Staring Into the Pipeline

The side effects of treatment can make us doubt our personal strength. 



I often say that there is no better time to be a prostate cancer patient–if you have to be one–than today. I believe it. I encourage many fellow patients with the idea. The pipeline, as underscored by the news coming out of this week’s ASCO meeting, is full of promising new drugs, combinative therapies and neoadjuvant (prior to primary treatment) use of new drugs that are currently being used later in disease progression.

But there are times when it is difficult to embrace the optimism.

For me, weekends can be the hardest times to believe. During the work week, we wear our “everything is fine” masks, we’re distracted by tasks and issues of the office, working hard to keep up physically and mentally and crashing when we return home, often falling into our beds early with no other option. There is little time to ponder how we feel emotionally or physically. Forward… forward… forward… There is little choice for anything else. We need to keep our lives together and strive for normalcy.

Weekends are different. Like everyone, we shift from overdrive to neutral. As patients, we can remove the masks. We hope to coast a bit, spending newly revalued time with family and loved ones and perhaps catching up on a few projects that have been put on hold for obvious reasons. But, with our weekly guard and distractions down, simple things like taking a long healthy walk, organizing the garage or planning to have friends over can hit us over the head with fatigue and pain. Tired and vulnerable, the cracks in our emotional armor can widen and turn to gushers. I find myself walking through the aisle of the supermarket trying hard to resist a tearful breakdown. It is driven, no doubt, by a near total lack of testosterone and the fact that each step makes me feel like an 85-year-old man. In the privacy of my home the emotional episodes come without warning. Physical pain overtakes will.

It’s times like these that one’s optimism for the pipeline can turn to doubt. Sure, if my disease recurs, there are more treatment options. If I become ADT resistant, there are multiple options including chemo and new drugs such as Zytiga (approved) and enzalutimide (pending approval) with Alpharadin and XL184 fast on their heels. More than 20 others are also in trials.

I believe in the pipeline. I believe overall…

Like many patients with whom I speak, my experience has taught me that I am not afraid of death. That is a matter of nature and biology. From the day we are born, it is our fate. What I am afraid of is missing those I love. That’s a matter of the heart.

I’ve always been a proponent of not putting the cart before the horse. Yet, I’ve learned it’s not always easy.

In my moments of doubt and vulnerability I wonder: should the time come when I have to stare into that pipeline of promising new treatments, will I be able to find the strength–supported by love and duty–to persevere and step up to the plate? Or, might I fail the test, tempted by an urge to let nature prevail? Others find the inner strength everyday. Would I be able to measure up?

That’s the haunting question that brings me to my emotion’s knees. It’s the dragon many of us need to slay with our swords of the heart and a battle cry of “I believe!”