Tuesday, September 30, 2008
Second Opinion
We have an appointment with Dr. Julio Pow-Sang on 10/15. He is Division Chief of Genitourinary Oncology and Senior Member at H. Lee Moffitt Cancer Center.
Q&A session with Doc Baker
Anne and I met the doctor yesterday (9/29/2008) for a Q&A session.
What does the prostate do?
Your prostate has two important functions: one is to help control urination and the other is to help sexual activity.
The prostate has a so-called passive role in the process of urination. It helps to control the rate at which urine flows out of the bladder and into the urethra. It does this by the effect of muscle fibers in the prostate that surround the urethra.
The prostate also has an active role in sexual activity. The prostate gland makes a whitish glandular secretion which collects within the prostate and is fed into the urethra during ejaculation. This glandular secretion helps the motility of the sperm in the urethra and makes up about a third of the seminal fluid, thus giving seminal fluid its whitish appearance.
What causes prostate cancer?
Don't know.
If the prostate is cancerous, does my ejaculate contain cancerous cells that can be passed to my partner?
No. The doc tried to explain to me why this was so, but honestly, I got lost. Bottom line - I'm not putting cancer into my wife.
What stage is my cancer?
T1c. We call a prostate cancer stage T1c when it is found as a consequence only of the patient having a positive result to a prostate specific antigen (PSA) test but no other clinical sign of the disease. This stage compares precisely to the so-called stage B0 disease in the Jewett-Whitmore staging system. Because of the rapid increase in the number of patients having PSA tests in the past few years, stage T1c has become a relatively common stage of prostate cancer to be diagnosed.
How long have I had this cancer?
Hard to say with certainty - about two years is his best guess.
How fast does prostate cancer grow?
The doc told me it takes (on average) about 10 years for prostate cancer to be detectable via a digital rectal exam (DRE). This is one reason the PSA test has been so helpful - it can detect prostate cancer far sooner than a DRE.
How will I know I am cancer free?
Continuing PSA tests.
Do I have additional risks for rectal/bladder cancer?
No additional risks in my case.
Since I have some form of cancer, does that make me more susceptible to other forms of cancer (e.g. lung cancer)?
There is no evidence that having prostate cancer increases the risk factors for other forms of cancer. At least that's what he said, but I still wonder...
Survival rate for my age group
Due to early detection and my overall health, I am in the 99% cure rate category.
My treatment options
Hormone therapy. Not a viable option for men in my age group.
Radiation. There are numerous radiation therapies out there: Brachytherapy (seed therapy), External Radiation therapy, Proton External Beam Radiation, HDR, etc. Doc said that these treatment options are not advised for younger patients due to the "collateral" damage than can occur. Further, radiation leaves the prostate in the patient and turns it into scar tissue, which can lead to long term problems.
Surgery. The "gold" standard in prostate cancer treatment. You have three basic types: open, laparoscopic and robotic laparoscopic ("da Vinci"). The latter represents the current "state of the art" in surgery and offers the highest rate of success . This is the treatment method that I have (currently) selected. Here is a YouTube video of this gizmo: click
Incontinence
After the operation, I will have to wear a catheter for the first week. I will also be incontinent for at least a month, probably closer to three months. Due to my age and health, I have a better than 90% chance of having urinary control after three months. As I understand it, I may have life long "issues" with some leakage under certain situations (squatting, lift heavy objects, etc).
Impotence
I will be impotent for some amount of time after the operation. It's no surprise, but every patient is different in this respect. Some patients have erections within a few days of the procedure, some can take up to a year and others never have an erection (unassisted that is).
It seems the bottom line is this: the sooner you catch the cancer, and the better your health and "functions" are prior to the operation, the better your chances for a recovery to full function after the operation. Makes sense when you think about it.
Lastly, as I understand it I'll almost certainly be a Viagra (Cialis, Levitra, etc) customer for life. I suppose there are worse things in life to deal with. Maybe I'll get lucky and won't need them, selling my tabs to neighbors for beer money. :)
Recovery/Rehab
I should be back on my feet within a few days of the operation. Urinary control rehab involves Kegel exercises. Long pause... It's amazing how fast you lose almost all modesty when you have prostate cancer, but there are limits. There is one more "rehab" I have to do daily: use a vacuum erection device. There, I said it. The doc says it helps keep a fresh supply of oxygenated blood to the penis while the nerve structures and surrounding tissues are healing. There was another reason, but I was so weirded out by what he was saying that I forget it. Good Lord. Are there no limits to how embarrassing this process is going to get???
Schedule
I currently have Dr. Baker scheduled for the da Vinci procedure. Back to his office on 10/30 for instructions, scripts, etc. Pre-op at Brandon Hospital on 11/13, surgery on 11/17.
What does the prostate do?
Your prostate has two important functions: one is to help control urination and the other is to help sexual activity.
The prostate has a so-called passive role in the process of urination. It helps to control the rate at which urine flows out of the bladder and into the urethra. It does this by the effect of muscle fibers in the prostate that surround the urethra.
The prostate also has an active role in sexual activity. The prostate gland makes a whitish glandular secretion which collects within the prostate and is fed into the urethra during ejaculation. This glandular secretion helps the motility of the sperm in the urethra and makes up about a third of the seminal fluid, thus giving seminal fluid its whitish appearance.
What causes prostate cancer?
Don't know.
