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A quick Question
why is dying from prostate cancer more dramatic than dying from good health?
by Someone Who’s Had Just About Enough of It
If dying is the inescapable invoice for the simple act of being alive, then why, exactly, are we spending billions trying to negotiate a discount? Cancer care alone gulps down enough money annually to fund a small moon landing, all in service of delaying the inevitable by months, maybe years, rarely decades. It’s a curious economic model: throwing limitless resources at a guarantee. We don’t spend this way on education, on poverty, on mental health, or on people who are actually alive but inconveniently struggling.
No, we save our fortunes for the dying; for those circling the drain in sterile rooms, hooked to machines, generating a tidy profit with every scan and side effect. It’s less about curing and more about extending the invoiceable portion of existence, one billable unit of suffering at a time.
Let’s start with the only real truth worth the copay: life ends. Always. Universally. Irrevocably. A 100% fatal condition, stubbornly resistant to treatment despite centuries of research, prayer, green juice, and good intentions.
So why, if death is so predictable, are we so pathologically afraid of it? Why do we shrink from it like it’s some unthinkable deviation rather than the most democratic event we’ll ever attend?
Here’s a darker question: if the final outcome of prostate cancer is death, whether from the disease itself or from the charming bouquet of side effects gifted by its treatment, why do we fight it like cowards with credit cards?
We nuke our glands, choke our hormones, shatter our bones with bone-sparing drugs that rot our jaws, and then crawl through the wreckage to the next appointment. For what, exactly? Another month? Another scan? Another staged conversation about “quality of life” from a doctor wearing a Rolex and a mask of concern?
If the logical outcome of life is death, and spoiler alert: it is, then why, exactly, are we so hell-bent on prolonging the agony? Why do we clutch our pearls at the mere mention of dying, as if we weren’t all hurtling toward that destination with the same inevitability as a prostate swelling under the guidance of time and testosterone? And why is dying from prostate cancer more dramatic than dying from good health?
We spend billions, yes, with a b, each year on prostate cancer alone. Not to cure it, mind you (heaven forbid we do something so radical), but to manage it. To monitor it. To metastasize the bureaucracy. To fund the glorious arms race of radiation beam penis preservation. Meanwhile, people who are merely alive, a far more precarious condition, really, get sweet bugger-all in support. Can’t work? Can’t eat? Can’t afford rent? Sorry, not dying fast enough to qualify for aid. Come back when you’ve grown a tumor or two, and we might stick a needle in you or, better yet, a radioactive seed.
There’s something perversely elegant about it all. If you die of cancer, it’s tragic. If you live in poverty and die quietly, it’s statistics. We’ve medicalized death and economized life. It's all very tidy. Why the disparity? Why does the oncology wing have walnut paneling and espresso machines while social workers share a single stapler and a bag of off-brand raisins?
Simple: Dead men don’t invoice. But the dying, the dying are a goldmine. We can milk them for imaging, biopsies, hormone therapy, pain management, end-of-life counseling, grief therapy, genetic testing, dietary supplements, robotic surgeries, and yes, inspirational TED talks with titles like “Dancing with My Diagnosis” or “My Tumor, My Teacher.” And prostate cancer? It’s the crown jewel of this carnival. Slow enough to string out for decades, dangerous enough to frighten, and deeply entangled with the organ most closely associated with masculinity, making it a veritable jackpot of fear, shame, virility, and Viagra. The trifecta! Or quadfecta, if you count the incontinence pads.
But here’s the cosmic joke: whether we die of the disease or the side effects of trying not to die of the disease, we die anyway. We march in the same parade, just in different costumes; some dressed in hospital gowns, others in hospice sheets, others yet in three-piece suits. Most without money, some very rich. The worms don’t care. You taste all the same.
The real disease isn’t cancer. It’s our delusion that death is optional, a failure of planning or insurance coverage. It's the irrational belief that if we throw enough money at the problem, the Grim Reaper might accept a copay.
And where did this sectioned, diverse, perverse logic come from? Somewhere between the hospital marketing department and a bottle of Ativan. Somewhere between the priest and the pharmaceutical rep. Somewhere in that uneasy alliance of capitalism and compassion, where the human body becomes a ledger and a life becomes a subscription service, cancelled only upon nonpayment or non-breathing.
Meanwhile, the living who simply can’t go on, who suffer from a chronic condition known as being alive in a system not designed for them, remain overlooked. No radiation. No research grants. No glossy pamphlets. Just another appointment missed because the bus didn't come, and the rent did.
So yes, we fear death. But not as much as we fear irrelevance. And death, at least, still gets top billing. Living poor? That's just bad taste. But really… we keep living, not because we’re brave, but because no one wants to admit the game was rigged from the start. We fight death not to win, but because surrender would mean acknowledging that the emperor not only has no clothes, but has terminal cancer, a ten-thousand-dollar deductible, and a follow-up in six months. And so we persist. Not because it makes sense. But because nonsense, when properly funded, becomes the standard of care.
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Oddly enough, North, I know a few people who’ve been denied an MRI by their ins. Co. Unless they did 6 weeks of physical therapy first.
My best friend requested one for excruciating hip pain and upon review, the ins. co. Said nope - PT for you. Turns out he had a vertical fracture in the head of the femur and PT was making it worse. Talk about a waste of $$?
