Prostate Diary: Finding Out

Last May, while walking across the corporate campus where I work, the physician's assistant at my doctor's office called to tell me that I had an elevated PSA count of 6.7. The prostate-specific antigen is a protein produced by both normal and malignant prostate cells. Roughly speaking, as long the PSA count remains below 4.0 (and there's nothing palpable), men can assume that the antigen is being produced by normal cells. When the count goes above 4.0, a physician will usually recommend a consultation with a urologist. In my case, the PA had already scheduled an appointment. She said that the urologist would likely want to perform a biopsy.

My appointment was in two weeks. Honestly, I didn't think much about it. I knew that PSA readings were often false and that there were reasons other than prostate cancer for an elevated count. The urologist said as much -- he didn't want to recommend a biopsy on the basis of a single reading, and confirmed that there was no palpable evidence of a tumor. Moreover, none of the symptoms of prostate cancer were present. He recommended a second PSA test and -- in the event -- performed a third.

The results were not encouraging: The count for the second test was 7.1, and dropped slightly to 6.9 for the third check. The urologist recommended a biopsy and told me that there was a 50-50 chance that I had prostate cancer.

Two weeks later, I underwent a prostate biopsy, an invasive, depressing procedure that left me shaken. Three weeks after that, the urologist informed me that I had prostate cancer. The tumor, he explained, looked to be localized, which was to the good: This meant that the goal of treatment was a cure.

A biopsy on a normal-sized prostate involves taking six samples from the left and right sides of the prostate. A pathologist reads the samples and -- after the findings are confirmed by a second pathologist -- issues a report. My report showed that three of the samples from one side of my prostate tested positive for cancer -- two of them were classified as <50% cancerous and one as <30% cancerous. The other side was cancer free.

The pathologist also issued a finding on the aggressiveness of the cancer -- its Gleason score. The higher the Gleason score, the more likely the cancer is to spread. The average Gleason score for a man diagnosed with prostate cancer is 6; mine is 7. A Gleason of 7 is significant because it eliminates the option of active surveillance, in which the cancer is monitored but not treated.

The urologist advised me to have a CT scan, which he thought would confirm that the tumor had not spread beyond the prostate. He seemed confident that it had not, which the CT in fact confirmed. He did not think that an MRI was necessary, a conclusion that I later came to question.

So, I had been staged. My prostate cancer identity was and is: T2aN0M0, Gleason 7 (<50% 3+4, <50% 3+4, <30% 4+3). T2a signifies an early stage tumor; N0M0 indicates that the tumor has not metastasized into pelvic lymph nodes (N0) or beyond (M0).