Here was his email response: “Urgency. Frequency: Those were terms I thought I understood – until now!”
I phoned to get a better view of things.
While Zack was in no pain, the warnings about “side-effects” from the seed implantation came to fruition. He had frequent and urgent need to urinate. Because he is a psychotherapist, this caused occasional embarrassment during his office hours.
Zack told me that other than that, there were no significant problems. During his hormone therapy (prior to the implantation) he had had some diminution in libido, a psychological feeling that he’d never had before. (I didn’t need to hear about Zack’s sex life, so I quickly moved him on.)
Now, aside from the urination problems, and the anxiety about carrying around little radioactive seeds, he felt he’d licked the problem.
“The problem,” you may recall, was that Zack had a Gleason rating of 6, and his PSA had gone up in the last two years. I had suggested he wait another six months for another PSA, and that he should get a second opinion, but he made up his mind to get things taken care of right away. That led to the hormones and the seeds.
I like the man very much, so I’m hoping this is the end of this matter.
But what about the rest of us? How do we make up our minds about this in-between state of affairs, when an iffy Gleason and a raised PSA cause alarms? What we’re all hoping, I suppose, is that the new tests I wrote about recently (the EPCA-2) will come out of testing around the world to be the standard. That way, a raised PSA won’t alarm us; that way, we may be able to sit with a mid-level Gleason for six months.
But, you know what? I doubt it. I think any man who gets a Gleason that’s past 5, and who has an oncologist or urologist who is concerned with that score, will go the route of surgery or seeds or radiation. And the reason is, we’re not prepared to gamble with our lives. No matter that there are side-effects (including possible urinary incontinence and impotence); no matter that most men will die with but not of prostate cancer; no matter that it’s a slow-growing cancer.
We’re fallible human beings, and we don’t find it easy to look possible mortality in the face – and turn away.