The message was waiting on my answering machine. That is how the recommendation to remove my prostate entered my house: through a little machine with a blinking red light. Not exactly the bedside manner I had in mind.
In 1998, a Kaiser urologist diagnosed me with prostate cancer. I had been having trouble peeing, and my libido had waned. My prostate was swollen, my PSA was elevated, and a biopsy confirmed disease in the gland. Those details matter. Difficulty urinating and an elevated PSA do not, by themselves, establish cancer. In my case, there had been a biopsy. However, if I had to do it again, I would forgo the biopsy. To see why, read the explanation in My Cancer Journey.
I was expecting his call. When I saw the light, my stomach moved and my throat tightened. I waited before pressing play. Part of me wanted the answer. Another part was reasonably content with the silence.
Then came the message: “We need to remove your prostate!”
I looked around. I was alone. I played it again, hoping, apparently, that the machine might have developed a more attractive treatment recommendation since the first playing. It had not.
A recommendation is where my questions began
I did not return that call. That is what happened; it is not an instruction for another man to ignore his doctor. I was frightened, unconvinced, and unwilling to accept an irreversible procedure before I understood more about it. My immediate response was that there had to be another way.
That reaction became the beginning of years of research. It also became one of the central questions in My Cancer Journey: how do you remain responsible for your own decisions when you are scared and somebody with medical training sounds very certain?
I did not have that neatly worded question in my pocket at the time. I had an answering machine and a proposal I did not like. The neatly worded part came considerably later.
The mechanic had explained the engine
At sixteen, I bought a 1957 Chevy that looked better than it ran. I washed and waxed it. The engine remained unimpressed. It sputtered, coughed, and smoked, regardless of my enthusiasm for its exterior.
The mechanic explained why a tune-up would not solve the whole problem. He talked about neglect, accumulated gunk, and rebuilding. That conversation stayed with me because he explained what he thought was wrong and why the work I wanted might disappoint me.
Years later, I wanted that kind of explanation about my body. What exactly would removing the prostate accomplish in my case? What would it leave unresolved? What could happen afterward? What alternatives deserved a proper discussion?
The Chevy became my way of explaining those questions. It was a metaphor, of course. An engine is not a prostate, and cleaning a crankcase does not establish a theory of cancer. But I understood maintenance, consequences, and the difference between a shiny exterior and a healthy machine.
The consequences belonged in the conversation
I worried about urinary control, erections, ejaculation, nerve damage, and recurrence. Those were not minor details to be discussed after the fact. They were part of deciding what I could live with.
My conversations with other men shaped my concerns. They did not produce a scientific recurrence rate. I could hear ten frightening stories and still not know the odds for a man with my own medical findings. That distinction is easy to lose when the stories involve people you have actually met.
The useful questions remain practical: What benefit do you expect for someone with my findings? What are the possible lasting effects? What would recovery involve? How much time is medically reasonable to obtain another opinion? I would want those answers in language I could repeat accurately after leaving the office.
What I would carry forward
I continued to need doctors, tests, monitoring, and eventually important medical treatment. My story did not become a tale of replacing every doctor with a stubborn man and an internet connection. There was already enough trouble under the hood.
What I wanted was a place in the conversation. Surgery might be the right decision for another man. My refusal was my decision, with consequences that belonged to me. The lesson I would pass along is to get the explanation, understand the tradeoffs, and agree on the next medical step rather than disappearing into unanswered questions.
That blinking light began a much longer story. The book tells where the questions took me, including the places where my own certainty needed a second look.