Lorenzo Q Squarf threw several cats among the prostate cancer community pigeons with his outspoken statements in the late 1990s which he posted on various Forums. He had an excellent website expounding these irreverent views but it is no more. These items were salvaged from the site before it went and give a taste of what the great man had to say. He was last sighted in about 2009 haranguing other parties on other subjects - and still with no PCa therapy.

Lorenzo Q. Squarf

Flamekeeper of Western Civilization

"I am not fat! My prostate is slightly enlarged.."

 

-Understanding the Game

-Playing the Game

-Two years later - [quavering voice] "I am still ALIVE! Kaf, kaf!"



Message #1: UNDERSTANDING THE GAME:

Prostate cancer is the single greatest overrated disease in the history of civilization. Forty thousand men, it is claimed, die from prostate cancer each year in this country. [This was the (over)estimated death toll in the mid-90s] Forgive me, but that number is not medically or socially significant. There are about 130,000,000 males in the United States. Forty thousand is but a whisker off the beard of the testosterone contingent. The survival of the masculine gender in the United States is in no way threatened by this trifling disease. Many more men die on the highways of our beloved land each year from road rage, or have the life snuffed out of them in marriages to the wrong women.

Hello, I am Lorenzo Q. Squarf and I have prostate cancer.

Well, I probably have prostate cancer. The probability is in the vicinity of 90%+. I don't know for sure because I refused an "urgently recommended" biopsy. I have no intention of allowing anyone to violate the integrity of my trouble-free reproductive organs with sharp instruments so that scientific curiosity about my asymptomatic prostate gland, which seems to have produced theoretically disturbing test results, can be hypothetically satisfied. Here is my relevant medical history:

DREs: a slightly enlarged prostate gland was detected -- it was declared to be normal and suitable to my age which is 65. I have no urological symptoms whatsoever. No nighttime wee-wees, no nothing. I pee vigorously, no dribbles, and not that often. I have an active and highly appreciated sex life. I got my first PSA because I read about that test in a magazine and thought that I would see how my new Medicare supplement worked -- it was a freebie. That is the only reason I requested the PSA test.

May 19, 1997 -- PSA 7.4 -- referred to a urologist by my GP.

May 27, 1997 -- PSA 5.0 -- urologist redo of the PSA test

June 21, 1997 -- PSA 9.4 and 9.7 -- another redo at the urging of the urologist; two labs, same blood at my stipulation, plus some other tests

ProstAssure test results came in with a skull and crossbones stamped across them -- Zone Four, indicating a 90%+ probability of prostate cancer. My free PSA was below 15% and caused scowls and grimaces.

When my urologist, Dr. Doom, received the initial 9.4 PSA results, he adopted his funeral director's demeanor and informed me that he was scheduling me for a biopsy. I burst out laughing, mumbled something about "under advisement," wished him a good day, and walked out of his office, humming, with a light step, and never returned. Dr. Doom promised me a horrible death from metastatic cancer and subsequently sent me a registered, certified, return-receipt letter informing me that I was no longer his patient and that he was no longer my urologist. He covered his ass. I chuckled and covered Squishalie Doodlebug Provolone, my neurotically voluptuous girlfriend, with my biologically active body and had a wonderful time. I do not have the slightest intention of ever allowing anyone to come near my asymptomatic clangers with a meat hook, ice tongs or a chain saw.

I am writing this with a slight backache. It is either the usual backache of a 65 year old man -- and I have had them come and go all my life -- or it is metastatic bone cancer. Yawn! It has been bothering me slightly for the past four to six weeks. I really do think, though, that it is a routine backache and that my chiropractor, Captain Crunch, will be able crack something in the lower area of my spine and that I will be able to boogie with the Force or with whatever comes along without the slightest difficulty. I will ask him, though, to take an X-ray so that he and I can scan it and look for Swiss cheese holes or some abberational nibbles in the pelvic bones and lower vertebrae. If things looks okay, I will let him play snap, crackle and pop with me. If things don't look okay, I will undergo some other non-invasive diagnostic procedure to clarify the situation. It is useful to name things when they are part of you. As they say in French, nishgaferlich. There is no sense in even attempting to chase down and slay the dragon of metastatic bone cancer once it is on a rampage. The treatment is worse than the disease and one can check out whenever things become truly intolerable. It is a philosophical issue, not a medical one. Let's be adult and realistic.

Prostate cancer is a delight as compared to all other life-threatening afflictions. Think about it: PCa is a conversation-laden disease and nobody has a definitive fix on exactly what ought to be done. And no matter what is done, there are no guarantees... except, of course, that the moment anyone submits to any invasive diagnostic or therapeutic procedure, he becomes a miserable wretch and a professional PCa patient, the latter for the rest of his life... and sometimes the former. I, personally, refuse to watch my prostate gland like a flute player watches a cobra. If it aggravates me sufficiently, I will destroy it. It has been informed. I, meanwhile, am grooving right along and enjoying things.

