DR SCHELLHAMMER: Although I should have known better, when I was diagnosed I began thinking that I would live perhaps three to five years.

It took a few weeks of seeing charts of patients who were five, 10 and more years out from their diagnosis to have a greater sense of security. Despite my knowledge base, initially my visceral reaction was significant.

DR LOVE: What kinds of things help people overcome those types of reactions?

DR SCHELLHAMMER: It takes a significant amount of physician interaction to provide patients assurance that even if the disease cannot be cured, it can be controlled for long periods of time.

That is, however, a difficult message to impart in a convincing manner without several interactions and a lot of reading on the part of the patient. It becomes a real subject of study, deliberation and interaction.

DR DEETHS: I had the same feelings when I was diagnosed seven years ago. I had a biopsy on a Friday, and because I was known at the hospital, the pathologist came in and read the slides on Saturday morning. I happened to be on call that weekend and was making rounds on two patients I had operated on for prostate cancer. I heard the diagnosis in the middle of my rounds and was devastated.

DR LOVE: How were you able to adapt to this situation and deal with it?

DR DEETHS: It takes time. It took me six months to a year to really come out of the doldrums. Before that I said to myself, “I’m not going to buy any new shoes or clothes” because I didn’t think I would live long enough to need them.

DR LOVE: You told me that you had a Gleason 2+3 tumor. I’m sure that when you are taking care of men with lowgrade tumors, you reassure them that they have an excellent prognosis. Did this experience change the way you view those men?

DR DEETHS: Prior to my own experience, I didn’t really understand what happens internally when you have the diagnosis of prostate cancer. I have always tried to distance myself from my patients so that I could deal with their problems. When you have the disease, things are different.

My doctor was one of my practice partners, and it was difficult, in a sense, because he knew what I knew about prostate cancer, the treatments and all the ramifications.

Also, I didn’t involve my wife in the decision-making because I knew what I wanted to do. That was a serious mistake because she didn’t feel like she was part of the experience. Spouses definitely need to be part of the experience all the way through, from the time of diagnosis.

RICHARD: I would echo the visceral nature of being diagnosed with prostate cancer. For me, I felt a great sense of sadness and a feeling that things had changed. Even if you have 15 percent of one core, Gleason 3+3, things have changed. It is now part of your life, and you can’t put the genie back in the bottle.

DR ROBERTS: I think we sometimes become very cavalier in how we treat other physicians. This may be a good learning experience for those of us who have to go on taking care of patients when we have prostate cancer.

When a physician finds out he has prostate cancer, I don’t think he necessarily reacts any differently than anybody else. It reminds me of the fact that in my work, I deal with ethics and end-of-life issues, and when my mother was dying, I didn’t know any more than anybody else about whether to put her on a vent or not.

The urologist who did my biopsy called my wife to tell her the results. My Gleason score was 9; my PSA had doubled in the previous year and I had a palpable lesion.

Maybe it was because I’m a physician and he thought this was okay for him to do, but when I arrived home, my wife was convinced that I only had a year to live.

DR LOVE: Your wife was told first?

DR ROBERTS: Yes, and I just think that we have to tell people these things a little differently than over the telephone.

DR LOVE: Is it common for people to be given a diagnosis over the phone?

DR MOUL: I don’t know if this was an anomaly, but in my former practice in the military, we had patients coming in from quite a long distance and sometimes we were forced to give them a diagnosis over the phone.

I don’t know how common that is in the “real world,” but it always bothers me. I think with the growing shortage of urologists in this country, it may be happening more often.

Another fairly common decision we all face is whether to give a patient bad news on a Friday afternoon or wait until Monday morning.

DR LANGE: I believe that giving patients control over what and when they learn about their disease, whether it’s a diagnosis or their recent PSA, is an issue.

Paul and I have talked many times about when we look up our PSA. Should we do it before or after we’re going out for a big dinner or when our kid is getting married?

I think that rather than telling patients we’ll call them, and then not being able to connect with them and having them experience anxiety, we could alleviate that stress using modern web-based methods.

This would give patients the power to learn when they wanted to, rather than when you’re available. I think the idea that the physician is going to be the primary person to inform everybody, particularly if you have a busy practice, is unrealistic. We need to develop other methods whereby patients have more power over this.

I always tell patients who are about to undergo a biopsy, “If you have a diagnosis, it’s not the end of the world.” But it is humbling to experience that fear, in some cases receiving your first taste of your own mortality.

I have learned that even though I take prostate cancer somewhat lightly, because I know about autopsy cancer and the Pound paper, I remind patients that they are going to be okay and I do that early.

I often say, “You’re going to be fine. This is not lung cancer in terms of the frequency of mortality and its speed of mortality.”

RICHARD: Having a Gleason 3+3 tumor causes uncertainty. What does it mean? Is this really disease? Is this something that’s destined to be clinically significant? Does this need to be treated and will the treatment cause significant morbidity?

For the physician-patient, the sophisticated layperson and treating physicians, this is a very difficult issue. My surgeon was candid about the limitations of his knowledge about who needed to be treated.

Sixty percent of my practice is dedicated to breast oncology, and my experience with prostate cancer and the uncertainty I felt has certainly impacted the discussions I have regarding adjuvant therapy of breast cancer.

DR STUTZMAN: I had a biopsy in mid- December and received a diagnosis right away from my colleagues. Christmas is always a big time for my family, and I went through the holidays without telling them anything about my diagnosis. Finally, before everybody went home, I sat them down and told them that I already had a surgery date. My wife has never forgiven me for that, and now when I have any problem, she says, “Are you lying to me?” I have told patients “Get your family involved,” because I learned personally that not involving them was the wrong thing to do.

DR LOVE: Why didn’t you tell your family?

DR STUTZMAN: I didn’t want to ruin their holidays.

DR MOUL: This is very moving to hear. I’m struck because urologists are always receiving criticism for overdiagnosing prostate cancer. I just heard these physicians, who scientifically recognize that Gleason 6 prostate cancer is probably not necessarily life threatening, yet they had the same emotions as a man with life-threatening prostate cancer. This blows me away.

Then, the question comes up: “Should we consider not even calling these tumors prostate cancer?” Would it change things if we considered it a precancerous state to avoid freaking out people with these favorable lesions?