Lay off the prostrate

I've mentioned the prostate before . . . far too often if you're younger than me and/or don't have one: "he would say that" the youthy/lady constituency cries, "he's an ould feller, so he would be concerned". But I'm not, of all the things that keep me awake at night, the prospect of prostate failure/cancer is definitely not on the list. Prostate cancer is the second largest cancer-killer of men after lung-cancer but it's peculiarly slow growing and so many more men die with prostate cancer than of prostate cancer. Only 3% of US men die of it: two terminal cases I've Blobbed are Linus "Vit C" Pauling and Sherwin "End-of-Life" Nuland. The images [even two anecdotes aren't data!!] of those two elderly chaps will sway our decision more than the actual probabilities because most of us are crap at thinking rationally. There was also a briefly supposed epidemiological association with vasectomy which paused my pal from getting snipped; although his subliminal fear of the vasectomy doctor from Kilcock played a part in his hesitation as well.  The take home is that as men get older, control of cell-division down there gets to be a little less tightly regulated; but doing something about that is not necessarily the best response.

Here I'm going to use this topic as a springboard to open The Organized Mind by Daniel Levitin again [previously]. Levitin is advising a robust defense for maintaining the status quo when your urologist/surgeon is advising you to have surgical treatment; which usually involves the excision of the whole gland, like they do for such 'useless' bits as tonsils and appendices.  This suggestion will get traction from many men because the C-word looms large in our list of boogie-men and too many of us played with Action Man  as kids: "do it Doc and have done with it".  But informed consent requires Mac the Knife to list the downsides and their probabilities:

• erectile dysfunction 80%
• shortening the penis by 25mm[!!] 50%
• urinary incontinence 35%
• fecal incontinence 25%
• hernia 17%
• severed urethra [!!] 6%
• at least one of the above = 97%

Levitin then goes on to carry out a number needed to treat NNT analysis. Because it is slow-growing, and indeed without symptoms in most men with one, a prostate tumour can be left safely untreated in most men.  In statistical fact, for every 48 prostate surgeries performed only 1 will achieve an extension of life . . . and none of them, nor their medical teams, know which one will win the prize. Surgeons are known for their ability to take decisions: you can't piffle about when an artery disintegrates before your probe. They like to be in charge and they are trained to act rather than let things slide. And the economics of litigation and insurance almost insist that surgery goes ahead.  Obviously this contributes enormously to the ballooning cost of healthcare in The West.

Here's a neat symmetry. The average life-extension brought about by prostate cancer surgery is six weeks (we have to factor in the 47/48 chaps who do not benefit at all!).  Ho hum, good medical practice advises that the recovery period after major abdominal surgery is . . . six weeks. But information is key.  If you can gather extra information about how the disease, prostate cancer or whatever, impacts on your demographic [men rarely get breast cancer and never get ovarian cancer] then you can help stack the odds in your favour. Obsessive crunching of relevant numbers in his essay The Median is not the Message, bought Stephen J Gould another 20 years after his cancer diagnosis. Read that, it's empowering and inspirational.  Relevant numbers, lads! I've written about palpating the gland and prostate-specific antigen PSA's fall from fashion as a useful diagnostic tools. What about:

Don’t just do something, stand there?