My PSA & Diagnosis
Having read a lot of the posts here, I can only respond by sharing my experience and what I've since learned having gone through all this.
In May of 2009, I had received my diagnosis that I had prostate cancer. I had been to see my GP for my routine wellness exam and
my bloodwork showed my PSA went from 1.9 the year previously to a 3.7-- almost doubled. Followup with a urologist digital exam and
he found a hard "nodule" on the left side , did another PSA that confirmed the first and scheduled a needle biopsy. Long story short:
the biopsy revealed a Gleason 7/12 which means that I had 7 areas that had cancerous cells. Follow-up scans showed pretty much confirmed the left side of the prostate was mostly cancerous and the right side had some signs.
I had been getting PSA & digital exams since my mid 30's as I had some family history with men on my dad's side having this happen to them. Most had died from other conditions due to smoking and poor diet in the late 50's to late 60's. But a few had been diagnosed with prostate and / or bladder cancers.
Now I elected to have robotic surgery because of the apparent aggressiveness of the cancer... and
I was in my early 50's and in pretty good health, non-smoker, and good weight, etc. I had been looking into
Cryo-therapies as there had been some good studies out and I talked with some patients who had this done and their outcomes were good. They were also much older and they felt they felt they could mentally deal with having a recurrence and then proceed with things like radiation, etc. Plus they didn't have as much cancer in the prostate as I did which made them better candidates for a more successful outcome. (There's some argument to be made as to which is best at which age ...but I'm telling my story here-- not theirs.)
I went with robotic surgery because there weren't enough docs in my area who had experience with Cryo-therapy treatments for prostate cancer. And those clinics that were within decent driving distance had a waiting list for almost two months before I could even get an initial consult and then likely wait another two or three months before having the procedure done. I wanted the cancer out ASAP and so I make the decision for the Da Vinci surgery. I had looked into radiation and other therapies but I wasn't comfortable with the 10 - year outcomes when compared with radical prostatecomy. And
proton radiation was very limited in the US at the time which is much more targeted, less side effect / damage to healthy tissue, etc. Now we have two Proton treatment centers nearby and they stay booked up.
So I had this rationale in making my decision: As others had posted previously --
data shows that for many men -- they will die from other health conditions before the prostate cancer spreads -- but -- more younger men are being diagnosed early than ever thanks to PSA, scans, etc. And while I wouldn't recommend a needle biopsy to anyone -- I was surprised at how easy it was and while not comfortable -- I wasn't in agony after it was over. It was a tad gross dealing with the residual blood afterward which can give you a start when urinating afterward but it does subside in a couple of days or so.
The thing is that until recently -- the docs really didn't have enough data to give me a definite "yes this is super aggressive and will spread in a matter of months" to "Let's wait a few months and see where this goes if it does."
"Watchful Waiting" was/is a choice that some docs will throw out there and yes some men may have very slow-growing prostate cancer and may never need to deal with it as they may die from other things. But my doc who I had been seeing since my 20's told me that the diagnosis was showing my cancer to be of the aggressive kind based on my routine checkups... several years of PSA / digital exams, etc.
I had a friend recently go through the same experience and his cancer analysis was pretty more detailed in the biopsy:
his needle core biopsy demonstrated focal signet ring cell-like features. That means it is a rare and aggressive cancer, hallmarked by a fast metastasis to the bones and little to no symptoms. That is...no symptom until it is too late.
So there's that. Anyways he's on to recovery and
I will be 12 years from my surgery back in July 2009. I had one side nerve bundle removed along with a lymph node and my final pathology was T2n which was 2nd stage and everything contained within the gland "capsule". I had limited side effects initially but all is well and I am "still in the game" so to speak without need of ED meds. (It helps that my better-half still turns heads even in her 60's... she looks 39
)
Like I said earlier -- this is MY STORY -- I don't presume anyone to have the same thoughts, opinions, rationale, etc.. But I will say that getting a PSA and digital exam every year is a really good idea.
ALSO --
elevated PSA simply means "inflammation".. If you had any "exertion" the day before (workouts, constipation or bedroom play ) you may elevate your PSA level to a point that could cause concern. Even so, docs will recommend a 2nd PSA to verify along with a digital exam and/or ultrasound...and even then maybe some scans before going the needle biopsy route.
ONE FINAL THOUGHT -- Cancer doesn't play fair and it is the Emperor of all maladies. Become well-informed and don't take off-the-cuff social media anecdotes as gospel as everyone is different. Don't ignore it and go get checked and re-checked if you need a second opinion. I went to see another urologist/prostate doc who was not part of the same hospital group and he pretty much said the same as the doc before. He recommended an 'old school prostatectomy going through the groin'... simply because that's all he had in his practice -- no robotic capabilities. AND --
this is important -- get a doc who has had at least 300 or so surgeries and ask for his "complication rate"... any surgeon who says they don't have any is simply not telling the truth. All surgeons who do it enough have complications. My surgeon had more than 600 on the Da Vinci robot and he had <6% complications and told me what went wrong on each of them -- more than half were because of pre-existing conditions (obesity, cardiovascular issues, machine "freezing", etc.)
Every doc I asked said he was the doc they'd want doing it so that was a good sign.
Anyways... that's my story ... FWIW. Good luck to all who may be facing these decisions. But thanks to better surgical interventions and the Proton therapy -- there are better outcomes than in previous years.
