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Advanced prostate cancer fundamentals - Bruce Kynaston


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Posted on behalf of Bruce Kynaston

1. We must be honest with ourselves.

We must admit to our humanity.

Likewise to the fact we are mortal

2. We have prostate cancer

in its advanced form,

in fact some are in advanced, advanced (meaning no longer responding to ADT).

3. While we are 'up and about' we are capable of having/acquiring one or more of the diseases in the pathology (= study of disease) textbook.

From the above, we are all going to die either because of prostate cancer or with prostate cancer but from some other cause.

Questions then are: How, when, where and why.

How: This is a tricky one, for no matter what we may think at this moment, it is unknown.

That is something that could make one fearful, so it is better not to speculate and not to worry, as it is pointless.

When: If the 'writing on the wall' is getting larger, then time may be shorter.

Where: If one has any say in it, then as the 'when' factor becomes prominent, one could choose. It is probably better to have some thoughts set down even now/soon.

Why: (Refer to the fundamentals.)

Current status.

As a doctor, I could ask: when were you last in your usual state of health?

Think about it, as a good question to be asked.

If you started: when my PSA began to rise, that could be accepted if it referred to the most recent occasion.

Especially if it was quite recent.

I say that because the advanced cancer patient, from my professional experience, lives from day to day.

Most people with whom I had dealings accepted that they had a problem and were doing what they could about it.

If a man with advanced prostate cancer has truly accepted the fact, as above, then he is in a strong position to control his destiny.

It is described as a state of grace.

In that, for one who is up and about, it is possible to contemplate today and compare it with yesterday.

If the comparison indicates: much the same, then that person could make a very positive mental note to make 'this day to be the best day of the rest of my life'.

One lives from day to day.

Such does not prevent one's going to seek a consultant's advice, be it GP or urology/radiation/medical oncologist about any unexplored avenue to follow to improve one's situation.

BK's attitude to palliative care differs from the usual interpretation of 'terminal care'.

Consider (from Wikipedia) 'Palliative care is specialized medical care for people with serious illnesses. It is focused on providing patients with relief from the symptoms, pain, and stress of a serious illness — whatever the prognosis. The goal is to improve quality of life for both the patient and the family.'

I submit it commences the moment your doctor diagnoses incurable cancer, even if that is but a sustained rise in PSA after a previous aggressive treatment in a man thought once to have localised disease.

At that situation one could live from month or year to ….. until.

To be honest as I must be with group members, I believe I am in the category of reactivated prostatic cancer, with a steady rising PSA, but without regard as to where it may be located. I am on this section of the 'club'.

As a former consultant, I am very aware of the need for psychological support, and have left it to the last so it is not unnoticed.

Times are stressful, and help should be sought at any time when pressures dictate. A good doctor should recognise the 'vibes' in the absence of a mention by the man, but it is necessary for a man to seek help if it is needed.

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