The not-so-royal we

I have never been a Royal watcher. I was, however, intrigued recently when King Charles III announced that he was entering a private Clinic in London for a “corrective procedure” for a benign prostate condition, presumably BPH. He did so to “increase public awareness” and encourage men to pursue appropriate screening for prostate disease, a most noble gesture, as one expects of a King. The revelation, although not a Movember initiative, could hence be named Manuary, by Royal assent.For those of us with a prostate disease propensity, any acknowledgement by a respected or revered public figure and endorsement for early screening and detection of disease renders an enormous public service. We heaved a collective sigh of relief at the “benign” pronouncement by King Charles as he was discharged to the Palace from the Clinic. Attention quickly defaulted to Princess Kate, still recovering from recent “abdominal surgery” of undisclosed description. The privacy of Royals is an unalienable right, except perhaps when they have made a public proclamation of their nuanced medical maladies. And then more breaking news, Buckingham Palace announced that King Charles had been diagnosed with an undisclosed form of cancer. “Swift intervention by his medical team came after the cancer was discovered during a procedure to treat a benign prostate enlargement.”The King’s ‘not prostate cancer’ cancer remains unspecified. It has, however, nurtured speculation both amongst the public and the wider medical community. The King went public with his diagnosis “in the hope it may assist understanding for all those around the world who are affected by cancer,” an all-inclusive statement that lacks the anticipated and necessary specificity. The Canadian Cancer Society executive VP of mission, research and advocacy, Stuart Edmonds, said the decision was incredibly helpful. “He’s talking about early detection and the fact that if cancer is caught early enough . . . they can actually treat and he has options.” Not entirely so! The King’s cancer, wherever it’s origins, was identified by serendipity, an incidentaloma carcinoma. If the King had not developed the constellation of urinary symptomatology we “older men” frequently experience, he likely would not have been subjected to the BPH surgical management which fortuitously revealed his occult cancer.Whatever “screening” may have taken place, it clearly didn’t identify an underlying malignancy. There is little doubt that the King receives the Royal treatment when it comes to health matters. His cancer, however, escaped the detection of his medical contingent. Knowing the specifics of the cancer diagnosis better serves the principles of prospective screening and investigation for a concerned and respectful global audience. It would identify a population at increased risk and provide the essential information for pursuing appropriate investigative and ultimately diagnostic and therapeutic pathways. In a recent article in Doc Daily, ‘King Charles’ cancer candour ‘helpful’ for Canadian awareness, agencies say,’ there is a statement that “unlike the King, many Canadians don’t have access to a family doctor.” The final sentence, “the inequity needs to be addressed, but in the meantime, people with those symptoms (unexplained weight loss, increased fatigue or a lump or nodule) should go to a walk-in clinic.” At least they didn’t suggest going to the ER. I agree that the glaring “inequity” needs addressing. The solution, however, does not lie in the walk-in clinic where coordinated, comprehensive and longitudinal care are a logistical challenge. I anticipate that further details will be revealed about the King’s condition in the coming weeks and months. In so doing, a compassionate and caring and concerned public will be better served. So, too, will the multitudes amongst us who suffer with the spectrum of urological conditions, both benign and malignant, inclusive, and in all “candour,” of the ‘not prostate cancer’ cancers. God save the King.

The not-so-royal we

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HOWARD GOLDSTEIN

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