The Elder Zone - Prostate Cancer
Part One
If you are looking for humor, you clicked on the wrong link.
I always hope to get at least a smile from the three of you who take the time to read my blogs, but that is not my primary intent with this piece.
This is a cautionary tale: I share with you what I have lived through and am living through, in the hope that other men can learn from my experience.
Cancer is a big word, one that defies sugarcoating, lacking any available euphemism.
According to the American Cancer Society, one in six men will be diagnosed with prostate cancer.
Many of them live in The Elder Zone.
I am one.
This article will describe how surreal the world of prostate cancer can be.
I share my personal adventures, in which two internationally respected hospitals and two “world-class” surgeons reviewed the same data and came to completely divergent opinions on what it means and what to do about it.
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Why Me?
I was a stranger to cancer of any kind until 2011.
I was sixty-two at that time.
No one in my family had cancer: no breast cancer, no lung cancer, not even skin cancer.
Cancer was one of those things that happened to other people.
I was fit.
My drug of choice was cycling.
I also dabbled in yoga, Pilates, strength training, and power walking daily.
I ate clean and lived a healthy lifestyle.
Then, I went in for my annual physical.
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My PCP examined me and praised me for being what appeared to be a healthy specimen.
In those days, before portals, email, or text messages, many internists would send the blood test report to the patient by mail with a note of some kind.
I was expecting something like, “Keep up the good work.”
Instead, I got “PSA is elevated.”
I did not know what “PSA” was and did not know anything about how being elevated affected me.
Was he paying me a compliment?
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Educate Yourself
What is a prostate?
It’s a gland.
Most of us men live without awareness that we have a gland residing at the juncture of the bladder, rectum, urethra, and erectile nerves.
If you envision your bladder as a lake that empties into a river, down the penis, and out of your body, the prostate sits at the mouth of the river, like a delta, sometimes compared to a walnut, sometimes to a plum.
Elevated PSA
I learned that in the world of prostate cancer, PSA was the “canary in the coal mine.”
An elevated PSA is a marker for possible prostate cancer.
Normal is 4.0.
Over 4.0 is the danger zone.
In 2010, my PSA was 3.9 – just under the line.
On November 11, 2011, it jumped to 4.6.
I would later learn that the PSA test is the first method of torture used by urologists.
The test itself is no big deal; it’s a simple blood draw.
Waiting on the results can make you crazy.
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Lab Results
Before agreeing to a PSA test, ensure the lab will email the results directly to you as soon as they are available. Some doctors prefer to review them before forwarding them to you. This will turn 2-3 days of staring at your computer into as many as 6 or 7. I know of few experiences more stressful than waiting for results from a PSA test when you surpass “elevated.”
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Doctor Shopping
When you learn that you have a serious problem with your prostate, you need to find the “right doctor” to help you.
“Right doctor” is hard to define.
You want a urologist who is compassionate, has experience and knowledge about your problem, and will take the time to explain things to you without snowing you with medical terms as obfuscation.
Always take someone with you to see a doctor about a serious medical condition, like cancer.
You may be so stunned by the word “cancer,” you won’t hear half of what else the doctor tells you.
If you can find a “patient advocate,” employing her services early on may pay big dividends in the long run in many ways.
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The Biopsy
When your PSA is elevated persistently, your doctor will probably advise that you need a prostate biopsy.
The biopsy is a procedure in which a doctor will put a device up your rectum and take samples of tissue.
Typically, it is an in-office procedure with a local anesthetic, but it can be done in the OR under general anesthesia.
This is another “torture method.”
A friend of mine told me that her husband had an in-office prostate biopsy, and it was the most painful experience he had ever had.
Based on that advice, I resisted having a biopsy.
While I was resisting, my PSA jumped to 6.9.
At that point, I could not afford to continue risking the potential consequences.
I opted for a biopsy in the OR.
Wrong!
When you undergo your biopsy, opt for a local anesthetic. The procedure is a little painful, but not so much that you need to incur the risks of general anesthesia.
Cancer?
After your biopsy, your doctor will tell you if they discovered cancer.
Because a biopsy only takes snippets from different areas of the prostate, it may not snip from the area where the cancer is.
In other words, the biopsy may not discover your cancer.
This may lead to additional diagnostics, such as an MRI.
The source of the elevated PSA must be identified and eliminated.
Gleason Scores
If they discover cancer, you will learn about “Gleason scores.”
A Gleason score is a metric used by the lab to determine the aggressiveness of the cancer.
How they do this is a mystery to me.
Typically, Gleason scores are 6, 7, or 8 (although I have read that Joe Biden had a score of 9 recently).
Gleason 6 – not aggressive. You will hear the adage, “More men die with it than from it.”
A common approach to a Gleason 6 is “active surveillance.”
This means that your medical professionals will check your PSA regularly and may likely require another biopsy in a year or so.
Gleason 8 = very aggressive - act now!
A major Dallas hospital reviewed my biopsy and reported, “Gleason 6.”
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Then
My PSA rose to 8.13.
Then, it dropped below 4, staying there for several months before reaching a low of 3.16.
I discussed this with my PCP.
He suggested that I get a second opinion from a reputable hospital in Baltimore.
So, I went from a world-class doctor in Dallas to a world-class doctor in Baltimore.
I sent the biopsy image to Baltimore before the meeting.
When I met the doctor in Baltimore, he asked me why I was there.
I told him I was interested in his active surveillance program.
“You’re not a candidate for active surveillance. Have you seen the new lab reports?”
“What new lab reports?”
Labs can differ dramatically in their interpretation of biopsy images. They also make errors.
The lab in Baltimore examined the same image as the one in Dallas, but Baltimore concluded, “It could be a Gleason 8.”
WTF?
Shot to the groin!
And I had broken my own rule and failed to take someone with me to Baltimore (after all, who wants to go to Baltimore?).
I had no idea that two labs could examine the same image and come to completely divergent opinions.
Who to believe?
What to do?
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To be continued