Wednesday, May 18, 2011

Gerry's Prostate Cancer Journey

I guess I always knew there was a high probability that some day I would hear the dreaded words; "you have prostate cancer".  After all my father had prostate cancer and there was a history of prostate cancer on my mothers side as well.  I do try to eat reasonably healthy foods, I have stayed physically fit and I thought maybe I could beat the odds.  But no such luck.  This week I received the results of the prostate biopsy I had last week and there it was:  "Cancer"!!

It wasn't as bad as it could have been, the cancer only showed up on two the the twelve samples taken from my prostate and based on the  Gleason Grading System ( see below) of measuring the cancer I had a score of 7 which placed me in the middle in terms of aggressiveness.  My scores were 4 - 3 from one sample and 3 - 4 from the other sample.

Gleason Grading System

Gleason grade Lower grades are associated with small, closely packed glands. Cells spread out and lose glandular architecture as grade increases. Gleason score is calculated from grade as described in the text.
The Gleason Grading system is used to help evaluate the prognosis of men with prostate cancer. Together with other parameters, it is incorporated into a strategy of prostate cancer staging which predicts prognosis and helps guide therapy. A Gleason score is given to prostate cancer based upon its microscopic appearance.[1] Cancers with a higher Gleason score are more aggressive and have a worse prognosis.

The pathologist assigns a grade to the most common tumor pattern, and a second grade to the next most common tumor pattern. The two grades are added together to get a Gleason Score. For example, if the most common tumor pattern was grade 3, and the next most common tumor pattern was grade 4, the Gleason Score would be 3+4 = 7. The Gleason Grade is also known as the Gleason Pattern, and the Gleason Score is also known as the Gleason Sum. The Gleason Grade or Gleason Pattern ranges from 1 to 5, with 5 having the worst prognosis. The Gleason Score ranges from 2 to 10, with 10 having the worst prognosis. For Gleason Score 7, a Gleason 4+3 is a more aggressive cancer than a Gleason 3+4. Also, there is not really any difference between the aggressiveness of a Gleason Score 9 or 10 tumor.

How do you know that you may have prostate cancer?

The realty is that if you are a man and you still have your prostate the odds are pretty high that if you live long enough you will get prostate cancer.   For most men the likely-hood of having prostate cancer before you are 40 is pretty low.  After you reach the age of 40 the odds of having prostate cancer increase with each passing year.  As for myself, I never had any problems with my prostate.  My MOJO is still working pretty well.  While I wouldn't rate myself as a Don Juan, I haven't had any complaints from my wife.  Like most men, for the past 5 to 10 years I do tend to get up once or twice during the night to urinate.  I think trying to find a 65 year old man who doesn't get up at least once during the night is like looking for the proverbial needle in a haystack.  My doctor would also perform a digital examination of my prostate (that's where the doctor sticks his finger up your ass and feels for an enlarged prostate or lumps).  Theses examinations have always been very good.  The bottom line is that I didn't have any physical issues that would cause me to believe that I may have prostate cancer.

About 15 years ago I began having blood tests done that would check my cholesterol, as well a a number of other factors.  One of the tests done was the PSA.  A PSA number between 1 and 4 is considered good and there is no need for concern.  My original PSA scores were between 1 and 2 so there was never any indication that I had a problem with my prostate.  In 2007 my PSA started to climb and by 2009 it was at 3.8.  In December of 2010 my PSA was at 7.0 and my doctor decided it was time to "take a closer look at the prostate".

  Ginny and I were spending February and March in Florida so there wasn't much that we were going to get accomplished before we got back.  I did have a meeting with a urologist in Lancaster in January and he suggested that I schedule another blood test when we returned from Florida to check the PSA.  On April 5, 2011 I had a blood test and the PSA number was 6.8.  My urologist determined that there was enough concern on his part that it was time to do a biopsy on the prostate .  So we scheduled to have the biopsy done on May 3.

My word of recommendation is that if you are a male over 40 years of age have your PSA checked at least once a year.  Many times the PSA will give a false positive but at the present time there really isn't a better test to monitor the health of the prostate.

Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer and in other prostate disorders. A blood test to measure PSApositive predictive value of only about 35%.[1][2][3]

Rising levels of PSA over time are associated with both localized and metastatic prostate cancer (CaP).

The Prostate Biopsy

The procedure for taking a prostate biopsy is very similar to a colonoscopy.  You can't eat after midnight the day before the procedure and you can't take any blood thinners or similar medication one week before the procedure.  You are also required to begin taking antibiotics the day before the procedure to fight any infection.  The procedure itself is pretty uneventful and only takes about 15 minutes.  I elected to be totally out during the actual procedure.  I did this for a number of reasons.  The obvious reason is that you don't feel any pain.  I also felt that if I were awake I may make some sudden movement which could cause some problems.  Lastly I didn't want to distract the surgeon by asking a lot of annoying questions.  The reality is that there wasn't much I could contribute to the whole thing so why not take a nice nap?  If you insist, you can be awake during the biopsy and I understand that there are some people that elect this option.

