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The Patient From Hell
CAVEAT: This did not unfold at the Mayo Clinic, or some gleaming temple of medical excellence where treatments are tailored and minds remain open. No, this took place at the Grand River Regional Cancer Centre in Kitchener, Ontario—a place where the oncology script is carved in stone and questioning it is heresy. The oncologist’s name was Anupam Batra. In another time, say the Middle Ages, he would have been known as Batra the Arrogant—the kind of man who, had he been handed a leech and a chalice of bile, would have declared the patient cured before they were even diagnosed.A Treatise on Medical Dogma, Testosterone, and the Inconvenience of Thinking
"What are you doing here? You're wasting my time."
— Medical Oncologist, on meeting a patient with inconvenient questions.
That was how it started. Not with a handshake. Not with a review of labs or imaging or any nod to the Hippocratic niceties. No. It began with a dismissal. The sort of tone you reserve for telemarketers, Jehovah’s Witnesses, or people who ask for ketchup in a French restaurant. Apparently, my crime was showing up to a medical oncology consult while daring to bring… curiosity. Questions. A hypothesis.
You see, I am that patient. The one who read the studies. The one who asked why the tumor, which grew quite nicely in a body that was already low on testosterone, would be further subdued by taking away the last drops of the very hormone it didn’t seem to need in the first place.
Let me rephrase that for the algorithmic minds behind cancer care protocols:
If the plant is growing in sand, is more sand the solution?
Welcome to the templated hellscape of prostate cancer treatment. You, dear reader, might have assumed that a cancer diagnosis would be followed by a nuanced discussion, a personalized plan, and perhaps the faintest glimmer of scientific curiosity. You’d be wrong. What you get is the Dogma Flowchart™. Do not pass Go. Do not collect options.
PSA high? Biopsy bad? Glands cribriform?
Initiate Protocol Alpha: Androgen Deprivation Therapy (ADT), External Beam Radiation, Brachytherapy boost. Three-part harmony. No solos allowed.
And so I asked the question that turned me into The Patient from Hell:
If a tumor develops in a naturally low-testosterone environment, isn’t it already living off the grid? Doesn’t that suggest it’s learned to survive — or thrive — without testosterone?
If you then remove the little testosterone that’s left, aren’t you, in effect, telling that tumor, “Congratulations, you’re now the fittest survivor. Here's your evolutionary incentive to get creative — metabolically, genetically, violently.”
To put it another way: when you cut down the last trees in a forest, the fungus doesn't die. It takes over.
But no. In the Holy Scriptures of Oncology, ADT is sacred. Questioning it is heresy. And so I found myself standing before the High Priest of Medical Certainty, who, rather than engage with the nuance of my case, declared me a waste of his time. A theological inconvenience in his evidence-based cathedral.
Now, let’s be clear. I’m not anti-science. I’m anti-template. I’m anti-treatment-by-pedigree-where-the-tumor-is-a-footnote. Because when your prostate decides to go rogue in a testosterone desert, that’s not a common case. That’s a molecular insurgency. A biochemical coup. And that deserves more than a Ctrl+C, Ctrl+V plan recycled from a 72-year-old with a beer belly and a midlife PSA bump.
I raised the possibility that ADT, in my case, might be fueling resistance. That what was sold to me as chemical castration for therapeutic good might in fact be encouraging the cancer to adapt, mutate, and metastasize out of spite.
I asked about AR-V7 expression, about genomic profiling, about whether a different systemic therapy might make more sense — not instead of ADT, but in consideration of the specific tumor biology. I might as well have been speaking in Klingon.
You see, templated medicine has no space for original thought. It rewards compliance, not questions. The oncological gods are busy — too busy, apparently, for patients who think their bodies might be more than a sum of statistics.
Let me tell you what they do have time for:
15-minute consults.
Pressed white coats.
Protocols laminated in plastic.
A religious belief in T suppression as cure-all.
They do not have time for men like me.
Men who ask what happens when you beat a hormone to death — and the cancer doesn't blink.
Men who suggest that maybe, just maybe, cancer is smarter than a flowchart.
So here I am.
The Patient from Hell.
The man who questioned the gospel of gonad suppression.
The man who thought maybe a cribriform, perineural, test-resistant tumor growing in a low-T body meant something.
And maybe, in time, they’ll write about patients like me in the medical journals — the ones they laughed at, ignored, or dismissed until the science caught up. Or until the tumors did something interesting enough to warrant retrospective attention.
Until then, I remain a heretic with hormone suppression.
And a sneaking suspicion that the real tumor is medical orthodoxy.
