A Hobson's Choice

Merriam-Webster’s dictionary defines a “Hobson’s Choice” as “an apparently free choice when there is no real alternative.” I feel like that’s a pretty good description of where I find myself right now.

For the last 5+ years, my body’s hormonal system has been manipulated into producing little-to-no testosterone through a process called “androgen deprivation therapy” (ADT). With ADT, prostate cancer cells are deprived of testosterone, which is a fuel that helps them to thrive and proliferate, with pernicious effects. Whereas normal levels of testosterone are about 300 – 1,000 nanograms per deciliter in a man’s blood, mine has vacillated between 3ng/dl to 25 ng/dl for the last five years. Given that a prostate cancer cell’s uptake of testosterone is akin to me drinking wine on a trip to Napa Valley, I have been very grateful to be on this class of drugs that has clamped down on my cancer for the last 5+ years.

One of my favorite Led Zeppelin songs is “When the Levee Breaks.” A famous line from that song is “when the levee breaks, I’ll have no place to stay.” That’s where I find myself now, as I can no longer stay where I am at, or where I have been. Prostate cancer has found a new pathway and is no longer responding to ADT, so I need to do something different.

My medical oncologist told me the other day that the next phase of my treatment will be something of a paradox. He said that one of the “uncomfortable and counterintuitive things about your upcoming treatment is that you feel well now, but I am going to have to make you sick so that you will feel better later.” So it’s the classic Hobson’s Choice, where you are choosing to do something you don’t have to do, but yet there is no real alternative.

The levee has indeed broken on ADT and doing nothing is not a practical or wise option at this point. Thankfully, I don’t have other co-morbidities such as diabetes, heart disease, circulatory system issues, etc. I feel like I am in a good position to take this on, but it is slightly terrifying to read the “informed consent” documents that I need to sign to be accepted into the clinical trial being recommended for me.

It feels daunting to willingly enter a clinical trial that relies on a handful of unproven, non-FDA approved drugs. Yet, it would be disingenuous of me to stand on the shoulders of people that have gone through clinical trials in the past and not be willing to do it myself. Their willingness to participate has resulted in the FDA-approved drugs that have kept me alive and well for the last 8+ years. I am trying to think of it in terms of fixing your roof or waterproofing your basement before the levee truly does break and you are trying to mop away water (or rogue cells) from places they were never meant to be.

Until next time,