If you’re a man, you have a 1 in 8 chance of developing prostate cancer at some point. (Women have a 1 in 8 chance of developing breast cancer.) This will generally happen when you’re older, and in most cases, it will be so slow growing that you will die of something else before your prostate becomes a problem. That’s good news.
It’s still shocking to hear the doctor say you have cancer. My annual PSA test came back with a number that was much higher than the year before, so I knew something was afoot. The news surprised me because I had no physical symptoms of a problem. I expected to end up in the large “we’ll watch to see if anything changes” group that most men are in where nothing needs to be done.
After a number of finger palpitations over the months (the dreaded DREs, digital rectal exams) and a series of scans (bone, CT, PSMA-PET), a biopsy revealed that I had an aggressive form of the cancer. I didn’t have the option of doing nothing. My choice was either surgery to remove the prostate or a combination of hormone chemotherapy and two types of radiation.
Not knowing anyone who had prostate cancer, when I casually mentioned this to my male friends, I was surprised to hear how many of them had already been flagged by their doctors and were being monitored. They hadn’t spoken of this before, as if it was an embarrassing secret. But then men, as well as women, don’t generally talk openly about any significant health matter that affects their lives. It would be easier on us if we shared what was going on and had the ongoing support of a group of people.
No cancer is good to have. My friend Michael says that if you’re a man and are going to get cancer, this is the kind to get because it’s treatable and curable, especially if it’s caught early, so I’m not likely to die from it. That’s good news, too. But did we catch my cancer early enough?
Researchers are looking into what causes prostate cancer to set up shop, but the findings so far are so ubiquitous that they don’t offer anything useable. Genetic screening can tell us who is most likely to develop cancer, but it can’t say if any of these people will. I’ve looked at the stats and know that after I’ve taken care of this cancer, when doctors say “there’s no evidence of any cancer remaining,” there’s a thirty percent chance of it coming back.
While both of my choices had comparable, positive outcomes, what I worried about most, outside of the pain and discomfort of the procedures themselves, were the effects of the treatments on my body. Incontinence and erectile dysfunction are common for those who have surgical removal. There are more bowel and bladder complications with radiation.
Three years later, my treatments are over. I had brachytherapy, where eighteen radioactive needles were inserted into my prostate for a time, then five weeks of daily radiation. Hormone chemotherapy started off with Casodex and then Lupron, and I’m still dealing with the aftereffects and side effects of all of this. While some disruptions have gone away, others have not, and my doctors tell me to give them more time to fade away. While my PSA has remained low, it continues to go up and down, and not all of the categories on my blood tests have returned into normal ranges, especially those replenished by my bones. I will have to wait to see if all of my body’s regulatory and metabolic systems reset, and wait longer to find out if my cancer is truly gone.
Rather than dying in old age as body parts wear out, I have something that might end me sooner. There is anticipatory grief in this because of the dreaded “what ifs” — what if I only have five years left to live? What if I’m left with physical limitations that I have to deal with every day?
Cancer will forever be a horse that is grazing in the back meadow.
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