Following the tests the urologist
Following the tests the urologist told me that my bladder was normal and the nodule on my prostate had disappeared. My blood test indicated a PSA level of 2.5, also well within normal limits.
My urologist speculated that perhaps I had "passed some gravel" -- fine-grained calcium deposits that build up in the urinary tract over time and may temporarily block the duct that conducts urine from the kidneys to the bladder. He recommended a six month follow up visit and urged me to call him immediately should anything out of the ordinary happen again.
I felt that I had dodged a bullet.
I went home chastened but no wiser about my condition and immediately began to consume large quantities of zinc tablets. I felt that I had dodged a bullet. I procrastinated, of course, and did not return to the urologist for nearly a year.
At my follow-up visit my PSA was 4.0, and a week later a retake of the test showed a PSA of 4.3. Clearly, the bullet had not been dodged. I was scheduled for a prostate biopsy -- another uncomfortable but bearable procedure -- and then began the excruciating wait for the results.
On the afternoon of April 3, 2000 my wife and I sat down with the urologist and listened while he explained the biopsy results. A pathologist who examined the eight samples of tissue withdrawn during the biopsy found a thin layer of cancerous cells mixed in with otherwise healthy tissue. The urologist explained that the cancerous cells were so few that the first pathologist was unable to pronounce them as carcinoma; a second pathologist in another city was consulted -- a researcher with better than average skills in this kind of detection. My urologist explained that it was this second opinion that caused the delay in getting the results to me.
The news that I had only a minute trace of cancer bore no comfort for me; and my urologist also exhibited a distinct lack of good cheer. It was cancer, he said, and while it wouldn't kill me right away, it had to be confronted. He explained the options for treatment.
The first option, which my urologist strongly favored, was surgery -- total removal of the prostate. This was the "gold standard" he explained, the one sure way to be aggressive with the cancer. Take out the organ that contained the cancer and it would never recur. My urologist assured me that he would use the latest nerve sparing surgical techniques to provide the best possible outcome.
It was rigorous surgery to be sure, but he had performed the operation hundreds of times with excellent results. My overall good health made me an excellent candidate for the procedure. He explained that pathologists use a grading system called the Gleason Scale to describe the size and relative aggressiveness of prostate cancer. My cancer was assigned a Gleason score of 6, which meant that it was small in quantity and almost certainly confined to the prostate -- the best possible scenario for a surgical candidate.
The second option was external beam radiation -- the preferred method of treatment for cancers in many parts of the body; it was most effective when the cancer was detected in its earliest stages, success rates were lower in advanced cases.
The third option was called brachytherapy, a procedure whereby radioactive material was implanted directly into the prostate. Brachytherapy had been around for nearly a century and had a mixed record of success until recently, when technological refinements made it a more viable treatment for many men with prostate cancer.
There was also a new treatment called cryosurgery, which essentially killed the cancer cells by freezing them. Cryosurgery showed promise, but my urologist considered it highly experimental...