If the prostate is cancerous, does my ejaculate contain cancerous cells that can be passed to my partner?
No. The doc tried to explain to me why this was so, but honestly, I got lost. Bottom line - I'm not putting cancer into my wife.
What stage is my cancer?
T1c. We call a prostate cancer stage T1c when it is found as a consequence only of the patient having a positive result to a prostate specific antigen (PSA) test but no other clinical sign of the disease. This stage compares precisely to the so-called stage B0 disease in the Jewett-Whitmore staging system. Because of the rapid increase in the number of patients having PSA tests in the past few years, stage T1c has become a relatively common stage of prostate cancer to be diagnosed.
How long have I had this cancer?
Hard to say with certainty - about two years is his best guess.
How fast does prostate cancer grow?
The doc told me it takes (on average) about 10 years for prostate cancer to be detectable via a digital rectal exam (DRE). This is one reason the PSA test has been so helpful - it can detect prostate cancer far sooner than a DRE.
How will I know I am cancer free?
Continuing PSA tests.
Do I have additional risks for rectal/bladder cancer?
No additional risks in my case.
Since I have some form of cancer, does that make me more susceptible to other forms of cancer (e.g. lung cancer)?
There is no evidence that having prostate cancer increases the risk factors for other forms of cancer. At least that's what he said, but I still wonder...
Survival rate for my age group
Due to early detection and my overall health, I am in the 99% cure rate category.
My treatment options
Hormone therapy. Not a viable option for men in my age group.
Radiation. There are numerous radiation therapies out there: Brachytherapy (seed therapy), External Radiation therapy, Proton External Beam Radiation, HDR, etc. Doc said that these treatment options are not advised for younger patients due to the "collateral" damage than can occur. Further, radiation leaves the prostate in the patient and turns it into scar tissue, which can lead to long term problems.
Surgery. The "gold" standard in prostate cancer treatment. You have three basic types: open, laparoscopic and robotic laparoscopic ("da Vinci"). The latter represents the current "state of the art" in surgery and offers the highest rate of success . This is the treatment method that I have (currently) selected. Here is a YouTube video of this gizmo: click
Incontinence
After the operation, I will have to wear a catheter for the first week. I will also be incontinent for at least a month, probably closer to three months. Due to my age and health, I have a better than 90% chance of having urinary control after three months. As I understand it, I may have life long "issues" with some leakage under certain situations (squatting, lift heavy objects, etc).
Impotence
I will be impotent for some amount of time after the operation. It's no surprise, but every patient is different in this respect. Some patients have erections within a few days of the procedure, some can take up to a year and others never have an erection (unassisted that is).
It seems the bottom line is this: the sooner you catch the cancer, and the better your health and "functions" are prior to the operation, the better your chances for a recovery to full function after the operation. Makes sense when you think about it.
Lastly, as I understand it I'll almost certainly be a Viagra (Cialis, Levitra, etc) customer for life. I suppose there are worse things in life to deal with. Maybe I'll get lucky and won't need them, selling my tabs to neighbors for beer money. :)
Recovery/Rehab
I should be back on my feet within a few days of the operation. Urinary control rehab involves Kegel exercises. Long pause... It's amazing how fast you lose almost all modesty when you have prostate cancer, but there are limits. There is one more "rehab" I have to do daily: use a vacuum erection device. There, I said it. The doc says it helps keep a fresh supply of oxygenated blood to the penis while the nerve structures and surrounding tissues are healing. There was another reason, but I was so weirded out by what he was saying that I forget it. Good Lord. Are there no limits to how embarrassing this process is going to get???
Schedule
I currently have Dr. Baker scheduled for the da Vinci procedure. Back to his office on 10/30 for instructions, scripts, etc. Pre-op at Brandon Hospital on 11/13, surgery on 11/17.
Sunday, September 28, 2008
September is Prostate Cancer Awareness Month
Did you know that? Me either. I think the three that do know this are off fishing and the boat sank with them in it. I can certainly tell you that Walmart doesn't know it. The wife and I are in there last night buying cat food and on an end-cap is a big display of pink spray bottles. Buy one and they make a donation to Breast Cancer Research. BREAST CANCER? WTF? How about something that makes a donation to prostate cancer research?!?!?
While I'm at it, did you know that even though more men will contract prostate cancer than women who contract breast cancer, the government spends $0.50 for every dollar spent on breast cancer research!?
While I'm at it, did you know that even though more men will contract prostate cancer than women who contract breast cancer, the government spends $0.50 for every dollar spent on breast cancer research!?
Friday, September 26, 2008
This is not a Public Service Announcement
A PSA in this context is not a Public Service Announcement, it's Prostate Specific Antigen. It's a blood test and does not require any dropping of pants or gloved hands. Prostate-specific antigen (PSA) is a protein produced by the prostate gland. The prostate will produce this antigen for a number of reasons, but one is the presence of prostate cancer. This means that you may have some level of PSA in your blood, but it doesn't mean you have definitely have cancer - just that you might have cancer.
National Cancer Institute : PSA Questions and Answers
My experience was this:
The first PSA test came back at 7.6. Did the antibiotics, waited and re-tested. This second PSA test included a deeper test - the "free PSA %". The doc explained it to me this way: The antigen produced by the prostate tends to "latch" onto cancer cells. If you have an elevated PSA value, but most of it is floating around in your blood "free", then the probability of cancer is greatly reduced. However, if most of it is "attached" to something (i.e. not "free"), then that increases the probability of cancer and a biopsy is needed to confirm. My second PSA panel came back with a PSA of 7.4 and 14% free. In my case, it was the 14% that was the red flag and why the doctor ordered the biopsy.
