A man walks away as his shadow transforms into a monster.

Stalked by a Stealthy Cancer, Part 1

An elusive form of prostate cancer nearly cost me my life. Here is the first part of my story, covering the diagnosis. You can also read Part 2.

Early warning signs

The first warning signs started about ten years ago when I was dismayed to find blood in my reproductive tract.  My primary care physician (PCP) told me not to worry; my PSA was normal (less than 3 ng per milliliter), and he did not feel any abnormalities during a digital exam.

I was not convinced and visited a urologist. Again, I heard the same refrain; there was nothing to worry about, as long as I did not have blood in my urine. These sorts of dismissals went on for about 8 years until my urologist retired, and I found a new urologist named Dr. Vincent Harisaran.

A subtle irregularity

For the next couple of years, Dr. Harisaran closely monitored my PSA and did regular digital exams. During an exam in 2018, he noticed a very subtle irregularity on my prostate. Although my PSA was only 2.9, Dr. Harisaran was suspicious; he ordered an ultrasound and biopsy.

Oddly enough, the ultrasound technician commented on how small my prostate was. I took this as a good sign, but I should not have. I drove home that day, happy that all this cancer business was behind me.

In blissful denial

While waiting for the biopsy results, I was in blissful denial. In all my 66 years, I had never had cancer or any other major health issues.

My PCP had done a digital exam a few months before I visited Dr. Harisaran and found nothing. In addition, my PSA continued to remain low. Dr. Harisaran must have been mistaken. What could possibly be wrong?

A shock

About a month later, the biopsy results came back; they were a shock to me. The left lobe of my prostate had Gleason scores of 8 and 9. My right lobe had some 6’s. Together this was group 5 prostate cancer, the highest level.

Dr. Harisaran told me that he had never encountered such an advanced cancer with such a low PSA. He said he had read about it, but it was rare. By ordering a biopsy, Dr. Harisaran saved my life.

A low PSA and a cancerous prostate

How is it possible that I could have such a low PSA and a cancerous prostate? The reasons are a little murky, but it is thought that the cells in the prostate can become so damaged or mutated that they can no longer produce large amounts of PSAs.

Of even more concern to me, I've found that some recent studies seem to indicate that high Gleason scores combined with a low PSA could indicate a more aggressive form of prostate cancer.

Catching this stealthy cancer

The important lesson that I take from my experience is that depending on the PSA level is not enough; I think a careful digital exam is also needed. Even then, this type of cancer can remain a stealthy killer until better biomarkers are developed.

I don't think the correlation between blood in the semen and prostate cancer is that strong. Studies have shown only 4 to 6 percent of men mostly over 40 with blood in the semen had prostate cancer develop.1 Finding such blood was horrifying to me at the time, but it ultimately led me to a urologist who caught this stealthy cancer and saved my life.

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