And yes, it's cancer.
And so it was that my urologist, after complaining about the annoyance of having to go to take his daughter to school that same morning, threw me there as if nothing was the diagnosis of cancer, without blinking. Two weeks earlier, I had not even a urologist.
Yes ", he said, looking at the results with slightly puzzled air," I was also surprised.
While my new doctor spoke to me after that disconcerting announcement about Gleason's cell nuclei and scores, survival probabilities, incontinence and powerlessness, reasons to think about surgery and what kind of surgery would be more appropriate, I felt his voice fade in the distance, as in any film or television series on a guy who feels he has cancer... a classic..
I was diagnosed with prostate cancer on 13 June 2014. On 17 September of the same year, the results of the examinations confirmed that I was healed. The three-and-a-half months were a crazy rollercoaster ride, a familiar experience for at least 180,000 men in the United States alone.
Immediately after the shock news, while I was still trying to elaborate the keywords that resonated confusingly in my head ("probability of survival-enza-enza-enza-enza survival...","incontinence-enza-enza-enza-enza..."), I quickly went to the computer to googulate "men who had prostate cancer". I had no idea what to do and needed to see evidence that it was not the end of the world.
John Kerry.... Joe Tower... very good, both still alive and well. Mandy Patinkin... Robert De Niro. All in great shape. Well, fantastic. Feeling relatively optimistic, I decided to enlarge the research to more tense perspectives by typing quickly "they died of" instead of "they had".
As I discovered more and more things about my disease (one of the main discoveries: not to googulate "men who died of prostate cancer" immediately after receiving the diagnosis), I realized that I was incredibly lucky. Yes, lucky, because the cancer had been diagnosed in time to be treated. And also because my internist had made me take an extra exam compared to the required ones.
It was the PSA exam and saved my life. Literally. That is why I am writing these lines today. In recent years there have been many controversies about this examination: articles and editorials that questioned its safety, studies that apparently could be interpreted in many different ways, discussions about whether men need to undergo the test or not. I am not presenting a scientific point of view here, only my personal experience. And my experience is this: I was lucky to have a doctor who made me do the so-called "basal" PSA test when I was just 46 years old. I do not have any other cases of prostate cancer in my family and I am not in the high risk group, since, as far as I know, I do not have African or Scandinavian ancestors. I had no symptoms.
What I had - and why I'm alive and healthy today - was a scrupulous internist who thought that at my age it was a good idea to start checking PSA levels, and he talked to me about it.
If, on the other hand, as recommended by the American Cancer Society, I had to wait until I was 50 years old, I would not have found that I had a tumour mass for another two years after the end of my treatment. If my doctor had followed the US Preventive Services Task Force (USPSTF) guidelines, I would never have done that examination and would not have found out that I had cancer in time to intervene and treat it.
Now, in my case, my doctor, Bernard Kruger, had noticed an increase in my PSA levels for more than a year and a half, with a check-up every six months. And so he had sent me from the urologist, who had subjected me to a physical examination a little invasive using a gloved finger. It's an exam that lasts only ten seconds and I don't recommend it for fun, but incredibly there are those who suggest that you don't do it yourself. And after this examination and having seen my PSA levels continue to increase, the urologist advised me a magnetic resonance to get a more accurate picture on the prostate.
Resonance is a non-invasive procedure, like the one that athletes do after a ligament tear. It is noisy, but painless. Only after analyzing the results did my doctor recommend another test for no fun at all: biopsy. Unlike magnetic resonance, biopsy is the most invasive you can imagine: long needles slipped into very delicate parts - and at the same time other chattering about children to go to school.
The results of biopsy were positive. Of course, the term "positive" in medical examinations usually does not have such a positive meaning. My Gleason's score was 7 (3+4), which corresponds to "medium grade aggressive tumour". Surgical intervention was recommended. At this point I decided to try to hear other opinions. All physicians who appealed agreed on the need to work to remove the tumour.
In the end I found a wonderful surgeon, Edward Schaeffer, who put me at ease. He performed a radical laparoscopic robot prostatectomy. Thanks to his great skill and a touch of benevolence from some superior strength, he was able to remove all the tumour. I have not had cancer for two years now, and I am deeply grateful.
So, what is this examination of the SAP and why are there such divergent views on the subject?
It is a simple blood test, completely painless. It does not in itself involve any risk. If the values of prostate cancer prostate cancer in blood are high or increase sharply, they may indicate the presence of prostate cancer. This is certainly not an infallible examination.
Criticism of the test focuses on the fact that physicians, depending on how they interpret the data, sometimes subject patients to other examinations, such as magnetic resonance imaging and the much more invasive biopsy, even when they are not needed. Physicians sometimes detect low-risk tumours that are not lethal, especially in older patients. In some cases, men with this type of cancer are subjected to "excessive treatments" such as radiotherapy or surgical interventions that involve side effects such as impotence or incontinence. Of course, this is not good; but everything is within the competence of the doctor who treats the patient.
And without this PSA examination, or any screening procedure, how do doctors diagnose asymptomatic cases like mine before the tumour has spread with metastases throughout the body to become incurable? And what about the men most at risk, those of African origin, and those with other cases of prostate cancer in their families? There is growing evidence that these guidelines have led to an increase in cases of prostate cancer diagnosed too late to give the patient a chance to survive the disease.
Five years after its initial recommendation to discontinue the PSA review, USPSTF is now "updating its recommendations" as announced on its website. I believe that men over 40 years of age should be able to talk about the examination with their doctor and receive more information, so that they can be screened. Based on that, an informed patient can make responsible choices about how to proceed.
I know that I am lucky to have had a doctor who offered me these options. After my decision to undergo the examination, he referred me to doctors working in centres of excellence in this field to determine the next steps. This is a complex and still evolving issue. But in this imperfect world, I am convinced that the best way to determine how to act against the most curable - and at the same time most lethal - cancer is to diagnose it in time.