Journey To A Diagnosis

I have an annual physical as health insurance covers that expense. As I am over 50, I listen to what my doctor says and heed his advice. My doctor stopped doing digital rectal exams (DREs) as the PSA (Prostate Specific Antigen) blood test does as good a job of identifying those who need to keep an eye on their prostate.

For my physical in 2018, my PSA numbers were high. The doctor said I could wait a few weeks and check again. The number went down, so we made a note to keep an eye on it next year.

Guess what, my 2019 physical my PSA numbers were high, we waited a few weeks and tried again, and the numbers went down, but were still high. So my primary doctor suggested I see a urologist.

So I made an appointment to see a urologist. I had my initial appointment March 17, 2020 just as things were going on lock down due to COVID-19. My urologist explained to me that my PSA, while it went down both times with the blood work for each physical, it was still high both times. He advised a biopsy. The urologist did do a DRE and estimated my prostate to be double normal size, which is about the size of a walnut.

My maternal grandfather was 83 when he was diagnosed with prostate cancer. His was so bad that they had to castrate him to stop the male hormones from feeding the cancer. It was not pretty and he had other health issues, like multiple myeloma. See what he went through encouraged me to do a biopsy.

The urologist said if it was him, he’d do a biopsy. I elected to do a biopsy, and at worst it was an inconvenient experience that gave a baseline for future comparison, and would hopefully catch any cancer early.

The Biopsy

The biopsy involves an ultrasound probe up the anus. It requires a minor clean out, which is a limited diet the day before and an enema before you go in for your appointment. All in all, not the major ordeal of the full clean our for a colonoscopy. I have had one colonoscopy and am due for another. They should be done every five years.

The probe is about the size of a thumb. To me it felt larger than that. It is an ultrasound device that allows the doctor to image the prostate and verified it was about as big as it was from a DRE.

There are ports in the probe from which to insert sample collection needles that sample the right and left half of the prostate and be sent in for pathology. Twelve total samples are taken, six from each side.

My urologist said that it will feel like a bee sting. That worried me, as I have been stung by a bee on the pinkie and my whole hand and arm hurt. However, a numbing jell is used so I just felt pressure. I assured the doctor, that was NOT as bad as a bee sting.

Following the biopsy there was blood in stool, urine, and semen. It lasted about six weeks till things were back to normal. Sitting was only an issue the day after. However, I did not feel like riding my bicycle for several weeks, as the bike seat would put pressure on the affected region.

The Results

About a week or so after the biopsy, I got my results. Eight of the twelve sites sampled showed signs of cancer. Of the other four samples, one had abnormalities (Atypical Small Acinar Proliferation (ASAP)), so only three samples showed normal tissue. They were all slow growing, with low aggression. The fancy terminology is invasive prostatic adenocarcinoma. Two of the samples had signs of perineural invasion present. The urologist said that my prostate was basically full of cancer and it was best to act before it spread beyond the prostate. From what he could tell from a DRE and the ultrasound, it did not seem to have any irregularities indicating it had spread beyond the prostate.

Here’s the video where I discuss my diagnosis of prostate cancer.

The Options

There are 3 typical options:

• Radiation
• Freezing
• Surgery

Radiation has the side effects in fifteen to twenty years like tissue damage and secondary cancers of the bowels or bladder. Due to my age at diagnosis, 55 1/2, he did not think that radiation therapy was a good option. This is usually a better option for men who won’t live long enough due to their age to experience the delayed effects.

Freezing destroys the prostate and cancers but also the nerves that controls sexual function. This is usually a better option for men 70+.

Surgery is now done with robotic assist and is laparoscopic with 4 or 5 holes poked in the abdomen. The doctor does his best to preserve the nerves. The biggest benefit to the surgery option is that if the cancer is contained, it is usually a total cure. If not, radiation is a good fallback plan for surgery. Whereas, after radiation, the tissue is cooked and doesn’t heal well with surgery.

My Choice

I didn’t like any of them, but freezing was off the table in my opinion. Radiation with secondary cancers was also a no go. One cancer is more than enough. So I elected for the surgery.

Here is the video where I discuss my treatment decision.