Joining the Cancer Club

Cancer

. . . joining the club

Sam Broadie is a retired army colonel living in the Appalachian foothills north of

Atlanta, Georgia. In the fall of 1993, Sam and I sat on a sofa in his home, watching

a baseball game on television. For the better part of three hours, while the contest

played out on the screen, Sam reflected on his recent battle with prostate cancer.

"Ron," he said, "you should get a PSA test."

"What's a PSA test?" I asked.

"The PSA test is a simple blood analysis," Sam replied. "It measures how much

'prostate specific antigen' the prostate gland is secreting into the bloodstream. An

elevated level could indicate that cancer is present. Most medical references urge

every man over the age of fifty to undergo a PSA blood test at least annually."

Sam always thought he had received first-class medical care in the Army. As a

young man, he had been subjected to a complete physical exam every five years.

After age forty, the frequency of the examinations increased to once per year.

In late spring, 1990, having recently turned fifty years old, Sam reported to the

post hospital for his final physical examination prior to retirement from the Army.

The doctor who examined him saw no need to look beyond the traditional digital

rectal exam (the infamous "finger wave") and pronounced Sam fit for release into

civilian society. It wasn't until Sam visited a local Atlanta doctor a couple of years

later that he finally received his first PSA test -- and cancer was discovered. The

civilian doctor told Sam that cancer had been in his prostate for up to eight years!

Having survived his own ordeal, Sam embarked on a mission to enlighten others.

It dismayed him to discover how little most men knew about the subject of prostate

disease. Speaking to an audience of one that day, Sam stressed the importance

of awareness and regular testing. "Ron," he said, "at forty-six years old, you are

fast approaching the danger zone. You need to get yourself tested pretty soon."

In spite of Sam's strong feelings, I felt no great urgency to get tested. My own

fiftieth birthday still lay four years in the future. Besides, Sam's case fell outside

the norm. Prostate cancer attacks old geezers, not healthy young studs like me.

* * * * *

I understood the importance of medical screening and had every intention of

getting a PSA test but, for a variety of reasons, kept putting it off. As the months

passed into years, Sam Broadie's voice rose repeatedly from my subconscious,

like a foghorn in a storm, "Early detection is key to survival. Don't wait too long!"

Finally, a few days past my fifty-first birthday, I scheduled a complete physical

exam and asked my German doctor to also administer a PSA test. He stared at me

for a long moment, nodded his head, and said, "Sure, if you want one."

A healthy man secretes between 0 and 4 nanograms (one billionth of a gram) of

prostate specific antigen per milliliter of blood. The result of my first PSA test was

9.9, followed one month later by a 10.7 -- which thoroughly alarmed my doctor who

immediately referred me to a urologist who passed me on to a hospital for a biopsy.

The biopsy results came back negative for cancer. Over the next five years, a

total of four urologists in three countries administered fifteen PSA tests and five

biopsies, all of which came back negative. My PSA scores rose from that first 9.9

in August 1998 to an astounding 34.0 in July 2003; but, to the amazement of all

medical professionals involved, not a single malignant cell revealed itself.

One urologist opined that I might belong to a rare group of men who, for no

discernable reason, display an unnaturally high PSA level. "All we can do at this

point is continue to monitor the situation," he said. Thus lulled into a warm feeling

of complacency, I gradually lost interest in the possibility of cancer.

* * * * *

In September 2003, at home in Switzerland, all-too-familiar symptoms began to

surface, suggesting that a kidney stone might be working toward my bladder. A

thorough physical examination revealed nothing, however, so I packed a bag and

departed for a two-month visit to our condominium in Florida.

Two weeks later, the pains in my bladder continued. One day, I awoke with a

throbbing headache that would not go away. Normally, I will give a nagging illness

a chance to heal of its own accord before seeking the services of a physician, but

this time was different; an invisible hand kept nudging me toward the telephone.

Finally, I called a local urologist with impressive credentials -- a board certified

"fellow" affiliated with a highly respected clinic. Sitting in his office, I described my

medical history and produced a few substantiating documents. Mulling through the

papers, the doctor recommended a cystoscopy, a procedure that would examine

the bladder, ureters, and kidneys. "By the way," he said, "as long as you will be

asleep for this procedure, do you mind if I also perform another biopsy?"

A biopsy is not a pleasant experience, under any circumstances. A fair amount

of bleeding occurs, and complete recovery can take several weeks. No man ever

volunteers for a biopsy. I had undergone one a mere five weeks prior, again with

negative results, and did not relish the idea of another one so soon afterward, but a

soothing voice deep within assured me that another biopsy was, indeed, necessary.

"Sure, Doc, knock yourself out," I replied.

* * * * *

Talking to the doctor afterward felt a lot like arguing with an auto mechanic who

cannot locate the noise in your car that has been driving you nuts. No, the doctor

assured me, he had not found any kidney stones in my system. "Well, then, what

is the source of all those strange pains I have been experiencing?"

