The good cancer

Generally speaking, prostate cancer don’t get no respect. Going into my biopsy, I was reasonably sure I had it because of family history and four elevated PSA scores. I wasn’t much concerned, though, because as everybody knows, prostate cancer is slow growing and rarely fatal unless you catch it very late. I already knew what my treatment option was going to be: watchful waiting, meaning I’d test again in a year and see if it was going anywhere. If not, more watchful waiting.

I was half right. I have prostate cancer. Over the last few months, though, I’ve learned more than I imagined possible about the dizzying array of treatment options. In the end, the patient has to make the tough choice of which one is right for him, and for me, watchful waiting is not an option.

If you’re diagnosed at, say, age seventy, chances are good that your cancer is slow growing and you’ll probably outlive it. Plenty of men choose to treat it aggressively anyway, but an equal number choose to watch and wait. It would be my choice at that age.

At sixty, though, which is my age, your cancer by definition is more aggressive, and now the choice is between surgery, radiation, implanting radioactive seeds, or a host of less common treatments. There’s still time to look at all the options carefully and make a choice that’s best for you, but it’s not something you want to put off for a year and see how it’s going. In a year, it could be too late. My friend John was just diagnosed at age 45, and for him it’s important to begin treatment immediately. His outlook is also favorable but there’s not the luxury of going on vacation for a few months and then getting serious about treatment options when you get back.

This has been a hard decision, but I finally settled on surgery, radical prostatectomy, which is considered the “gold standard” treatment if the cancer is still organ confined. Still, it’s not an easy choice. If they don’t get all the cancer, follow-up treatments include radiation, chemotherapy, and/or hormone therapy, also cheerfully referred to as “chemical castration.” Or then again, there’s actual castration.

Even if you have a good outcome on the surgery, the complications can be life changing: mild or serious incontinence (which I frequently mispronounce as “incompetence”) and mild or serious impotence. Everyone experiences some degree of these conditions, but in most cases men regain at least near-normal function within about a year. Some men never do.

I’m optimistic. I’ve chosen a surgeon in Medford, who has much more experience than our local guy here in Klamath Falls but is still close enough that I can be out of the hospital and back home in a few hours. If there are complications, and there usually are to some degree, I can be back in his office equally quickly.

I’m scheduled for September 10th.

Generally, my emotional state is very good, though I sometimes get either depressed or angry about the whole thing. In the end, though, I expect to have all of this behind me a year or so from now. In the meantime, I’m trying to keep a good attitude and stocking up on good books and films (with an emphasis on comedies).

Again, I urge all my men friends to get regular PSA tests. Since I’ve learned I have prostate cancer, it’s amazing how many men I know who have the same thing, most of them my age or younger.