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@hanscasteels I am sorry about your experience with your oncologists. There are other oncologists at the Grand River Regional Cancer Center. I suggest that you request an appointment with another oncologist there.
In my experience, I didn't have the chance to choose who to see in my cancer center. One of my appointments was with one of the top oncologists at my cancer center. However, on the appointed date, another doctor (his assistant, it seemed to me) saw me and did my gold seeds/fiducial markers implant. I also did not have the chance to choose the members of my care team (an aspirational goal based on a few posts I read). Each one of my 5 SBRT sessions was with a different radiation team. I heard that my cancer center does a thousand SBRTs a year, so I can assume each team has enough experience anyway and know what they are doing. But I have been seen four times by the same radiation oncologist (except the one for the fiducial markers). I think this is the limitation of our taxpayer-funded medical care, we don't get to choose who will treat us, compared to who will want to pay with our own or our insurance money for treatment. I believe there are other oncologists who could have been more helpful to you. Regards,
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4 ReactionsYes, if Grand River works like my cancer centre (elsewhere in the province), the senior oncologists lead teams that include at least one resident and maybe some interns as well as an oncology nurse.
My onsite appointments would involve my going into a room and meeting the nurse first, then waiting a few minutes and seeing a resident, then at the end, the senior oncologist (sometimes accompanied by an intern). It was useful, because the nurse and resident had more time to talk, so I could refine my questions before I got to the senior onco.
The nurses made their own entries in my chart, separate from the oncologists.
Now I have a younger oncologist (ex Harvard med school) who hasn't built up a team under him yet, and we meet mainly remotely, since my situation has been stable for a long time. He's easy going and chatty, which is a big change from my former Big Gun (who was great, and got me onto what was in 2021 a cutting-edge treatment path).
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1 ReactionI'm so sorry you had such a terrible experience. I hope and pray you can find your way to better care.
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1 ReactionOh, and for the record, while a cancer centre will initially assign us to whichever oncology team has space free, even under universal healthcare we do have the right to ask for a second opinion or even a different oncologist. More info here:
https://cancer.ca/en/living-with-cancer/coping-with-changes/working-with-your-healthcare-team/getting-a-second-opinion
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2 ReactionsAs far as testosterone goes, while we talk about it "feeding" prostrate cancer, I don't think that's quite accurate; what it does is just throw the switch to start the cancer cells reproducing.
Just as a toddler can throw a light switch as easily as a 300 lb weight lifter (and the light doesn't shine any brighter because the weight-lifter is stronger), it probably takes only a relatively small amount of testosterone to start the prostate cancer cells reproducing.
Eventually, some (not all) cancer cells figure out how to switch themselves on, though ARSIs like the -lutamides can delay that for many years in some cases.
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5 Reactionsmuch appreciated. You’re right: in a publicly funded system, we don’t often get the luxury of choosing our specialists. But while I understand the logistical reality, I don’t believe it should excuse poor communication or dismissiveness. When an oncologist opens with, "What are you doing here? You’re wasting my time," that’s not a resource constraint—it’s a failure of professionalism.
Like you, I’ve accepted that continuity of care is patchy at best, and I don’t expect concierge service. But I do expect that if someone’s going to implant radioactive seeds near my rectum or decide my long-term survival strategy, they might engage for more than seven minutes and refrain from treating questions as a personal inconvenience.
I agree—it’s reassuring that these centers handle high volumes and have experienced staff. But volume doesn't justify apathy. Competence without compassion is assembly-line medicine.
So yes, I’ll be requesting another oncologist—and perhaps logging a formal complaint, not out of vindictiveness, but because if we don’t call this out, it continues. We deserve better, even in a “free” system.
Thanks again for your thoughtful response—and I genuinely hope your treatment continues to go smoothly.
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3 ReactionsYou're right...
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1 ReactionI'm also sorry for what you've been through, Hans.
Sadly, as with family doctors. there's probably a law of supply and demand at work: the less-friendly ones have openings for new patients more often than the kind ones, because the unfriendly oncologists' patients keep leaving for someone else. 😕
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2 ReactionsIt’s way more than a lack of professionalism - it’s downright rude! I doubt he would have the nerve to speak to you this way outside of his protective bubble: white coat, clinic, medical degree….
Just another power trip for a cowardly little man who finds ‘courage’ in his exalted position.
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2 ReactionsI can so relate as my SO actually sneered while in mid question to him. I got the ADT and today I am meeting with a new Oncologist at a Comprehensive Cancer Center. I chose him from a picture and resume at a teaching hospital. Ha! But did have a good reference from a support group guy. If this one is a dud I will made the 10-12 hour drive to Mayo once off of private insurance.
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