Deciding on a Treatment, Without All the Answers

When you face a fork in the road you suddenly face options. You can stop and remain frozen in place. That is okay until you get hungry, cold or wet, need sleep or more. You could just forge ahead and trust those guy gut feelings. You could ask questions of the many passersbys coming toward you and hope their experiences offer some insight. Or you could flip a coin and let chance be your guide. 

When I faced my first prostate cancer diagnosis, I found myself at an unwelcomed fork in the road. There was no turning back. There was no escape, because the act of doing nothing turns out to be a decision. So how do you make a treatment decision when diagnosed with prostate cancer, and you don’t have answers? Here is my story.

What I learned

Somewhere along the line I learned you can make a great decision based on what you know, and still have a bad outcome. That unwelcomed result does not mean you engaged in a faulty decision process. Upon closer observation, I recognized that in my life and in most others' lives life never turns out to be 100% perfect and expected.

While it is tempting to think we make decisions based on cold hard facts, reality suggests there is a lot of gray space in between the black and white facts. It took me time to fully understand that trying to be a perfectionist in an imperfect world was counterproductive.

Deciding ... when you don't know what to do

Being the most under-informed medical decision maker in the room of MDs when diagnosed, I asked myself: what tools are needed when you don’t know what to do? I told my MD that I needed a few days to think. After returning home and after a lot of deep breathing I realized the need, importance, and value of focusing on the quality of my decision process, versus focusing exclusively on the result.

When I had asked my MD about possible outcomes he said, “Every patient is different, and the results of any treatment can also be different.”

I learned that some men regained urinary control in a matter of days, others took months; there were others who needed follow-up surgery. Some men were sexually active in a matter of days after their catheter was removed following surgery. Others required injections and pills, while still others needed a penile implant if they wanted to achieve penetration.

Seeking advice from others

My first step was to focus on the accuracy of what the doctor said. Second, I figured it was OK to guess on my possible outcomes, and that meant both positive and negative results. Third, I spoke to family members and others and asked for advice based on the one fact I knew to be true: “everyone’s outcome is different.”

During that discovery process I got feedback that both supported treatment and others that did not. I learned people disagreed, and that simple discovery taught me lot. There was no right or wrong answer. For the first time I also started to listen to myself and how I was asking questions to influence their point of view.

Coming to a decision

While this process may sound time-consuming, I accomplished a lot in just a week and came to a comfortable decision based on my interactions and experiences. The facts were:

• I had an aggressive case of prostate cancer
• It was not going to cure itself
• My chances to live life for a few more years looked better if I took real action

In the end I followed the fork that led to surgery. That choice was made in 2013. As of this writing in early 2024, all remains under control. I have fought prostate cancer 3 times since my original diagnosis. After the death of my wife, I found a new lady and we are starting a new life in a new state. All in all not a bad outcome as I look back at that unwelcome decision fork that suddenly popped up on my road some 11 years ago.

The question I ask others is: how will you decide when it comes to your future with prostate cancer, when you don’t have all the answers?