Consider a sudden and crippling stroke. Now there is a real catastrophe! No warning. No conversation. BLAM! Paralyzed and drooling. Your affairs are in a total mess and there is nothing that you can do about them. I would rather have PCa and join in the endless small talk about it, whenever I want to, as I go about the game of life with gusto.

How about a massive coronary? No warning. No conversation. BLAM! Tubes coming and going into and out of every orifice in your body. Your personal affairs are in total chaos as you lie there like a potato latke as they shuffle bedpans beneath you. No, thank you. I would rather have the kind of PCa that I have and its related luxuries, not the least of which is that my phenomenological health is splendid and my activities are utterly unaffected by it.

Gentlemen, we Watchful Waiters are extremely fortunate.

My next message about this heretofore confusing subject will be a thunderbolt of clarity. I shall stipulate -- fearlessly, I might add -- what I believe *everyone* ought to do in light of his test results and symptoms. If Einstein had the courage to successfully tackle gravity, the least I can do is punt PCa.

Have a nice day.

-Squarf

Message #2: PLAYING THE GAME:

My backache was not the result of metastatic cancer ravaging my pelvis and spine thank you for your good wishes. It was caused by misaligned vertebrae. The X-ray was refreshingly clear about that. Captain Crunch did his stuff. My backache is gone. My prostate cancer and I seem to be ignoring each other. My pelvic bones look lovely -- no Swiss cheese holes from cancerous rats and no nibbles from cancerous mice. So much for the dire warnings of the Dr. Dooms of this world. Freud said that a cigar was sometimes just a cigar. Well, a backache is sometimes just a backache.

Here is the Squarfian Analytical Matrix for dealing with the hysteria of prostate cancer. This is not medical advice; this is advice about living. All disclaimers known to man are hereby invoked. If you are an attorney, I suggest that you ignore my advice and get a radical prostatectomy without delay, anaesthesia or compelling reasons. Everybody else, here we go:

1) If you have no symptoms, but have an elevated PSA do nothing. NOTHING! Never mind the doom-and-gloomers. If everything is functioning normally as far as you are concerned, then forget it. No exceptions. Do not, under such circumstances, allow a biopsy. The odds are wonderful that, by doing nothing, you will eventually anguish and die from something altogether different than prostate cancer. There. Feel better? Good. Me, too. I shall never have another DRE or PSA and screw biopsies, altogether. A death wish? Nope. Quite the contrary. Read on.

2) If you have no symptoms, but a DRE indicates an irregularity, get a couple of PSAs down the road, and a couple of follow up DREs to see if a) the PSA is climbing significantly, and b) if the irregularity has changed significantly. If not, and if you continue to have no symptoms, get it checked once a year. Don't let anyone panic you into anything. Do not get a biopsy. Don't worry. Enjoy life. When and if something is wrong, you will be the first to know. In the meantime, forget it because you will probably die of something else first. So? So cheer up!

3) If you have distressful symptoms, that is another story, but remain clam. CLAM! Getting up once or twice a night to make a wee-wee is not the end of the world. If that is your only problem, or if your problems are of such a trifling nature, why, disqualify such slight inconveniences from inclusion in the "distressful symptom" catagory. Nervous? Can't stand to do nothing? Okay. Buy a book on nutrition and consume prostate-specific nutrients. They won't hurt, they might do some good, and you will feel rather purposeful; besides, this is a much less traumatic approach than turning your life over to the dice-and-slice crowd for a bit of exploratory mayhem. And a slightly or moderately enlarged prostate whose only disadvantage is a weak stream or the semi-frequent need to pee is not sufficient justification to allow anyone to use a meat hook on your prostate gland merely to see what sample chunks look like under a microscope.

4) If you have seriously distressful symptoms -- and this would include the inability to pee, whizzing blood, loss of bladder control, severe groin pain, or other highly suspicious dissatisfactions, then you have to do whatever is required to find out what is causing the situation so that you can take appropriate action. And this might require a biopsy. Your ass may well be grass, but you really do not have the choice of ignoring things. You do, however, have a number of options as to which therapeutic modality or combinations thereof are available. Learn what they are. Check them out. Pick the least intrusive and distasteful alternative and go with it. Goodbye and good luck. You have just left the Watchful Waiting Club. And I am grateful, by the way, that you are in such a teensy-weensy, downright minuscule minority. Nothing personal, mind you, it could happen to any of us... although it is so damned unlikely as to make Watchful Waiting a fairly pleasant, boring, but supremely sane game.