I must have been out for about a half hour and when I awoke in the recovery room I felt a little groggy at first but quickly recovered.  I felt no pain at all and was up and walking within 15 minutes.  I did feel a little discomfort the afternoon of the biopsy but never experienced any real pain.  My urine was a bit darker for about a week after the procedure and I assumed that it was from blood.  The only other side effect I had was some discomfort around my anus.  If the doctors intent was to give me a good case of  hemorrhoids he didn't succeed but he came awfully close.  Within two weeks everything was pretty much back to normal.

Prostate biopsy is a procedure in which small samples are removed from a man's prostate gland to be tested for the presence of cancer. It is typically performed when the scores from a PSA blood test rise to a level that is associated with the possible presence of prostate cancer.

The procedure, usually an outpatient procedure, requires a local anesthetic, with fifty-five percent of men reporting discomfort during the biopsy.[1] The most frequent complication of the procedure is bleeding in the urine for several days, some bleeding in the stool for several days, and blood in the ejaculate for several weeks afterwards.

The procedure may be performed transrectally, through the urethra or through the perineum. The most common procedure is transrectal, and may be done with tactile finger guidance,[2] or, more commonly and precisely, with ultrasound guidance.[3]

About a dozen samples are taken from the prostate gland through a thin needle - about six from each side. If the procedure is performed transrectally, antibiotics are prescribed to prevent infection. An enema may also be prescribed for the morning of the procedure. In both the transrectal and the transperineal procedure, the doctor inserts an ultrasound probe into the rectum to help guide the biopsy needles. A local anesthetic is then administered into the tissue around the prostate, similar to the local anesthetic administered for a dental procedure. A spring-loaded prostate tissue collection needle is then inserted into the prostate, through the rectum (or more rarely through the perineum), about a dozen times. It makes a clicking sound, and there may be considerable discomfort.[3]

Okay, you have prostrate cancer now what?

Well, the first thing that needs to be determined is; "has the cancer spread to other parts of the body?"  In order to determine this I have been scheduled to undergo the following procedures:

Ultra sound of the kidneys and bladder
Additional blood work
Chest  x-ray
bone scan

I had the ultra sound on the kidneys and bladder yesterday (5/17/2011) and "no irregularities were observed".  I also had a blood sample taken yesterday and they will be looking for cancer markers.  I will have the results next week.  Both of these procedures were very easy and uneventful except for a little incident during the drawing of my blood.  I went to a blood clinic at the health center on Harrisburg Pike and it is a real blood sucking factory.  There must have been at least 20 people in chairs having their blood samples taken.  My phlebotomist whose name was Grey was getting ready to take my blood when I heard an announcement; "Grey we have an emergency at station 6".  With that Grey took off to station 6 leaving me in the lurch.  I happened to have a clear view of station 6 and I observed a teenage girl who was having her blood taken and she threw up all over the station.  They had a real mess to clean up. About 10 minutes later Grey came back to my station and I asked her; "did you wash your hands?"  She assured me that she had and she asked me if I was a puker.  I told her that depended totally on how well she did her job.  Fortunately Grey is a very proficient phlebotomist and the blood sucking proceeded without further incident.

Today, 5/18/2011, I am scheduled for a chest x-ray and bone scan.  The chest x-ray was pretty straight forward, one from the front and one from the side.  The bone scan is a bit more extensive.  The first thing they do is inject a very small amount of radioactive tracer into my blood stream.  This tracer has to circulate completely throughout my blood stream which takes about three hours.

I just got back from the bone scan.  Pretty uneventful.  I had to lay on a bed that went back and forth underneath a camera that  scans my entire body.  The entire procedure lasted about 30 minutes.  Some people say that they find it uncomfortable laying completely still for 30 minutes under this large camera but it did not bother me at all.  I just closed my eyes and took a short nap.  After I was done the technician told me to wait in the lounge while they reviewed my pictures to determine if more were needed.  After waiting for about 15 minutes he came out and told us that we were done and no more pictures were needed.  I asked him if anything showed up on the pictures.  He told me that he was not qualified to review the results with me but then he said with a wink in his eye; "when they don't ask for more pictures that is a good sign".  Now the wait begins until next Tuesday when we review the results with the experts and consider our options.


  1. Thanks for sharing. Hoping for the best and looking forward to following your story.

  2. Gerry and Ginny, Best of luck. Thanks for all of the detailed information. We look forward to hearing more about Gerry's treatment and recovery.

  3. Hey Gerry:

    I hope this goes through...apparently my last attempts never made it. I was so shocked when I learned of your prostate issue. I can't believe that a young man with your athletica abilities could ever experience prostate cancer. How are you doing? I have tried to open your blog that Rob snt me but can't get it to work...if you do receive this, please send me the blog.

    We pray for a speedy recovery.

    George & Linda