My Post-Diagnosis Bomb Takeaways

I've told you about the bomb that was dropped when I got my diagnosis. As I think back on that time, I can think of some key takeaways from this that I think may be helpful to share with other men:

Know your PSA and what it means

Know your PSA, and the key thing with me was what they call the “velocity” of the PSA, or the fact that “something down there” (my non-medical term) is growing fast.  And at my age then (I was 5 weeks short of 69 when that bomb was dropped), it was very unlikely the prostate itself was growing that fast.

There is quite a bit of debate on the PSA testing, and for a good synopsis of that debate, the National Cancer Institute does it quite well. 

One caveat from my urological oncologist on not having your PSA tested – he said that’s really a debate by primary care physicians, and you won’t find a urologist who agrees with not doing PSA’s.

From a personal point of view, when they draw blood for any lab work such as cholesterol, they just draw a little more for the PSA so it’s no big deal getting it tested.  (And once you get prostate cancer, you will have your PSA tested for the rest of your life.  I’ve been tested quarterly since June 2013 until June 2017 and it will be every 6 months from now on as prostate cancer can come back 20 or more years later.)

And that guy called Gleason

Know the Gleason scores, which are graded 1 to 5 for the primary cancer and 1 to 5 for the secondary cancer, so mine was a 4+4 for a Gleason 8, which meant I had an aggressive prostate cancer.

A grade 5 is the worst form of prostate cancer and the fastest growing.  I said to my urologist when he told me I had an 8, “Thankfully it isn’t a Gleason 9 or 10”, to which he replied that some with a 9 or 10 are saved.

I heard Dr. Otis Brawley, the Chief Medical and Scientific Officer of the American Cancer Society, give a talk in which he said that Dr. Donald Gleason, who developed the Gleason grading system, argued that Gleason 1 through 4’s shouldn’t be called cancer because some doctors will treat them and Dr. Gleason strongly felt 1 to 4’s shouldn’t be treated. [Editorial note: this approach is now termed "Active Surveillance" and is considered a non-aggressive approach to treatment].

I felt Dr. Brawley, by re-stating what Dr. Gleason said about lower grades, was implying he agreed with Dr. Gleason as well.  For those who are interested, Dr. Brawley’s talk can be seen online here.

Thanks for reading this.

I hope it helps you get a better understanding of what goes into detecting prostate cancer and determining the best way to treat it.  And next time, I’ll talk about the choice of surgery, called a prostatectomy, or radiation.

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