All Newly Diagnosed Men Should Be From Missouri. But There Are Limits . . .

BY RALPH BLUM

Missouri is known as the “Show Me State,”  a nickname made popular around 1899 by Congressman Willard Duncan Vandiver, who famously declared, "I'm from Missouri and you've got to show me." Appropriately enough, the state animal is a mule. Newly diagnosed men with prostate cancer, take heed. But also, know when to listen to the experts.

The newly diagnosed men I know who’ve had the best treatment results questioned everything related to the pros and cons of various treatment options. You need to develop the “I’m from Missouri” mindset, so that when an authority figure with a big reputation pronounces, “You need surgery. I’ve got space in my operating schedule next Thursday,” your automatic reaction is not “Whatever you say, doc.” It is “Well, I’m from Missouri and I need to know more before I make that decision.”

 Remember: 90% of us have the slow growing type of prostate cancer. Time is on our side. Second or even third opinions make sense. But—and I am here to tell you there’s a big “But…” Once you have chosen a treatment you had better pay attention to your doctor’s advice. I learned the hard way.

Back in 2002, when my PSA bumped up to 18.3, given my aversion to being sliced open, fried by radiation or poisoned by chemotherapy, it was only logical that I decided to pursue the minimally invasive treatment known as hormone blockade. The objective of hormone blockade is to reduce the production of testosterone—the hormone (androgen) in the blood credited with fueling the growth and spread of prostate cancer—as near as possible to castrate level. But there are some basic rules to follow once you opt for hormone blockage, and I soon began to wish I had taken Mark’s advice about how to avoid some of the adverse side effects that occur in the absence of testosterone. The most talked about one, of course, being no libido.

The protective measures are simple enough: You need to exercise in order to prevent weight gain and muscle wasting—even if, like me, exercise has not been part of your routine. Recommended: 45 minutes of weight training twice a week. Hate it, resent it, but do it. Otherwise? Somewhere down the line, chances are you’ll find your ability to lift, squeeze, steer and reach are all seriously compromised. The truth of “Use it or lose it” becomes painfully apparent. And the longer you wait, the greater the deficit, the harder to repair the damage.  

And then there’s my least favorite adverse side effect from injections of Lupron, which is breast enlargement.Official name gynecomastia. My options were: Either low dose radiation prior to the use of Lupron, or  taking the estrogen blocking drug Femara. I wasn’t keen on undergoing radiation unless it was of critical importance. And somehow I just never got around to taking Femara. Next thing I knew, there they were—my very own set of boobs. A souvenir of my trek through the libido-free zone.

So I’m a living example where ignoring instructions was mulish behavior of the wrong kind. If memory serves, this set of honkers is bigger than those of my first girlfriend. But on the bright side, after months of hormone blockade, my PSA had bottomed out at 0.05, only a breath away from the magic goal line marked “undetectable.” And nowadays, I am only from Missouri on carefully selected occasions.