You’ve gotten a PSA test result that may indicate prostate cancer. Or, more daunting yet, you’ve been diagnosed with it. What’s your next step?

If you’ve read my Healthy Manager column, you know that I’m a survivor of this process. I am not someone who sleeps on a bed of nails. If I can get through it, you can, too. It will be more of a psychological journey than anything else. And, I hope it will bring you many years of good health. 

If you’re like I was, you’ve developed something of an obsession with prostate cancer and the important decisions you must make about treatment. Maybe I can save you a few hours of Internet searches and offer suggestions on sorting out the medical advice.

The dreaded biopsy

A spike in PSA levels only means you might have cancer. The next step will be a biopsy and even that has about a 15% chance of finding cancer. It involves needles, where the sun doesn’t shine. Small tissue samples are needed to find out if prostate cells are malignant. In reality, the so-called transrectal ultrasound and needle biopsy is a bit like visiting a badly misdirected dentist. Urologists have finally caught up with the dental profession and most use a topical anesthetic and a shot of lidocaine to numb things up. Make sure yours does. It’s not entirely painless, but most of the rapid-fire needle samples felt to me like a rubber band snap. I’ve had three biopsies and went back to work after one morning session with barely noticeable discomfort when the lidocaine wore off. You’re likely to have blood in urine and perhaps in semen afterwards. For me, and for most men, those side effects weren’t painful – just part of your psychological journey. 

Here is a technical paper on the biopsy from a urologist’s point of view.

After my first two biopsies, a nurse called a few days later with good news. The lab test was negative. After the third, it was my urologist on the line, and I knew the news wouldn’t be as good. During the biopsy, my doctor told me he couldn’t see any tumor with ultrasound. But the lab test showed that 5% of the sampled prostate cells were cancerous. That likely meant the biopsy had caught the disease early and it hadn’t spread. But he scheduled a bone scan to make sure. I would see him the next week to get the scan results and discuss my options.

The grim researcher

Feigning calmness, my wife and I drove out to my urologist’s suburban medical clinic the morning of September 27, 2011, for my consultation. I expected to meet in my doctor’s office. Instead, we waited in a small, spare examining room until he showed up wearing surgical scrubs.  He told me the bone scan showed I had a small amount of arthritis. I was still holding my breath. And no cancer in the bones. Had there been, we would have talked about ways to extend my life, not possible cures. Relieved, I spent the next 45 minutes taking notes as he laid out treatment options.