National Cancer Institute : PSA Questions and Answers
My experience was this:
The first PSA test came back at 7.6. Did the antibiotics, waited and re-tested. This second PSA test included a deeper test - the "free PSA %". The doc explained it to me this way: The antigen produced by the prostate tends to "latch" onto cancer cells. If you have an elevated PSA value, but most of it is floating around in your blood "free", then the probability of cancer is greatly reduced. However, if most of it is "attached" to something (i.e. not "free"), then that increases the probability of cancer and a biopsy is needed to confirm. My second PSA panel came back with a PSA of 7.4 and 14% free. In my case, it was the 14% that was the red flag and why the doctor ordered the biopsy.
Thursday, September 25, 2008
Lies, Damn Lies and Statistics
Every procedure has its table of statistics. It always shows you how their process is superior to others. It's like trying to buy a mattress. No two stores sell the same mattress. It's some industry rule or something (really). You can try to copy down specifics about each as you go from store to store, but ultimately you realize that process is hopeless and buy the one that "feels" best.
One common problem I'm seeing with everyone's data is that it groups all men with prostate cancer into one bucket. For example, the da Vinci process states that 86% of patients have sexual function at 12 months. OK, I have two questions about that. One, exactly what is their definition of "sexual function"? Second, what is the success rate for men under 50 who have this procedure? It seems logical to me that the success rate of such a procedure can largely be dependent on the age of the patient. Eh?
One common problem I'm seeing with everyone's data is that it groups all men with prostate cancer into one bucket. For example, the da Vinci process states that 86% of patients have sexual function at 12 months. OK, I have two questions about that. One, exactly what is their definition of "sexual function"? Second, what is the success rate for men under 50 who have this procedure? It seems logical to me that the success rate of such a procedure can largely be dependent on the age of the patient. Eh?
Support Groups
I live in the Tampa Bay area (Brandon) and guess what? There doesn't seem to be one support group for prostate cancer! Could this be right? It's the most common form of cancer among men (1 in 6 of us will get it) and not one support group in one of the largest markets in the nation?!?!
Ripples
I was sitting outside on the patio this morning enjoying a beautiful September Florida morning. Temps in the low 70's, a slight breeze, bright blue sky, birds chirping and squirrels running this way and that. Considering we've been having mornings in the upper 80's with 90+% humidity, it's more than a welcome change.
While I'm sitting there, I notice something fall from the top of the screen enclosure into the pool. I tend to notice, and be entertained by things many people never seem to take note of. For example, I really enjoy watching cream being poured into a hot cup of coffee. I have a special clear coffee mug just for this purpose. Depending on how and where you pour that cream into the coffee, the result is entirely different, yet predictable. Besides, it looks really cool. I also like to watch it rain. I can't explain why, but I find it relaxing and enjoyable. There is detail in rainfall. No matter how hard it's raining, you can watch one spot on the ground for many, many minutes and never see one drop of rain hit that exact spot. It'll land all around that spot, but not the spot you're watching - until you look at one of those adjacent spots, then it hits!
I'm watching this object fall and start to think about how random its fall seems to be, yet I know that there are mathematical equations that can clearly define everything I'm seeing as "random" - which I think is pretty darn cool. I don't understand those equations, but I know they exist and that there are folks who do understand them. Good enough for me.
I run out of time and the object hits the water. It does just what you would expect it to do - produce ripples. An event happened at that point on the water surface, and now the result of that event is being imparted on everything around it, in all directions. It occurs to me that this is an analog of my prostate cancer. Yes, "I" have prostate cancer, but, the effects of this event are touching everyone around me, some in unexpected and profound ways.
My wife has been terrific in this process. She has never shown any sign of "weakness", always "strong" and positive. But think about - it has to be scarring the crap out of her too. If it were me, I know I'd be scared !@#$less. My daughters - both broke down in tears upon hearing the news. Steph is 27 and Allison 16, but neither should have to carry that kind of burden at that young an age.
I am blessed to be from a large family - seven sisters (no brothers, I'm third in line). Yea, I know. Different story for a different time. We are all still quite close and keep in touch on a semi-regular basis. Thanksgiving is always at our house and Christmas Eve dinner/gathering is always at Val's house. If nothing else, we always see each other those two times a year.
Most are taking the news well, and all are wonderfully supportive. My parents are being great, but I can hear the crying in Mom's voice when she calls pretending to be strong. One sister isn't taking this news so well. Her and I were closet growing up, so it's understandable. If the shoes were on the proverbial other foot, I'm sure I'd be reacting the same way. Probably worse. I also have many friends and there has been an outpouring of support from them as well. Neighbors too. Anne and I have often said that even if we were to win the lottery, we'd still live right where we are now because of how great our neighbors are. We all know and watch out for each other. You can't buy good neighbors.
It's only been a few days now, but I can't help but notice, and be oddly entertained at how the ripples from this event are reaching out and touching the lives of others... I am truly blessed.
