Prostate Diary: The Docs Weigh In

One of out every seven men will get prostate cancer, and it's thought that all of us would if we didn't die of something else first. Prostate cancer kills about 25-30,000 men every year -- the most cancer deaths among men who don't smoke. For whatever reason, is a scourge among African-American men.

For what it's worth, I was not at risk: No family history of the disease, I'm in good physical condition, and I eat and drink in moderation. Sometimes, you just get it.

The diagnosing urologist presented me with two treatment options -- surgery and radiation -- and recommended that I read up on the subject and consult a radiation oncologist before deciding on treatment. He thought that at my relatively young age I would want surgery, and then added "but then I'm a surgeon." He recommended two books in particular, both of which proved problematic.

In the event, I read from the books, talked with survivors, and consulted with three urologists, a radiation oncologist, and a medical oncologist. The urologists included a robotics surgeon, a standard cut surgeon, and a brachytherapy (seed implants) surgeon. The collective advice was emblematic of the frustration and difficulty of dealing with this disease:

Urologist #1: Don't do radiation. Get it out and get on with your life. (The problem is that this is easier said than done.)

Urologist #2: You should probably get surgery, but radiation is a defensible option.

Urologist #3: You can do whatever you want. You're going to do well no matter what.

Oncologist #1: Your chances of a cure are the same (roughly 75% for localized Gleason 7 prostate cancer), so it comes down to a choice of side effects. But you have to do something.

Oncologist #2: Don't get surgery: You'll regret it. The outcomes are the same, so why court impotence and incontinence?

I wound up believing that there are good reasons to go either route, depending on who you are. I chose external beam radiation -- I'll get into why -- but I wouldn't presume to tell any man that that's what he should do. This time, it really is all about you.

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).