With today's news that Senator Christopher Dodd has been diagnosed with prostate cancer, I guess this is an apt moment for me to come out as well.

I have prostate cancer.

It was in March or so that I was diagnosed.  Pretty standard story: high and rapidly increasing PSA, measured over the course of 18 months; a positive biopsy; a Gleason score elevated enough (mine is 6: 3 + 3) to suggest surgery.  On Monday I will head into Boston to prepare for a robotic-assisted laparoscopic radical
prostatectomy on Tuesday.

I've learned a fair amount about prostate cancer in the past few months and, to tell the truth, I am not really worried about this.  There are certain factors that are working in favor of my recovery and survival: the cancer is very slow growing and mine has been discovered early; there is no evidence that it has spread out of the prostate (I had a c-t scan and a bone scan to check); my age, 52, is on the young side for this condition and that likely means fewer complications (I am in generally good health).

Another discovery for me has been the very large number of men who have faced this same situation, many with good outcomes.  Shortly after I was diagnosed, I approached a colleague whom I knew had had prostate surgery.  We sat down and talked and he mentioned another friend, whom I had not known was in the same boat.  I spoke with him, too. And then another, and another.  It is quite a fraternity.  Talking with these men, and with four different doctors, helped me think through treatment options and reassured me that, although there are some unfortunate side effects, life goes on and can be good again after prostate surgery.  That is my working assumption right now.

Chinese philosophy has also shaped my approach to the disease, even if indirectly. 

When the first doctor, a local urologist, first put forth the diagnosis and reviewed treatment alternatives, my first reaction was Confucian.  There are three general categories of treatment: "watchful waiting" (which is really not appropriate for my age bracket); radiation therapy; or surgical removal of the prostate.  Although both radiation and surgery have rather high survival rates, surgery's is a bit higher.  As the doctor laid out his view of the possibilities, I found myself immediately gravitating toward surgery with the higher survival rate because I was instinctively thinking of my wife and daughter.  Were I to die within the next ten years, it could leave them in a rather difficult position.  Best to go for the option that provided the best chance (all of these are probabilistic, after all) of longer life.  My wife (a nurse), who was with me at that first revelation of the diagnosis, initially thought radiation might be best, since no incision (and thus risk of infection) would be required.  But she, too, gradually came around to seeing surgery as the best option.  We settled on the "robotic" technique because it had the effectiveness of surgery together with lower risks of infection and blood loss.

However, even if my first reaction was Confucian – embedding the personal decision in a social context – my Taoist sensibilities have not been entirely irrelevant.  In all of this there is chance and fate.  There are uncertainties, especially when trying to calculate outcomes for particular individuals.  I know this well from what Aidan taught me.  He would often surprise us and his doctors by his remarkable and unique responses to various medical conditions.  Thus, I cannot know, no one can know, precisely how things will go for me in my present circumstance.  That kind of uncertainly might be unsettling for some.  For me, it is simply the unfolding of Way.  This moment is exactly like all the other moments of my life: tossed by the ebb and flow of "occurrence appearing of itself" (Hinton's translation of zi ran – 自然).  So there is little use of worrying about loss of control now – I've never really been in control of my life, not, at least, in the way we might want to assume.

Once I made my treatment decision (a decidedly un-Taoist process) I have not second guessed or lost sleep.  With some luck (and a very good doctor) things will go well. 

Blogging will therefore be light in the coming week, but I will likely have something to say about my brief hospital stay and recovery as this all proceeds.  In the meantime here's a thought from Chuang Tzu; it is how a person who faces a debilitating medical condition responds to the question: "do you resent it?"

"No, why should I resent it?" replied Adept Cart.  "If my left arm's transformed into a rooster, I'll just go looking for night's end.  If my right arm's transformed into a crossbow, I'll just go looking for owls to roast.  And if my butt's transformed into a pair of wheels and my spirit's transformed into a horse, I'll just ride away! I'd never need a cart again."

So, I'll just follow Way where it leads….

And if any men out there want to connect, exhange ideas, or just chat about prostate cancer feel free to comment here (I will respond) or email me (see the "email me" tab at the top left corner of this page).