While I'm sitting there, I notice something fall from the top of the screen enclosure into the pool. I tend to notice, and be entertained by things many people never seem to take note of. For example, I really enjoy watching cream being poured into a hot cup of coffee. I have a special clear coffee mug just for this purpose. Depending on how and where you pour that cream into the coffee, the result is entirely different, yet predictable. Besides, it looks really cool. I also like to watch it rain. I can't explain why, but I find it relaxing and enjoyable. There is detail in rainfall. No matter how hard it's raining, you can watch one spot on the ground for many, many minutes and never see one drop of rain hit that exact spot. It'll land all around that spot, but not the spot you're watching - until you look at one of those adjacent spots, then it hits!
I'm watching this object fall and start to think about how random its fall seems to be, yet I know that there are mathematical equations that can clearly define everything I'm seeing as "random" - which I think is pretty darn cool. I don't understand those equations, but I know they exist and that there are folks who do understand them. Good enough for me.
I run out of time and the object hits the water. It does just what you would expect it to do - produce ripples. An event happened at that point on the water surface, and now the result of that event is being imparted on everything around it, in all directions. It occurs to me that this is an analog of my prostate cancer. Yes, "I" have prostate cancer, but, the effects of this event are touching everyone around me, some in unexpected and profound ways.
My wife has been terrific in this process. She has never shown any sign of "weakness", always "strong" and positive. But think about - it has to be scarring the crap out of her too. If it were me, I know I'd be scared !@#$less. My daughters - both broke down in tears upon hearing the news. Steph is 27 and Allison 16, but neither should have to carry that kind of burden at that young an age.
I am blessed to be from a large family - seven sisters (no brothers, I'm third in line). Yea, I know. Different story for a different time. We are all still quite close and keep in touch on a semi-regular basis. Thanksgiving is always at our house and Christmas Eve dinner/gathering is always at Val's house. If nothing else, we always see each other those two times a year.
Most are taking the news well, and all are wonderfully supportive. My parents are being great, but I can hear the crying in Mom's voice when she calls pretending to be strong. One sister isn't taking this news so well. Her and I were closet growing up, so it's understandable. If the shoes were on the proverbial other foot, I'm sure I'd be reacting the same way. Probably worse. I also have many friends and there has been an outpouring of support from them as well. Neighbors too. Anne and I have often said that even if we were to win the lottery, we'd still live right where we are now because of how great our neighbors are. We all know and watch out for each other. You can't buy good neighbors.
It's only been a few days now, but I can't help but notice, and be oddly entertained at how the ripples from this event are reaching out and touching the lives of others... I am truly blessed.
Fear, Uncertainty and Doubt
FUD. This has always been a marketing term to me. Now it's a reality.
Fear: Learning that I have cancer is scariest thing that's ever happened to me. Cancer kills people. This isn't something that can be put off and it will not get better in a week or two with bed rest. I have cancer! Don't tell me about how prostate cancer is very curable. The only cancer that kills more men is lung cancer. More men will wind up with prostate cancer than women with breast cancer. Prostate cancer can be seriously deadly stuff.
Uncertainty: Is there anything more uncertain than having cancer? Which doctor is best for me? Which treatment option is best for me? Will I be wearing a diaper the rest of my life? Will I no longer be able to have sex in a natural manner?
Doubt: I'm not a doctor, but I will have many doctors who all are very knowledgeable, all offering different advice. How the hell am I supposed to pick the right doctor/procedure? I'm not trained or well versed in this field. I'm a computer programmer. Been one almost 30 years. I have a friend who reads about some new language that's supposed to make developing an application super easy and super quick. He even has examples of such success. I advise against it, but he hires a team to do it anyway. Long story short, it was a disaster. Why? Because you can't take a few examples of success in a field you do not have a deep understanding of without the risk of making serious errors. Same here - I do not have a deep understanding of cancer research. I cannot simply "read" about it and be sure that I'm making the right choice. Lots of doubt...
Fear: Learning that I have cancer is scariest thing that's ever happened to me. Cancer kills people. This isn't something that can be put off and it will not get better in a week or two with bed rest. I have cancer! Don't tell me about how prostate cancer is very curable. The only cancer that kills more men is lung cancer. More men will wind up with prostate cancer than women with breast cancer. Prostate cancer can be seriously deadly stuff.
Uncertainty: Is there anything more uncertain than having cancer? Which doctor is best for me? Which treatment option is best for me? Will I be wearing a diaper the rest of my life? Will I no longer be able to have sex in a natural manner?
Doubt: I'm not a doctor, but I will have many doctors who all are very knowledgeable, all offering different advice. How the hell am I supposed to pick the right doctor/procedure? I'm not trained or well versed in this field. I'm a computer programmer. Been one almost 30 years. I have a friend who reads about some new language that's supposed to make developing an application super easy and super quick. He even has examples of such success. I advise against it, but he hires a team to do it anyway. Long story short, it was a disaster. Why? Because you can't take a few examples of success in a field you do not have a deep understanding of without the risk of making serious errors. Same here - I do not have a deep understanding of cancer research. I cannot simply "read" about it and be sure that I'm making the right choice. Lots of doubt...
Treatment options
The first thing we talked about are the treatment options. You have two basic choices, radiation and surgery:
- According to my urologist, radiation (including seed therapy) pretty much nukes the prostate, turning it into scar tissue. That can lead to problems down the road that can't be easily fixed with surgery (without gutting you that is). Radiation can also kill many/most of the nerves that make things work down there.
