Adventures with my prostate

I started to write this because if this whole thing should head south and takes a turn for the worst, I want to document it.

This journey has started because I turned 40 as one usually does if they spin around the sun enough.  For my birthday I gave myself complete “executive” physical at Medcan.  I wanted to give myself a Rolex but Zuimei gave me one and so I used the money for this instead. As part of my physical I got a PSA blood test. On October 25, my total PSA came back 3.24, which isn’t especially high except that most men 40 years of age have a PSA  less than 2.  The more alarming issue is the free PSA  at 0.367 and a FPSA/TPSA ratio of 0.11.

The report back from the clinic reads:

FPSA / TPSA ratio 0.11  

>0.20 Probabiltiy of prostate cancer less than 10%
less than 0.10 Probability of cancer greater than 90%

So I am somewhere between 10% and 90% sure I have cancer…

As this was cause for concern my physician recommended I get another PSA test.  On December 10th I went back to Medcan for the follow up to another exam and as part of it had lab work done. My PSA had risen to 3.81 and the FPSA/TPSA ratio went down to .1.

This is not good.

Being the analytically inclined fellow I am, I quickly did some math in my head.  In 47 days my PSA rose 0.57. At this rate it would double in 6 months.  When I got home I made a chart to see if my math was correct and I was just a little off. Yay for me.

Keep in mind I still haven’t seen a urologist. In fact, I haven’t even “officially” gotten back the results from the doctor (he’s still on vacation). I just pestered the poor nurse into giving me the results to get me off her back. Rather than wait for the doctor to return I decided to start doing some research on my own.

That was a mistake.

So I know PSA density, velocity and FPSA ratio are all important.

“PSA velocity only “somewhat” improved the prediction of prostate cancer, compared with a single measure, but PSA velocity is nonetheless valuable, especially for predicting aggressive disease, say the study authors.” That is not so good considering my PSA doubling in just over 6 months is pretty fast.

PSA density is the relative measure of your PSA compared to the size of your prostate. And as luck would have it, I happen to know that from the men’s health assessment I did in October.  According to the report my prostate volume is estimated to be 18.9cc and so my PSA density is 0.17. However, when comparing two patients who have the same elevated PSA and different prostate volumes, the patient who has the smaller prostate is more likely to have prostate cancer. Again not so good.

The Free PSA ratio I already mentioned with the whole 90% cancer thingy…

Here is what else I know from my research.  Lots of men gets prostate cancer at some point.  It usually grows so slowly though something else kills you before it does.  The government doesn’t want to do PSA tests for men under 50 years old because it is expensive ($50) and because it gives false positives (high PSA readings without cancer) and false negatives (cancer without a high PSA).  This leads to a lot of unnecessary anxiety and treatments which cost a lot of money.

Despite this, it is still the best marker we have.   Prior to this the doctor has to feel it during a DRE (Digital Rectal Exam) and often the treatment was palliative (you’re gonna die, but we’ll make you comfortable) rather than curative (you’re going to live!) The government also doesn’t want PSAs performed on older men because, “why bother they’re going to die and not vote anyway”.  Okay they didn’t actually put it that way but you can read between the lines.

So now, here I am with my elevated PSA reading about a prostate biopsy which sounds like it fucking hurts.  It involves a trans-rectal ultrasound (been there, done that, bought the t-shirt) with the added bonus of a sharp needle jabbing your most special place  a dozen times.  In case you didn’t know, the prostate is the male “g-spot”.  Google it, I’m not kidding.

The biopsy takes about 15-20 minutes and then you can go home.  But you have to be careful to make sure you don’t get a fever or have trouble eliminating because that could be a sign of infection, which can go septic and kill you.  I shit you not. It’s very rare, but it happens.

Here is the best part.  The biopsy is no better than a random test.  Each biopsy sample is 1/10,000 of your prostate just to give you an idea of size.  It is very easy to miss the cancer.  If you look at an image of a biopsy you can see the biopsy needle only gets to the back part of the prostate.   I read 70% of prostate cancers are located there but that still leaves almost 1 in 3 missed.

Now there are more precise ways of checking.  For example one could use diffusion weighted imaging from an MRI to determine where exactly the biopsy needle should go but again, those cost money and the government just isn’t ready to fork over that kind of money.  I could also shell out big bucks to check my genes to see if I have a BCRA mutation which makes men who have it get very aggressive cancers at a young age, but considering my father and his brother are in their late 70s with no signs of cancer I think I am safe there.

So now my mind is churning over the blogs and sites I have read from support groups like the PCCNToronto, and from various hospital websites. So am I scared? Your damn right I am. None of the indicators bode well, and I haven’t been that lucky lately.

I suspect on Monday the doctor will call to set up an appointment with the urologist and he in turn will recommend a biopsy.  And if that is the case I will ask to have it at Sunnybrook since they have a rapid biopsy lab.  They can turn around a biopsy in 2 or 3 days instead of the 2 or 3 weeks.  Personally I don’t want to spend two weeks thinking about “what if it is positive”.  I would rather just know so I can deal with it.