Mr. P., a 77 year old, had always been insistent on having an annual PSA, despite his age and despite previous discussions on PSA testing in the elderly.
The most recent result was slightly high and the biopsy performed (at his insistence) by the urologist showed a "minute focus of adenocarcinoma (not surprising)." The amount was so small that a Gleason score couldn't be determined.
He wanted to undergo radiation therapy.
He was going to see the radiation oncologist the next week for a consultation.
He came to see me prior.
Me: Have you just thought about watchful waiting (I did not think he needed to aggressively treat his microscopic prostate cancer)?
Mr. P.: No, I just want to get rid of it once and for all.
Me: Are you aware that it might be such a small amount of cancer that it won't shorten your life...are you aware it still might come back after radiation...are you aware of the potential complications and adverse side effects of radiation therapy...are you aware that some folks develop colitis from the radiation, have incontinence and erectile dysfunction?
Mr. P.: Yeah, I just want to get rid of it once and for all.
Me: Do you know anyone who has had prostate cancer?
Mr. P.: My best friend, my buddy for over 50 years, died from it. He and I were retired Army and Civil service workers. We were also hunting and fishing partners. He got diagnosed with prostate cancer and decided not to do anything. He went and bought a casket and paid for his funeral. He died 6 weeks later.
Now I understood. I briefly discussed the fact that his friend most certainly had metastatic cancer at the time of diagnosis, not microscopic as was his prostate cancer, but I let him know I hoped everything would go well with the consultation for possible radiation therapy.
Mr. P.: And thanks for talking to me about this. You gave me some things to think about. At least I know some additional questions to ask before I make my final decision.
Cool, he really was listening.