Perplexity

Every time I attend a man who discovered an elevated PSA  by "accident", then suffered a prostate biopsy, and were shocked by the word cancer as it was written in the pathological report, once there are not chance for more delays and I must to inform him about the treatment, I wonder How will I be able to convey the advantages and disadvantages of each alternative. Resignedly, I begin my explanation like this: "you can be operate to remove the prostate, you can receive radiation therapy or you can avoid any kind of treatment." Then, i follow trying to argue that the differences, in terms of survival or at least in terms of quality of life, between the three alternatives are very low and the reliability of the studies that illustrate these small differences are also very weak.During the explanation, the reasons why i decided to become a surgeon fall collapsed. I dreamed to meet real patients with clearly effective treatments, instead of that I am faced with microscopic disease and treatments that nobody can clearly prove if improve or worse the life of anybody.