PSA
This incoming essay might could be construed as a public service announcement, in one sense. But, in this instance, I am referring to PSA as in a Prostate-Specific Antigen test. If you are unfamiliar with it, the PSA test is a blood test which all men of a certain age should start adding into their annual blood work which helps to screen for prostate cancer. The test is a diagnostic tool, and not an absolute binary result. So, the TL;DR version of this story is that I recently received a diagnosis of prostate cancer. A serious situation, and one which I believe I have now addressed. In my case, PSA testing is the main reason why, hopefully, I will be sticking around for a while longer yet. Please keep an eye on your prostates, gentlemen. Schedule your appointments now.
Beyond the recap above, I’m not really sure why I’m writing these personal vignettes in long form, as opposed to broadcasting a pithy social media announcement or two. But if you’re still with me here…
Back in October, 2021, After a few different doctors’ appointments, and due to an elevated PSA number, it was recommended I undergo a prostate biopsy. I had not been looking forward to this procedure, for obvious reasons, and I had hoped that maybe the elevated numbers were due to my riding a stationary bike a lot during the pandemic. So, before I committed to the biopsy, I stopped riding for a bit, thinking maybe, hopefully, that could be the cause of my elevated PSA. I retested a few weeks later, only to find that my numbers had climbed a little more still. I think my last test number was 5.65, which isn’t really a crazy high number, but was still a noticeable uptick from the 3–3.5 range I had been logging in recent years. My urologist, on this change, alongside my family history, predicted a 50/50 chance of my having cancer. I am not sure if my doctor was suggesting this was a literal coin flip, or if perhaps he was really trying to manage my existential dread. Overall, I was worried, and reasonably so, but somehow I did kind of believe I was too young to have prostate cancer. Alas.
December 14th, was the date I had the biopsy. And I, much to my chagrin, was awake for it.
Somehow, I had miscommunicated with a nurse/scheduler and, inexplicably, had declined sedation because of… my nerves and/or stupidity. The scheduler had called me to get me on the calendar. She said some words, asked some questions, and somewhere in there, she mentioned the possibility of intubation, and I was like no, what?! But I don’t want… why would they even need to…? Then she mentioned some people prefer to avoid sedation. With my being an escapist by nature, I said that sounds crazy, but she said more words, then…. I somehow checked the wrong box, wandered through the wrong door, and when the morning of the biopsy arrived, I would find myself breathing through and talking my way through a pelvic transgression I wish I did not remember. Hear me. Should you ever need to undergo a prostate biopsy, I implore you to sleep through it. There will be some soreness after in either case, but having to chat about college football while a needle gun repeatedly perforates your personals is just a patently terrible time. And that doesn’t even take into consideration the camera, the icepick and all of the other back of the tool catalog implements that find their way through your back door for 20 minutes or so. Learn from me. Sleep through this one.
Long story short, a couple of weeks later, I learned that of the ten needle biopsies performed, five showed evidence of cancer cells. Not good. My doctor was pretty matter of fact about it and that helped. A little. There is a lot of technical info and further testing I will skip over here but the main takeaway was the diagnosis of cancer. Specifically, my particular situation was neither the most nor the least aggressive of cancer possibilities. Intermediate risk. Two of the needle biopsies earned a Gleason score of 7. This was cause for concern I learned, and I had a pretty earnest freakout, but as far as cancer goes, we’ve all heard that prostate cancer is one of the more treatable cancers when caught early. Being 56 years old, I am on the youngish side for such a diagnosis, and there is a sense that effective treatment might earn me another 30 years hopefully. Had I been maybe 70 years or older, I might reasonably have opted to surveil my disease as prostate cancer — most often — advances relatively slowly and, ultimately, something is gonna get us. But for me, in this moment, I felt the need to pursue treatment, as I am aspiring to the best life expectancy I can muster.
As to which treatments are out there, there are a few options. In my case, a radical prostatectomy or radiation were the main two paths ahead.
