My Encounter with a Prostate Cancer Diagnosis: Postscript
I met with my urologist on March 13th to review the pathology report on the 48 tissue samples extracted during my prostate assay conducted on February 27th. I intended to report on the biopsy outcome, but a pandemic got in the way.
I don’t have cancer.
If you’ve been following my earlier post on this topic (here), you might be surprised. I know I was. My PSA score was a 12.5 after steadily climbing since 2016. The radiologist who reviewed my MRI stated cancer was more likely than not. My urologist was convinced as well—because the radiologist said so and my PSA score was a 12.5. So, on February 27th, I reported to the hospital for an outpatient biopsy.
The days between February 27th and March 13th were unpleasant. I wore a catheter for almost six days. That was ugly. Awaiting to hear that I did indeed have cancer was even worse.
During the March 13th biopsy review, my urologist scheduled me for another PSA test on June 9th—not here yet. He believed doing one earlier was too soon. He visited a bit of violence on my prostate—48 tissue samples!—and wanted to give the poor organ a chance to recover. However, my PCP scheduled my health exam, and prior bloodwork (on April 30th), for my exam on May 7th.
My April 30th PSA score was a 7.2. That’s a 5.3-point drop. My urologist was concerned that I did have cancer, but it had not developed enough to be detected by the pathologist. He was worried my PSA score would rise above 12.5 over time. If so, then it was off to another prostate biopsy experience!
I wouldn’t be surprised if a PSA test on June 9th, as scheduled, produces a score lower than 7.2.
What happened?
During the three years my PSA scores were on an upward march (from a 6 to a 12.5), my PCP didn’t want to hear about my concerns on the documented error rates of the PSA test. He didn’t want to hear about my exercise regime. He saw the score. The score was high. A biopsy was the only plausible course of action. In November 2019, I finally acquiesced but only after I insisted on a high contrast MRI beforehand.
My insurance company authorized the MRI. This is becoming the gold standard in prostate cancer diagnosis. A biopsy is VERY invasive, painful, and can cause its own set of problems. An MRI, on the other hand is just a long, noisy, and non-invasive x-ray of sorts. Remember, more than half of first biopsies produce negative (i.e., no cancer) results. The medical community has seen too many biopsies. They know that. They wring their hands about this issue, but they are absolute slaves to PSA scores.
My MRI was my first encounter with a radiologist. His report zeroed in on two swollen nodules in my prostate. He believed “more likely than not,” the swollen character was highly suggestive of cancer. His interpretation of the imaging was influenced—as he noted—by my high PSA score.
In mid-2016, I started spinning—ala Peloton. Three to five times a week, my Peloton session consisted of a five-minute warm up, followed by a 30 to 45-minute low impact ride, and ended with a five-minute cool down. Low impact meant my rear never left the seat. Effectively each ride was a prostate massage.
Urologists and PCP’s know better than to draw blood for a PSA test immediately following a digital rectal exam. The finger gooses, pardon the expression, the PSA score. I was having three to five prostate massages each and every week through February 26, 2020. And I rode each day prior to the blood test. In retrospect, was I surprised by the possible relationship between spinning and my inflated PSA scores? No. Could I engage my PCP to consider this causal relationship? Again, no.
The urologist based his decision to biopsy based on the radiologist’s interpretation of the MRI. I was the one who insisted on the MRI. Of course, I did so to avoid an unnecessary biopsy. I guess the joke was on me.
So, here we are. I’ll have another PSA test on June 9th. The score will likely be lower than 7.2. A meeting with my urologist a week later will probably result in my discharge as his patient. A PSA score in the sixes or sevens is still high for a man of my vintage. Yet, not if you also have BPH—which I do. Thanks to the radiologist who has confirmed my enlarged prostate.
Living with an enlarged prostate beats a cancer diagnosis any day. Having avoided the biopsy would have been ideal. Engaging my PCP in a meaningful discussion about my exercise habits would have been best. We could have arranged a test: Stop spinning for 60 days followed by a PSA test on the 61st day. I have every reason to believe I would have been spared the cancer diagnosis, confirmation by a radiologist who was influenced by my PSA score, the biopsy, the catheter, and two weeks of waiting for the pathologist’s report.
To further note the strange notion of all this, consider the following: I’m a gym rat. Have been for 54 years. Had it not been for the pandemic and the closure of health clubs, I would have been back on the bike spinning between March 14th and my April 30th PSA test. My PSA score would have likely remained elevated, maybe even higher than 12.5. My urologist would have recommended a second biopsy, and ….
Instead, I was saved by a pandemic. Who else can make such a claim?
Of course, the medical community could give greater consideration to their admittedly over treatment of prostate health. Most PCP’s claim that getting men to share during their medical exams is challenging. To which I would add: Getting PCP’s to listen is harder yet.
If it appears I’m taking members of the medical community to task, it’s because I am. However, I’m even more distraught with myself. Like all men, I must become a better advocate for my own health and healthcare.
Copyright 2020, Howard D. Weiner
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