If I ever get a cancer in my prostate...
My personal views do not commit anyone but myself. I will not give any advice nor prescription.
I am just reporting a flfty years personal experience with sincerity : I would apply my own opinion to myself.
I refuse any biopsy before treatment :
a) diagnostic can clearly be done by rectal palpation and Prostatic Specific Antigen (PSA) blood level, without any invasive surgery.
b) normal rectal palpation by itself increases the PSA blood level
c) biopsy needles open blood vessels and release malignant cells into the circulation.
New fashions advocate more and more numerous biopsies. I do not agree. I refuse my prostate being changed into a bloody sponge.
There is no doubt that the moment of the first malignant dissemination is very hard to assert. Nevertheless my practical experience and my survey of an important file of a cancer hospital let me believe that , in new cases, this event is often contemporary of the first surgical operation - biopsy or transurethral resection - that opened venous vessels.
Numerous medical papers based on supposed metastase free series are simply foolish : there is no means of detecting cancer on the beginnings.
Bone scintigraphy can accurately identify only cellular bulks that started their growing from a few migrating cells about two years before and that are already beyond cure therapy.
I want that a hormonal treatment be instaured the very day of diagnostic, without any delay.
a) Why a hormonal treatment ?
1) Death by prostate cancer is mostly due to bone metastasis of the spine.
I refuse such a life's end, overcome by such a pain that the unescapable solution is euthanasia, disguised as compassional treatment with morphine.
2) the only really working treatment of distant metastasis is hormonal.
- Every urologist can recall spines flooded by malignity that unbelievably recovered an apparently normal aspect by the effect of oestrogens or antiandrogens.
- The medically correct argumentation on the subject still remains the sixty years old survey of the american veterans who were treated by diethylstilbestrol .
This huge investigation came to conclusions that diethylstilbestrol :
- soothes bone pain
- does not prolong lifespan
First, as do numerous colleagues, I contest the second of these conclusions, not only because analysis refinements show clearly that statistic samples have been distorted but above all because daily observation simply shows the contrary.
Then, instead of drawing the honest and simple conclusion that giving the drug for bone distant metastasis is justified, the medical authorities spread the assertion that diethylstilbestrol could not be given but for relief of bone pain.
I claim that no one can enact such a law when the molecule had not been tested in any other case but terminal and beyond hope conditions.
b) Why a primary hormonal treatment ? :
a) - Only scarse populations of malignant cells can be completely destroyed by hormonal therapy. The typical feature of cancer is the disorder of genic deviance. After the hormonal blast a tiny percentage of surviving cells still makes a rather numerous population whenever the original bulk is large so that independent colonies can organize and expand. This is not the case in scarse populations where the few surviving cells can hardly resist against natural defenses because the statistic chance of selecting resistent genomes is much lower and presumably because one cell alone can't stay alive. The only hope of healing bone sites of metastasis lies in very early action against scanty cellular stuff.
Definitive stabilisation is no utopia. As in breast cancer, a similar hormonodependent tumor, attaining recovery is not so rare. I had the opportunity to assess it in my own family.
b) - Primary hormonal treatment does not impair any of other options. On the contrary it enhances their efficiency by lowering the tumoral mass. I wish to emphasize that in my personal experience previous hormonal treatment never blurred the histological diagnosis on resection or biopsy material.
c) - Vascular risk linked to hormones falls to almost nothing when rational doses are given under small doses of protective antithrombotics.
Prostate cancer and sexual philosophy
In western countries prostate cancer is deeply involved in sexual philosophy.
According to christianity Life is the highest of all values. Yet, facing every day concerns, emotion often overcomes good sense and set male erection at the highest level as being the leading part of health.
If questioned about the sentence to be applied to children rapists and murderers a huge majority would choose life imprisonment or even hanging rather than testicular pulpectomy.
Putting an end to the murderer's erection seems much more unbearable to one's conscience than putting an end to his life.
Honourable men would rush to the front row pleading the lack of scientific proof. These people are the same who, for more than a century, advocated tobacco arguing that its harmfulness had no scientific evidence. Nobody hurries up to find the scientific harmfulness of what he loves.
During african tribal wars I saw dozens of young men who had their genitals cut away. I assert that loss of testicular hormones annihilates sex drive and wish . These poor fellows were not worried by sexual impotence for the simple reason that they felt no deprivation. Either they were pushed to the consulting room by the harassing request of a family waiting for descendants, or because section of the urethra produced a blocking stricture, often complicated by enormous abcesses and water can perineum.
In the same manner any debate on hormonal drugs for prostate cancer is completely corrupted by the underlying supremacy of male erection over life itself. Therefore estrogens and antiandrogens must necessarily be given only to desperate cases in terminal life.
I do not personnally adhere to that common mass philosophy. I regard Life as the highest value.
Being a surgeon, I could accept the supremacy of Health over vegetative life. But erection of the aged male is by no way a health function that could be above Life.
Let it be said -by the way- that the medical power is commonly detained by quinquagenarians whose heat of passion is proverbial, bodily strength intact and who are obviously unable to pay any real-life attention to the elderly.