DR LOVE: What is it about the word “cancer” and the disease itself that is so unsettling? In many situations cardiovascular disease can be much more life-threatening. What is it about our culture and this disease?

DR LAWTON: I think one of the things that stirs that visceral reaction, especially in physicians, is that we can’t help but think of that patient who did extremely poorly.

When my dad was diagnosed, his PSA was 93, which was overwhelming. He didn’t get screening PSAs because he believed that screening is a way for doctors to make money, which is neither here nor there, but that is what he thought.

With a PSA of 93, I immediately assumed he had bone mets and a whole litany of things, as did my brother who is a physician. When all of his scans came back negative, it was surprising. In fact, my dad looked at me and said, “You’re surprised.” I said, “I am.”

DR MOUL: Neil, I thought the audio program Colleen did with you about her father was very moving. We’ve been talking about conveying optimism and I want to comment about my father-in- law.

He was diagnosed with prostate cancer in the late eighties right at the beginning of the PSA era. His PSA was approximately 40 and he had what was interpreted as a negative bone scan and a negative CT.

Like any good son-in-law surgeon, I encouraged him to have a radical prostatectomy and referred him to one of my buddies from medical school who did a radical prostatectomy and, not surprisingly, he had non-organ-confined disease.

I then referred him to one of my other buddies, a radiation oncologist, and he underwent postoperative radiation therapy. Then he had a PSA recurrence. I kept reassuring my family that prostate cancer is not a lethal disease, and that we were going to have him a long time.

He was dead within 36 months of the diagnosis, and I feel like I let my family down because I kept reassuring them that he was going to be with us. He had the one “way out on the bell-shaped curve” case of prostate cancer that we occasionally see in practice.

DR DEETHS: To go back to your original question about why cancer has such a bad connotation: Cases like this are the reason. Many of us grew up in a time when surgeons would say, “Well, I opened and closed the patient and there was nothing we could do.” At that time, cancer was a death sentence and that’s what most of us remember.

RICHARD: If we go back a couple of generations and talk to our parents or our grandparents, they recall a time when cancer was actually a shameful diagnosis — something to be concealed.

Even now, if you talk to patients with European backgrounds and some other cultural backgrounds, it’s still so terrible that you can’t even name the word.