Which brings Robert Frost to mind:
“Two roads diverged in a yellow wood,
And sorry I could not travel both
And be one traveler, long I stood
And looked down one as far as I could
To where it bent in the undergrowth…”
Except, where Frost seems to be imploring us to choose the individual’s path in life, the road less travelled, as opposed to a more conventional path laid out for us by the establishment, I was standing at my crossroads thinking fuck both of these paths. Don’t get me wrong, I am grateful for modern medicine, I am grateful for knowledgeable and caring medical professionals, I am grateful for robotic technology, and I am grateful for the opportunity to be treated for a serious disease after which, I will have a pretty solid opportunity to be cancer free. Or things may not go so smoothly. Who knows? But I am NOT going to allow myself to be surprised down the road. Anyway, my outlook is supposed to be pretty good. Fingers are crossed.
So where Frost and I diverge — see what I did there? — is that he was ruminating upon a real-time multiverse and making his case for rugged independence versus numbing conformity, while I was staring at two effective, but daunting, solutions to my one serious, though treatable, problem.
Surgery or radiation? To be or not to be, that is the question… Strangely, I wasn’t being pushed in either direction by the urological establishment. Though each of the courses were said to be effective as far as life expectancy, such an inglorious choice also presents two menus of potential side effects…. commonly including erectile dysfunction, incontinence, bowel issues, and pretty much on down through depression, anger, and delusions of haunted genitalia.
I ultimately elected to have my prostate removed, and this was scheduled for April 4th, 2022. Now, among my other concerns, I do fear I took too long getting around to my actual treatment. But they — the medical monolith — won’t operate on you until at least two months have passed after your biopsy, so, in all, I spent probably an additional 8–10 weeks stewing on my dilemma and exploring alternatives. High Intensity Focused Ultrasound looks like it may well be the future for prostate cancer treatment. But HIFU is less established at present, and seems to be more effective with less aggressive cancers.
For me, surgery seemed like the way to go. This way, I will still have radiation in my pocket if I need it down the road.
On the road to removal, a few more appointments were made, and a few more boxes checked. The hospital has its own pre-admittance screening. Hypochondriac, that I am, I was certain that while I was actively being treated for prostate cancer, the hospital was going to turn up something new for me to worry about. For instance, I was certain the chest x-ray would be troubling. One might say I was losing my bearings just a little. In the midst of my melodrama, one afternoon an appointment just popped up on my calendar for the next morning, an appointment with an unfamiliar doctor… my irrational fears then fully bloomed. With only a short time to think about it, I began to imagine the possible reasons I was meeting, unexpectedly, with a new doctor. This guy must be, I decided, the guy who specializes in giving patients horrible news. I grew certain I had more devastating problems than I even knew, and this was the guy who was going to break it to me…
The next morning, while I was sitting in yet another waiting room, I googled furiously to see if there might be some kind of yelp reviews on this new guy, my urological reaper, but I was called almost immediately back to learn my fate. The doctor was calm, or, at least, appeared to be reasonably comfortable with his grim duties, so when he told me to take a seat in his examination room, I was already falling deeply into give-it-to-me-straight mode. And when, finally, he initiated our conversation, he stated kindly that he was there to counsel me on the post-surgical possibility of erectile dysfunction… Praise be! I have never been so relieved to talk about ED in my life. A therapeutic regimen of low dose Viagra? Sounds interesting! You say you have some literature on penis pumps? Sure, I’ll have a look! I think my obvious mood elevation may have taken him by surprise. Further lessons in humility are neverending it seems.
So, this brings us to the actual laparoscopic event. I turned up at St. Mary’s Hospital on a Monday morning, at 6:30am. One nurse hooked me up to IVs, while another put stockings on my feet. Drugs were kicking in around 8:00am. At some point, someone was rubbing my belly with something… and then I was out. Under the knife by 8:30am. And it is worth noting, said knife was wielded by a DaVinci robotic system controlled by an experienced surgeon — yay science! I woke up in recovery a couple of hours later.
