Prostate Cancer and Me

It started with crispy pata, as with everything that happened to me over the past couple of months. Because I was eating so much delicious fatty pork, I decided to get a medical check-up, you know, just to be sure. As I expected, my cholesterol—both the good and bad kind—and other vital signs were at desirable levels, but I was surprised to learn that my creatinine was elevated.

Like many other living-in-denial nearly-senior guys, I resolutely ignored that one abnormal outcome in my comprehensive blood test. My creatinine had gone up before when a gigantic kidney stone had gotten stuck somewhere causing me enough pain to make me miss a lunch meeting; but after doctors blasted the stone out of existence with sound waves, the mysterious creatinine went back to normal. I wasn’t worried. Besides, I felt fine.

Several weeks later, when I saw my regular HMO-recommended physician to get my routine prescription of diabetes meds, I asked her about the creatinine thing just to make conversation. She said I should see a urologist. I completely understood why she avoided answering. Back when I was practicing law, I used to tell people that they shouldn’t consult a corporate lawyer about election law just as they shouldn’t ask an electrician to fix their plumbing. Anyway, I had time that day—no good movies at the mall—so, back I went to the HMO office in search of a new doctor . . .

My brand new urologist greeted me with a standard What can I do for you, sir? And I said with a smile, Doc, my creatinine level is high.

“Why are you here? You should see a nephrologist. I am a urologist. Uro, Uro,” he replied brusquely.

What?! I thought to myself. Not one to back down, even from those who think themselves gods, I searched my brain for an argument and plowed on: I told him I believed my internist sent me to a urologist because in previous check-ups my prostate had been found to be enlarged.

“Ahh, things are beginning to make sense,” he said. “Do you have a history of cancer in your family?”

What the hell? Cancer??! My father died of cancer, I related to him nervously, and I knew of other relatives with cancer. But then, I added my mother passed away due to kidney failure, hoping at that point to be sent to a nephrologist . . .

After a few more questions on how I pissed and a brief lecture on human anatomy, however, the urologist recommended a full bladder ultrasound, plus a PSA test to begin the process of screening for prostate cancer. When you hear that cancer is a possibility, you don’t put off getting the test. You want to know right away. I went straight back to the HMO office and from there to the hospital outpatient department for the test. They drew the blood quickly enough, but they said the results wouldn’t be ready until 5:00 pm.

What do you do when you have a few hours to kill? Go on the Internet, of course. Several websites later, I had learned that the PSA test measures the amount of Prostate-Specific Antigen in the blood. After that, however, everything got confusing. A high level of PSA might indicate the presence of prostate cancer but it might be a result of something else entirely. Huh? Ok, but what level of PSA is high? The websites very carefully said that “there is no specific normal or abnormal level of PSA in the blood” but traditionally the cut-off for concern about the risk of prostate cancer has been 4 nanograms per milliliter (ng/mL). Most men have less than 4 ng/mL; therefore, if your number is below 4, you don’t have to worry (even if it doesn’t mean you don’t have cancer). On the other hand, if your PSA number is above 4, your doctor may recommend a biopsy (which sounds pretty bad) or a digital rectal exam (which sounds pretty yukky). Clearly I did not want to see a number higher than 4.

At 5:00 pm, the lab receptionist printed out my PSA test result and handed a sheet of paper to me over the counter. I quickly took a look and saw the number 5. Oh, shit.

Unfortunately, this was at 5:00 pm on a Friday. I wouldn’t be able to see the urologist again until Monday morning. What do you do when have a whole weekend to contemplate the prospect of dealing with cancer? Go back on the Internet.

All the medical websites warned that one bad PSA result was very far from a determination that I had cancer, but what if I did? One unfortunate headline said: “Detecting prostate cancer early may not reduce the chance of dying from prostate cancer.” Bewilderingly, the accompanying text went on to discuss the possibility of over-diagnosis and explain the potential complications and harmful side effects of overtreatment, including urinary incontinence, erectile dysfunction and infection. Finally, it ends with the ominous statement that “finding cancer early may not help a man who has a fast-growing or aggressive tumor that may have spread to other parts of the body before being detected.” Ano ba talaga, kuya? As one respected site blithely put it, “There is a lot of conflicting advice.”

I found some comfort in remembering what a friend told me after his diagnosis—prostate cancer can grow so slowly that you will probably die of something else before the cancer gets you. Still, stepping into the same room with one’s mortality, though not quite coming face to face with it yet, is a sobering experience. I’ve lived exuberantly for the past twenty years despite the possibility of one big fatal heart attack; but anticipating a struggle with cancer got me to sit down. I began to question my decision to write a living will and give instructions to “do not resuscitate.” Did I want radiation and chemotherapy after all? For the record, my answer was no. But I had other questions: Was I in fact ready to die? Had I really completed my bucket list already? Why was my list so short? Didn’t I want to see Machu Picchu? Or the Banaue rice terraces?

First thing on Monday morning I was back at the urologist’s clinic. As I pulled out my test results, he said, “No need. The lab sent up your results already.”

I stopped what I was doing and focused on what he was saying.

“Other men would be very happy with your results. We usually want the PSA to be below 4. Yours is point 5.”

WHAT??! ZERO POINT 5?!

I didn’t hear much of what else my beloved urologist had to say after that. I looked carefully at my copy of the test results and there it was: 0.5 ng/mL. Well below 4.0. Below 1.0 even. I had not survived cancer. I had only survived my own stupidity.

My medical problems continue, however. I need new glasses.

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