1. < Prostate Cancer

No. Prostate Cancer is not the “good one”

Posted by hans_casteels @hanscasteels, Apr 14 3:39pm

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.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

deku | @deku | Apr 18 11:46am

@heavyphil - surgery was not an option for me, my primary tumor grew outside the prostate as well as metastasized to dozens of regional and distant lymph nodes. Radiation plus ADT made me feel like a zombie, although fatigue is back to ADT-only levels now that I'm 10 days post-radiation. The calendar says I'm 51, but I feel like I have aged 10-15 years in the past six months.

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1 reply
heavyphil | @heavyphil | Apr 18 4:17pm
In reply to @deku "@heavyphil - surgery was not an option for me, my primary tumor grew outside the prostate..." + (show)
@deku

@heavyphil - surgery was not an option for me, my primary tumor grew outside the prostate as well as metastasized to dozens of regional and distant lymph nodes. Radiation plus ADT made me feel like a zombie, although fatigue is back to ADT-only levels now that I'm 10 days post-radiation. The calendar says I'm 51, but I feel like I have aged 10-15 years in the past six months.

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Geez, 51 yrs old and it had already spread…that’s awful and there’s no way to sugar coat it. It sucks. The radiation was OK for me until it was over…THEN it hit me.
The fatigue was incredible and lasted for 3 months. I couldn’t even keep up my regular exercise routine - and didn’t care either.
I hope you start feeling better; our bodies have an amazing ability to cope and adapt and sometimes our rational mind - so impatient - needs to give the larger organism a chance to catch its breath and get in sync with the new norm.
Peace, brother
Phil

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john6stodolka | @john6stodolka | Apr 19 9:27am

After the first cancer diagnosis three years ago, I just found out yesterday that an x-ray shows my prostate cancer may have travelled to the right hip and femur - in the bones. I get a CT scan next week to see what's going on.

I understand that some people get types of cancer out-of-the-blue that give them weeks or months to live and this is terrible news for anyone to receive. People rightfully call them bad cancers. I also understand that prostate cancer is generally slow moving and that's why people call it the" good cancer."

Living with any cancer is living with a time-bomb. Rather than giving them monikers like good and bad, how about calling any type of cancer ... cancer.

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VancouverIslandHiker | @vancouverislandhiker | Apr 19 11:05am
In reply to @hanscasteels "First, thank you, fellow warrior. James, it’s truly a gift when you enter a sauna seeking..." + (show)
@hanscasteels

First, thank you, fellow warrior. James, it’s truly a gift when you enter a sauna seeking peace and get a full-on clinic of unsolicited Karenology. Lots of people pretending to know issues they know nothing about... on everything, including prostate cancer, despite not knowing the first thing about it. Naturally, she’s misinformed—after all, why let our own opinions and experiences, decades of research, medical experience, or actual statistics get in the way of a good old-fashioned opinion?

Her "mild one" line is a gem, though. Mild, like a whiff of cologne or the slow death of dignity in a medical system that won't even let you get a PSA test without permission. She’s got her feelings—and that’s more reliable than decades of actual data and research. Your prostate’s misfortune, I’m sure, is only the result of not eating more quinoa.

As for the government’s rules on prostate cancer testing? Brilliant, isn’t it? A cheap, early detection test is available, but no, the state insists you’ll survive simply fine without it—after all, what do doctors know? Let them spend more time following rules than, you know, saving lives. Keep the torch burning, James—somewhere out there, logic is quietly crying in the corner.

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Sir Hans , Again you are on the mark . Karenology is well meaning or to beat you down ? HA!!! Thanks for the advise . Your words ring true . You are logic driven in a world gone mad ! 🙂 Today - I will make the best of the day . 18-22 C today on Vancouver Island , Hiking with the dogs in the Alpine is usually a great prescription for me. Overall I consider myself very lucky in that although my operation did not send my PSA to absolute zero which chair is 0.008. But rather I still had some background PSA. Had 0.14 , I had 22 session of radiation and no ADT . Seem to hav done the Trick. I still get some radiation bounce , but they are low levels the last 5 were down , 2 weeks ago it was up slightly to about 0.058 , two days ago I got another PSA , down 0.046 . I gather the machine can red slightly different values depending on days . Very sensitive machine I hear . In Saskatchewan , their machine goes down to 0.10 - after that they say "undetectable " . Interesting .....

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rotate | @rotate | Apr 19 4:03pm
In reply to @hanscasteels "The noble PSA test — that quaint little bloodwork most men don’t get unless the stars..." + (show)
@hanscasteels

The noble PSA test — that quaint little bloodwork most men don’t get unless the stars align, the moon is in retrograde, and their doctor is feeling unusually proactive between golf games.

