In My Prostate

Gleason Scale

A Musical Guide for Prostate Cancer Patients
Bill McLaughlin, M.D.

The songs on this page have been loosely grouped by their relevant risk categories.

For men with low risk cancers (the small c) the first question is "to treat or not to treat?" Some low risk cancers are ideally suited for the deferred treatment approach, while others are not. Likewise, some personalities are ideally suited for deferred treatment, while others are not.

For men with intermediate risk cancers, treatment is almost always recommended. The main questions are "which proven treatments are available, and when are more aggressive approaches warranted?" Surgery, beam radiation, and seeds are the competing options a man must consider.

For men with "high risk cancer," the term itself may provoke anxiety. Most high-risk cancers are curable with aggressive treatments. Such treatments may temporarily disrupt quality of life with side effects. These men must move from grudgingly accepting this course (i.e. “taking their medicine”) to embracing their treatment. The treatment itself is seldom as difficult as men imagine it would be. In fact, nearly 100% of men complete their planned treatment. 

For low, intermediate, and high-risk cancers, cure is the first priority. Quality of life after treatment is a secondary, but increasingly important, concern. In recent years, cure rates have increased and quality of life has improved. Two men with exactly the same level of cancer may make very different decisions based on how they individually weight these concerns. One may choose an aggressive option with a very high cure rate and care very little about the potential side effects. This is the “CURE and quality of life” approach. Another will choose the treatment with the best-proven quality of life, even if the initial cure rate drops slightly. This is the “QUALITY OF LIFE and cure” approach.

For men with metastatic cancer, excellent treatment options are available that can control the disease for years and sometimes decades. The psychological hurdle of understanding what it means to be incurable is the immediate challenge. Once a man understands that his cancer is treatable and easily controlled, despite being incurable, a level of positivity can be restored. The hope for a long remission replaces hope for a cure.

Men diagnosed with prostate cancer should never feel that the burden of determining which treatment is best rests solely on their own shoulders. Expert panels from every discipline and approach have been formed to provide a list of proven treatments from which a man may choose.

The best place to start the songs section is the introduction songs


Introductory Songs
In My Prostate
Read, Don’t Worry

Low Risk Songs
Sometimes Less is More
Better Safe Than Sorry

Intermediate Risk Songs
In My Prostate
Cut it Out
Why Would Anyone do Anything Else

High Risk Songs
Testosterone
Pimp My Prostate

Deciding on Treatment Song
Read, Don't Worry

Metastatic Cancer Song
The Horse is Out of the Barn

Post Treatment Recovery Song
Where There’s a Will, There’s a way


Introductory Songs

In My Prostate - a man relives his experience


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A man relives his prostate cancer experience. He had a highly curable Gleason 7 level cancer, one step beyond the lowest grade of Gleason 6, and imagined that he would die. He has lived to tell the tale with humor and comes to a different conclusion about life than Stanley, who warned him years ago, “No matter what they tell you, the golden years suck!”

Read, Don’t Worry - after hearing many strong opinions on how to treat prostate cancer, a man asks his doctor’s opinion


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In the modern era there are countless cancer experts giving strong opinions. Here, a newly diagnosed man has heard strong opinions from other patients and competing opinions from doctors. He just wants a doctor to tell him what to do. Instead, his doctor tells him that reading and educating himself is the only way to find the right answer for him, as painful as that may be.


Low Risk Songs
To treat or not to treat?

Sometimes Less is More after a poor outcome, a patient speaks against treatment


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In this song, a man who had a poor outcome with treatment warns others not to make the same mistake. He realizes that he did not seriously consider the watch and wait approach, but now wishes he had. He could have written the article “I want my prostate back.” It is not hard to find men voicing this opinion at support groups or on prostate cancer blogs. Their intention is good. The weakness of his argument is generalizing his experience to others. In the modern era complications are rare, and when asked a year after treatment, the vast majority would choose the same approach.

Even if men do not choose deferred treatment, it is critical they understand there is good science to support this approach. Their cancer may never live up to the word cancer, and may not require treatment at all. It is important for peace of mind to understand you are in such a favorable prognostic group. Unfortunately, the term cancer carries such ominous weight and invokes so much fear that the idea of not treating it can seem absurd, dangerous, and irresponsible. It is critical that patients move from Brand X cancer lurking in the unconscious mind, to their specific cancer that may be as far from Brand X as east is from west.

The problem with this man’s approach is assuming that everyone who has the treatment he had will have the same complications. One must consider the possible complications of treatment and make sure he can accept them if they occur, while knowing that severe complications are rare in the modern era.

Better Safe Than Sorry – a man decides to treat his low risk cancer


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In this song, a man has been told to consider deferred treatment, but, fearing his cancer is a “wolf in sheep’s clothing," elects to have immediate treatment. During surgery, 20% of men with what appeared to be low risk cancers are found to have more aggressive disease that warrants treatment. Currently, 100% of these men must undergo treatment to cure hidden, aggressive cancers. MRI may ultimately prove useful in finding the aggressive 20%, saving a great number of men a treatment that may not be necessary.

It is never a wrong decision to elect treatment. Even though deferred treatment is an acceptable option, some men and their spouses find this choice incompatible with common sense and coming to peace. For them a “better safe than sorry” is the only approach.

