Sunday, August 18, 2013

The Prostate Monologues by Jack McCallum *****

I am a few days away from a prostate biopsy, so I found The Prostate Monologues by Jack McCallum especially timely and relevant.

 As McCallum points out so well, prostate cancer is currently a puzzle, some medical people even want to change the name to prostatic epithelial neoplasia ... like that could help anything. Part of the puzzle is the currently popular screening test: the PSA test. For a favorable test result (say 2.5), some men are close to death, and for a unfavorable result (say 4.5) some men are in no danger. However, if you have a result is like 800, you ARE close to death.

After that there are the treatments. There is no obvious advantage between radiation, regular prostatectomy, and robotic prostatectomy. All offer a chance for incontinence and/or impotence in exchange for chance to fix a problem that might not have existed to begin with ... or not.

McCallum does a great job to provide a balanced view with lots of interviews with doctors and patients. Anyone who knows what a DRE is should read book.

If you can forget your (or your partner's) prostate, the book raises an interesting philosophy of science question. What is the role of anecdote in science? Traditionally anecdote is an anathema  to scientists. This book points out that after the research is delivered to practitioners and patients, anecdote rules.

Consider the current controversy on PSA testing. Urologists who see people die of prostate cancer - their universe of anecdotes - recommend lots of testing and treatment. While general practitioners who see a incontinence and impotency after treatment - their universe of anecdotes - are against testing and treatment. That leaves the poor patient confused in their little universe of anecdotes. The beauty of this book is that it extends the patient's world of anecdotes.

That helps ... or not.

I won a copy of this book in a Goodreads First Reads giveaway on August 6, 2013. I received the book on August 13, 2013. 

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