PSA Tests are key to monitoring prostate cancer probability.

by Hugh Gilmore

My cancer is back, like a dirty little rumor. Don’t worry, it’s not contagious. I look normal. Healthy even. Lord knows, I’m pleasant enough to be around, but there it is, according to the lab tests. It’s microscopic right now, but, after seeming to nap peaceably for most of a year, it’s awakened with a raging hunger to consume my flesh, my blood, my bones, my tissues and yes, my life. I thought we had reached detente, but apparently we hadn’t, so I’ve decided to try to kill it before it eats me. Over the next few months I’ll tell you how it’s going.

Some background: Fourteen months ago (November 2016 – January 2017) I wrote a series of columns for the Local about being told I had high-risk prostate cancer that needed treatment. Not wanting to live with cancer inside me, I opted for a radical prostatectomy via the DaVinci robot method. My prostate gland was surgically removed the week before Christmas in 2016. After recovering from the operation itself, I felt good through the end of winter into spring. In fact, on May 25 of last year, I wrote in these pages:

Folks who know me, but haven’t seen me lately, are surprised when we meet by how ‘good’ I look. I guess they expected me to wear my illness more outwardly. Perhaps they expected me to look shriveled, or gaunt. But I’m not. I’m as energetic as I ever was. And smiley. And still just about the funniest guy ever.”

The prostate is a walnut-sized gland that resides between a man’s bladder and his bowel. Its main function is to provide a buoyant and nourishing fluid stream for sperm on its way out of the body. The prostate is one of the bodily structures more likely to develop cancer. If the cancer cells remain inside its capsule they tend to multiply comparatively slowly, doubling perhaps every four years. In some cases, though, they grow more quickly – or escape the gland, or both. That is not good.

Until then, however, there are very few external signs that one has prostate cancer. It’s said that by the time the external symptoms show, the man feeling them is in trouble and needs immediate attention. Prostate cancer is the second leading cause of cancer death among men (after lung cancer).

I also wrote in that May 25 column what I hoped was a useful public health message: “Ladies: Tell the men in your life, and Men: listen up: a simple blood test measuring a man’s PSA level, taken yearly, perhaps when his cholesterol is checked, only takes a minute and is vital to well-being and peace of mind. (A PSA test measures the amount of prostate-specific-antigen in your blood stream.) There are both incidental and unhealthy causes of of high PSA scores. But it is wise for a man to try to find out what’s the case with himself. I had noted a steady rise in my PSA level over time and when I couldn’t stand wondering any more, when I was on the verge of fear, I asked for a biopsy. I was unlucky. It showed I had prostate cancer that was severe enough to not be ignored. CAT scans and bone scans showed it had probably not (yet) spread outside the gland.”

After my operation, which I felt as a brush with death, my life changed, mostly in subtle ways. I didn’t experience any specific pain I could attribute to the cancer, but did feel some unpleasant after-effects from the surgery itself. The body does not easily forgive invasions like that.

After that, for the past year my life has been punctuated by having a PSA test every three months. An ideal score would be zero. My three scores through winter into July were .016, 0.15 and 0.18. Steady enough. Small enough. Way less than 1.0. Not to worry, I thought, PSA normally doubles in about four years. If I were lucky, it might never knock louder than that tiny, muffled rap of .018. Then again, it could grow big enough to blow my house down. But, what, me worry?

Then, early September: 0.25.

Then, late November: 0.39. That made three rising PSAs in a row. One of the golden rules of prostate cancer had now been introduced into evidence.

Three different urological oncologists told me last fall that I should do something. Three! Three medical experts vs. one in-denial, stubborn, pater familias know-nothing.

Yet I couldn’t make up my mind that the time had come to listen to the grown-ups and get out of my sandbox. I told myself and them: “There are consequences to treatments, you know.” I pointedly asked all three what would happen if I did nothing. Couldn’t I just outrun this disease on my way to the graveyard?

Nobody (especially my loving wife) liked my attitude on this issue. “So … OK, I’ll have just one more test,” I said. Last Monday I got another PSA test at Chestnut Hill Hospital. On Wednesday I went back for the results. As I opened the envelope I still hoped that my numbers had magically receded like a freak flood tide. No such luck.

To be continued next week.

Hugh Gilmore is a writer, antiquarian-bookseller and pathological optimist who lives in Chestnut Hill.