- That leaves surgery. Older surgery methods also risked damage to those same nerves. Pretty much guaranteed in fact. There is a new method of surgery available that my doctor has been doing about 2 years (and he trained at Moffit for three years prior to that). It uses a robotic gizmo and he sits at a video booth! It allows much better control, and its success rates are much higher than other methods. This daVinci gizmo looks like my best option to (first and foremost) get rid of the cancer and secondly, have a good chance at a normal life thereafter. Brandon Hospital got the latest model 4 months ago... Here is a link to this device: click
Wednesday, September 24, 2008
The wait is over
My follow-up appointment for the biopsy was 9/23/2008. There are days you will remember the rest of your life. The day you get married, the days your children are born, etc. I will always remember 9/23 as the day I learned that I have prostate cancer.
Anne was with me for this appointment. Neither of us expected this. Both of us were stunned. I have localized prostate cancer with a Gleason Score of 6 (that's supposed to be non-aggressive). I suppose that's good news.
Anne was with me for this appointment. Neither of us expected this. Both of us were stunned. I have localized prostate cancer with a Gleason Score of 6 (that's supposed to be non-aggressive). I suppose that's good news.
Background
Hi. My name is Chris and I'm a 47 year old male. I live in a middle class neighborhood with my wife Anne, and my youngest daughter Allison. My oldest daughter, Stephanie, is 27 and has a beautiful family of her own (husband Clint, daughter Madisyn and a boy on the way). My son Chris, almost 25, is soon to be married to the lovely Becca. He's also training to become a Fireman. How cool is that?
This process started about three months ago, June 2008. I suspected that I had a hernia in my groin so I went to my regular MD for a check. She gloved up, I coughed and she had all she needed to verify it was a hernia (properly known as a "inguinal hernia"). She referred me to a surgeon and while I was there she ordered your basic blood work panel. What I didn't know then was that she also ordered a test called a "PSA". It test for the presence of "Prostate Specific Antigen". In brief, the prostate puts out this antigen when it is under attack by cancer. I get the blood work done a day or two later and don't think much about it after that.
At the surgeon
A few days after getting my blood work done, I'm at the the surgeon. He examined me and found three more hernia's. That was surprising in itself. He explained "open" versus "laproscopic" procedure and it's pretty obvious that I am going to do the laproscopic method. During this process he also explains what exactly is going on - the muscle wall is torn and the intestine is bulging through that wall. It's putting pressure on that cord/vein/tube/whatever that runs from somewhere inside me down to my right testicle. So that's why I have those occasional pains out of seemingly no where! Just for fun, any pressure in my abdominal cavity will exacerbate the problem (sneeze, cough, etc).
He asks if I have any other questions... Over the past year I'd noticed that I was having a more difficult time starting to urinate, and when the flow would stop, I still felt like there was more. I'd wait a few minutes and then be able to finish the job. I ask him if this hernia thing could be why I'm having that problem (thinking that the intestine is pressing on some part of the "plumbing"). He looks at me oddly, says "No" and offers to check my prostate.
I'd never had a prostate check, but I had a good idea of what that meant. I was right. He gloves up, I drop my pants, get on the table, lay on my left side and curl up into a semi fetal position. The doctor tells me that I will feel a "bit" of discomfort. I'm not sure what I expected, but I sure didn't expect him to start digging around in there like he was trying to fish a class ring out of a drain pipe. Thankfully this only lasted about 15 seconds, although it did seem like 15 minutes.
While I'm dressing he tells me I have an enlarged prostate and that I will need to see a urologist before we can do the hernia surgery. I'm somewhat surprised by this news and almost miss the chair while sitting back down. "Enlarged Prostate"? What is that? He explains it can become enlarged for a variety of reasons, but the only one I hear is "cancer". It's damn hard to think straight when you hear that word...
Anne finds and makes me an appointment at a urologist. They request blood work, but as you will recall, I did that recently. They explain that I will also need a "PSA" test - Anne informs them that the blood work I did a few days ago had this test requested and that makes them happy.
Back to the MD
A few days later, my MD calls and wants me to come back in. The blood work is back and there are problems with my blood sugar levels and with my PSA level. That's a little scary - I've never been called back in to the doctor for anything. They do some other blood test (A1C) and that clears me on the blood sugar front. Cool. However, my PSA is 7.6 and she wants me to see a urologist about it. I tell her what the surgeon found and that I already have an appointment with a urologist. She asks me to keep her updated and that ends that.
Google is your friend
While I'm waiting for my urologist appointment date, I google PSA and learn enough to really confuse me. A PSA of 0 almost certainly means you do not have cancer, but 7.6 means you may or may not. In other words, an elevated PSA value can be a indicator of cancer, but it doesn't mean you do have cancer. I ask some guys I know and most have had an elevated PSA at one time and never any issues with cancer. One even had a PSA of 11 at one time, no cancer. My uncle regularly has a PSA of 6.5 and never any cancer. This looks promising.
The Urologist
The day finally comes that I get to see the urologist. He seems nice enough, a little young maybe (mid thirties I'd guess), but about right if you want a doctor with experience, but is also up to snuff on the latest and greatest. He tells me what I pretty much already know about the PSA value. He tells me he doesn't like it that high in my age group - he'd like to see it below 2.5. He suggests a two week regiment of some super-duper antibiotic in case I have an infection in my prostate. I didn't know you could have an infection localized to just the prostate, but that's why he was wearing the doctor garb.
I take the antibiotics for the two weeks, wait one week, get new blood work for PSA and go back to urologist for a "flow" test.