5) OVERVIEW: We can find anything that we really look for: the accuracy of Nostrodamus' predictions, UFOs, God, or abberant cells in any organ of our bodies. We just have to search hard enough, long enough and destructively enough. Frankly, there are some things which I do not wish to find. And if those things want to find me, well, they know where I am, and they know how to get my attention.

What did men do before there was a PSA test? They lived until they died, and it was usually from something other than prostate cancer. Check the stats. You will smile. Check the stats more closely and you will grin from ear to ear because a lot of men died with, and not because of, prostate cancer. It just never bothered them while they were alive. They had no idea! There is a moral in here somewhere which suggests that an awful lot of men over a certain age have prostate cancer percolating amongst their clangers, but that, and in the normal course of events, it never managed to brew a troublesome cup of coffee. Got it? Good. Have a cup of tea.

If something seems to be functioning well, then leave it alone.

Do not fix what is not broken.

Gentlemen, there are no survivors on planet earth. Prostate cancer has no real cure and no pleasant treatment. Let me quote from a man who has much more experience than I. His name is Tom Feeney. He is 83 years old and he has prostate cancer. Tom writes:

"There is currently no treatment available that has been proven capable of providing a cure, capable of extending life, or of doing more good than harm. In addition, all treatments have undesirable side effects that can seriously detract from the patient's quality of life for the rest of his days." -- from Tom Feeney, on this website, recommended reading [Tom has, alas, passed on - from a heart condition, the fate of most men - but his site, although it was assembled in the mid sixties contains some excellent material, much of it confirmed by later events and studies]

If you really research the subject, you will probably discover that many urologists would not -- repeat NOT -- follow the advice for themselves that they are providing to many of their patients. Read the previous sentence again. And again. It is not only true, it is terribly important and revealing.

So? So I have decided to not make a career out of my asymptomatic prostate cancer. No more DREs, no more PSAs. To hell with my ominous test results. If I get an ouchie, I will seek a fixie, but not a moment before then and as non-radical as possible. And yes, I will use my own decision-making analytical matrix which I have outlined above.

All I know now, and all I want to know, is that I have a fully functioning and trouble-free prostate gland which performs magnificently! Watchful Waiting? No. I am neither watching nor waiting. I am living. There is a big difference. I recommend it to everyone. Frankly, I consider the odds stacked heavily in my favor.

-Lorenzo Q. Squarf

MESSAGE #3: TWO YEARS LATER "I am still ALIVE! Kaf, kaf!"

Hello there. I am now 67 years old. My last two years were vibrant with across-the-board good health. Something occurred a month or so ago which might interest you. First, I must inform you that I have not seen a doctor nor have I had an exam or test of any kind during the past couple of years... with the exception noted below. And I have not modified my lifestyle which includes unmoderated red meat, cognac and cigars. In a gesture of New Age preciousness I tried tofu, but gagged on it. It reminded me of dragon snot and is barred from my home. Now to the recent occurrance:

A friend, who is a well-known and highly respected PCa pathologist -- a uropatholgist -- gave me an unsolicited freebie PSA as a social gesture in June 1999. The PSA came in at 5.2. FIVE POINT TWO! Down from an untreated 9.7 of two doctor- and intervention-free years ago. It looks as though my Dr. Doom will die of sclerosis of his personality long before I will platz from anything. My first reaction to the new PSA test (which, in my opinion, approximates age-adjusted normal)? Wow, I don't have prostate cancer after all! My second reaction to that test? Yes, I probably do have prostate cancer. BFD.

In my humble opinion, I believe that that mature and maturing males enable the development of PCa, but that their very maturation renders it moot... provided that they leave it alone. Very probably. I guarantee anguish to anyone who lets the medical profession take an aggressive whack at his clangers. Remember, when the only tool a man has is a hammer, why, everything looks like a nail in need of being slammed. Think of your urologist. All is not lost. Read on.

We need to face up to some realities:

1) we are all going to die eventually and from something;

2) nothing has ever been proven to lengthen the life of a PCa patient;

3) Virtually everything that is done to interfere with real or imaginary PCa has horrific side effects ... and if they don't, then they are truly extraordinary exceptions. Horror stories abound. Pollyanna tales of innocuous treatment, cures and lovely life are rare enough to be considered mythology. And, yes, some chaps have aggressive PCa which really does require serious intervention in order to reduce the situation to semi-manageable proportions. Sorry about that. It happens. But it happens a lot less frequently than the medical profession is able to identify and stipulate with any degree of credible science to support it. Let me put it differently: some prostate cancers are not meaningful and are best totally ignored; others are dangerous, but no one can differentiate the baddies from the goodies. So? So a lot of guys get wrung out when, in fact, they might have the innocuous variety of PCa.

