As I’ve said several times, I’m not a physician, so my opinion on these matters is only that of someone who has undergone the same fears, tests, and outcomes as many of you. Nonetheless, now that I’ve written a book, friends call me about their prostate problems, and I try to answer as best I can.
This month was strange, because I got two such phone calls a few weeks apart; with quite different approaches and outcomes.
One friend, let’s call him Paul, contacted me in late May, telling me that his regular doctor had found an “elevated” PSA and thought Paul should go at once to a urologist for a biopsy. The new PSA was 5.5. The doctor said, “Four is normal, so this is significant.” I told Paul that the idea of a “normal” PSA is not accepted by many urologists, and that a rise from 4 to 5.5 might – or might not – be considered significant, depending on how long it took to get to 5.5. I asked Paul what his old PSA was, and how long it had taken to get to 5.5. It turned out the doctor didn’t have that information.
Paul was frightened. He’s a tough guy, so he didn’t show the fear, but he called me several times during that week, telling me that the urologist was suggesting a biopsy, but would do a second PSA first. A few days after that second test, the news was a little different: the PSA was not 5.3. I told Paul that the idea of a fluctuating PSA was not unheard of at all – both up and down – and that I still thought he should know what his old PSA was before he got panicked about having cancer.
But he was panicked. He had always been in good health, but now that he was 65, it occurred to him he was mortal, and that prostate cancer was going to kill him; and soon!
I spent most of my time on the phone cautioning him that he had absolutely no proof yet that he had the slightest bit of cancer. He said his prostate was enlarged, and had been for years. That, I said, was sign of nothing but an enlarged prostate. Paul decided not to have any more tests for a month. I urged him to wait for a six month period. Since prostate cancer is slow-moving, and since he had no idea whether his PSA had gone up over a month, a year, or five years – or what it had been before – waiting couldn’t hurt.
A month later, his PSA had come down to 4.39. He was put on a course of antibiotics and motrin. The urologist who had urged him to have a biopsy right away was now suggesting that there might be nothing to fear.
My other friend, Zack, called just two days ago. He had had a PSA of 4 and it had gone up to 8. I said that that didn’t sound all that good, but that he, too, should be aware that men of 65 (his age) could live out their life even with prostate cancer, as long as it hadn’t gone into the bones or other organs; that many men have prostate cancer without symptoms, and die of something else. But I also said that he should take the biopsy step to see where the Gleason score was, and then we’d talk further.
He’d already had the biopsy, it turns out, and he would call when he knew the results; but he wanted to ask about treatment options right then and there, and I told him what I know, including side effects.
A day later, he revealed that the Gleason was 6. Since this was the same as mine had been when I was a few years older than Zack, and since I knew that 6 is “borderline” in terms of making decisions, I counseled Zack that he had a lot of thinking to do, and that I’d be there to help him through if need be. I sent him a copy of my book and these essays.
End of story. Two different men. Two different situations. Two different kinds of decisions.