One out of every nine men in America will get prostate cancer in their lifetime. Some will be fooled into thinking their health is good because prostate cancer may be present without symptoms. For some, the only indication there could be a problem may be an elevated PSA. It is an essential test for men over 55 and may be needed by men as young as age 40.
The PSA test is not conclusive, but in the absence of other symptoms, it is the only signal to take a closer look. When there are symptoms, it may provide indications as to the why of those symptoms.
I had normal PSA results for several years, no family history of prostate cancer, and by most measures was very healthy. Then I went a few years without a PSA test or exam. When I resumed testing, the PSA was elevated. My doctor referred me to a urologist who did another PSA test and DRE. The PSA was elevated even more and a biopsy was scheduled.
A week after the biopsy, my wife and I met with the urologist to get the report. It was positive in 10 of 12 samples and most of them had very aggressive cells. He told us about next steps in the diagnosis, some of the quality of life issues, and possible treatments. My wife and I are not people who are easily frightened, but being told you have cancer is gut wrenching.
There are a lot of other experiences and information that I can share but I want to focus on why it is so important to know your numbers. In so doing, I want it to be clear that I am not a physician nor do I want to practice medicine in any way, or have you to think of this as medical advice. My sole intent is to share my experience and my interpretation of the many things I have been told by my great doctors and read on websites.
Here is why it is essential to know your PSA level.
1) The only way to avoid metastatic prostate cancer is by early diagnosis and treatment. Here is just one of thousands of examples that should make you avoid metastatic prostate cancer. A reasonably young executive of a company for which I have been an Independent Director, produced brilliant ideas and results. Even more he was highly respected by his team and peers, and valued by his CEO and Board of Directors. He was diagnosed with metastatic prostate cancer. He performed his job as his condition deteriorated and balanced the burden of palliative care with family and career. There is no cure for metastatic prostate cancer. It ends brilliant careers, fatherhood, and great marriages. He passed away about 3 months before I received my diagnosis.
2) Having more widespread tumors, even though contained in the prostate, eliminates some treatment options. Because I let my cancer go undetected, it was stage II B at diagnosis. The B means that cancer was present in both the right and left sides of my prostate. Ten of the 12 samples taken for biopsy contained cancer. While the treatment options that were eliminated for me were probably not those that I would have preferred, other men have preferred them.
3) The treatment for prostate cancer has a lot of bad consequences. Early detection may allow the treatment to be less aggressive and thereby result in fewer bad consequences. I read an interview with a urologist who said she believes that doctors don't adequately explain the consequences (or side effects) and I agree.
There are many ways to treat prostate cancer. Radical treatments can include surgical removal - a prostatectomy or freezing - cryoablation. Radiation treatments can include external beam radiation therapy (EBRT) or brachytherapy which is the implantation of radioactive seeds. It is common to also have androgen depravation therapy (ADT) in concert with other treatments. ADT uses a drug to stop the production of testosterone. Testosterone is the fuel for prostate cancer. The prostate cancer cells cannot reproduce without testosterone.
Radiation therapy can damage organs and nerves that are near the prostate and result in erectile disfunction and incontinence. In some cases it may be temporary and others will be permanent. While damage from EBRT can be serious, it seems to be relatively narrow in its scope.
ADT on the other hand will have far reaching issues. And, according to studies that I found online, a longer course of ADT is more difficult to recover from than a short course. Short course (6 months) ADT is more likely to be used when the cancer is in an early stage and tumors are not widespread. For my cancer, the doctors recommended a 24 month course.
ADT may take a couple of weeks to begin its work, but after several weeks, the man will have a pre-pubertal level of testosterone. At about that time, libido is gone, and impotence is present. Trust me, this is one of the gentler side effects. There are many more, and I have read that not all affect all patients, but here are some.
Hot flashes began after about 3-4 weeks for me. Now I understand what my wife has been going through. I can be sitting in a cool room when one strikes. The feeling is like a fire from the inside that causes sweating and discomfort. They disrupt sleep and add fatigue.
Fatigue sort of happens like hot flashes. In the words of a Jimmy Buffet song about gravity storms, "it strikes without a warning." Sometimes it requires a short nap and sometimes I can just power through it for an hour or two.
Osteoporosis is a possibility, but I don't seem to have symptoms. Early into my treatment one of the doctors recommended I start on a vitamin D supplement and I take it everyday.
Cognitive loss is a side effect that is probably least understood and discussed by doctors. I suppose in part because prostate cancer is most often a disease of older men (median age at diagnosis is 66), so it is difficult to determine if the cognitive effect is caused by ADT or age. Either way it sucks.
But here is the big one. Testosterone loss. Having essentially no testosterone causes a cascading series of bad stuff. Most people think of the impact on sex first. That is probably the least of the problems. First, it causes a loss of muscle mass. Because there is less muscle, metabolism is reduced and weight gain ensues. Some say the average man gains 10%-15% of their body weight while on ADT. That is consistent with my experience.
Second, because there is less muscle, blood sugar increases and diabetes becomes a challenge. So far I feel fortunate to have remained pre-diabetic. For those who do become diabetic, there are a host of other problems.
One study that I read compared the time for testosterone recovery after short course ADT to recovery after long course ADT. More than 90% of the men studied in the short course ADT had recovered normal testosterone level in a year. For the long course ADT, slightly more than 50% recovered normal testosterone after 2 years. If we don't recover a normal T level, we continue to be at risk for all of these other health problems.
We can't avoid cancer, but we can try to catch it early enough to have less adverse treatment. You can't catch it early enough if you don't have the PSA tests and DRE's. So, KNOW YOUR NUMBERS.
Tagged with: #psatest, #prostatecancer, #menshealth, #healthcare
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