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Accepting your Diagnosis of Cancer

It was supposed to be an ordinary physical, but I requested a PSA test as part of my routine screening just because I’d heard how common prostate cancer is in men. Doctors won’t normally prescribe a PSA until you’re 50, but I was only 47.

I was in good physical shape and had a thallium stress test to screen for heart disease at 45 and passed with flying colors, so I really had no health worries. A PSA is just a blood test for prostate specific antigens and it’s only about $70 so I thought it was worth it to be prudent.

When my doctor called to say he wanted to see me again because my PSA was elevated, I wasn’t concerned. There could be many rather benign reasons. After a second test came back elevated, he wanted an ultrasound done. “No problem,” I thought to myself. Better safe than sorry.

The ultrasound didn’t show anything significant, but that was probably the bad news. It wasn’t an enlarged prostate. A third PSA came back slightly higher. The doctor now wanted a biopsy.

I didn’t know it at the time, but you really don’t want to have a prostate biopsy unless you really need one. Even with all the Valium, it’s not any fun.

(In case you don’t know, the prostate is a male gland that produces seminal fluid that mixes with sperm when a man ejaculates. It’s just under the bladder, and wraps around the urethra so it can inject the fluid into it. It happens to be adjacent to the rectum, which is why the doctor wants to stick his finger in there to feel for an enlarged prostate,)

To get a biopsy, they insert a probe in your rectum to shoot a hollow needle through the wall of your intestine into the prostate to get a “core sample.” They do it six times in different locations because one sample can sometimes miss hitting a cancer tumor, if there is one. (They didn’t warn me that afterward I would have bloody ejaculations for a week. That was even more disturbing.)

Then the results. My test came back with three of the six samples showing malignant cells. I had prostate cancer.

Everything after that was surreal.

The first issue was how advanced was it and had it spread outside of the prostate already? Prostate cancer is normally such a slow growing cancer that 50% of men will have it when they die, and just not know it yet. Mine was Stage 2 to Stage 3. About halfway to the worst, Stage 5.

When prostate cancer spreads, it normally goes to the bones first. Sadly, bone scans aren’t totally reliable in proving or disproving the existing of bone malignancies. The importance of knowing is that if it’s already in the bones, then you don’t need to go through a prostate surgery; it would be pointless.

While scheduling the bone scans, I came across a newspaper article about a local judge who happened to be trying a major tobacco case. He had earlier recessed the case for three months, and was just now revealing it was because he had prostate cancer.

I don’t normally telephone high-ranking court judges, but I guess I wasn’t normal, was I?

His secretary took my message that I had prostate cancer and wanted to speak with him. He called me back within the hour. I’ve since learned that those of us who have had it WANT to talk to the people following along in our footsteps to let them know what to expect. It doesn’t matter who, or when, or where. We are brethren. (Call me!)

It turned out that he and a physician friend had flown around the country interviewing prostate surgeons to find the best, and he chose Dr. William Catalona at Barnes-Jewish Hospital in St. Louis. My choked “thank you” was not nearly enough reward for his kindness and openness.

The bone scans didn’t uncover any spread of the cancer, so prostate removal seemed the correct course of action. We scheduled surgery for April 2, 1998.

I should mention that my wife and I had been together only two years at this point. The year before, 1997, her nephew died, her mother died, my father died, and her cousin died. We had just been married Dec 30, 1996, so our families dubbed it the year of four funerals and a wedding. But that was before my cancer turned up. It kind of wasn’t funny any more.

During all this time, I busied myself with the logical decisions necessary to chart a path through treatment. That my life could possibly be coming to an end only creeped around the fringes of my mind. I was too busy just trying get through life normally, reassure my wife, friends, and family, and make those all-important health care decisions.

My prostatectomy was successful. Dr. Catalona is one of the pioneers of nerve-sparing surgery. You see, one of the historical side effects of prostate surgery is the inability to ever have an erection again because the usual procedure cuts through critical nerves involved in erectile function. New techniques go at it from a different angle.

So here is my report nine years later.

I’m alive.

I have follow-up PSA tests, initially every six months, and now every year, just to make sure some rogue cells didn’t get loose in my system to later start wreaking havoc. So far, so good.

I have some erectile dysfunction, but thank God for Viagra and Cialis. With those drugs, I’m here to tell you, there is incredible sex after prostate surgery (as long as it’s nerve-sparing surgery).

The only downside to report is that a few years after my surgery, I started suffering a chronic pain in my rectal/abdominal/lower back area. It lasts a few hours a day, but not every day of the week. Despite a lot of tests, the cause is indeterminate. One of the suggested sources is scar tissue involving the nerves near my surgery site.

Oh, well. I can live with that. I can live.