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Prostate Blues

The Return

 
Catherine and I had been through my symptoms, diagnosis, staging, treatment and hormone-deprivation therapy. "It'll be like a menopause," the consultant had said, and it certainly was. Through flushes, mood swings, emotional fragility and a whole host of side effects from the drugs, she was there, supporting me all the way. Then the treatment was done, a fading memory that had strangely enriched our lives, bringing insights otherwise unobtainable. As I said, half-jokingly, I got in touch with my feminine side. 

My First Prostate Cancer Screening

 
According to the National Cancer Institute, about 11.2% of men will be diagnosed with prostate cancer in their lifetime. When caught early and treated, the five-year survival rate is 100%.
 
When Prostate Cancer Awareness Week began in 1989, my hospital decided the best way to educate the public about prostate cancer was through screening. We offered men in the high-risk group (ages forty to seventy-five) free prostate checks, and about a hundred men preregistered. Participants had their blood drawn for the prostate-specific antigen (PSA) test and received a physical exam from a urologist, who felt the participants' prostate gland for size and the presence of lumps. An abnormal finding on the exam or an elevated PSA led to a recommendation of follow-up and a biopsy.

A Different Perspective

 
As I started my third year of medical school on the consultation psychiatry service, I wasn't sure what to expect. I was naive, afraid, and honestly unprepared. Or that's how I felt anyway. 
 
My first patient was a man who was referred to our team because of depression. I was sent to talk with him before the rest of the team, including the attending physician, made its rounds. The man was 77 years old but looked more like a older 50. As I introduced myself, a gentle smile formed on his face.

It Eats At You

What is it like to know you have prostate cancer and do nothing to combat it? The medical term for my husband's treatment plan is “active surveillance,” but watching and waiting sure doesn't feel very active.

Spend Your Life Learning How to Live

 
I met George Sheehan, a noted cardiologist as well as a legendary runner and writer about running, in August of 1986. I had been designated to pick him up at the airport in Aspen, Colorado, late the night before he was to speak at a conference that I was managing. We hit it off immediately.
 
That first meeting, I learned several months later, happened to fall only a few days after he had been diagnosed with prostate cancer.
 

My Father's Prostate

 
As a newly graduated, idealistic physician assistant in 1991, I enthusiastically took to heart all recommendations for health promotion and disease prevention screening. The PSA test was encouraged for all men at that time, and when I found out my father had not been offered what I had been taught was a life-saving test, I beseeched him to have it done. He did and it turned out his PSA was elevated, initiating a medical journey that I am still processing over twenty years later.
 

Tears of Fear


After a four-day bout of intense, immobilizing, lumbar back pain, associated with a fever of 103.4, my wife and I decided that going to the ER was indicated. Within a very few hours, I was in the ICU with a presumptive diagnosis of Staph septicemia (infection) and pneumonia. Faced with my falling oxygen saturation, the intensivist recommended intubation and thus, for the next five days, I was in an induced coma while he and the infectious disease physician battled to save my life.

What If the "N of One" Is Me?


I am a 54-year old academic, family doctor. Last May, after the US Preventive Services Task Force issued a draft recommendation that physicians talk with patients about PSA (prostate-specific antigen) testing at age 55, I was updating my clerkship presentation about preventive screening. At the time, I was experiencing some palpitations (sensations of an abnormal heart beat), so I decided to check my TSH (thyroid stimulating hormone) and CBC (complete blood count).  

Not having checked my PSA since age 48 (it was 0.9 then), I decided, on a whim, to add a PSA to my blood tests. It came back 10.8, which means there was a possibility of cancer.

Unexpected Repercussions

 
As a female, I do not have to deal directly with prostate issues, but I did have to support my father through his own prostate challenge. In February of 1986, Dad's surgeon said the words we all hoped to never hear: "You need prostate surgery before things deteriorate."