Stand down, General Patton

The art of cancer warfare

I’m profiled in the latest Cancer Health.

Cancer flips the gravitational rules so everything rises. My PSA continues upward, but it’s such a lazy climb we’re free to act as if nothing’s changed. I’ll continue the treatment I’ve been on, whose toll is pretty minor compared to the alternatives.

My MSK lab results. Since March, when my PSA was undetectable, it’s been rising 0.01-0.02 at each test. We won’t change anything till it reaches 0.20.

Cancer combat

I’ve been reflecting on how much I love the treatment style of my oncologist, Dr. Rathkopf.

I've seen some patients get uneasy without lots of tests, lots of tension, lots of adjustments. For their doctor they want General Patton — tough, self-assured, a little stagey. “Attack rapidly, ruthlessly, viciously, without rest, however tired and hungry you may be,” Patton said.

Cancer does resemble war in at least one way: fateful and irreversible decisions must be made from scarce and unreliable data.

But cancer is not a George S. Patton war. Those missiles and shells you’ve ordered are targeting you.

What’s needed is not a rampaging motherfucker, but that familiar serenity prayer:

Grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

No doctor is smarter or more vigilant than Dr. Rathkopf. She is always hopeful, unlike Patton who is always clanging the alarm, but she isn’t resting. She’s observed that my cancer’s PSA tends to run low, so she has also been checking other blood tests. (Those look good, too.)

There’s a treatment detail we could have fiddled with and didn’t — my pills. They might have been abiraterone, enzalutamide, apalutamide, or darolutamide — the Rosencrantz and Guildensterns of pilldom. No trial has compared all of these, and you can go crazy deciding. It’s likely there won’t be a big difference in outcomes, and Dr. Rathkopf unhesitatingly proposed darolutamide, the pill with least side effects, though it took insurance wrangling. She also believes patients deserve a say, so if my heart had been set on abiraterone I’d be taking that.

We’re talking about terminal illness. People ought to treat you nice, your doctor especially. I’m grateful to be under her care.

From the Cancer Health interview. Photo by Megan Senior.

On the cover

I’m profiled in the latest Cancer Health magazine, which spoke with me on my patient advocacy and blogging. The magazine is read by 150,000 patients and health-care professionals.

I owe thanks to Howard Wolinsky, an OG journalist, cancer-rights advocate, and wiseacre, who connected me with the editor when the magazine was planning a prostate cancer profile. I think it’s a great interview — many thanks to editor Trent Straub, writer Jennifer Cook, and photographer Megan Senior.