Update on Zack and Paul

Christopher Lukas Health Guide
  • Zack and Paul’s situations have changed, once again!

    Paul, who, as you may recall from two of my earlier posts, kept refusing to do anything like a biopsy, went back yet again to get a PSA test. This was his third or fourth. His urologist had said that a PSA of 4 was normal, and that Paul’s PSA had been at 5.3, which was “bad,” and now it had gone to 5, and if it dropped further—say, to 4.5—then he’d call off the biopsy. Paul wasn’t buying any of it, but he got his extra PSA. The antigen had indeed dropped again, to 4.5, but the doctor said, “It’s borderline.” Get another one done.
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    Paul was, to say the least, angry. He’d done what he was told to do, and he now began to believe that perhaps his specialist left something to be desired. “You said 4.5 was what I needed!” he said to the doctor. “Yes, but it’s still not low enough.”

    The next PSA was 4.3. “I guess you don’t need a biopsy,” his doctor said.

    Paul shook his head and went home.

    There may or may not be lessons in this for anyone else, but for Paul it was clear that a “high” PSA, in and of itself, meant nothing. He did say, however, that he was left with a shadow on his health—that he felt residual fear, and was angry that the doctor had been so cavalier about his diagnoses.

    As for Zack, he went to see a urological surgeon. He didn’t want surgery, but he and his wife had decided that it wouldn’t be a bad idea to get a second opinion, and this man came recommended.

    You will recall that Zack had a PSA that shot up over a year, that he had a Gleason of six (a truly borderline number), and that it was recommended he have hormones, then external radiation, then seed implantation—a lot of treatment, I thought.

    The surgeon spent some of the time with both husband and wife talking about side effects. He said that the new thought on impotence was to medicate with Viagra or Cialis before, during, and after treatment. They were beginning to discover, the surgeon said, that this could make a difference in how much erectile dysfunction there was and how quickly and effectively it could be corrected.

    He also suggested that Zack still have the hormones, and then wait and see what treatment seemed necessary.

    Continue to stay tuned to this fascinating case.

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Published On: October 12, 2006