“We keep testing and biopsying and still there’s no cancer.” The case of Marshall P. Marshall was 74 at the time of the fourth prostate biopsy, which discovered an intermediate grade (Gleason 7),...

“We keep testing and biopsying and still there’s no cancer.” The case of Marshall P.

Marshall was 74 at the time of the fourth prostate biopsy, which discovered an intermediate grade (Gleason 7), small tumor confined to the gland. His life expectancy was about 10 years. Data strongly suggest his cancer would not be life threatening. Marshall and his urologist had a discussion about what to do next. Marshall opted, and his urologist agreed, that no treatment was indicated. Their mutual rationale was that Marshall’s anticipated life span was about 10 years and that prostate cancer was very unlikely to claim his life in that time span or even if he lived substantially longer. The prospect of ED or incontinence, which affects about 30–40% of men regardless of mode of treatment, was more misery and risk than either of them could justify, especially considering that Marshall might also be debilitated by advancing Parkinson disease. Marshall and his urologist disagreed on the need for further PSA monitoring. The urologist favored further testing; Marshall thought otherwise but agreed to keep an open mind as new research revealed additional information.