August 6

Part 3


The trip

I didn’t know it, but I was about to embark on a 3-year journey that would change almost everything that I thought was important in my life.

Persistent docs

So I went to the hernia surgeon; he did a digital rectal examination (DRE) and found a somewhat enlarged prostate. No surprise; I was, after all, almost 58 years old. The examination was, I thought, undignified, but I consider them routine now. When he asked me when my last PSA test had been, I fudged and told him I couldn’t remember, hoping he would let it go at that. After all, I had surgery to worry about. Why add to it? He didn’t let it go. He took a blood sample and told me he was going to send it out to the lab.

You are so screwed, John. No more games.

Houston, we have a problem

PSA came back 13-something. The ostrich died on the spot, and the sand washed away. No more fooling around. I realized that the research I had been reading was theoretical and dealt with broad economic issues of testing. In other words, from a personal point of view, it became useless to me overnight. Very suddenly, I knew metaphorically that I had taken a bullet. Now what?

Well, first things first. On October 15, 2002, I got the hernia fixed, recovered from that (wow, I didn’t remember how hard surgery can be!), and made an appointment to see the first urologist whose name I was given, because—very early in this life-and-death game I have been forced to play—I don’t know any better. I was in a state of near panic.

Apologies to Douglas Adams, but it’s true . . .

Rule number 1: Don’t panic!

An introduction to reality

Urologist is a good-looking guy who resembles one of my favorite movie stars. I like his movies and find that reassuring--he saved the world once, so, well . . .. (Logic is not one of my strong points at this time.) He starts talking in terms of “Gleason scores” and “statistical survival rates,” and a certain small amount of discomfort begins to take root in a corner of my mind. Occasionally, he remarks that it’s “all just statistics,” and I realize he’s talking about my survival. However, I understood that if I decide to have a radical prostatectomy (complete removal of the prostate), which is the recommended treatment on the internet depending on which page I have open, the odds may be on my side.

A little diagnostic pain and how to avoid it (important!)

The urologist has to have a biopsy of my prostate to see what kind of cancer I may have (there are grades of concern at the cellular level, which is expressed as the Gleason score—the higher the score, the more concern) and whether it has spread.

A biopsy procedure for the prostate is performed by the surgeon entering your body from the rear, locating the prostate with the aid of ultrasound, and snipping small pieces of it off, to be studied later in the laboratory.

My urologist assured me that I would experience some pressure and minor pain (like a “bee sting”). That was somewhat "misleading." A prostate biopsy is very unpleasant and the more slices they can take, the more accurate my diagnosis may be, so there is no motivation to abbreviate this procedure. The sensation is rather frightening. No, it's just plain scary!

I did not learn until later that many surgeons will offer their patients a local anesthetic. Find a surgeon who does that. This message is important, and those of you who go down this road will thank me for it.

Did I say don’t panic? The treatment decision may be one of the most important decisions of your life--one that you are certainly going to have to live with for a long time. Take a little time. Consider all of your options.

Rule number 2: Never assume.

Stay with me; there’s much more to come in Part 4.