Dealing with Fears of Recurrence
Some fears can fairly quickly be dealt with by a bit of rational thought and investigation. Worried that you might die in the aftermath of a meteorite striking the earth? Well, your chances of death are pretty high if you are within meters of the strike point, but the last fatal meteorite strike was, well, never actually. There are no recorded instances of such an event.
Let's talk about recurrence rates
Prostate cancer on the other hand, well, if you are reading this article then you or someone you love has it, and recurrence is a very real possibility. An article on the Harvard Medical School blog reveals that recurrence rates can vary greatly between men depending on Gleason scoring, PSA and disease staging.1Memorial Sloan Kettering Cancer Center offers prostate cancer nomograms which can be used to predict and assess recurrence risk.2 I’ll declare an interest here -- I’m in the higher risk group as the unfortunate recipient of a G4+3, T2C diagnosis, albeit with a PSA that was not recorded higher than 5.95.
So my rational thought and investigation could (or should) have the result of making me very fearful. And to an extent I am worried. Next week I have my annual PSA test to check on possible recurrence. I can tell you now that I’m already developing a bit of scanxiety (the worry caused by any scan, blood test or examination) and that will peak about four days after the blood test when I have to call for the results.
Coping with fears of recurrence
How do I deal with it? I start by reminding myself that it’s by now probably more of a meteorite than anything else. By that, I mean that because I have had eight consecutive negative tests the chances of a ninth are really very small. That article I referenced earlier does not cover that aspect.
Beyond that, I know that if this next result returns a cancer-positive result then it’s been found early, again. All the evidence is that early detection and treatment of cancer deliver by far the best outcomes, and because I was treated for the first time in a world-class center I’ll be able to access the same quality of treatment again, while in the meantime the understanding of my disease has moved on remarkably.
Scanxiety persists for other cancers
As it happens I’ve actually had greater fears of contracting other cancers, even recently. A little knowledge is often said to be a dangerous thing, so when my bowels became noticeably irregular and my stools quite variable in consistency I started thinking about the possibility of bowel cancer. I’m right in the zone for it, being a 60 year old man, after all. I remember being out on a long run and becoming almost convinced I had the disease, to the point that I was reconciled to it.
Fortunately here in the UK, we have a national screening program for bowel cancer starting at age 60. A few weeks after my birthday a small package arrived by post containing the sampling kit. I sent back my sample. I wasn’t so sure I had it by then, but still, I had scanxiety. Ten days passed and in the mail came the statistically expected letter telling me no sign of bowel cancer could be detected.
Next week’s PSA test will be the same, I’m sure, but can I deal easily with that now? No, I can’t. I don’t blame you if you can’t either. I hate it.
Do you feel heard and understood by your doctor?