Two books, one project .
One available now. One in preparation. Written for different readers: one for men navigating a diagnosis, one for anyone thinking more carefully about health and evidence.
Prostate Cancer
A Calm and Intelligent Guide
Diagnosis. Decision. Life Beyond.
Most men who receive a prostate cancer diagnosis are given a plan before they are given an understanding. This book attempts to correct that, not by challenging the plan, but by providing the understanding that should have come first.
Written by a patient who spent two years building the biological literacy he wished he’d had at diagnosis, it moves from the first frightening conversation through treatment decisions, post-treatment management, and life beyond. It does not tell you what to decide. It gives you what you need to decide well.
Three ideas changed how the author understood this disease.
The first was natural history. Johansson and Albertsen followed men with untreated prostate cancer over fifteen to twenty-five years and found something that runs counter to everything fear tells you at diagnosis: many prostate cancers progress slowly, and PSA kinetics and tumour grade matter far more than the simple presence of cancer. The data pointed toward something unexpected, that prostate cancer is often a long ecological process, not an immediate lethal event.
The second was evolutionary oncology. Gatenby and Greaves demonstrated that tumours behave like ecosystems, competing populations of cells, not a single enemy to be destroyed. That containment can sometimes outperform eradication. Not because the fight is abandoned, but because the thinking has shifted from military to ecological.
The third was hormonal dynamics. Morgentaler’s saturation model proposed that prostate tissue becomes maximally stimulated at relatively low testosterone concentrations , beyond which additional testosterone produces little additional growth signal. That distinction matters clinically and personally.
When these three ideas sit together, a different question emerges. Not: how do we destroy the tumour as quickly as possible? But: how do we change the biological conditions in which the tumour must live?
What the book contains.
Part 1, The Patient's Guide
- Before You Read Another Word
- The Investigation
- The Answer
- The Decision
- Active Surveillance
- Surgery
- Radiation
- Surgery or Radiation
- Hormone Therapy
- After Treatment
- For Partners
Part 2, The Decision Framework
- How Doctors Actually Think
- Why Good Doctors Disagree
- Understanding Medical Evidence
- Choosing Between Good Options
- Second Opinions
- Living With Uncertainty
- Long-Term Identity and Masculinity
- When to Stop Treatment
- Building a Life Beyond Cancer
Part 3, The Clinical Architecture
- What PSA Really Measures
- The Gleason Score Revisited
- Genomic Testing Explained
- Imaging Beyond the First MRI
- Active Surveillance in Practice
- Recurrence: What the Numbers Mean
- Hormone Therapy in Depth
- Metastatic Disease
- Clinical Trials
- Building Your Medical Team
Generally Well Accepted
How Medicine Lost the Individual
Medicine’s most powerful tools were built to answer a population question: what works, on average, across patients with a given condition? They answer it with extraordinary rigour. But the person in the consulting room is not asking a population question. They are asking an individual one: what is true about this specific body, under these specific conditions, at this specific moment. The population answer, however precisely derived, is not the same thing.
This book examines the gap between those two questions. It traces the structural reasons why medicine’s evidence machinery is better designed to answer one than the other, and what the consequences are for the patients whose biology departs from the average in ways that determine their outcome. It is not an argument against evidence-based medicine. It is an argument for finishing it.
Drawing on cancer biology, metabolic medicine, ageing science, and the author’s own experience navigating a prostate cancer diagnosis, Generally Well Accepted makes the case that individual biology is not a refinement of the population model. It is where the biology actually happens.
The population tells you what is likely. The individual tells you what is true.