Thank God for hip replacement surgery!
Phil
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2 Reactionshmmm, again, you are not wrong, but...
As a society and as individuals, couples, families, we do need to discuss end of life, quality vs quantity.
That being said, I was diagnosed at age 57, two daughters, both in high school...
I felt I had a lot of living left, graduations, birthdays, vacations, anniversaries, maybe even weddings and grandchildren (not yet, though one may be close), doing things with friends...
All those have been experienced, well, no weddings or grandkids. My wife and I have vacationed two or three times each year, skiing and hiking in Colorado, the Big 5 in Utah, Ring Road in Iceland, New England, Oregon Coast, I have attended both daughters' graduations from high school and colleges, played pickleball with friends, gone skiing with them too. I've watched my younger daughter becomes sports director at two separate television stations and cover two super bowls, a NCAA championship and MLB post season playoffs. I've seen Billy Joel, Bruce Springsteen, Willie Nelson, Chicago and others in concert, attended baseball and college basketball games for my favorite teams, rode with my daughter and sister in the Garmin Unbound in the Flint Hills near Emporia, KS, and did the Battan Death March with my sister in White Sands, NM. As I type, I'm at Lake Tahoe for a week with my wife, two daughters and one boyfriend.
I could go on, you get the idea, a lot of living.
It's been 11+ years since that day when my urologist called me with the diagnosis. I had my pity party, then I picked myself up off the floor, literally, and set about figuring out how to either cure this or live the longest possible life with it balancing quality and quantity.
I have succeeded, in part thanx to medical researchers, a quality medical team, accepting responsibility for advocating for myself and shared decision making between my medical team and I, firing some very distinguished medical experts when they were not active listeners and offered baseline standard of care.
Have I enjoyed time on treatment and the side effects, heck no!
Do I look forward to the future, heck yeah, goal is 83, I'm 69+ now.
Will I have to make decisions about quality vs quantity of life later, maybe. I'll deal with it then. I have prepared in a way, have an estate plan, put in place medical power of attorney, discussed with my wife and children my desires not to live a long life in a hospital bed...
Kevin
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7 ReactionsA repeat mpMRI may prevent or forestall unnecessary repeat biopsies in a well informed surveillant patient. With each new mode of treatment modality we get closer to simpler preventive and early curative interventions. It certainly would be nice if a PEZ- dispenser could provide an effective OTC treatment in the
not too distant future.
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1 ReactionPlease, Hans, can I be your literary agent?
You were diagnosed with a PSA of 2.1 only and had metastases?
Death, where is thy sting?
I was diagnosed w/PSA of 2.1. However, not in the traditional way.
In September 2010 I had DVT and PE (I'm here, so survived...), shutting down my lungs. my Primary Care provider had completed a CEMU that discussed the relationship between DV, PE and cancer. So, she ordered a colonoscopy to start, that showed a few polyps, albeit benign.
Still, that resulted in another colonoscopy three years later where the gastrologist also examined my prostate and when I woke up, suggested I see my urologist.
I did, a DRE and then TRUS biopsy showed PCa.
They did a PET/CT scan, it showed nothing but keep in mind the state of technology and imaging in 2014, not likely it would with a PSA of 2.1. Still, a very "successful" surgery and yet 18 months later, BCR. So, odds are there was micro-metastatic PCa outside the prostate too small too small to be seen at that time.
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2 ReactionsAs has been the case during my lifetime, it’s about lifestyle choices, self-advocacy and shared decision-making.
Despite the fact that none will get out of this alive, we have the choice of not hastening our demise by bad lifestyle choices. Though there are always exceptions, the majority of early deaths are caused by bad lifestyle decisions. (And with prostate cancer, it’s mostly about early and annual screening, which often leads to early detection.)
As for overtreatment here in the U.S., that’s our choice as patients as well. I recall that prior to starting my 28 proton radiation treatments for my localized 4+3=7, my RO asked me if I wanted another biopsy. (I had 4 of them over 9 years while on AS.) I said, “no thank you - let’s proceed with the treatments.” I could have just as easily said yes.
I suffered very little during proton radiation treatments, choosing to undergo modern medicine, rather than a much less expensive, nearly two-century-old technique. With today’s data showing there’s no statistically significant difference in outcomes between surgery and radiation, there is rarely a medically-necessary reason for a prostatectomy. More expensive but much more expensive options will continue into the future as treatment options continue to press the envelope.
During my now 13-year prostate cancer journey (and now at ~70y/o), never once have I been seriously concerned about my demise from prostate cancer - technology and science will once again bail me out, and continue to extend my years (as I get older and grayer).
But, that longevity comes at a price - $$$.
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3 ReactionsKevin, why 83? That's an odd number.
Actually, I'm hoping to live to an odd number myself: 81, so I can celebrate my 50th wedding anniversary. Then I'll be ready for checkout.
Unless, of course, my PCa is miraculously cured, as well as my arthritis. Then I might hang around a bit longer.
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1 ReactionHans , the more I read your posts the more I regret at 78 going thru surgery radiation and hormone injections. Some of what you say may seem you live in a dark life but most of your comments like it or not are true but many afraid to accept it .