I am not a Luddite. Let me clarify my go/no-go criteria for hurling yourself into the great maw of urological mayhem:

If you are in your 50s, avoid biopsies until and unless you have negative urological symptoms which clearly indicated the need for a biopsy to determine what might be going on. If you have a suspicious DRE that does not clear up you fall into this catagory. If your PSAs are beginning to sequentially rocket upward you fall into this catagory. Absent these criteria, avoid urological procedures.

If you are in your 60s, the same criteria apply.

If you are in your 70s, ditto, but be very fussy about what constitutes negative symptoms. If they are not all that distressful consider treating the symptoms. Think amelioration of discomfort rather than aggressive intervention, but, if ordinary stuff can't supress your discomfort, why, discuss your particulars, and especially your personal values, with a urologist who listens carefully, and who seems to care more about you than his theories of aggressive intervention.

If you are in your 80s don't play the therapy game. Period. No. Don't do it. It will destroy the rest of your life. Ameliorate negative symptoms with medication. You can probably do this in an agreeable manner for a longer time than you might imagine. Smile. You have won.

But, if you are like many folks, you will cruise and schmooz around the PCa conferences like a moth around a flame. Please pay particular attention to all the definitions and descriptions and procedures that are bandied about with such seeming authority. Definitions are not meanings. They are too antiseptic. It is one thing to talk about changing your own catheter or urine collection bag or diaper, and quite another thing to actually have to do it. And never mind sitting in a bathtub full of hot water, weeping, because you are unable to make a pee-pee. Question: Was it really necessary to wind up that way in the first place? Really honest to God necessary? How do you know? How do the doctors know? Know as in KNOW! Just because a profession knows how to do something with a knife doesn't mean that it makes sense to do it... without a really persuasive reason. Get the picture?

And note the career-building that is going on in the PCa conferences. Endless chit-chat. The same guys. Year after year. How come nobody gets better? Oh, one or two report that they are cured, but they are truly rare exceptions and might never have had the bad kind of PCa in the first place. Most of the participants have full-time jobs as PCa patients and "survivors" -- sounds noble, huh? I have even seen the word "heroic" used. I can't see any nobility or heroism in dragging one's ass around in treatment- induced diapers or other assorted indignities, including moaning and groaning -- my personal values are peeking through here. Yours may be different. Some guys are dealt a really lousy hand of cards by The Dealer -- and if it wasn't prostate cancer for them maybe it would be have been cancer of the lungs, pancreas, brain or liver -- now those things kill; prostate cancer, for the most part, seems to cause endless conversations and second careers. To be fair, in some -- but far from all -- cases of PCa, nothing short of massive intervention is indicated. And there is usually no question about it. And the unlucky chap really doesn't have much of a medical choice in the matter.

Extraordinary interventions require extraordinary justifications. An asymptomatic man -- a phenomenologically healthy fellow -- (qualified by the criteria noted above) who submits to any destructive diagnostic or therapeutic interventions deserves (not really) the lousy consequences, not the least among them is becoming an amateur urologist who, despite intensive study and mastery of language and procedures and theories, still doesn't know what is the best course of action. Hello, there! Will a real authority please stand up? There are none. Read the previous sentence again.

When you get over your relief or nausea, and if you feel like it, why, drop me a note and a brief summary of your urological facts. I am accumulating statistics. They keep validating my position.

-Squarf

[Unfortunately Squarf lost interest in prostate cancer over the years and went on his merry way - to write a book about flying (one of his great loves in life) and to annoy other people on other Forums with his views on a number of subjects. He is missed. His old website was taken down, but archived here if you want to see all his views The World According To Squarf ]

Squarf did pop back in 2005 to say this:

And here I am in May. 2005 at the age of 73. Do I look like I have trouble making a wee-wee or that I have any health problems whatsoever?

And again in 2006

Ga-ha-hasp! I celebrated my 74th birthday on May 13, 2006. Ah' kin hardly believe it... And ah'm real healthy! Ah-hough! Ah'm so precious... And prostate cancer is such a bullshit game!

I managed to contact Squarf in 2011 and ask him for an update - here it is, in typical Squarfian style:

I turned 79 last month. My health is excellent, and my clangers (and related body parts) are worthy enough to be registered with The National Bureau of Standards; in short, my urologicals are totally splendid.

Latest thinking on the subject of PCa treatment: My original views on the subject (published about 14 years ago) have been reinforced, re-affirmed, and re-validated over and over again by subsequent independent scientific research and publications.

Hey, thanks for carrying the Squarfian Torch of Enlightenment into the future! Forward march in all directions, and keep smiling!!