Flow Test
A flow test is simple and (almost) painless. You show up at the doctor with a full bladder (you drink 32oz of water 1 hour prior) and urinate in a fancy bucket that measures A) how much and B) how long it takes. After this test, the tech tells me I did "great". They needed about 100cc and I did 300+cc. The only "bad" part is that the first time I showed up at the doctor for this test, the machine was broken and after 40 minutes I couldn't hold things any longer.
Back to the Urologist
A few weeks later, I return for the follow-up at the urologist fully expecting good news. In general, I "feel" better than I had in a while, and, my urine flow had dramatically improved since the antibiotic regiment. I was certain that all I had wrong with me was a simple infection.
The urologist comes in and after some brief small talk he informs me that my PSA hadn't changed significantly (7.4) and that something called the "free" PSA is too low at 14%. The logic is this: the PSA cells/molecules/whatever "attach" to cancer cells in the prostate. If the PSA level is high, but the "free" PSA is also high, then there's a better chance it's not cancer (lots of antigen harmlessly floating around in your blood). However, a high PSA coupled with a low "free" percentage can mean that the prostate is pumping out antigen and that most of it is hooking up with cancer cells in your prostate.
He tells me that we have to do a prostate biopsy. Given my expectations, this news was quite shocking. About this time the room began to slowing spin. Everything moved in slow motion, even the doctor. I could hear him talking, but I can't remember what he was saying. I recall that my eyes watered up and was overcome with emotion. It wasn't fear, or sadness - I don't know what it was, but it was intense for a few moments. Apparently I was visibly shaken because, bless his heart, he tried to assure me that this didn't mean I had cancer. Just that the odds weren't real positive for someone in my age group with a PSA that high. Thanks doc.
I gather myself and begin to ask coherent questions. He gives me the quick overview of a prostate biopsy. One of the things I distinctly remember him telling me was that the biopsy wasn't that "bad". He said I'd feel a few small pinches, and a few "thumps". He demonstrated the "thump" on my thigh. It won't be that bad at all he assured me.
At the conclusion of the visit, he walks back up to the front desk with me. I've never had a doctor walk back to the front desk with me for any reason, so I'm impressed. The woman behind the desk comes up with some date that is about four weeks out - he tells her "no, get me something early next week, even if it means overbooking". Again, I've never had a doctor do something like that.
The Biopsy
First, you don't just go get a prostate biopsy. You have to prepare for it. The device used to perform the biopsy will be poking holes in the lower intestine (specifically the colon) in order to get to the prostate gland. In order to prevent infection from this procedure, you have to take antibiotics (I had Cipro) the day before, the day of and the day after. Further, and less thrilling, are the enema's. You have to have an enema the night before, and 2 hours before the appointment. Somehow, in 47 years of living I'd never had the need for an enema - again, I had no idea what to expect. Not fun is as best as I can do.
I arrive at the urologist for the biopsy. A few minutes later I'm told the machine is broken and could I come back next week. I couldn't believe it. I'm all "prepped" for this biopsy now I'm going to have to do this all over again?!?! I leave, pick up Allison from school and head back home. The phone is ringing as I come in the door. It's the urologist - they got a another machine from another office and they want me to come back in an hour. Sure. Great - lets get this over with.
I show back up for the biopsy. A few minutes later I'm being lead though a labyrinth of hallways to the bathroom. If you visit the urologist, you pee in a cup - it must be some rule. I do, place the cup in the "secret passage window" and exit the bathroom. I'm then lead to another room where there are a lot more people standing around than I expected. Two men and three women.
The doctor is not "my" doctor - it's one of his partners, but he seems very attentive. After a brief exchange of difficult banter, he instructs me to drop my pants and get on the table, on my left side in a fetal position. I notice that my hands are slowly starting to unbuckle my pants, but my brain is preoccupied with wondering when those women are going to leave. It takes me a few seconds to realize they weren't leaving - they were part of this process.
I get on the table and attempt to position myself in the manner instructed. They move me around a bit and they drape some cloth with a hole it over me. A few minutes later the good doctor is telling me I may feel "some discomfort" as he inserts the biopsy device. If you haven't figured it out, this device goes up your bum. Well, "some discomfort" doesn't quite cover it.
He pushes this thing up me what feels like four or five inches and tells me that he is about to inject the site with anesthetic. I feel a few pinches, but it's not too bad. While he waits for the anesthetic to take effect, he goes on a tour of my lower intestine. Doc, I assure you, there's nothing lost up there - stop digging!
After a few minutes of this fun, he tells me he is about to start the biopsy procedure. He tells me I will feel a "slight" pinch and then a "thump". Then he asks if I'm ready and I give the thumbs up.
Allow me to digress for a moment - I think that I've figured out a life rule: Any time a doctor asks if you're "ready", do not believe what they told you a few minutes ago about it not being "that bad".
He pulls the trigger on the first sample. Yep, a "pinch", but not that bad. About 1 second later the "thump". WOW. That felt weird. Sort of a shock wave that I could feel in my pelvic bones, thigh bones and all the way down the urethra to the end of my penis. I no longer remembered or cared that there were women in the room. Sample number two. Same small pinch, but this time that "thump" felt like a lighting bolt shooting out the end of my penis. It takes your breath away. By the fifth or sixth sample, the pinches were starting to be more than a "pinch". It was starting to really hurt. I was soaked in sweat by this time. I had sixteen samples taken.
