Saturday, March 21, 2009

Now you tell me...?

I won't make you read this March 19, 2009 article about prostate-cancer testing unless you want to. Click on it to make it full size.

I was referred to my urologist by my family doc, who felt a hard node on the left side of my prostate during a routine digital rectal exam December 17, 2008. I've been getting those since I was in my forties. I'm used to them now, but some men are skittish about having someone's finger in their bum. Anyway, for years I've had BPH, which meant my prostate was enlarged. I've also taken a PSA test each year, which is a blood test that can indicate specific antigens in the prostate, leading to a clean bill of health or--brrrr, shudder--cancer.

In my case the PSA number was 258, which is pretty well within the normal range. It was higher than last year's test, but not that much, and the urologist asked why she referred me with that number. As soon as he felt the hard spot he knew. On January 16 I had a needle biopsy and on February 14 I had my prostate removed. The left lobe of my prostate was 19% cancer and the right lobe 1%.

Now comes a study that says that men who get PSA tests don't live any longer than men who don't. So maybe they're right, because as the urologist told me, "Many primary care docs wouldn't send me a guy with a PSA this low." So the guy would have cancer and no one would suspect because the PSA didn't show a large number. So what does it all mean? It means that men need the combination of the PSA and digital exam to see if there is anything unusual about the prostate.

Men are often told that prostate cancer is slow growing, so watch and wait. I have no idea whether my cancer was aggressive or slow-growing. The hard spot on my prostate was not there the year before, and then 1/5th of my prostate had gone malignant. Is that aggressive? I don't know, but I knew I wanted it out of my body, and the urologist agreed.

My friend has a dad who was diagnosed with prostate cancer at age 78. His doctor told him, "We won't take it out because prostate cancer is slow growing and something else will kill you first." (I hope the doctor didn't put it that bluntly.) Now my friend's father is 88, his cancer has spread and is killing him. So my friend is mad at the doctor for not taking the prostate out originally. Who knew he'd live long enough that the doctor's prediction didn't come true? Anyway, something will get us eventually, but I want to hold off as long as possible. I've got some things to do yet, and die of cancer at a young age is not one of them. My urologist said, "You could live another twenty years!" I try not to think like that, because it puts a timetable on my life. Cancer has a way of making you sit up and take notice that what I've been denying all my life is true: there is a timetable on mine and everybody's else's life. I've just got to push it back a ways.

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