I Never Imagined I Was at Risk for Prostate Cancer

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Care to know one of the ‘why’s’ for my involvement with consumer education and preventive medicine, on behalf of PrevientMD?

Permit me to share.

For the first 65 years of my life, I felt in reasonably good health, had no identifiable health concerns or diagnosed conditions, and had kept up a regular exercise regimen that for several decades included running five miles a day, followed by a decade of religiously working out on gym machines and in yoga classes.  

You could say that complacency had become my middle name

While self-congratulating myself on this regular exercise routine and good health history, I had virtually ignored three other big essential pieces of the optimal health puzzle: a preventive dietary strategy, annual preventive diagnostic testing, and preventive stress management.

Those oversights, singly and together, would prove to be my downfall.

It had been several years since I had undergone a routine physical, with blood testing, and when I finally had one performed midway through my 65th year, the results came back showing a PSA (prostate specific antigen) level of 23, six times higher than normal.

My physician put me on a week-long regimen of antibiotics—Ciprofloxacin-- to see if benign inflammation could account for the high PSA score; a subsequent blood test after the antibiotic showed a 19.9 PSA score, still five times higher than normal.

I was then referred to an Urologist, for a prostate biopsy.

Needless to say, I was stunned. What had happened over the intervening couple of years, since my last blood test, to account for this abnormally high PSA reading?

It was a particularly vexing question for me, because there was no history of prostate cancer in my family. Furthermore, I hadn’t eaten beef or pork in a decade, both of which, based on my reading of some medical studies, had been identified as possible risk factors in triggering prostate cancer. (I had overlooked chicken and dairy foods, which my subsequent research also found to be possible risk factors, particularly for prostate cancer recurrence.)

There was one undeniable wildcard factor underlying my previous three years of health history--- chronic stress.

During those three years prior to my abnormal PSA test, as President of our neighborhood homeowners association, I had been the lead plaintiff in a lawsuit against our County government, after two leaks in its water utility had resulted in the collapse of seven houses and damage to my own home.

The stress of this protracted legal battle had been unrelenting and in retrospect, it’s clear that I didn’t manage the stress well. I didn’t exercise as often, or as rigorously, as before the lawsuit, and I gained 15 pounds as a result. That combination of factors may have compromised my immune system.

Prostate Biopsies, Cancer Grades, Treatment Options

If you’ve never had a prostate biopsy, let me sum of the experience in one word—invasive.

While lying halfway in a sitting position, legs up in the air in stirrups, the Urologist injected a localized numbing agent into my prostate, followed by jabs from a dozen long needles to collect prostate tissue samples. Each needle injection was accompanied by a popping sound, like an air rifle exploding.

These would be relatively painless injections, the Urologist had reassured me, but every needle jab that came close to a nerve, and there were several, produced a shock wave jolting my entire body.

Off and on for several weeks afterward, I had observable blood in my urine, semen, and bowel movements; also, sitting for any extended period of time caused some discomfort and occasional shooting pains.

When the biopsy results report came back less than a week later, my Urologist phoned me. “Some microscopic cancer cells were found,” he said diplomatically, trying not to alarm me. “You need to come in so I can discuss your options.

It turned out my Urologist was retiring from the profession in about a week, and I was one of his last patients. So when we met again, he not only gave me my biopsy results---three of 12 tissue samples showed cancer---he referred me to the cancer center at UCSF, the University of California at San Francisco, for treatment.

He also offered me some parting advice: “I’m a surgeon. I cut things out. If I were you, I’d have it {your prostate} cut out, so you don’t have to worry about it anymore.”

Those biopsy results were neither worse nor better than I expected, because I had, by this point, released all expectations. I was deep in uncharted territory for my life experience.

The pathology report rated my cancer samples as 6 on the Gleason cancer grading scale. Gleason scores can range from 2 to 10, and this scoring system is designed to predict how likely it is for the cancer tumor to spread.

A Gleason score of 6, accompanied by a relatively low PSA of less than 10, is considered low-grade, my Urologist explained. But a Gleason 6 accompanied by an unusually high PSA score of 20 or above, such as mine, was suspicious and required further testing.

To help determine whether the cancer had already metastasized to other parts of my body, I underwent a series of bone and abdomen CT scans at the Ukiah Valley Medical Hospital. Those tests came back negative, thank goodness.

Once my medical file was in the USCF system, appointments were arranged with a UCSF surgeon, who would be available to surgically remove my prostate, if I chose that option, and with a UCSF brachytherapy practitioner, a cancer treatment process involving the implantation of radiation pellets into the prostate.

Four Friends, Four Very Different Experiences

Meanwhile, I was contrasting the experiences of friends who I knew to have battled prostate cancer, or to have been alarmed about its possible occurrence.  

My late friend Rudy, a speech pathologist, three years older than me, had died the previous year of prostate cancer, after it had metastasized while he spurned conventional cancer treatments and relied on herbal supplement and restrictive dietary remedies. Visiting him in hospice and watching his steady physical decline had convinced me that I would never rely upon alternative treatments alone.

An old friend around my age, Mark, had treated his prostate cancer using HIFU, a high-intensity focused ultrasound, in which sound waves are used to kill cancer cells. He praised the relatively new procedure as being minimally invasive, and having fewer side effects than other treatments. But he also confessed that after a first round of treatment a few years earlier, his prostate cancer had recently returned in a more aggressive form. That news naturally made me feel cautious about considering this treatment.

One of the attorneys representing our neighborhood in our lawsuit against the County had undergone a radical prostatectomy, the complete removal of his cancerous prostate, at USCF, a few years earlier. Bart, in his mid 60’s, had a PSA level in the so-called normal range, well below 4, and his prostate cancer was only discovered by a doctor’s digital rectal exam that found a lump. Bart praised the surgery as having given him a new lease on life, with many fewer severe side effects, such as sexual dysfunction, than he had initially anticipated would occur.

Finally, I consulted an old classmate from college, Rusty, whose PSA levels of 10-- and above-- had resulted in three prostate biopsies over the previous five years. “I’m never having another biopsy,” Rusty said. “All three of mine came back negative. I may just have a naturally high PSA.” Rusty was placed on what urologists call “active surveillance,” periodic monitoring of prostate health, using PSA tests and digital exams.

Because my own PSA score was so high, the doctors I consulted at UCSF wanted a second more sophisticated biopsy done, called a MRI-ultrasound fusion biopsy. They didn’t completely trust the previous findings. This news raised my anxiety level a few notches.

As a prelude to having this second biopsy, I had to undergo an invasive prostate MRI procedure, to generate images for use in directing the biopsy procedure a month later.

Suffice it to say, I wouldn’t wish the discomfort of this prostate MRI on anyone. It involved the insertion of an inflatable probe into my rectum, as I lay in the MRI chamber, arms strapped to my side, for nearly an hour, while being bombarded through the pelvis by Tesla magnet coils to produce spectroscopic images of the prostate tumors.

Coming next for me, would be the MRI-ultrasound fusion biopsy, conducted by Dr. Katsuto Shinohara, the developer of this procedure.

That’s when my motto of ‘always expect the unexpected in life’ came true once again.

More to follow...


Posted in Cancer on February 25 at 09:11 AM

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