I Give People Cancer. Part 1

benign-and-malignant-prostate-glands

Benign (left) and malignant (right) prostate glands

I had the following conversation with a new acquaintance at a recent dinner party:

"I do merger and acquisitions, it was slow for a while, but now it is heating up again. I do OK. How about you, what do you do."

"I guess I do OK too. I'm a pathologist. I run a medical diagnostic lab for a big group of urologists."

"What does that mean. You run blood tests?"

"Oh, we do some blood testing, but I spend most of my time looking at biopsies. As a urology group, we get mostly prostate biopsies to decide if they are benign or malignant."

"So you give people cancer."

It is not quite accurate of course. I don't pass out diseases from a punch bowl. I am not Typhoid Mary reincarnate. No need to quarantine me. But a few dozen times a week, yes, I am the first to say "Mr. Kranz has prostate cancer, Mr. Ferrick has prostate cancer, Mr. Blaine does not."

I have the best staff and equipment to assist me, I have my valuable colleagues to verify my work.  But in the end, it is my electronic signature on a report that is going to set into motion life-changing events. In that way, I DO "give people cancer."

About half of the patient biopsies I see I will diagnose with prostate cancer. It is "flip-a-coin" likelihood, and like a coin flip, it sometimes feels very random. An eighty-year-old retiree with a firm prostate on the urologist's exam may have a negative biopsy, while the 50-year-old executive with a slightly increased blood PSA level may have an aggressive tumor filling each core of the biopsy.

As with a coin flip or with the spin of a roulette wheel, things sometimes get "streaky." There are days when I am merciless, with case after case receiving a malignant diagnosis. I feel as if I am a curse or have developed an evil eye. At other times, each biopsy I look at is bland and harmless.

After a few negative diagnoses in a row, I begin to wonder if I have suddenly forgotten what prostate cancer looks like under a microscope. I begin to worry about each minor aberration, each slightly enlarged nucleus or shrunken gland. I take a deep breath and regain my balance, knowing that over the course of a few weeks, the numbers will even out. The statistics I calculate every month tell me so.

Of course, the urologists have a harder role to play than I do.  They must tell the patients with cancer the news, apprise them of the risks and benefits of the various therapies, hold their hands and dry their tears. But they also get to pass our the good news when a biopsy is benign or when treatment is a success.

So why would I go into pathology, and deal with cold glass slides instead of warm-blooded patients? In Part 2, I look at what brought me, and other pathologists around the country, to this field. We didn't all start out this way...

In the meantime, read up about PSA.
Rather read a shaggy dog story? Here's the link to our previous post: It's A Dog's Life

I Give People Cancer, Part 2

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The opinions expressed above are those of the author. They are not those of UroPartners LLC.

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