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No. Prostate Cancer is not the “good one”
The narrative is tidy. The reality is not.
People say all kinds of things when they find out you have prostate cancer.
“Oh, that’s the good one.”
“If you’re going to get cancer, that’s the kind to get.”
“Uncle Bob had it. He’s fine. Lost a little down there, but hey—still golfing!”
These comments are delivered with the confident tone of someone who once read an article in a waiting room and now believes themselves an authority on urological fate. It’s meant to reassure. But it lands somewhere between tone-deaf and absurd. Let me offer a correction: if this is the “good” cancer, I’d hate to see the bad ones.
I’ve been diagnosed with high-risk prostate cancer. And no, that’s not the warm-and-fuzzy version. It comes with a steep PSA, aggressive cell patterns, and words like “perineural invasion” that make even seasoned oncologists frown into their coffee. There is no “watchful waiting” here. There is no “small bump in the road.” There is a full-court press of hormone suppression, radiation, injections, scans, and silent calculations no one wants to say out loud.
I am not devastated. I’m not shaking my fist at the heavens. I’m on Firmagon, a hormone-suppressing drug that’s left me with the emotional depth of a cold yam. But I am grieving—just not what people expect.
It’s not my mortality I mourn. It’s the system. The ritual depersonalization. The slow and seamless replacement of medicine with manufacturing.
Somewhere along the line, healthcare stopped being about care. It became process. Diagnosis, categorize, apply template, discharge. Repeat. It’s not medicine—it’s operational logistics. And I? I’m not a patient. I’m a barcode. A chart. A line item in someone’s quarterly review.
When I received my diagnosis, it didn’t lead to a thoughtful conversation. It triggered a workflow. PSA? Gleason? Protocol 7A. We’ll beam you, drug you, and file you. Please don’t ask too many questions. You’ll jam the system.
And I don’t resist. I comply. I sit. I nod. I attend my appointments like a citizen of the bureaucracy. But I’m fully aware that if I died mid-consultation, someone would update my file before closing my eyes.
What’s missing isn’t care—it’s thought. The professional curiosity. The raised eyebrow that once said, “This doesn’t quite add up.” That moment is gone. There’s no billing code for nuance. No reimbursement for uncertainty. We’ve replaced judgment with guidelines, and humanity with templates.
If you dare ask for something different—something tailored—you’re marked as “complex.” “Noncompliant.” A threat to throughput. Heaven forbid you need medicine that isn’t pre-approved by flowchart.
I don’t rage. Rage would require more hormonal capacity than I’m currently authorized to possess. What I do is observe. Document. Witness the quiet dismemberment of individuality in the name of efficiency.
They say cancer robs you of power. But let’s be honest: the system got there first. It took my individuality, stapled it to a protocol, and called it care. I’m not angry. Just quietly aware that I am being processed like all the rest.
So no, prostate cancer isn’t “the good one.” It’s just the one we’ve learned to market well. We’ve turned it into a manageable narrative. Not by making it easier, but by making the process more sterile.
Let’s not confuse predictability with compassion. Behind the spreadsheets, the survival curves, and the cheerful pamphlets, some of us are still watching. Still thinking.
So the next time someone tells you they have prostate cancer, maybe skip the clichés. Don’t offer them borrowed optimism.
Just ask how they’re really doing.
And please—don’t tell them it’s the good one.
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Hans,
These essays need be published in book form. They are masterfully written, and taken together, offer great insight into this trail of tears we share.
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12 ReactionsI wouldn't think anyone would be interested. My only hope is that they get read by those coming after us or standing before decisions for which they cannot possibly know the consequences. If someone wants all the Word documents, they're welcome to have them.
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4 ReactionsOMG the cheerful pamphlets make me want to (metaphorically) light them on fire in the waiting room. When I saw one that said "Intimacy may not be what it was before, but with discussion and planning you and your partner can find new forms of intimacy, like cooking a meal together." I used to cook meals with my MOM and, while it was certainly nice, it wasn't "a new form of intimacy."
"Hey dad, want to be intimate?" "WHAT?!?!?" "You know, grill some steaks together."
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7 ReactionsI just couldn’t help myself. Thank you for the laugh. I needed it. Come to think about it…here’s another pamphlet idea
Once upon a time, foreplay meant whispered innuendos, roaming hands, and a general air of possibility. Now it begins with, “Did you remember to defrost the chicken?” and ends with one of you falling asleep upright in a chair. The pamphlet would like you to believe this is still intimacy — that your apron strings are the new lingerie, and that nothing is sexier than synchronized sautéing.
They speak of “cooking together” as if it’s a tantric ritual, a kind of slow-motion orgy conducted over a cutting board. But in reality, it’s two people standing in silence, one of whom can no longer taste food thanks to medication, while the other resents being the designated chopper because “your wrist cramps up again, doesn’t it, Harold?”
There’s no seduction here. No heat, unless you count the microwave. Garlic has replaced perfume. Your most intimate exchange of the week was probably a dispute about whether to keep the damn kale. And yet, this is what we are told to embrace. This, they assure us, is our new erotic landscape — a land where sensuality has been outsourced to domestic tasks and mutual supervision of fiber intake.
The term “cooking as intimacy” sounds romantic until you realize it mostly involves reminding each other what you’re not allowed to eat anymore. “We can’t have that,” she says, “too much sodium.” “And that?” “Might interfere with the statins.” You stare longingly at the forbidden block of cheese, the last symbol of your once-dangerous passions, and settle for something beige, boiled, and utterly sexless.
But hey — the pamphlet says intimacy is evolving. You’ve just leveled up to the part where your libido is a shadow, and your romantic connection is expressed via the even dicing of a zucchini.
And if that doesn’t stir your loins, don’t worry. There’s always Chapter Two: Folding Laundry with Eye Contact.
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8 ReactionsVery concise and thought-provoking.
Agree, wholeheartedly!
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2 ReactionsSeriously? They need to be complied….
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2 ReactionsYeah that's the good Cancer. I think I will go to my Urology office and spread that around and see how they react. Thanks Hans you continue to help us all cope with this a little better with your posts. 🙂 Have you thought about a youtube channel? 🙂 I would love that 🙂
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5 ReactionsHaven’t … don’t want to commercialize this. Just trying to be helpful leveraging a little humor and gently questioning the system.
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10 ReactionsHans, you are so spot on, on every one of your points, as are the replies you have received, along with some much-needed and welcome humor. It really bothers me that people can be so cavalier about prostate cancer, and that it has been so minimalized by our society. We in this forum all know that younger men do get it, it can be aggressive and fast-moving, it can metastasize and be as horrific as any cancer, it robs you of so much, and it’s not just an old man’s disease that many die with, not even knowing they have it! So much for an enlightened society. Regarding intimacy, there is a seriously major component missing in the consultations as to the course of action to be taken, treatment, and short and long term aftermath, and that is required couples counseling (if you are fortunate enough to have someone go through this with you). It is uncharted waters for both, a monumental change in the relationship, and far too important to leave it to the couple to work out (or not) on their own. Some people are understandably much too uncomfortable to get into the subject on such a deeply personal basis, but that is where the mental and emotional health care professionals really need to step up, interject themselves, and insist on being involved.
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