My Experience of the Process
(c) 2015, Davd
The first prostate cancer story i ever heard personally, came from a friend of my father’s, more than 40 years ago; and in a year or two, he died. I’m not sure how he was diagnosed; but a Cancer Society volunteer confirmed that it couldn’t have included the blood test that started me—and starts very many men—into the process today. It’s called PSA, for “Prostate specific antigen”.
There are two meanings available for “digital prostate examination”. One involves pushing a finger [digit in semi-Latin] in a thin glove, up through your anus and feeling the prostate for size and lumps. Older men should get one of these uncomfortable examinations every year, at least every two years. (It is one good reason for men to prefer a same-sex physician1.)
The other involves computerized [“digital”] chemical analysis of blood samples, especially the fraction of PSA in that blood. I don’t believe either kind existed when my father’s friend Bill was diagnosed, nor when he was buried. Perhaps the finger version was known but because it was uncomfortable and embarrassing, seldom used until something else led to suspicion of prostate cancer. The biochemical version depends on technology that probably didn’t exist, certainly wasn’t widespread, in the 1960s.
My experience tells me, so i’ll tell you—if you’re an old man, even over 50, at least ask for both “exams” with every annual check-up. If you’re over 65, you should definitely have them.
In 2014, i was referred by a Salvation Army officer friend, to a “new” physician, Dr. K, whose practice the Major had left when he was transferred, as Salvation Army officers are every few years. There had been awkward aspects to consultations with the one that i had been sent to as “available”; and at least for now, i will not identify individuals: Few readers if any will be in either practice. I will say that while both physicians used laboratory tests, one seemed to be letting a computer software system interpret them, while Dr. K, a man whose appearance resembled my uncles when i was a boy, seemed to be interpreting them himself.
I will say that Dr. K. included the PSA test in the blood sample analysis he ordered as part of my first annual check-up within his practice. His finger exam found the prostate to be enlarged, the PSA score was higher than normal, so since i was less than 75 years old, he referred me to a urologist, Dr. V. Dr. V. repeated the finger examination and concluded that not only was my prostate larger than normal—something fairly common in old men—he felt a lump2. A biopsy was ordered for some 6-8 weeks later.
The biopsy was in fact, “day surgery”; and since the majority of readers likely have neither had such surgery nor will in the next year’s time; i’ll just report that it was messy, somewhat painful, and broke most of the rules of everyday modesty. If you or a friend get to this stage, expect it to take most of the day, leave the patient unfit to drive or appear in public, and thus, require either a taxi if you live in a city, or a driver if a taxi would be too expensive (as is usually true for rural people.) When it ends most patients will not feel like riding the bus or even standing around at a bus stop.
A few weeks later, i heard the results: The lump was a tumor with a “Gleason sum score” high enough to call it cancer. Next came a “CAT scan”, a chest X-ray, and a “bone scan”, to see if it had spread. Those tests came back negative: If there were rogue [cancer] cells outside the main tumor, they were solitary or in groups too small to detect.
I had been “diagnosed with” carcinoma of the prostate, not yet metastatic, and was immediately given two “androgen suppression” drugs to inactivate the tumor [make it stop growing, perhaps even shrink]. End diagnosis, begin treatment … and with the cancer still localized.
If i had continued in that other practice, where i don’t remember any PSA screening and know very well i never had a finger exam of my prostate, i might not know even today, that i have prostate cancer. Meanwhile, that cancer might have spread, over the months, if it hadn’t been suppressed and now is being zapped. It might have spread over more months past this Movember, months when i might still not know; to where radiation would not be enough and knocking the tumor out for longer than my remaining life expectancy, very unlikely.
I’m not “home free” yet. The radiation treatments are about half done. I will continue to be weakened by them for some weeks after they end, until Christmas or later. There is even some risk that the radiation will trigger cancerous changes in cells around the prostate and i will later have a different kind of cancer. But at 73, having a life threatening cancer changed to a dying cancer, or one knocked so far back that i’m very likely to die of something else instead, is a great improvement compared to finding out when it’s too late, like Bill did.
It’s important to know a tumor is present earlier rather than later, and to know as soon as it becomes serious enough to need treatment (if it ever does.) Older men should have regular PSA and gloved finger examinations. If you have a regular GP [General Practitioner, aka family doctor] and don’t get those two tests every year if you’re over 65, at least every other year if you’re 50-65, methinks it’s time for a change. For the men who don’t have a regular GP to go to, Movember Clinics providing those tests [and perhaps other men’s health examinations and advice] sound to me like a good use of Movember donations—and for that matter, of public health spending generally.
1. My favorite example of an ideal medical “family practice”, was that of Drs. Guy and Elizabeth Richards, in Saskatoon. Their examination and waiting rooms were in their house; they had bought a big house and set aside part of it for their practice. They had as short a walk to work as possible; they were available to their children when not seeing patients (and could make patients wait a minute if the children needed something quickly). Guy could counsel men and boys as one who had the same kind of anatomy and physiology; and Elizabeth could do likewise for women and girls—maximum empathy and “i’m built like that too” understanding; minimum embarrassment…and family connections in health needs and care, could be easily determined between the two doctors because they shared most of their time. (I write “was” because i am now 73, and they were older than i—still are, if they are still walking the Earth.)
2. Dr. V, as a urologist, had more experience with prostate cancer than Dr. K, who is a general practitioner. Finger examination is somewhat subjective; he had a greater experience base from which to assess.