Physician examining rooms are usually small and windowless, with no comfortable place to sit. They’re lined with cabinets and drawers you just know contain all sorts of demonic tools with which to inflict pain. Likely on you. The usual minutes go from 60 seconds long to 240 seconds. It seems.
Finally, the door opens, doctor walks in, and the first words out of his mouth are “Hello. You have advanced prostate cancer and if you hadn’t shown up here two months ago, you’d be dead by now.” Word-for-word. Great bedside manner.
He hands you a copy of the biopsy report from last week’s visit. It’s all right there in pictures, diagrams, diagnostics by scale and the lab’s conclusion.
That was my lab report, cooly handed to me on a grey coastal day last Fall. Several depictions were cross-sections - “slices” of my prostate divided into nine regions. The lab used the commonly accepted Gleason scores ranging from zero to five with five being very bad. Mine showed a 4.9, a 4.8 and down - or 90% and 80% positive. No need for a second opinion here. The evidence in my hand was black and white. And conclusive.
I hadn’t made my first appointment with this urologist because of any bodily symptoms. With prostate cancer, there are usually no symptoms you can feel. What got my attention was a PSA score that had gone from 1.8 to 4.8 in six months. PSA means “prostate-specific antigen” and is determined by a normal blood test. Many doctors don’t give it a lot of importance. But it can be a good predictor that something is wrong if it changes radically in a short period of time as mine did. My primary care doc seemed unconcerned. But I insisted on a second test. That second test saved my life. I also got a new primary doc.
There are four major procedures to deal with prostate cancer: surgery to remove the prostate performed either by a surgeon the traditional way or with the DaVinci robot remotely controlled by the surgeon; radiation; chemotherapy; cryosurgery or a combination of two or more of these.
Most often, surgery is not “medically appropriate” - insurance talk - for seniors because of cost, compared to how much longer a senior may live without dying of some other problem. Radiation and drugs are often used in combination. But I’d had previous personal experience with both and knew the bad side-effects. I researched everything I could find, then opted for cryosurgery and hormones.
I took nine powerful hormone shots in eight months. The PSA reading went from 4.8 to 0.01, meaning the drug was killing the testosterone - the life-blood of prostate cancer. It also was shrinking the gland to be a better target for cryo.
Cryosurgery is done with two surgical rods. A cut is made in the lower body area between front and back. Both rods are inserted. One is shoved firmly into the prostate while the urologist watches using a tiny TV camera. During the two-hour procedure, gasses are used to freeze the prostate. First shot is -125 degrees and lasts for as long as the doctor believes necessary. Then wait. The second shot drops to -187 degrees. The idea is to kill as many cancer cells as possible on the first try and weaken the rest. Then, after a warming period, hit the weaker cells even harder. The second rod is a warming instrument to try to protect the bladder, bowel wall and other vital spots from being damaged in the freezing.
None of this sounds very comfortable. But, four weeks after the procedure, there’s been no pain from day one. I’m eating anything I want, bathroom habits are normal, I’ve been housebound but able to walk freely and do most daily activities. I feel great.
Based on his years of experience with cryo, the surgeon believes he got all the cancer. I’ll take the hormone shots for another four months. What we wait for now is a blood test and the PSA reading in about 70 days. We know it’s 0.01 today. If it’s at or close to that on the next test, we’ll have won this round.
One bad issue with prostate cancer is it often returns, no matter what procedure is first used. Maybe a year or two, or 10, or 12. With each return, you have reduced options depending on age. For me, at my age then, if it returns in a few years, the only options will be hormones and radiation. Eventually, the body will figure out how to make testosterone a different way and drugs will be needed to starve it again. May add another one to four years of life at that time.
Prostate cancer is a man-killer. But survival odds are getting better. Cryosurgery, while relatively new, is also improving, as my own experience shows. Medical science keeps working on this universal male problem and is improving the odds for all of us.
I didn’t describe all this to pander for attention. I want to make the most important point - in the strongest possible way - that males - ALL males - NEED TO GET REGULAR PSA TESTING! At least very six months. Especially after age 40. Most insurance plans pay for it once or twice a year. Do it! Pay for it yourself, if necessary! It’s not expensive. Record the results to track the trend between tests. A slight movement up is usually not cause for alarm.
But, if it climbs quickly, as mine did, get to a urologist immediately. He’ll probably recommend a biopsy so you’ll both know better what’s going on. With local anesthetic, it’s painless. And it’s damned good information. Quick and easy life saving information.
Now, GO. You’ve been warned!