At first, you're told PSA testing isn’t “standard protocol,” because, you know, men’s health must always remain a delightful game of Russian roulette. “It’s not reliable,” they say. “It causes unnecessary worry.” Translation: “We’d rather not know, and neither should you.”

Then — surprise! — your PSA shows up looking like a bar chart from a horror movie. But suddenly now it matters. Now it's gospel. Now you’re having your PSA read to you like it's your credit score before a mortgage application. Weekly. Monthly. Quarterly. Is it trending? Is it stable? Is it climbing? Is it… you?

Before diagnosis: “PSA is unreliable.”
After diagnosis: “Your entire existence will now be judged by these unreliable numbers.”

It’s a bit like being told your brakes don’t matter until you’ve driven off a cliff.

WTF indeed.

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My experience has been different. PSA was considered important. As for unreliable, I think they are referring to false positives - PSA jumps, but no cancer.

That happened to me several times. They wanted to do biopsies but since the best biopsies are MRI guided, I said "If the MRI is negative, why do a biopsy." And both times, it was negative.

Then last year it jumped a lot. MRI in Dec showed "60% probability of clinically significant cancer." Biopsy showed Gleason 9.

So I'd say that while PSA can give false readings that suggest cancer, in my case anyway, it was worth it - it caught the cancer early.

Now enjoying radiation therapy (actually, not that bad - i almost fall asleep during it), and the effects of low T (ugh).

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hans_casteels | @hanscasteels | Apr 20 2:14am
In reply to @dpfbanks "Seriously? They need to be complied…." + (show)
@dpfbanks

Seriously? They need to be complied….

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I did. Read: “whisk me one more time.” Thanks for the prompt.

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dpfbanks | @dpfbanks | Apr 20 7:03am

Whisking superfluous metaphors!

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laccoameno5 | @laccoameno5 | Apr 20 10:19am
In reply to @hanscasteels "The noble PSA test — that quaint little bloodwork most men don’t get unless the stars..." + (show)
@hanscasteels

The noble PSA test — that quaint little bloodwork most men don’t get unless the stars align, the moon is in retrograde, and their doctor is feeling unusually proactive between golf games.

At first, you're told PSA testing isn’t “standard protocol,” because, you know, men’s health must always remain a delightful game of Russian roulette. “It’s not reliable,” they say. “It causes unnecessary worry.” Translation: “We’d rather not know, and neither should you.”

Then — surprise! — your PSA shows up looking like a bar chart from a horror movie. But suddenly now it matters. Now it's gospel. Now you’re having your PSA read to you like it's your credit score before a mortgage application. Weekly. Monthly. Quarterly. Is it trending? Is it stable? Is it climbing? Is it… you?

Before diagnosis: “PSA is unreliable.”
After diagnosis: “Your entire existence will now be judged by these unreliable numbers.”

It’s a bit like being told your brakes don’t matter until you’ve driven off a cliff.

WTF indeed.

Jump to this post

Recently a few gem quotes from an old high school classmate's oncologist. "Side effects of Lupron are rare" "but you have no family history of PC. " I don't recomend PSA testing for men over 70" "same for biopsies" WTF indeed! Myself diagnosed at 71 PSA 43, Gleasons 7-9! Quackery is abundant for sure.
SW

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1 reply
hans_casteels | @hanscasteels | Apr 20 10:57am
In reply to @laccoameno5 "Recently a few gem quotes from an old high school classmate's oncologist. "Side effects of Lupron..." + (show)
@laccoameno5

Recently a few gem quotes from an old high school classmate's oncologist. "Side effects of Lupron are rare" "but you have no family history of PC. " I don't recomend PSA testing for men over 70" "same for biopsies" WTF indeed! Myself diagnosed at 71 PSA 43, Gleasons 7-9! Quackery is abundant for sure.
SW

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It's maddening. And worse, it's common. The medical system is rife with lazy heuristics, ageist assumptions, and “practice guidelines” that often lag ten years behind the evidence. You’ve encountered what I like to call “Standard of Scare” medicine, where the risk of offending someone’s dogma outweighs the risk of letting cancer advance untreated.

Quackery isn't just abundant — it's accredited.

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1 reply
cstrutt52 | @cstrutt52 | Apr 21 9:21am

To be fair, while no cancer is "good", what is clearly meant is that prostate cancer currently has a cure rate of 99%. Compare that to pancreatic cancer with a cure rate of 9%. Do people die and suffer with prostate cancer? Of course. When I got my PC diagnosis, I didn't stress over it, I just worked to see what I could do to get rid of it. If it had been my pancreas or live, I might have been updating my Will and making funeral arrangements. https://247wallst.com/special-report/2021/02/04/cancers-with-the-highest-and-lowest-survival-rates/

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