"Can't say," he replied, "but the biopsy results do show some cancer."

Cancer. After five years of worrying, false hope, and then putting the thought

behind me, the dreaded diagnosis had finally arrived. Funny, it brought no shock

or fear. The fact simply registered; then something like relief swept over me, as

though to say, "Well, it's about time! Now we can get on with the treatment."

Three previous urologists had stuck nearly forty needles inside of me, searching

specifically for cancer, and found nothing. This guy, on the prowl for a wayward

kidney stone, strikes cancer. Such are the marvels of modern medicine.

Of twelve needle probes, three had come back positive for cancer. The location

suggested an early stage, and the aggressiveness, a six on the Gleason Scale, fell

within a moderate range. Subsequent tests revealed no evidence of spread beyond

the prostate; so, given my age, physical condition, and life expectancy, the doctor

recommended a radical prostatectomy as the preferred method of treatment.

* * * * *

Nothing happens quickly in the world of medicine. Between diagnosis and the

operating table, interminable delays occurred due to various tests, exams, x-ray's,

and weekly blood donations. On January 19, 2004, I finally went under the knife.

The operation itself went smoothly, but the pathology report contained a surprise:

more cancer present than expected, concentrated in the upper central region of the

gland, growing right up to the margin. A malignancy in that spot is quite abnormal.

Cancer in the upper region of the prostate is so rare, in fact, that most doctors

don't even bother probing there, concentrating instead on the lower portion of the

prostate where the disease is expected to appear -- which answers the riddle of

why my five previous biopsies all came back negative. Because none of those

other doctors had expected to find any cancer higher up, they didn't test there.

Of course, the surgeon had no way of knowing any of this during the operation,

so he could not say afterward whether his scalpel had severed the cancer's line of

advance, or not. "The odds are fifty-fifty," he said. "There's a fifty percent chance

that you are cured, and a fifty percent chance that some cancer cells remain. The

results of your first post-operative PSA test should point us in the right direction,

and we'll have to monitor the situation very closely for the next four years, or so."

Epilogue I

More than two and a half years have passed since my surgery. For the first

twenty months, blood tests failed to detect any trace of PSA in my system; but in

September 2005 laboratory equipment registered a positive reading, indicating that

a minute amount of cancer might still be present. Since then, two more tests have

hinted at a slight and gradual increase. However this develops, my doctor assures

me that we can fight this slow-growing malignancy for many years, and I will most

likely die of old age before the cancer gets me; but just to make sure that the good

doctor and I understand each other, I reminded him that my definition of "old age"

is ninety-eight. He laughed and said, "Well, we might not make it quite that far."

One thing is certain: regular PSA testing is now an integral part of my life.

(Postscript: In May 2005, The U.S. Department of Veterans Affairs officially "conceded" that my

prostate cancer resulted from exposure to the herbicide "Agent Orange," a chemical defoliant sprayed

extensively by the U.S. military throughout the Republic of South Vietnam, as well as near the Korean

demilitarized zone (DMZ) where I served in 1969. The use of Agent Orange during the Vietnam conflict

has received widespread publicity over the years; however, its use in Korea has rarely been mentioned

in public. Only by accident did I discover a newspaper article listing potentially infected units in Korea

(mine included) prepared by the U.S. Department of Defense and provided to the U.S. Department of

Veterans Affairs. It is unfortunate that this disclosure did not come to light earlier, as the information

might have proved quite enlightening to the several physicians treating my symptoms over the years.)

Epilogue II

By October 2006, my urologist became convinced that a small amount of cancer

did, in fact, remain in the prostate bed, and it was growing. Once he reached that

conclusion, we immediately agreed upon a seven-week program of external beam

radiation. The radiation treatments began October 18th and ended December 6th,

thirty-five visits in all, Monday through Friday of each week. The oncologist at the

Florida Cancer Institute stated that current dosages are significantly stronger than

those administered five years ago, and he expressed complete confidence that his

aggressive approach would eradicate the few remaining cancer cells. Hopefully,

the next PSA test, scheduled for March 2007, will confirm this.

Epilogue III

It is now March of 2007. Three months have passed since radiation treatments

ended. A new blood sample, taken last week, produced a PSA score of "<0.03"

(less than zero point zero three), which represents the smallest value this particular

laboratory equipment can measure. In essence, the test equipment found no trace

of PSA in my blood. This is great news, exactly what we had hoped for; however,

given calibration limitations built into the test equipment, a tiny margin for error still

exists, and my doctor is reluctant to declare me "cancer free" at this point. In fact,

he cautions that we must monitor my PSA scores for up to eight more years before

concluding that the disease is gone. So we will remain vigilant. Life comes with no

guarantees. The cancer could always return; but, right now, I like my chances.