This week, Peter Kafka, our Board Chair and Lead-Moderator for the Low/Intermediate Risk Prostate Cancer Virtual group highlights an issue that crosses the minds of many living with cancer:

How can I have cancer?  I don’t feel sick!

One of the odd things about a diagnosis of prostate cancer as well as other cancers is that it is often asymptomatic.  Prostate cancer is often detected though a routine blood test or digital rectal exam.  This is especially true for men who get regular physical exams.  Perhaps there might be some changes in our urinary function as we age, such as increased frequency and a lessening of the stream.  But generally, many men, in our sixties and seventies often proclaim that; “I am quite healthy, active and fairly fit.  How can I possibly have cancer?”

Fortunately, most men with a diagnosis of prostate cancer have very low-grade disease that might never need treatment beyond routine active surveillance by a doctor.  The only “downside” being that the man, and his doctor and family must be comfortable living with a diagnosis of CANCER and understand that the rate of growth is so low that it might never need further treatment.  Such men will never experience symptoms of prostate cancer beyond perhaps changes to their urinary stream or frequency which is common for most men as we age.

Even men like myself, with advanced prostate cancer can go through cycles where one feels quite healthy and vigorous yet tests can indicate that the cancer is spreading and growing within our bodies.  With the advent of advanced high-tech scans such as the PSMA scans, genetic testing, multi parametric MRI’s and other methods of early detection, indications of some level of prostate cancer progression can be observed at increasingly earlier stages when there are no outward symptoms or signs of distress.

The down side of these advances in early detection is that our minds can get into denial mode because we “feel just fine”.  In fact, it is very often the case that it is the side effects of treatment regimens such as ADT drugs, or the after effects of surgery or radiation that make us feel sick rather than the cancer itself.  Prostate cancer can be quite sly in this way and trick us into thinking that we are much better off without any treatment.  This is the dilemma of our modern age.  It used to be that men were diagnosed with prostate cancer only when it had already progressed to the point of distressing symptoms which could not be ignored.  We now live in a very different paradigm.  Lucky us!