The nuclear option

It's time for a new drug

Run for Your Life on NBC was too adult for 10-year-old me to watch in 1965, but Ben Gazzara, the star, shared my first name, and I’d hear the pounding theme music from my bedroom.

Sixty years later, YouTube has filled me in on the plot: 30-something attorney Paul Ryan (played by the other Ben), after a devastating doctor visit in the opening credits, sets out to “squeeze 30 years of living into one or two years.” Each of the 86 one-hour episodes has him in a different locale, sometimes with evildoers, sometimes with sexy women he can’t end up with. He’s living as fast as he can. He tells no one why.

Cramming more life into the one I have sounds exhausting. At the end of the day, I’ll still hate missing out — even if, like the passionate young violinist in a 2018 New Yorker article, I learn all the Bach partitas in the months before I die.¹

What I’m opting for is a full-immersion, full-time baptism of wonder. I want to be an astonished and delighted baby in a stroller.

My plans, you ask? I plan to have fun.

My PSA keeps rising, and while it’s still ridiculously low — there’s no upper limit to PSA, it can climb into the thousands, and mine is 0.23 — that isn’t necessarily comforting. PSA is a smoke detector, and not every fire is smoky. My most recent PSMA PET scan shows that the tumors, which should have shrunk under treatment, have grown, and the cancer is no longer confined to the lungs; there’s a lesion now on the lower spine.²

So I’m being scheduled for the pathbreaking drug Pluvicto. It’s generally more tolerable than chemo, which before March 2025 might have been my next step.³ Administered like chemo — an infusion via IV — Pluvicto is a radioactive smart bomb meant to target only cancer.⁴ As with all cancer treatments, mileage varies — responses can be spotty or short-lived. In my support meetings, when I hear a man is starting Pluvicto I’m secretly sad for him. It means he’s reached the point where doctors try one thing after another.

There aren’t enough specialists to administer Pluvicto, even at Sloan Kettering, so it will be a while before I start. I’ll keep you posted.

I’m just as hellbent for adventure as Ben G. (who in real life died nearly 50 years later at age 81), but I’m strolling, not running, and plot doesn’t matter. Let’s just have fun.⁵

1. “A Tech Pioneer’s Final, Unexpected Act” by James B. Stewart, published in The New Yorker on January 1, 2018. The story makes me feel like I'm dying all wrong. When I confessed this to ChatGPT 5.0, it responded:

If you strip away the journalist’s framing, it’s less “look at this heroic prodigy” and more “here’s someone choosing to keep company with Bach in his final year.” ... The quieter truth is that spending your last months with Bach is no different in spirit than tending a garden, rereading an old favorite, or sitting with friends.

2. The left anterior L3 vertebra. Before the scans there was a bit of false hope around the drug spironolactone, which my cardiologist had prescribed for high blood pressure. Sometimes spironolactone causes a spurious PSA rise, and Dr. Rathkopf thought we might be seeing that, but the rise continued after I stopped the drug.

3. Pluvicto was approved in 2022, but until last March you couldn’t get it unless you’d had chemo first.

4. Unlike broad-brush treatments like chemo that inevitably cause collateral damage, this is a nuclear weapon designed to spare the innocent. Unfortunately, some tissues also look like prostate cancer to the smart bomb, so there are unpleasant side effects like dry mouth that eventually clear up.

5. Backyard shade in a cushiony wicker chair. Walking beside railroad tracks. Oscar Peterson. Century Schoolbook. Jesse Nathan’s Eggtooth. The Star Candle Company’s greasy, fragrant loading docks. Proletarian Olsen Park. Two poignant friendships. Desmond, Anna, Perri, Robert — deep, clever, beloved. Morning hugs with Kathy. The smell of her hair.