Sheep or Wolf

There are many confusing realities with prostate cancer.


A man facing unfavorable screening results may in fact not have cancer, as Andrew came to find out. At the opposite extreme a man’s cancer may have been undetected until it was too late, so only palliative care was warranted, as Joe faced. Or the cancer may not warrant treatment for a variety of reasons, such as apparent low risk, so medically supervised monitoring is the strategy, as for Peter. On the other hand, the cancer threat may warrant treatment, despite the reality of serious and permanent side effects. But as for George, who now wears man diapers for his incontinence, he did not know how serious his cancer threat was. He just knew he had prostate cancer and was afraid of it.
To simplify the process and to understand my cancer’s aggressiveness, I sought to answer the question—was my cancer a sheep or a wolf? As many prostate cancers are known to spread slowly, recognizing it as a sheep would mean that it was slower moving and not that aggressive. Depending on one’s age and overall health, with a “sheep” cancer, one may never experience symptoms, may never need treatment and may well die from something else.
To understand local cancer and metastasis better, I thought of my prostate gland as “the barn,” the area surrounding the gland as the “barnyard,” and the blood vessels outside of the barnyard and the lymphatic system as the “highway” to metastasis, incurable disease. Using that analogy made it easier for me to comprehend the diagnostic and treatment challenges I faced.
If the sheep were in the barn, time would be on my side. Time to research and consider various treatment methods, giving me a very good chance for a cure. If the sheep were already in the barnyard, I would have less time to consider treatment options, but still a good chance for a cure. If the sheep were out on the highway, there would be no cure.
If I had a wolf, no matter the location, I would need to make my decisions very quickly. If still in the barn, it seemed reasonable a cure was possible. If the wolf was in the barnyard, maybe a cure was possible. But if the wolf was out on the highway, as with a sheep, there would be no cure, and life expectancy might have been precariously short.
Although it may seem to be a simple concept and question as to if one has a sheep or a wolf cancer, it took me nearly a year to reach my conclusions and to make my decision for treatment.