Weighing Quantity Versus Quality Of Life

Prostate cancer has the reputation of being a slow-growing and indolent form of cancer. An oft-repeated saying is that many more men die with prostate cancer than die from prostate cancer. For every hundred men diagnosed with prostate cancer this year, only thirteen will die. We are lulled into thinking of prostate cancer as a rather benign male rite of passage into old age. Fortunately, for the majority of men, it is.

But for a minority of men who get prostate cancer, it is anything but a benign rite. In 2005 it killed more than thirty thousand men in the United States, accounting for 10 percent of all male cancer deaths (second only to lung cancer).

Discussion of Death

Nothing is more inevitable than my death; nothing is more final, irreversible, or irrevocable. For those fortunate enough to have the time to contemplate their own deaths, as I have, nothing is more preoccupying. Very few people seem willing to discuss or even think about these things. "Morbid," they say, as they change the subject. It hasn't been my good fortune to find others willing to share their thoughts and feelings about their own deaths.

—Chuck Wheeler, Affirming the Darkness

Prostate cancer deaths are usually not pleasant deaths. Metastases of the cancer to bones can cause bone pain that may become severe and is often worse at night. Fractures of bones secondary to the metastases are not uncommon; if the fractured bone is a vertebra, it may cause compression of the spinal cord, a true medical emergency. The enlarging cancer may also block the urethra or the ureters, producing kidney failure. Weight loss, anemia, and extreme fatigue are common. Studies of men with prostate cancer in the last year of life have reported a slow but steady decline in the quality of life throughout the entire twelve months.19

Men who have derived as much benefit as they are likely to get from the multiple forms of prostate cancer treatment should address four tasks. The first is to put their business affairs in order, including writing or updating a will, drawing up a living will in case they become mentally incapacitated, and perhaps designating someone to have power of attorney.

The second task is to thoroughly discuss the issue of pain control with their physicians. Undermedicating patients with advanced cancer has been a severe problem in the United States. Opiates, nerve blocks, and spot beam radiation to treat bone metastases should be readily available for the relief of pain. Injections of strontium-89

Developing a Style

When you're ill you instinctively fear a diminishment and disfigurement of yourself. It's that, more than dying, that frightens you. You're going to become a monster. I think you have to develop a style when you're ill to keep from falling out of love with yourself. It's important to stay in love with yourself. That's known as the will to live. And your style is the instrument of your vanity. If they can afford it, I think it would be good therapy, good body narcissism, for cancer patients to buy a whole new wardrobe, mostly elegant, casual clothes.

—Anatole Broyard, Intoxicated by My Illness

(Metastron), a radioactive isotope that is selectively taken up by cancer cells in bones, can be highly effective in alleviating pain; it takes four to six weeks to take effect, but may provide relief for up to six months. It is crucial to become knowledgeable about pain control before you need it and to convey your wishes to your physicians clearly and concisely. If you think they are not hearing you, put your wishes in writing.

The third task is to assess your support network. Studies have shown that married men decline more slowly than unmarried men.20 Carefully think through the sources of your own physical and moral support. Visiting nurses and hospices can be extremely helpful in this regard and are strongly recommended.

Part of your moral support is being able to discuss death with others, but those closest to you often avoid the subject. Your prostate cancer support group or members of the clergy can often be helpful in this regard, as can books on death and dying. Death and Dying by Elisabeth Kubler-Ross, How We Die by Sherwin Nuland, and Final Gifts by Maggie Callahan and Patricia Kelley are widely used. Books on cancer in general, such as Stephen Hersh's Beyond Miracles: Living with Cancer, contain much useful information on the late stages of

Dying with Style

In July 2005, James Smith died at age fifty-five of prostate cancer. Since he was a devout Pittsburgh Steelers football fan, the viewing at the funeral home had Smith's body in a re-cliner in front of a TV that played continuous Steeler highlight films. He was dressed in pajamas and bathrobe in Steelers colors, had a Steeler blanket on his lap, a beer and pack of cigarettes at his side, and had the TV remote in his hand. Smith's sister noted that ''it was just like he was at home.''

cancer and dying. The two best books on dying from prostate cancer are Chuck and Martha Wheeler's Affirming the Darkness and Anatole Broyard's classic Intoxicated by My Illness.

The final task is to carefully weigh the quantity of your remaining months or weeks against their quality. Broyard urged men ''to develop a style'' when facing death. How people die is their survivors' final memory of them; it has been called ''love at last sight.''21 Cornelius Ryan, facing death from prostate cancer, elected to fight it:

I may ''have a rendezvous with death at some disputed barricade.'' The second to last word is important: the word ''disputed.''

Come tomorrow, every instinct, every nerve, every fiber in my body has now got the message, I hope that even in anesthesia my mind will dispute that barricade. I will even dispute the Man Upstairs about it—if I have to.22

Charles Neider, by contrast, chose to accept it:

But I was ready to go, if need be. Only a young man could have written Dylan Thomas's ''Rage, rage against the dying of the light.'' Raging in this context strikes me, at seventy-eight, as graceless. I admire Socrates, who drank his cup of hemlock with style, and

Robert Falcon Scott, who died quietly and bravely in the tent on the vast Ross Ice Shelf in Antarctica.23

It is not important what style you choose, merely that you choose. For men in whom prostate cancer appears to have won, it is a last chance for both a personal victory and a victory over the cancer.


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