A guided tour to the real conundrum of treatment choices

So, you’ve been diagnosed with prostate cancer. Congratulations. You’ve now entered one of the most exclusive clubs in the aging male body horror genre. It’s like winning the world’s worst lottery—except the prize isn’t money, it’s a buffet of equally disturbing treatment options and the chance to slowly lose all sense of normalcy. Please keep your arms and sense of masculinity inside the vehicle at all times.

It all starts innocently enough: a blood test, a slightly elevated PSA, maybe a digital rectal exam from someone who claims, without a hint of irony, that it’s “routine.” Then come the scans, the MRI, and the infamous biopsy, where a professional stranger jabs your prostate with what feels like a medieval weapon while chirping, “You’ll just feel a little pressure.” Sure. And childbirth is just a tickle. Eventually, a result arrives: cancer. Not “you might want to keep an eye on this” cancer, but full-fledged, “time to make life-altering decisions with wildly conflicting information and absolutely no clear answer” cancer.

And now, the real game begins: choosing your treatment. Or more accurately, choosing your punishment. Because each option is lovingly designed to cure you in the most creatively inconvenient way possible. First, there’s “active surveillance,” which sounds relaxing—like the cancer equivalent of sitting on a porch with a shotgun. You’ll be poked, scanned, and biopsied on schedule, all while pretending that the malignant cells inside your body are just chilling and not planning a coup. Your reward for this strategy is waking up every few months in a cold sweat wondering if you’ve made a fatal mistake by… doing nothing.

If passivity isn’t your thing, you can always go full alpha and have the whole damn prostate cut out. Radical prostatectomy is the go-to option for men who believe that no medical issue can’t be solved with a good old-fashioned amputation. Just rip it out. Problem solved. Until, of course, you discover that the prostate also played a minor supporting role in urinary control and sexual function. Whoops. But don’t worry—surgeons assure you that these functions “usually return with time,” which is technically true, if you’re very patient and have a rich fantasy life involving pharmaceutical support and absorbent underwear.

Maybe you’re not into knives. Maybe you like your suffering slow-cooked instead of flash-fried. In that case, radiation is for you. You can go external, where you’re zapped daily by a machine the size of a sedan while making polite conversation with the technician who’s probably twelve. Or you can opt for brachytherapy, which involves implanting radioactive seeds directly into your prostate, turning you into a glow-in-the-dark fertility deterrent. Radiation’s charm lies in its subtlety: you won’t feel a thing—until you do. Slowly, insidiously, your bowels revolt, your bladder burns, and you begin to understand what it must feel like to be a microwaved burrito.

But wait—what if you like all the side effects? What if you look at each treatment and think, “Why choose just one when I could ruin my body in multiple dimensions?” Enter triple therapy: the gourmet tasting menu of prostate cancer care. External beam radiation? Absolutely. Brachytherapy? Sprinkle that on top. And then—and this is the chef’s kiss—you’re lovingly marinated in androgen deprivation therapy for a year or two. It’s the full prostate purge, a medical cleanse in which your cancer is attacked from every angle while your endocrine system quietly implodes.

Triple therapy is the option for when you and your doctors agree that your cancer is just a bit too ambitious and needs a full-on smackdown. The upside? Statistically higher rates of cancer control. The downside? Statistically higher chances of feeling like a fatigued, emotionally fragile, hormonally unbalanced shell of your former self. You’ll wake up soaked in hot flashes, cry at dog food commercials, and slowly forget where you put your car keys… or your will to live. Meanwhile, your libido will become a quaint memory from a past life—like cassette tapes or drive-in theaters.

All the while, your doctors—each more confident than the last—will present their preferred treatments as The One True Way. Surgeons love surgery. Radiation oncologists swear by radiation. Medical oncologists believe everyone should be chemically neutered indefinitely. No one agrees, but each is 100% certain. It’s like a religious debate, but with more co-pays. Your role in this? To nod, Google obsessively at 3 a.m., and eventually choose the option that sounds least like medieval torture, knowing full well you might regret it later.

And what about the side effects? The real ones, not the sanitized bullet points on the pamphlet. We’re talking about the erosion of dignity as you leak urine in a shopping mall, the awkward silences in the bedroom, the slow, sinking realization that your body will never again feel like it used to. Not to mention the newfound ritual of anxiously awaiting every PSA test, hoping your cancer hasn’t decided to make a sequel.

In the end, there are no good options—just different flavors of compromise. You’ll pick your poison, endure the fallout, and try to patch together a new version of yourself from the slightly smoldering ruins. The good news? You’ll probably live. The bad news? You’ll have the rest of your life to think about the trade-offs.

Prostate cancer isn’t just a diagnosis. It’s a full-time job, an identity crisis, and a masterclass in medical gaslighting. But at least now, you’ll finally understand what they meant by “the good cancer.” Good, as in “not instantly fatal.” Or perhaps, good as in “you’ll eventually be grateful, once the fog of hormone-induced apathy sets in.”

So congratulations again. And remember: no matter what you choose, there will always be someone with a smug opinion telling you you did it wrong. But hey, at least you’re not dead.

Yet.