WOSTER: Be your own task force and when cancer hits, make your own decisionsIt’s been nearly 17 years since I had my first PSA test, but I’m still convinced the thing helped save my life.
By: Terry Woster, The Daily Republic
It’s been nearly 17 years since I had my first PSA test, but I’m still convinced the thing helped save my life.
If that’s too dramatic, well, for sure I’m convinced it helped detect my cancer earlier than without the test. I believe that saved me from more prolonged medical treatments and a more uncertain prognosis. But what do I know?
The PSA (that’s “prostate specific antigen”) was in the news earlier this month when a task force questioned its value for routine cancer screening. A positive test doesn’t always mean cancer. If it does mean cancer, it can often mean a small tumor that will be too slow-growing to be deadly. In other words, you might have cancer, pardner, but the odds are something else will kill you.
All I know about prostate cancer is what I learned after I was told I had it. I’m not a medical expert on the disease. I am a pretty serious student of the one case that mattered most to me. What I know from my own history is that the PSA test helped my family doctor advise me on possible next steps, and those next steps led to the treatment that eliminated the cancer, which so far hasn’t re-developed.
I understand what the task force is saying. Some men, perhaps significant numbers, have unnecessary biopsies or surgeries or radiation. Those can have grave side effects. I’m aware through my readings and discussions of the disease that “watchful waiting” is an accepted treatment many times. That means, even if you find out you have prostate cancer, you simply see what happens next — in consultation with your doctor, of course.
I had that option. Every medical person I talked with gave me that option, starting with the family doctor who recommended a PSA test when I turned 50. Truth be told, if he hadn’t recommended it, I was under strict instructions from Nurse Nancy to ask about having the test, anyway.
My test came back at 4.1. Doc told me that was about one one-tenth of a point outside normal range. If he’d said, “Let’s check in a couple of years” or five years or never, I’d have agreed. He didn’t. He said that because I was relatively young, he didn’t think the reading should be that high and it wouldn’t hurt to ask the urologist. That specialist said he couldn’t feel anything, but he recommended a biopsy, which I had on Valentine’s Day in 1995. That came back positive for cancer. A friend’s doctor — a physician uninvolved in my treatment in any way — told my friend the staging or grading suggested a rather aggressive tumor.
My urologist gave me several options. He did say he was a surgeon and if I wanted, he’d cut the thing out. He also said he’d line me up with someone who did radiation if I thought that made sense. And he said he’d work with me to find a good oncologist, if I wanted more information or if I just wanted to wait and see. I asked some questions, read some stuff and talked with Nancy. Then I told the surgeon to go ahead — inelegantly noting that in Lyman County when a farmer has rot in his crop, he gets rid of it. (Farm-boy talk like that would drive that national medical task force nuts, I suppose.)
Anyway, I had surgery. I’ve had no further treatments. Based on the post-operation lab reports, I’m convinced if I’d waited a year, the thing would have spread outside the prostate gland. I could be wrong. Maybe the surgery was a waste of time. Or, maybe without it, I’d be dead. I’ll never know, and neither will anyone else. Life is messy, and the best answer isn’t always clear.
I spent a lot of time listening and learning before I came to my decision. My doctor, my surgeon, Nancy, they all helped, but I had the most at stake. It was my decision.
That’s the only advice I’d give other men. Learn what you can, including what that task force says, and make your best decision. And good luck with it.