The chef’s recommendation
Talk to any chef at The Cheesecake Factory and you’ll probably find that they also have a personal favorite dish, but for different reasons than the server. The chef not only knows how good their concoction tastes, but also takes pride in the skill required to prepare it properly. They might favor a recipe they invented, or one they are supremely qualified to execute.
At TCF, the chef who prepares the dish is unlikely to also be the server who presents the menu. But with prostate cancer, the urologist is often both the server and possibly your chef, not only providing the list of treatments, but also speaking as your potential surgeon. This dual role can make the urologist’s influence even more intense, doubling the force of their guidance.
Indeed, many if not most urologists are surgeons trained in conventional or robotic surgery. They naturally and rightfully believe in what they do, and there’s nothing wrong with that. It is understandably their favorite because they’ve invested considerable time and money in learning how to do it, but that doesn’t mean you must necessarily share their viewpoint. You can appreciate the enthusiasm, acknowledge the skill, and then choose to agree or disagree.
One chef at TCF might believe their Pasta Da Vinci creation is simply to die for … A skilled surgeon might sincerely believe daVinci robotic surgery is the gold standard …
One chef at TCF might believe their Pasta Da Vinci (page 8) creation is simply to die for, and will recommend it at every opportunity. A skilled surgeon might sincerely believe daVinci robotic surgery is the gold standard for prostate cancer treatment. Both are respectable views worth hearing, provided we consider the source and keep them in the proper perspective.
The house special
It’s not hard to guess what The Cheesecake Factory is most famous for. Indeed, two full pages in the menu are devoted to variations of their signature delicacy. Once I’ve finished my meal, should I be surprised to hear the server ask if I’d like to try a slice of cheesecake?
Likewise, and happily so, medical facilities have specialties, sometimes proudly represented in their name. My treatment alma mater, The University of Florida Health Proton Therapy Institute (UFHPTI), makes no secret of their specialty, even though they can also provide (for example) conventional radiation when appropriate. Nevertheless, their main attraction—the house specialty—is unquestionably proton beam therapy, and they are especially proud to be one of its earliest pioneers.
While the staff of the Cheesecake Factory will be happy to tell you about their Lemoncello Cream Torte if you ask, their enthusiasm for cheesecake will predictably be greater. Likewise, the staff of a proton center will be most eager to trumpet the unique benefits of proton beam therapy, even if they offer other treatment options, too.
There is a justifiable bias associated with having a house specialty in any field, and it’s not a bad thing.
There is a justifiable bias associated with having a house specialty in any field, and it’s not a bad thing. If we remember to expect it and allow TCF and UFHPTI to describe their respective specialties, we’ll benefit from their experience and the first-hand information they provide. Who better to tell us about cheesecake nuances than TCF? The same applies to surgery hospitals, brachytherapy facilities, and cancer treatment centers of all flavors. Let them describe the house specialty, such as it is. Then make your own informed, very personal decision.
It’s all good
Today’s menu for treating prostate cancer is as amazing and extensive as that of The Cheesecake Factory. Choices abound, and the already high likelihood of achieving a successful outcome is still on the rise. But choosing a path is increasingly challenging, and it’s not easy to exert a consistent effort to sift through all the well-intentioned advice. Easy or not, we must be aware of predictable biases and make the necessary effort to see the entire cancer therapy landscape clearly and objectively.
So choose wisely, and enjoy your cheesecake.
I’m curious: was proton on your menu? Email me!