Do I have Prostate Cancer or not?

I’m beginning to write this now, July 7, 2017; however, I won’t finish it until after I’ve had a visit with a Urologist to which my primary care physician referred me. Each year I have a conversation with my primary care physician about prostate cancer and the blood test (PSA) that’s routinely given to detect problems with the prostate. She normally gives me the argument that the PSA isn’t a test that’s dependable for discovering whether a patient has cancer of the prostate. She quotes research published in medical journals that site cases of false positives, and trying to reassure me that most cases of prostate cancer involve slow progressing cancer that has a very low risk of death. Being a Multiple Myeloma patient, I’m faced with regular blood draws to analyze my blood chemistry for abnormalities related to the disease. My oncologist used to order a PSA as part of my blood analysis; however, he stopped ordering the PSA six years ago. The PSA that was done the last time was scored at three.

This year the conversation with my primary care doctor went a bit differently. I questioned her extensively about the statistics that tell us that African American men are more likely to die from prostate cancer than other ethnic groups. She would come back with the argument that all the body scans and comprehensive tests I’m subject to twice per year, as a Myeloma patient, would probably detect some abnormality in the prostate. At almost sixty-seven years of age, and being intimately familiar with what cancer can do to the body, I wouldn’t let the decision this year be based on my doctor’s opinion alone. I asked her to order a PSA. Later the day of my physical, I went to my computer to access my patient records. The result of the PSA had been posted. It was scored at six. This number didn’t alarm me in the least bit. I’ve had problems with my prostate before. About three decades ago, my primary care physician at the time, ordered a PSA, which came back with a number much higher than six. He was very alarmed by the reading and quickly referred me to a Urologist. Fortunately, there was no cancer, but just a bad infection. The Urologist took tissue samples. Tests showed no cancer. For a good while after then, I would return for follow ups, and things would be fine. My diagnosis with Multiple Myeloma and the treatment associated with it have taken a front seat, resulting in me not focusing as much as I should have been on prostate screening over the last few years.

Today, July 7, I had my visit with the Urologist. I had a lengthy conversation with him about my history of difficulties with my prostate. The normal approach for someone with a prostate reading as high as the one that brought me to him is to conduct a digital exam and a tissue biopsy. Since I’m a Multiple Myeloma patient, he decided to forgo causing that amount of trauma to my body. He chose instead to conduct a liquid biopsy, testing a urine sample to see if cancer cells were present. If this approach proves to be inconclusive, he will conduct a tissue biopsy. The results of the test should be available in a couple of weeks. In the meantime, I’ll continue life as usual. One thing I did find somewhat shocking. The PET Scan and MRI scans I’ve been having would not have shown any evidence of cancer in my prostate. These scans aren’t effective at showing whether a patient has prostate cancer. This makes it very clear to me that patients should question their doctors extensively. I’m glad I pushed the issue of having a PSA done this year. Until the results of the liquid biopsy come, my prayer is that I don’t have prostate cancer, or if I do, it’s a non-aggressive type, which won’t require treatment.

Today, July 24, I received a call from the Urology Clinic. I was busy doing chores around the house, so I missed the call when it came in on my cell phone. The call was from the advance practice nurse, who performed my digital examination a little over two weeks ago. His message indicated that the test results had come back and that I was at “low risk”. They wanted to follow-up with another examination in six months. He went on to say that I should call if I had any questions. Obviously, I had questions. The term “low risk” wasn’t clear and generated the following question: …low risk of what? After making several return calls to the number left in the message, and getting no answer, I decided to look up the number to the clinic on the University of Arkansas for Medical Sciences website. I could connect with someone there. The lady who answered told me that the APN was in clinic and that she would have him call me back. Later, I received a call back from the clinic; however, it wasn’t from the advance practice nurse. The call was from an RN, who thought she should get back to me sooner than the APN would be able to.

The RN explained to me that the test performed indicated low risk. I asked what that meant exactly. Did it mean I had prostate cancer or not? She said the test indicated that I had low risk of having a malignancy. The safe thing would be for me to return to the clinic in six months for another PSA, digital exam and liquid biopsy. She assured me that this is the normal protocol for someone with test results such a mine; however, I could have tissue taken for a biopsy if I felt it was necessary. Suffice it to say, I certainly didn’t want to undergo such a procedure. I’ve had it done before and it isn’t a walk in the park.

I started this blog with the title question: Do I have Prostate Cancer or not? I think I can say that the term conclusive doesn’t fit either side of that question. At this stage of my life, believe it or not, that does provide me a certain amount of comfort. At least now, I’m on a medical specialist radar screen, and I’ll be followed closely. This is another example, among others I’ve experienced over the last seventeen years, of why the patient needs to take some responsibility his healthcare. Doctors, though knowledgeable about a lot of things, aren’t repositories for all there is to know about all medical issues. I’m sticking with my primary care physician; however, I’ll be as noisy about her looking under the hood as I am when my mechanic looks under the hood of my well-kept 2005 Chrysler Crossfire convertible.

I’m old and blessed…hope you will be too.

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