I could not move at the end of the procedure. I was a sweat soaked pile of goo. Everyone was very kind and helpful, but I was wasted. After a few minutes, I was able to sit up and put my cloths back on. One or more of these fine folks held onto me at all times, but I kept assuring them that I was OK. They finally let go of me and as I turned to leave the room, the room turned with me and I started to fall. They were smarter than me, because one of the guys was ready for me to fall and caught my dumb butt.
They sat me down in a chair and made me drink some juice and eat some candy. Two or more stayed with me for at least 15 minutes until I had "color in face" and was really OK to leave.
The Wait
I had the biopsy on 9/2/2008 and it's going to be three weeks before I get the results...
This process started about three months ago, June 2008. I suspected that I had a hernia in my groin so I went to my regular MD for a check. She gloved up, I coughed and she had all she needed to verify it was a hernia (properly known as a "inguinal hernia"). She referred me to a surgeon and while I was there she ordered your basic blood work panel. What I didn't know then was that she also ordered a test called a "PSA". It test for the presence of "Prostate Specific Antigen". In brief, the prostate puts out this antigen when it is under attack by cancer. I get the blood work done a day or two later and don't think much about it after that.
At the surgeon
A few days after getting my blood work done, I'm at the the surgeon. He examined me and found three more hernia's. That was surprising in itself. He explained "open" versus "laproscopic" procedure and it's pretty obvious that I am going to do the laproscopic method. During this process he also explains what exactly is going on - the muscle wall is torn and the intestine is bulging through that wall. It's putting pressure on that cord/vein/tube/whatever that runs from somewhere inside me down to my right testicle. So that's why I have those occasional pains out of seemingly no where! Just for fun, any pressure in my abdominal cavity will exacerbate the problem (sneeze, cough, etc).
He asks if I have any other questions... Over the past year I'd noticed that I was having a more difficult time starting to urinate, and when the flow would stop, I still felt like there was more. I'd wait a few minutes and then be able to finish the job. I ask him if this hernia thing could be why I'm having that problem (thinking that the intestine is pressing on some part of the "plumbing"). He looks at me oddly, says "No" and offers to check my prostate.
I'd never had a prostate check, but I had a good idea of what that meant. I was right. He gloves up, I drop my pants, get on the table, lay on my left side and curl up into a semi fetal position. The doctor tells me that I will feel a "bit" of discomfort. I'm not sure what I expected, but I sure didn't expect him to start digging around in there like he was trying to fish a class ring out of a drain pipe. Thankfully this only lasted about 15 seconds, although it did seem like 15 minutes.
While I'm dressing he tells me I have an enlarged prostate and that I will need to see a urologist before we can do the hernia surgery. I'm somewhat surprised by this news and almost miss the chair while sitting back down. "Enlarged Prostate"? What is that? He explains it can become enlarged for a variety of reasons, but the only one I hear is "cancer". It's damn hard to think straight when you hear that word...
Anne finds and makes me an appointment at a urologist. They request blood work, but as you will recall, I did that recently. They explain that I will also need a "PSA" test - Anne informs them that the blood work I did a few days ago had this test requested and that makes them happy.
Back to the MD
A few days later, my MD calls and wants me to come back in. The blood work is back and there are problems with my blood sugar levels and with my PSA level. That's a little scary - I've never been called back in to the doctor for anything. They do some other blood test (A1C) and that clears me on the blood sugar front. Cool. However, my PSA is 7.6 and she wants me to see a urologist about it. I tell her what the surgeon found and that I already have an appointment with a urologist. She asks me to keep her updated and that ends that.
Google is your friend
While I'm waiting for my urologist appointment date, I google PSA and learn enough to really confuse me. A PSA of 0 almost certainly means you do not have cancer, but 7.6 means you may or may not. In other words, an elevated PSA value can be a indicator of cancer, but it doesn't mean you do have cancer. I ask some guys I know and most have had an elevated PSA at one time and never any issues with cancer. One even had a PSA of 11 at one time, no cancer. My uncle regularly has a PSA of 6.5 and never any cancer. This looks promising.
The Urologist
The day finally comes that I get to see the urologist. He seems nice enough, a little young maybe (mid thirties I'd guess), but about right if you want a doctor with experience, but is also up to snuff on the latest and greatest. He tells me what I pretty much already know about the PSA value. He tells me he doesn't like it that high in my age group - he'd like to see it below 2.5. He suggests a two week regiment of some super-duper antibiotic in case I have an infection in my prostate. I didn't know you could have an infection localized to just the prostate, but that's why he was wearing the doctor garb.
I take the antibiotics for the two weeks, wait one week, get new blood work for PSA and go back to urologist for a "flow" test.
Flow Test
A flow test is simple and (almost) painless. You show up at the doctor with a full bladder (you drink 32oz of water 1 hour prior) and urinate in a fancy bucket that measures A) how much and B) how long it takes. After this test, the tech tells me I did "great". They needed about 100cc and I did 300+cc. The only "bad" part is that the first time I showed up at the doctor for this test, the machine was broken and after 40 minutes I couldn't hold things any longer.
Back to the Urologist
A few weeks later, I return for the follow-up at the urologist fully expecting good news. In general, I "feel" better than I had in a while, and, my urine flow had dramatically improved since the antibiotic regiment. I was certain that all I had wrong with me was a simple infection.
