Prostate Cancer - Part II
I posted Part I of this saga on August 28, 2025.
https://www.coachingwithwisdom.com/blog/the-elder-zone-prostate-cancer
At the end of Part I, two super-doctors diagnosed me with prostate cancer.
Two reputable labs looked at the same biopsy slide; one came back with a conclusion of “not that big of a deal, just keep an eye on it” (a/k/a active surveillance) and the other with a conclusion of “huge deal - You need treatment ASAP!”
Diagnostics
I find it fascinating that most, if not all, diagnostics to check for prostate cancer involve some form of torture.
I say this not to scare the patient who needs a diagnosis, but to prepare him for it.
It amazes me that the medical profession cannot find ways to detect prostate cancer without a little old-fashioned medieval torture, but better to put up with it than live with untreated cancer.
DREs
The first method of torture is typically the “DRE” exam.
“DRE” is an acronym for “digital rectal exam.”
To put it plainly, your doctor will stick his finger up your ass (accompanied by a latex glove and lubricant, one hopes) to probe and feel your prostate in search of anything that feels like a tumor, or that may feel out of the ordinary to the human touch.
Putting as much lipstick as we can on this pig, it’s unpleasant.
It doesn’t usually last long, but you're unlikely to request an encore.
PSA Tests
The second form of torture is the PSA test.
In terms of physical pain, the PSA is no more painful than any other blood draw.
Why, then, do I call it a form of torture?
Because you may have to wait for days that seem like years for the results.
Some labs will send the results directly to you within 24 hours.
However, some doctors instruct the labs to send the results to them before sending them to the patient (I call this “data impeding”).
They want to review the results, add their spin, and send the results to the patient after incorporating their comments.
I understand why they may do that – probably cuts down on questions.
But if you are on the cusp of an elevated PSA, and want, or need, to know those test results that may tell you whether you do or do not have cancer, trust me, you don’t want to sit in front of your computer for days (not to mention nights – some doctors and labs torture you further by sending test results at 3:00 a.m.) waiting for them.
Biopsies
An elevated PSA indicates that you may have a tumor or cancer cells in your prostate.
To be more certain, your doctor will want to give you a “biopsy.”
PSA tests are notoriously unreliable detectors of PC.
Biopsies are slightly better but also imprecise and another form of torture.
In a biopsy, your doctor will insert a device into your anus and take snippets of your prostate.
He can do this in the OR under a general anesthetic or in his office under a local.
A friend of mine said it was the worst experience he had ever had and advised me to have it done under a general. I followed that advice and later learned it was wrong.
The biopsy is a form of torture, but most of us former Navy Seals tolerate it with decorum and courage without a general anesthetic.
Your doctor will then send the snippets to a lab for evaluation.
If the lab detects cancer cells in the vicinity of one of the snips, Bingo!
Welcome to the club, brother. You’ve got the big C.
But if your test comes back negative, you could still have it.
That is the next form of torture: the ambiguous (or incorrect) lab report.
That nasty PSA must be coming from somewhere.
In these cases, your doctor may continue to monitor your PSA with regular blood tests and biopsy you again in six months or a year, whenever he thinks it is prudent.
MRIs and cancer scans have also become popular methods of diagnosing PC.
None of these methods is foolproof; diagnosing PC can be tricky.
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Treatment for Prostate Cancer
If you are convinced that you have PC, the next question is whether to treat.
There is an old saying: “More men die with it than from it.”
The older a man gets, the more likely he is to have prostate cancer.
There are two primary treatment options: surgery or radiation.
Each has its own unique consequences.
No matter which one you select, if you decide to treat prostate cancer, don’t expect it to be anything like your last cruise to Alaska.
Treatment comes along with inescapable side effects.
This is one of many of the damned-if-you-do and damned-if-you-don’t dilemmas you confront with PC and another form of torture.
Treat, and you are looking at the possibilities of incontinence, impotence, insomnia, anxiety, colon issues, urinary tract issues, and a long-term marriage to your urologist.
Don’t treat, and you may be looking at a slow and painful death sooner than expected.
The mix of consequences may depend on your treatment decisions.
Resolving Conflict Between Experts
So much for PC 101: back at the ranch, your hero has differing lab results; one “world-class” doctor is telling him to step on the accelerator, and another is telling him he needs to pretend he is driving through a school zone.
How does the patient resolve those problems?
To be continued