I dodged this slow-moving bullet

To my male friends and everyone with a man that they love, I dodged a slow-moving bullet.? I'd prefer to keep this kind of information private but I am compelled to tell you so that you can dodge a slow-moving bullet too. This is a topic no man wants to talk about, but we need to face facts, one in eight of us is going to get prostate cancer. It is a hidden disease that I was fortunate to discover early.

I am not writing this asking for sympathy. I am blessed. I am writing it because a new friend casually told me of his good fortune in surviving prostate cancer, and I hope my experience will help you dodge that slow-moving bullet that could be aimed at you.

The story goes like this, my wife and I were out with some new friends and somehow the husband told us his prostate cancer story. His wife offered that internists are looking for the wrong thing, which delays diagnosis and costs lives.? She told us that many doctors wait for PSA readings to reach a level before acting; they should be watching PSA rate of change.

My PSA level went from 0.5 to 1.46 ng/mL gradually over about 20 years. That rate of increase is not alarming. Last year my PSA went up almost a full point to 2.36. Maybe you use MyChart; MyChart has my previous eight years of history and shows that my level is normal; it is below the 3.6 threshold. MyCHart has my history but does not use that in its assessment.? My internist ordered a retest in 6 months (but then he went concierge, so I do not know how he would have treated me). He never mentioned that my uptick in PSA was a cancer early warning.

The one-year jump matched our new friend's warning.? My wife is a nurse, so she would not let me wait for my internist to act and insisted I go to a urologist. Our friends also recommended a book no man wants to read, "Living with Prostate Cancer".? After looking at my increasing PSA, my wife immediately ordered it. It was in my hands two days later.? I ignored the book.? I didn't have cancer, right?

It took a while to get appointments. I wanted the best in the area so I went to Cleveland Clinic in Weston FL for a consult (about a two-hour drive).? After a couple of visits and a new PSA reading that went up another 0.44 in 6 months (still below the threshold), my urologist ordered a biopsy.? To my surprise, it showed low-level cancer in three places (Gleason score 6).? I never thought I would hear those words.

The doctor told me there is no need to panic (I am not prone to that anyway), this is usually a slow-moving cancer. He offered options and recommended surgery, but we were not so comfortable rushing into the operating room.? Also, surgery and a six-week recovery in Florida during hurricane season would be a bad move.? This is a tricky surgery, with future life functions at stake. I wanted the best advice and the best surgeon if it came to that.

I started getting smarter about my situation using the book you don't want to read. (Thanks for the book I don't want to read, dear.) I learned about symptoms (there are no symptoms until it's too late), diagnosis, immediate and long treatment options, potential side effects, as well as do nothing (a.k.a. active surveillance or watchful waiting).? We decided against having surgery in Florida and opted to get smarter in Chicago, where we went for consults at the University of Chicago and Northwestern Hospitals. We met two of the top people in this specialty. The Northwestern doctor was the co-author of the book you don’t want to read.

They both suggested active surveillance and getting a confirming biopsy within a year -- this time guided by an MRI. They both noted that my Cleveland Clinic doctor did not first order an MRI, and did the biopsy the higher-risk old fashion way.? It's hard to find good help.

Knowing I had time for this slow-moving bullet, but wanting more information sooner than later, I had the MRI and a confirming biopsy at about the five-month mark. The technology is really cool, they marry the MRI with a live ultrasound image to guide the biopsy to interesting areas revealed in the MRI. They also do a dozen random samples to canvas the prostate.? I'll spare the details. It's not great, but it’s over quickly.

The confirmation biopsy found more cancer, and some samples had a Gleason score of 7 (a little worse).? We discussed options with the University of Chicago specialist and did some more reading of the book you never want to read. I decided on surgery.

The surgery is also very high-tech. (I am hoping that the team that develops the software for the Da Vinci robotic surgery machine uses Test-Driven Development. If any of you read this, I'll give you free access to my TDD training.)? Five small incisions in the abdomen are all that are needed.? I was walking that night and sent home the next morning.

I'll spare the messy details. It's been a week since the surgery.? I get better every day. I do not expect any long-term problems.

I am grateful to our new friends for sharing their private information, my persistent and loving wife, and my supportive family and friends. I am grateful for advances in medical treatment and the skills of the University of Chicago team. I thank God for my good health, the skills of my surgical team, and living in these amazing times.??

I felt I had to tell this story. If I had not learned what I learned and acted on it, I’d probably be happy pain-free today, but unknowingly headed somewhere much worse.

I dodged this slow-moving bullet.