CW

Notifying the kiddo
June 20, 2016

Hi, Tracy.
It's always a toss-up on how much to tell you about my prostate, because the science is so incomplete. My prostate-specific antigen score has climbed suddenly, so I'm scheduled for my second saturation biopsy (first was five years ago) to determine whether I have prostate cancer, and if I do, whether it's the type of cancer to be concerned about. This is somewhat a fool's errand, because at 70 years old there's a 50 percent chance I have it anyway and that's it's nothing to worry about. This an aggravating issue for the doctor who will be performing the surgery, because the indicators are so ambiguous and the practice of even bothering to watch the PSA is controversial. So I have a biopsy next Monday when many in the medical field would say "don't bother!" But you are my son, and male, so I hope you will find this informative, but I hope not worrisome.

Here's the synopsis: In 2005 I had a PSA score that was about 6, if I recall, while the normal was 2-4. So I had a rather uncomfortable through-your-behind-opening biopsy that jabs a needle through your intestinal wall to pluck out a piece of tissue about 1/8 inch long and thinner than a pencil lead. They took 8 samples, examined them under a microscope, and found nothing. The PSA kept inching up, so I had a couple more biopsies over the years and was operating under the assumption that the odds of having cancer were really low after so many negative biopsies. But having a long life expectancy means I should pay attention, because I won't necessarily have the convenience of dying of something else before prostate cancer can take me down. So in 2011, I had my first  saturation biopsy, when my score was somewhat in the range of 10. The doctor took 50 samples.
Nada. Zip. Nothing.

My doctor told me to just continue to monitor it. It bumped up and down a bit, and then a couple months ago it was at 16, and we did another blood draw a bit later and it was at 19. The PSA score was growing rapidly.
This led to my having an MRI of the pelvic area about a month or so ago, and nothing was found, but just to be on the safe side the saturation biopsy has been scheduled for next Monday. I'm fatalistic about all of this, and not particularly worried. It will be what it will be.

A few years ago I was given the understanding that when the PSA reaches 20 there's a 50 percent chance that you have cancer and it has metastasized.  But now it's my understanding that only if you have an aggressive cancer there's a 50 percent chance it's metasticized at a score of 20. I think that's what the stats are; I'm getting a little fuzzy on this stuff.

I went in for my pre-op interview today and the doctor gave me some sort of 3 percent figure for fatalities from prostate cancer. You'll find it in most males by the time they are 80, or something like that. At this point I have stopped trying to understand and remember all the stats.

The difference between this biopsy and the last one is this: five years ago they probed the prostate through the intestine wall. This angle limits the percentage of the prostate they can sample. This time they approach from the perinea, the area in front of the anus extending to  the scrotum. I may be walking strangely for a few days following the procedure. They will probably take 40-50 samples including parts of the prostate they couldn't reach through the other method.

By the way, the MRI cost just under $400 and was covered by health insurance. I'm sure the surgery will be a lot more expensive.

So, this e-mail is just an F.Y.I. because I think as my son and heir you should at least be aware of what's happening.

OK, I've told you. Now I fully expect life to go on as it always has....

Love,
Dad