My wife tells me that other people don't really want to hear about my cancer. She says that my clinical situation is a private matter between my family and myself, and my urological team in Burlington, VT. Well, I think she usually she offers me excellent advice. That said, several male friends in my age group express great interest in my medical history and don't hesitate to question me about the most minute clinical details associated with prostate disease and its treatment at social gatherings, both formal and informal. After all, it's our version of breast cancer.
Women, as though scripted to do so, immediately excuse themselves from such conversations and move on to more gentle pleasantries. Well, I can only say that breast cancer is certainly no laughing matter, but then again neither is prostate cancer. A lot of people die from both (in pretty much the same ratios) and both raise deep psychological questions about losing our sexuality, our womanhood or our manhood to say nothing of our lives. It is apparent that our looming mortality is never a comfortable topic at cocktail parties.
On the other hand, if we've decided as a society that it's more appropriate to understate the disease of cancer (of either type), I personally believe no one would be served well. Ignorance is NOT bliss. And medical conditions should NOT be subject to financial exigency by insurance companies. If a woman undergoes a mammogram and is found to have a tumor, everyone recognizes that quick medical attention and the possibility for surgery is of the utmost importance. Yet, if a man has an elevated P.S.A. we are just as inclined to say, let's wait awhile, maybe this isn't as bad as it sounds. And at any rate, we all know that if it turns out to be cancer, it will likely be the slow-growing variety. Something else will get him before the prostate cancer.
My adage is a short one: never, ever, trust authority. About a week ago, a key government health panel, the United States Preventive Services Task Force, concluded that healthy men should no longer routinely be screened for prostate cancer using the prostate-specific antigen or P.S.A. blood test. This finding, of course, is a numbers balancing game. Basically, it has been concluded that although the P.S.A. does detect more cancers, it doesn't save more lives, and worse yet, overly aggressive treatments will leave men impotent, incontinent or both.
Likewise, about a year or so ago, it was also recommended that women in their 40's should no longer receive routine mammograms. That decision set off a firestorm of controversy. Is there a pattern here?
Now let me ask this question, what would YOU do? Frankly, if I were a woman I'd continue to press my physician for annual or even bi-annual mammograms, even though they are unpleasant and rude. And as a male, please rest assured that I feel my life now depends on receiving regular P.S.A.'s. I say this as a survivor, but I would also say it if I only had a vague, fluctuating result on the P.S.A.
I will now discuss what happened to me. Over the course of two or three years, my family physician routinely had my P.S.A. tested and recorded. I also received what us men don't ever appreciate: the DRE or digital rectal exam. As it turns out one is as important as the other. Then again, family physicians, especially it they are female, don't much enjoy conducting the DRE. I'm also told, btw, that it's all about feel -- doing them on a regualar basis improves clincial diagnosis.
In my case, consecutive P.S.A.'s began showing a definite upward trend, something I quickly pointed out to my physician. He retorted that I shouldn't be concerned, that my P.S.A. levels were in the high normal range. Eventually, and for this and other reasons, I changed physicians. The new one (actually she was a P.A. assigned to me), ordered a P.S.A. and then noted that it had climbed beyond the normal range.
I was referred to a urologist for a biopsy. Let me state that prostate biopsies are VERY unpleasant. During my first one, I became nauseous. I was told to relax. When the results came back the urologist immediately scoped my bladder. Sounds pretty suspicions doesn't it? He then told me I had prostate cancer and that I'd be dead in six months. What an asshole!
Because I have a few connections, within a week I ended up at the University of Vermont Medical Center in Burlington. I was also fortunate enough to be assigned to the Head of Urology and a research scientist there.
We reviewed my results: a rising P.S.A., the presence of rubbery lumps on my prostate (via the beloved DRE) and the calculation of a Gleason Score in the range of 6+ out of 10. My physician decided to place me on his list of "active, watchful waiting" patients. He is medically conservative. The P.S.A's continued on a regular basis. After treatment with certain pharmaceutical substances the P.S.A. actually dropped for awhile but then eventually started rising again.
So I think you get the picture. It's not just the P.S.A. It's a combination of P.S.A.'s (a barometer of sorts), the DRE or prostate palpitation, and biopsies. I stayed on "active, watchful waiting" for a couple of years. Then my urologist ordered a new biopsy (much less painful than the first, but only because I was distracted by the technician). The new Gleason Score turned out to be an 8 out of 10. The urologist decided it was game over and referred me for a robotic, radical, nerve-sparing prostatectomy.
Without the P.S.A's monitoring my general condition, however, it was only a guessing game. I say this with all due repect to the DRE (mostly my physician's sensitive feel) and that final biopsy.
The risk was in waiting. Doing nothing meant almost certain metastasis. Active aggressive therapy meant real risks. I can only say that the alternatives to bone cancer in addition to prostate cancer nearly eliminated any cause to move forward. I opted for surgery, and I believe to this day, that my physicans and surgeons at Fletcher Allen saved my life.
I am now two plus years beyond the radical prostatectomy. P.S.A. readings are a whole new ball game. Theoretically, I should be receiving .000 as my reading. I generally fluctuate between .135 and .250. At .300 I go into the oncology unit and chemotheapy.
Currently, I am considered to be in complete remission. My next appointment in Burlington is not until mid-April. My last one was in November.
I'm now working on age 69 and am pretty healthy, although slightly overweight. I do exercise regularly and believe that keeping my weight at a resonable level seems to be a wise regimen. As they say, it is what it is. I've lost to death three friends and neighbors in the past couple of weeks, so perhaps all of this is a bit more on my mind right now.
Let me suffice to say that life is back to almost normal. I thank the folks at Fletcher Allen for that.
Regardless, if you are a male, demand at your next annual physical that you receive a P.S.A. -- as well as a DRE.
Better to be safe than sorry.
Carry on,
Paul in Potsdam
<http://www2.potsdam.edu/loucksap/>
<http://loucksap.smugmug.com/>
<http://madstop68.blogspot.com/>
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