That first day was a lot. Reach out to me if you, for any reason, require the sordid details. I really don’t mind sharing but there is no reason for everyone to get dragged through my psycho-biological odyssey. Suffice it to say, and as invasive as it was, a radical prostatectomy is not too bad overall. The pain, especially due to the laparoscopic nature of this procedure, was pretty tolerable with some light pain meds. Each day was better than the previous. Until it wasn’t… A by the numbers recovery wasn’t for me, unfortunately.
Initially, an appointment was to be scheduled for a week after the surgery, at which point, I was expecting to gingerly float into this most glorious follow-up and that the catheter would be removed from my… erm…. penis.
But somewhere in that first week, I developed a urinary tract infection. What followed for the next 3–4 days, hews most closely to various first hand accounts of medieval venereal fever dreams. Cramps. Spasms. Fever. Vomiting. Too much bloody urine. Sorry about the visuals.
Antibiotics would bring me back to a reasonable stasis within a few days, but my overall recovery was likely set back by the infection. Ultimately, I would spend three weeks with that catheter swinging betwixt my legs. For 22 days, I was unable to produce relatively blood free urine. It was yet another lesson in humility, even as my body recovered from the surgery, I still could not do anything about the slow healing going on somewhere inside. Each day passed, as I stared at my pissbag obsessively, like a sideshow mentalist, trying to will my urine to be yellow. And I couldn’t make it happen. I kept returning for follow-up appointments, hoping to have my urinary nemesis removed, only to wind up shuffling back home with an infernal rubber intrusion attached to my special purpose. The catheter defined me there for a while. It was my keeper.
So, while my surgery may or may not have been completely successful, and while the twin specters of ED and/or incontinence are still out there looming…. I’ll admit I may have been a bit overly fixated on the temporary inconvenience of it all. But sometimes, you just get tired, and I hadn’t been mentally prepared for being laid up for a month. Four weeks, and more, of requiring care and patience. It is pretty humbling. My wife, and family, took amazing care of me and allowed me to lay low and rest day after day. There are so many greater problems in this world and far more serious issues with which I might have been presented. Overall, I am just feeling grateful. Meanwhile, the world kept spinning and I am about to jump back into it.
Why am I putting this account out there for consumption? Well, if you haven’t seen me around for the last month or so, this is the reason. Or if you have heard from me, or through the grapevine, that I have been dealing with something, then I am wanting you to know that I am doing okay. In fact, I am feeling pretty good. The surgery went well. The cancer appears to have been contained. The margins were good. I am feeling fortunate. Not completely at ease, mind you, but incredibly fortunate. But, I think the main reason I am recording my thoughts here, is that I am hoping to be candid about a serious topic, and that I might be of some use to others, friends and strangers alike, who may one day receive this type of unsettling news. I have been so very fortunate to have had support from so many people who have already been, or who are presently somewhere, along this path. It’s a bit of a rocky road, but very doable.
Many adventures ahead. Stay tuned…
***ADDENDUM***
Regarding the PSA test, while it is strongly encouraged, monitoring your PSA does not offer definitive results. The annual test is diagnostic, and thus somewhat subject to interpretation. Monitoring blood work seems to be pretty reliable though, and, for some, has become the standard of care. Thankfully, it was my PSA numbers which alerted my doctors to my disease.
But, it is also my understanding that many doctors are substituting the PSA for the old-fashioned digital rectal examination. I have another close friend who is on the same wild ride but their PSA numbers were lower than mine. Way lower, in fact, and holding steady. Yet, a digital exam still detected something unusual, a firm spot, which along with their family history, was enough to warrant further investigation.
The prognosis for my friend is also good, but the PSA just was not very helpful in his case.
However unpleasant it may be for most men, a finger inserted up your bum once a year, along with appropriate bloodwork, should still be part of your prescription for better living. I’d recommend seeing a urologist for your DRE, but experiment if you must.
***ADDENDUM TWO***
Could dogs be trained to detect prostate cancer? This seems like something they might be up for….