The urologist comes in and after some brief small talk he informs me that my PSA hadn't changed significantly (7.4) and that something called the "free" PSA is too low at 14%. The logic is this: the PSA cells/molecules/whatever "attach" to cancer cells in the prostate. If the PSA level is high, but the "free" PSA is also high, then there's a better chance it's not cancer (lots of antigen harmlessly floating around in your blood). However, a high PSA coupled with a low "free" percentage can mean that the prostate is pumping out antigen and that most of it is hooking up with cancer cells in your prostate.
He tells me that we have to do a prostate biopsy. Given my expectations, this news was quite shocking. About this time the room began to slowing spin. Everything moved in slow motion, even the doctor. I could hear him talking, but I can't remember what he was saying. I recall that my eyes watered up and was overcome with emotion. It wasn't fear, or sadness - I don't know what it was, but it was intense for a few moments. Apparently I was visibly shaken because, bless his heart, he tried to assure me that this didn't mean I had cancer. Just that the odds weren't real positive for someone in my age group with a PSA that high. Thanks doc.
I gather myself and begin to ask coherent questions. He gives me the quick overview of a prostate biopsy. One of the things I distinctly remember him telling me was that the biopsy wasn't that "bad". He said I'd feel a few small pinches, and a few "thumps". He demonstrated the "thump" on my thigh. It won't be that bad at all he assured me.
At the conclusion of the visit, he walks back up to the front desk with me. I've never had a doctor walk back to the front desk with me for any reason, so I'm impressed. The woman behind the desk comes up with some date that is about four weeks out - he tells her "no, get me something early next week, even if it means overbooking". Again, I've never had a doctor do something like that.
The Biopsy
First, you don't just go get a prostate biopsy. You have to prepare for it. The device used to perform the biopsy will be poking holes in the lower intestine (specifically the colon) in order to get to the prostate gland. In order to prevent infection from this procedure, you have to take antibiotics (I had Cipro) the day before, the day of and the day after. Further, and less thrilling, are the enema's. You have to have an enema the night before, and 2 hours before the appointment. Somehow, in 47 years of living I'd never had the need for an enema - again, I had no idea what to expect. Not fun is as best as I can do.
I arrive at the urologist for the biopsy. A few minutes later I'm told the machine is broken and could I come back next week. I couldn't believe it. I'm all "prepped" for this biopsy now I'm going to have to do this all over again?!?! I leave, pick up Allison from school and head back home. The phone is ringing as I come in the door. It's the urologist - they got a another machine from another office and they want me to come back in an hour. Sure. Great - lets get this over with.
I show back up for the biopsy. A few minutes later I'm being lead though a labyrinth of hallways to the bathroom. If you visit the urologist, you pee in a cup - it must be some rule. I do, place the cup in the "secret passage window" and exit the bathroom. I'm then lead to another room where there are a lot more people standing around than I expected. Two men and three women.
The doctor is not "my" doctor - it's one of his partners, but he seems very attentive. After a brief exchange of difficult banter, he instructs me to drop my pants and get on the table, on my left side in a fetal position. I notice that my hands are slowly starting to unbuckle my pants, but my brain is preoccupied with wondering when those women are going to leave. It takes me a few seconds to realize they weren't leaving - they were part of this process.
I get on the table and attempt to position myself in the manner instructed. They move me around a bit and they drape some cloth with a hole it over me. A few minutes later the good doctor is telling me I may feel "some discomfort" as he inserts the biopsy device. If you haven't figured it out, this device goes up your bum. Well, "some discomfort" doesn't quite cover it.
He pushes this thing up me what feels like four or five inches and tells me that he is about to inject the site with anesthetic. I feel a few pinches, but it's not too bad. While he waits for the anesthetic to take effect, he goes on a tour of my lower intestine. Doc, I assure you, there's nothing lost up there - stop digging!
After a few minutes of this fun, he tells me he is about to start the biopsy procedure. He tells me I will feel a "slight" pinch and then a "thump". Then he asks if I'm ready and I give the thumbs up.
Allow me to digress for a moment - I think that I've figured out a life rule: Any time a doctor asks if you're "ready", do not believe what they told you a few minutes ago about it not being "that bad".
He pulls the trigger on the first sample. Yep, a "pinch", but not that bad. About 1 second later the "thump". WOW. That felt weird. Sort of a shock wave that I could feel in my pelvic bones, thigh bones and all the way down the urethra to the end of my penis. I no longer remembered or cared that there were women in the room. Sample number two. Same small pinch, but this time that "thump" felt like a lighting bolt shooting out the end of my penis. It takes your breath away. By the fifth or sixth sample, the pinches were starting to be more than a "pinch". It was starting to really hurt. I was soaked in sweat by this time. I had sixteen samples taken.
I could not move at the end of the procedure. I was a sweat soaked pile of goo. Everyone was very kind and helpful, but I was wasted. After a few minutes, I was able to sit up and put my cloths back on. One or more of these fine folks held onto me at all times, but I kept assuring them that I was OK. They finally let go of me and as I turned to leave the room, the room turned with me and I started to fall. They were smarter than me, because one of the guys was ready for me to fall and caught my dumb butt.
They sat me down in a chair and made me drink some juice and eat some candy. Two or more stayed with me for at least 15 minutes until I had "color in face" and was really OK to leave.
The Wait
I had the biopsy on 9/2/2008 and it's going to be three weeks before I get the results...
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