27 days until surgery. Remember, this is NOT medical advice. I’m not a doctor. And I don’t even play one on TV.
Here’s the basic timeline of my Most Magnificent Prostate Adventure, without much fanfare or editorializing. Let me just start with this: there are, nor have there ever been, any physical symptoms. So there is piece of blue sky good news.
How it All Came Down:
Back in early March of 2022, I went in for what was supposed to be a run of the mill physical exam. During that exam, my doctor gave me a Digital Rectal Exam - not the most pleasant of things but something I’m a firm believer in, especially now - and this proved negative. We also ran a blood panel, and it was here that my newfound adventure began to raise it’s head, with a PSA of 6.02. Normal PSA is < 4.0. Men of a Certain Age (50+), please get this tested.
So my doc urged me to speak to a urologist, since in his opinion my PSA was trending in the wrong direction (it was < 3.0 just a year earlier).
I went to my urologist here in Bellingham, and based on the results of my blood test, he wanted to do a Prostate Biopsy. I agreed. This is where it also gets controversial, as most people recommend getting an MRI first, but I didn’t know any better at the time.
In May, I got a biopsy, which took 12 core samples of my prostate, 3 of which proved cancerous. My urologist at this point concluded that I had a Gleason Score of 3+3 = 6, which denotes low grade, non-life threatening cancer. There is even some debate as to whether this should be classified as pre-cancerous, but this is a topic for a different day.
Because the prostate biopsy leaves heavy scars, we had to wait 3 months for those scars to heal before getting an MRI. In early September of 2022, I got the MRI, which validated the 3 areas of cancerous growth, still at a 3+3 = 6 Gleason Score. The highest Gleason Score is a 10, so I felt pretty good about it. The doctor did too.
Treatment: I was put on ‘Active Surveillance’, which isn’t that really that ‘active’ at all. Bascally, it involved getting my PSA re-checked every 6 months, and my PSA actually dropped back into the 4 range after my first test in 2023. So far, so good. I went about life.
In February of 2024, we went on a road trip to visit my nephew Henry in Yellowstone, who was rocking it as a snowmobile guide. On that trip, I listened to this exhaustive podcast about Prostate Health with Dr. Peter Attia and Dr. Ted Schaeffer. Lots to absorb here, but when Dr. Attia asked Dr. Schaeffer ‘how do you know if you have a good doctor?’, Dr. Schaeffer replied quite bluntly: if your doctor does the prostate biopsy first and the MRI second, it’s time to switch doctors. Since this was exactly what my doctor had done, it was time for a second opinion (which, frankly, I should have gotten earlier. Why didn’t I? I need to explore this psychology more).
I decided to load the big guns, and went to Fred Hutch in Seattle. They’re considered a preeminent cancer center in the US, if not the world. My PSA was still in the 4 range, but my new doctor, Dr. Schade, was a little concerned about the frequency of my check-ups. He wanted an MRI right away.
In July, I went in for the MRI. Sure enough, there were signs of cancer growth and shadows in the image that needed to be explored.
In late September: Another prostate biospy, this one with 16 core samples. This procedure is not pleasant, and my doctor’s follow-up wasn’t optimum, but the bottom line: I was now a 3+4 = 7 Gleason Score, obviously trending in the wrong direction. Many of the core samples had indications of cancer, and one tumor in particular was approaching the prostate wall (not a good thing).
Doctor Schade recommends surgery to remove prostate entirely, or radiation. Both, he says, have high and almost equal efficacy rates. Multiple downsides and upsides to each.
After talking to various people, and a very informative Fred Hutch radiologist, I decide to go with surgery, for reasons I’ll describe in another post. This is a very personal decision, and other people make other choices with the same data set. If you want to know the absolute bottom-line, it’s sort of a coin flip. But my take is to remove the problem child entirely, in the hope this resolves it fully.
Surgery is scheduled for 12/9/24. About a 4 hour ordeal, I’m walking the same day, and leaving the hospital the next day.
4 week recovery. Rest and family.
Am I nervous? Oh heck yaz. Especially at 2:00am just about every morning. But all signs point to ‘yes’. And Radical Optimism.
So on December 9th, shoot some good karma my way, won’t you? I’ll feel it.