As I related in my article on Diabetes, one of the symptoms of diabetes is that you drink more, and when you drink more you pee more. That is an unavoidable consequence. But when I treated my diabetes, I reduced my need to drink and therefore my need to pee. For a while at least.

But in 2009 I noticed I seemed to feel the need more often. The funny thing was that I didn’t seem to have all that much volume. We tested for the most common cause, a urinary tract infection, and that was ruled out. Then I got the old finger in the south end test, and it seemed like there was swelling of the prostate, so I was referred to the Urologist for more tests, and meanwhile sent to the lab for a blood test for PSA, prostate-specific antigen. My urologist got the blood results, and my PSA was definitely elevated. He also found abnormal swelling of the prostate, and decided he wanted a biopsy to tell more.

The biopsy was done through the rectum, using a device that would punch through to the prostate, grab a piece, and pull it out for examination. While it was not a fun experience, it was not excruciating either. Uncomfortable, but bearable. The samples they took then went to the Pathologist for analysis. The main thing that came out of the Pathology  analysis was something called a Gleason score, which is expressed as two numbers which together estimate your risk from the cancer. My score was on the high-end of intermediate risk.

Risk

This is where sometimes people get confused, and understandably, because we tend to want definite answers. But as someone who has taught statistics and used it professionally I felt I was in a good position to handle this information. In any case where risk is measured, there are two possible ways to go wrong. Statisticians call them Type I and Type II error, while medical types use terms like false positive and false negative. Most medical tests have some degree of uncertainty in terms of what they predict, and if you get a test that says “We found no sign of cancer”, there is still a chance that you do in fact have cancer. That would be a false negative. Or maybe you get a test that says you do have cancer, but on further investigation they can’t find any. That is a false positive. Sometimes additional tests can reduce the degree of uncertainty, but generally they cannot eliminate it all. You just have to deal with it

In making a decision in an uncertain environment, you have to look at the possible outcomes and make a decision. In my case, my Urologist outlined several possible courses of action. Course 1: Do nothing. Prostate cancer does not always turn fatal, though it is a leading cause of cancer deaths in men. The fact is that so many men get prostate cancer that even a small proportion of them dying adds up to a lot of deaths. Course 2: Radiation therapy – This uses high-energy radiation to try to kill the tumor cells. Of course, one side effect is that it can affect other cells. Course 3: Surgery – This means cutting out the cancerous tissue, and in prostate cancer that pretty much means removing the entire prostate. There are some other options, though my impression is that they are not used as much, but you can see them here.

Based on my Gleason score and my PSA numbers, my doctor did not think that doing nothing was a good idea. We looked at radiation, and with that the question becomes how likely is that treatment to be successful? Of course, that is true for every treatment; uncertainty exists at every stage. The best you can do is give yourself the best possible chance, recognizing that while medical advances have made great strides there is no sure thing. My wife and I looked at the options, asked questions of the doctor, and decided surgery was our best option. But as one last check, my wife asked one of her clients, from the company that ran the Pathology lab, about my doctor who would be doing that surgery, and report that came back was “If I were getting the surgery, he is the doctor I would want.” So we set a date in early 2010.

Surgery

Once it was scheduled I had paperwork to do, including making sure that my wife was empowered to make any decisions for me. And there was some education on what the aftermath would be like. Radical Prostatectomy has certain side effects, notably incontinence and impotence, though in most cases they are temporary. Everyone is different though, and in my case the incontinence has continued so that I have to wear what are essentially adult diapers. But I was prepared for all of that. The surgery itself was done using a DaVinci “robotic” device that involves several small incisions, which means that you have to look pretty closely to see any scar at all by this point, and the recovery was not too bad. With the prostate removed, they had to sew the bladder to the urethra to reconstitute the urine flow, but for the first week or so after the surgery I had a catheter installed that drained into a bag. It was mostly bed rest that week, but I did join some telephone calls for work. Once the healing was sufficient (no more red in the urine), the catheter was removed and I went on with my life. All-in-all, it was pretty uneventful for abdominal surgery. My surgeon did a good job, and was able to remove all of the cancer and leave nothing behind but healthy tissue. Meanwhile, the removed prostate was sent to the pathology lab for further analysis, and report was that the Gleason score should have been even higher than indicated by the biopsy. As I said, this is decision-making under uncertainty.

Aftercare

Shortly after this my Urologist moved away and I transferred to a new doctor at the practice. He had me on Cialis for a time to help recover erectile function, and fortunately I have not had any problem there after a few months of recovery, and I no longer take any medication for that. I do get a PSA test once a year and come in for a follow-up exam, but the PSA has been undetectable ever since the surgery, so there is a pretty high probability that this cancer is history and never spread, but I just had my annual follow-up last month and will continue to do so. The new doctor generally looks at my medical record and tells me “You are a very lucky man,” which I tend to agree with for a number of reasons, though I think he is saying it with regard to the seriousness of the cancer I had and how good the outcome is. Bottom lie: I am convinced we made the right decision, and I am very happy with where I am now. I think I have a decent chance at another 20 years fairly healthy, and I want to spend a lot of it travelling with my wife.

Colon Cancer

My other cancer concern at this point is colon cancer.  My father died of it in his 50s, and his father also died of it at a young age. With that family history it should be no surprise that I have an ongoing relationship with my gastroenterologist. Every 3 years or so I have a colonoscopy, which means a uncomfortable day of prep (think of the worst diarrhea imaginable, induced by drugs, combined with no food). I need to be careful more than most because I am diabetic, so I cannot drink some of the things they recommend. But the procedure itself is no big deal, they put me to sleep and a little while later I wake up and don’t feel any residual pain or discomfort. My wife drives me home, though we usually stop at a local restaurant because it is 2 days since I had any food and I am hungry. Generally, they find a few polyps, but when they cut them out and look at them they always say it was nothing cancerous. Still, it is the sort of thing they keep an eye on. I think I have done this about a half-dozen times so far, and that is a good thing. Colon cancer is treatable, but catching it early definitely improves your chances.

Other Cancer

The only other cancer I was worried about is lung cancer since I was a smoker, but it has now been 10 years since I quit and nothing has shown up yet. Still, it is something to watch for since the risk does not appear to drop to non-smoker levels, though it does diminish over time. The basic message is that the sooner you stop the better you will be. I wish I had quit much sooner, or better yet, never started, but right now I am doing what I can to stay healthy.

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