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Prostate cancer: Now what?

DANIEL LOOKER Updated: 02/10/2012 @ 1:49pm Business Editor

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. 

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psa regard 02/10/2012 @ 11:52am Mr. Looker: I have read your articeles befor and generally agree with them whole-heartaly. I am a cancer survivor from prostate cancer. I had the same ordeal that you described to a tee. Although there has been many improvements since I had mine,it seems the little evaseive forms.have a way of hideing. I had retropubic prostatectomy in 1999. I had a psa reading in the teens and on both sides of my prostate gland. I also was advised the same way you mentioned on getting two opions as I did. With my p.s.a. being as high as it was I chose to go the route I mentined above. I was out of commission for 8 weeks and then climbed on a tractor and have worked every day since. After three years my p.s.a. shot back up and I took radition for 36 consecative days continuing work each day. My radioalogist said that was the best thing I could do. I am now dealing with slight bowl blockages they say is caused by scar tissue do to radiation. I am 79 years old and as far as incontince I have managed to handle that without much trouble. Impotenece is another story. But I have been able to see my grandchildren grow up, which was my goal when I was first told I had cancer. I still work every day and feel I am very fortunate as I look around and see so many with cancer at an early age with little outlook for recovery. J.N.

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DANIEL LOOKER Re: Re: psa regard 02/10/2012 @ 12:22pm Thanks for sharing your experience, John. I'm glad the radiation helped and that you have been able to enjoy your grandchildren. And I'm impressed that you were back on the tractor after just 8 weeks. I haven't had any radiation since my urologist believes he caught all of the cancer early enough. But, of course, I'm still getting PSA tests to make sure he's right. I'm careful in writing about my own experience to avoid claiming to be "cured." But I'm optimistic that I, too, will have many years to watch my granddaughter (who is now over eight months old) grow. And I hope you have many more years of relatively good health.

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