I have been threatening myself with the task of sitting down and doing a more thorough review of the literature and then writing something like this for some time. Now that the blogosphere at ASCO Connection gives me a less painful alternative, (yes, all you editors, you can comment as you wish but not tell me this is unpublishable...) I'll use this forum.

Starting with a recent article in the British Journal of Urology, there is an obvious challenge in caring for men with prostate cancer that I deal with quite frequently in my practice. Namely, as reviewed in Medline Plus, sexual dysfunction is a long-term bother for men who undergo prostatectomy. Compared to the outstanding progress that has been made in breast reconstruction, this represents a major challenge -- even greater if you consider the controversy regarding whether treatment is even necessary for the majority of these individuals. Yet, when I counsel a couple facing the decision of treatment for prostate cancer, I often find the wife favoring surgery with comments like "I just want him to get the cancer out of there."

The complexity of this is further heightened by the observation that so many women will undergo extraordinary toxicities even if the benefit in terms of cure for breast cancer is improved by only a few percentage points. The wives want their husbands to survive "at any cost," just as they would do, usually on behalf of their children and grandchildren. In contrast, after a 90-minute consultation going over all of the nuances of surgery (robotic, cryotherapy, nerve-sparing, etc.) and radiation therapy (brachy vs EBRT vs protons vs HDR etc.) or all of the various active surveillance programs, a man will often look at me, then his watch, and say "What time does the Bronco game start?" Maybe all of this is nothing more than a medical window on "Men are from Mars," but I have found it intriguing, none-the-less.