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I last saw my father alive in a Lincoln, Nebraska, nursing home in 1993. He managed a weak smile before lapsing into morphine-enabled sleep. He died weeks later – five years after diagnosis of prostate cancer – stoic and courageous to the end. He was 70.
My father believed he might have survived if he had gotten routine blood tests for prostate-specific antigen (PSA). Elevated levels of that protein in the blood can signal the presence of cancer. Tests for PSA can catch the disease early. Without them, my father’s surgery to remove his cancerous prostate came too late.
Genetic bomb ticks away
After seeing the debilitating course of his disease, I followed Dad’s advice to get PSA tests. My doctor said they’re not accurate. PSA levels spike from infections and other causes. But when I reached 50, he OK’d annual tests due to my high risk. It’s two to 11 times higher if your father had the cancer. And one in six men will be diagnosed with it.
In 2006, after my PSA rose suspiciously fast, my doctor sent me to a urologist for a biopsy. It showed no cancer. Blood tests for PSA every six months led to a biopsy in 2009. It, too, was negative. Last August, my PSA hit 10 nanograms per milliliter. I put off a third biopsy until after my granddaughter’s baptism over Labor Day and my chance to compete in a short triathlon a week later. I felt great. I hoped for another negative result, a hint that I didn’t have Dad’s cancer genes.
I drew the wrong genes. At 64, a year younger than my father had been, I, too, had the big C. The timetable was uncanny, but the prognosis was much better. The biopsy ultrasound showed no tumor; only 5% of sampled cells were malignant and weren’t too aggressive. I had a bone scan to see if it had spread. It had not.
“You’re a guy with a confined cancer,” my urologist said. So I was blessed with options: surgery, radiation, or watchful waiting. More than 90% of men live 10 years after surgery. About 80% survive as long after radiation. If you’re old enough, a slow-growing cancer may not kill you.
At my age, treating the cancer within three months seemed sensible. But I still had to choose a treatment, doctor, and hospital. I did background reading and talked to men I knew who had been through this. I knew a professor of urologic oncology in Detroit. I called him. He corroborated my urologist’s advice.
My task was complicated psychologically by news reports in early October about advice from the U.S. Preventive Services Task Force. It said PSA screening results in “small to no reduction in prostate cancer-specific mortality.” News reports said unneeded treatment leads to “devastating consequences” such as incontinence, impotence, and, rarely, death from surgery. Even the biopsy carries infection risk and is described as painful.
Be not afraid
Reports of pain and suffering don’t match my experience. I hardly slept before my first biopsy. It proved only a bit worse than seeing a dentist. When I needed treatment, I chose nerve-sparing open surgery in November. (Sparing nerves works about half the time.)
I hadn’t been under the knife since losing my tonsils at age 7. So, of course, I was apprehensive. There wasn’t a lot of pain, thanks to its management in the hospital. Surgery took about an hour, with a spinal block and sedation. I was out of bed most of the second day, home the third, and walking around the neighborhood the sixth. Having a catheter in for 12 days was mainly a nuisance.
If you follow my path, you may find the experience no tougher than the battering you get playing high school football or wrestling steers. If your chores require lifting, you’ll need help for six weeks.
I’m now two months out from surgery and seem to be recovering from side effects.
The Task Force cites reasons to avoid PSA tests, but urologists credit these tests with cutting cancer deaths by 40%. Farming, as well as family history, increases your risks, perhaps from pesticides. Testing, even treatment, seems minor compared to the painful cancer that first crippled, then killed my father.
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