Author's Note

I began as a man who was afraid.

When I was first diagnosed, I knew almost nothing about PSA, Gleason scores, imaging thresholds, or treatment pathways. I placed myself in the hands of capable surgeons and did what most men do, I complied. I was fortunate. I came through treatment largely intact. I remain grateful for the skill and seriousness of the doctors who treated me.

But gratitude is not the same as understanding.

Years later, after a second biochemical recurrence, my oncologist told me that when my PSA reached 0.2, we would proceed to imaging. It was a routine recommendation. Sensible. Standard.

I went home and began to read.

I learned that PSMA PET scans are powerful but imperfect. That detection rates at very low PSA levels are limited. That radioactive tracers are involved. That thresholds are chosen not because they are magical numbers, but because medicine is always balancing probability, exposure, cost, and uncertainty.

For the first time, I recognised something unsettling: I had been making consequential decisions without fully grasping the reasoning beneath them.

Not because my doctors were careless.

But because I had been passive.

Modern medicine often assumes that the patient’s role is to consent. The physician explains; the patient agrees. It is efficient. It is orderly. It is often appropriate.

But prostate cancer is rarely an emergency. It unfolds slowly. It allows time for thought. And time, if we use it carefully, offers something rare in medicine: agency.

That realisation changed me.

I began reading the literature, not as a hobby, but as a responsibility. I learned how PSA behaves over time. I learned how imaging sensitivity curves shift during biochemical recurrence. I learned how clinical trials are framed, what they measure, and what they leave unmeasured. I learned that “standard of care” is not fixed truth, but moving consensus built on incomplete data.

Out of that study came a long personal paper. Out of that paper came a framework for managing my own disease. And from that framework came this book.

This is not a manifesto against doctors. I trust medicine. I use it. I depend on it.

But trust and inquiry are not opposites.

A man can respect expertise and still ask for the reasoning.

He can accept treatment and still understand the trade-offs.

He can follow guidance without surrendering thought.

If you are reading this, you may be where I once was, holding a pathology report that feels like a verdict. You may feel pressure to move quickly, to decide decisively, to “deal with it.” That instinct is understandable. But prostate cancer often offers something unusual in oncology: space.

This book is an attempt to use that space well.

It does not promise control. Cancer humbles any illusion of control. But it argues that clarity is possible, and that clarity alters the quality of decisions.

Parts of this manuscript were developed with the assistance of language-model tools that helped clarify drafts and explanations and bring the underlying ideas into clearer alignment. The thinking, structure, and conclusions are entirely my own, shaped by lived experience and by a quiet refusal to remain a passive participant in my own care.

If this book helps you ask one more precise question, resist one unnecessary urgency, or walk into your next appointment with steadier footing, it will have done its work.

We are not only patients.

We are custodians of our own judgement.

Even in illness, that is worth protecting.

Finley Proudfoot

Cape Town, 2025