John C. McHugh M.D.

From " The Decision" “Dr. McHugh, what would you advise me to do if I were your father?” I am asked this question very often after telling a family that a biopsy shows prostate cancer. I almost anticipate it and have to be careful not to smile after hearing it; certainly a smile after delivering bad news would come across as inappropriate. The irony of the question is that I am not a big fan of my father. He left my mother and her five boys when I was in the seventh grade and went to Alaska. I saw him only one time after that, when he showed up at my part-time job during the Christmas break of my freshman year in college. He quizzed me briefly on my grades, told me that his had been better, and then left. I never saw him again. After the divorce, my mother, brothers, and I moved to LaGrange, Georgia to live with my grandmother, who was 73 at the time. Looking back on it, this was one of the best things that could have happened to me. LaGrange was a great place to grow up, I adored my grandmother, and I feel that not having a father to depend on made me a stronger person. So, when the inevitable question comes up, I fight back the smile and answer the question as if it were a good one, in the context of a normal father-son relationship. Rarely, however, after failing to withhold the smile, I’ve said, “That really is not the best question to ask me considering my past relationship with my father. Considering the part of the male body urologists work on, you might not like what I would recommend.” The urologist I chose to do my surgery I had never met, spoken to, or recommended to anyone. At my initial appointment, his nurse escorted me to his office, where he was waiting. After shaking hands and introducing ourselves, there was a somewhat uncomfortable pause, with the two of us sitting across from each other in silence. It was odd, two urologists who had never met; one needing surgery for something that both were accustomed to treating. “So, doctor…” he said, “you have your own disease.” "It’s not the mountains ahead, but the pebbles in your shoes." I was diagnosed with prostate cancer at the age of 52. I believe that I was lucky in that it was detected early and treated aggressively without any major complications, and hopefully I am done with it. I owe my personal diligence in diagnosing my cancer early, in part, to the knowledge of a friend whose father, Dr. Cecil L. Miller of Buford, Georgia, died of prostate cancer. In fact, I called Butch shortly after my diagnosis not to tell him about me, but to be sure he had had a recent rectal exam and PSA. He asked why I had thought to call him, and I told him, “I will tell you another time, something interesting happened to me that made me think of you.” His father was a family physician whose first symptom of prostate cancer was bone pain, indicating that his prostate cancer, which was unknown to him, had spread to bone. He was diagnosed at age 72 in September; he died the following June. My friend’s father’s story has had a lasting impact on me. Certainly the fact that this man was a doctor, relatively young, and diagnosed with metastatic prostate cancer when it was too late to treat it was a tragic event. It made me more aware of the potentially virulent side of what is usually thought of as a “slow-growing” cancer. His story made me more vigilant about advising my patients about the dual nature of prostate cancer and making sure I checked up on my prostate. I began having PSAs at age 48 and watched as they slowly increased from the normal range to abnormal over four years. This led to the biopsy, the diagnosis, and, finally, the treatment. It took me three months to decide which mode of treatment I would choose. The anguish experienced in determining which form of therapy to pursue, something I had witnessed over the years in hundreds of my patients, was now perpetrated upon me. For reasons I hope to make clear to you, despite the decision being a very difficult one to make if all relevant factors are taken into account, it can be simplified by using big concepts. This book is written primarily for the patient with newly diagnosed prostate cancer as an aid in arriving at a treatment decision that is right for him, and more importantly, made for the right reason. Nothing is as disappointing as the patient who bases his choice on incorrect or irrelevant information and subsequently has an unexpected, sub-optimal outcome. I am a surgeon, so feel free to take what I say with a grain of salt. I do favor the surgical removal of the prostate in general, but only in the right circumstances, with the patient having full knowledge of the ramifications of all therapeutic modalities. The decision is always the patient’s to make, and it’s a tough one. My goal in this book is to give you the knowledge of what is essential to know about prostate cancer, taken in the context of your particular situation, and to aid you in making an intelligent decision custom-made for you. I hope that my journey to “the decision” and my many years of helping others through it will be beneficial to you. By reading this book you are now privy to information that you might get in an extended office visit with your own personal board-certified urologist. The illustrations that follow are based on sketches I have drawn many times on exam table paper for my own patients, and they are intended to simplify the concepts that patients need to understand when considering treatment options. In addition, I offer the perspective of a urologist who has been through what you are about to experience. I have tried to present information in such a way that it places what is important to you at the forefront of the decision-making process. Despite my years of training and experience, my decision was based on big concepts rather than the fine points of various treatments or their potential for particular risks. As you go through this process, you too should use big concepts to make your decision and not be bogged down by “the pebbles in your shoes.”