One important thing to notice is that the man in this song makes it clear he has carefully considered the potential side effects and is okay with them. This is a good example for all men deciding on therapy.


Intermediate Risk Songs
Weighing the options

In My Prostate - a man relives his experience with external beam treatment


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A man relives his prostate cancer experience. He had a highly curable Gleason 7 level cancer, one step beyond the lowest grade of Gleason 6, and imagined that he would die. He has lived to tell the tale with humor and comes to a different conclusion about life than Stanley, who warned him years ago, “no matter what they tell you, the golden years suck!”

Cut it Out - surgery is the only answer


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A man responds to his diagnosis of cancer with an absolute certainty that there is one, and only one, correct solution: surgery. Even when the surgeon warns him that he may not get it all with surgery, his gut tells him he will not be able to sleep at night if he doesn’t do this. This is a perfectly reasonable individual decision. Physicians often help patients decide by asking the question: "Which treatment will let you sleep in peace at night?”

Again, it important to note the man has made an informed decision. He realizes there may be side effects and complications from treatment, and he is accepting of those side effects.


Why Would Anyone do Anything Else? - seeds are the only answer


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A man responds to his diagnosis of prostate cancer with an absolute certainty that seed implants are the only answer. His personality comes to this certainty in much the same way that the man in Cut It Out comes to his certainty.

Unlike the men singing Cut It Out and Better Safe Than Sorry, the man in this song may have read and believed the unbalanced propaganda version. The risk is that he has heard all the advantages and has ignored the disadvantages of the treatment. All proven treatments have compelling advantages and fortunately, rare disadvantages; but it is critical that men choosing treatment clearly see the whole picture.


High Risk Songs
Embracing therapy

Testosterone -a 55 year-old man dating a 35 year-old woman with a great love life must face shutting it down to address his cancer


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Some men are quite confident of their sexual prowess and reside where few other mortal men can go - at least that’s what they would like you to believe. The singer here is in that rare group, and the prospect of “shutting it down” is in some ways as fearful as the cancer.

Testosterone is the male hormone that essentially makes a man a man. Unfortunately, prostate cancer cells grow under the influence of testosterone. A critical treatment for aggressive prostate cancers is blocking testosterone production in the hope that the cancer may rapidly shrink to a more curable stage. The side effects vary widely, but total loss of libido is common. Thus, a man who has been quite active sexually will lose all interest for a brief time. For some this is a minor inconvenience and even a relief. “Strange to have the burden of horniness lifted after all these years,” as one patient put it. For others, it is a devastating blow to their quality of life well beyond the sexual side effects. Some men read the potential side effects (as our subject does) and may initially decide against it, but predicting which side effects an individual will have is never easy. In all treatments, roughly 10% will have minimal side effects, 10% will have bothersome side effects, and the rest will experience a wide spectrum of tolerable side effects.

Hormone therapy is one of the most critical arms of treatment, especially for aggressive cancers. Unlike other localized therapies, hormone therapy treats the whole body.

 

Pimp My Prostate - a man overcomes his fear of treatment


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This man, fresh from watching “Pimp my Ride,” a show about transforming old junkers into custom hot rods, imagines the doctor will pimp his prostate back into shape.

For men with aggressive cancers, the prospect of life-altering treatment is a major source of stress and fear. Physicians make a distinction between “taking your medicine” grudgingly and “embracing the treatment.” It is critical that men go “all in” on whatever treatment they choose. They should keep reading and soul searching until they feel the treatment makes sense and they actually want it. Unfortunately, some men with aggressive cancers keep reading and reconsidering as a way of stalling. It would be better for them to grudgingly take treatment than to delay necessary treatment.


Deciding on Treatment Song
When every expert has a different answer

Read, Don’t Worry -after hearing many strong opinions on how to treat prostate cancer, a man asks his doctor’s opinion


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There are countless cancer experts giving strong opinions. Here, a newly diagnosed man has heard strong opinions from other patients, and competing opinions from doctors. He just wants a doctor to tell him what to do. Instead, his doctor tells him that reading and educating himself is the only way to find the right answer for him, as painful as that may be.


Metastatic Cancer Song
Incurable cancer meets incurable love for life

Horse is Out of the Barn


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The song Horse is Out of the Barn deals with the initial shock of a diagnosis of incurable cancer. The reality of incurability is repeated three different ways in the first three verses. Each heightens the hopelessness, but psychologically this bottoming out is a kind of drilling down to release a defiant and positive energy that the man may not have known was there. This man would be unlikely to draw those same conclusions after time has passed and the cancer has been brought under control.

The irony is that in the end, the horse out of the barn is the patient. The profound awakening that comes to anyone diagnosed with a serious or life-threatening illness is unmistakable. As their illusions and false sense of security are stripped away, many would describe themselves as awake and free for the first time.

A further disussion of the challenges and expectations of the different prognostic stages of cancer is available in Introduction to Prognosis: Curable, Incurable, Transitional, Terminal.


Post Treatment Recovery Song
Climbing the ladder

Where There's a Will, There's a Way - a couple reviews the aids available to recover their love life


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In the modern era, if couples want to recover sexual function, specifically erectile function, “where there’s a will there’s a way.” As they move up the ladder of aids, from simple “pop a pill” solutions to less convenient and even uncomfortable solutions, each couple decides what they are a actually willing to do.