My most recent experience of a change in a blood test got me thinking about aging and survival as a priority—no need to be concerned about my health. I’m fine. I just wanted to share these thoughts.I don’t have a fear of dying. I have a fear of living a life focused on survival.
It's awakened, maybe.
The results of my bloodwork came back with a PSA at 9.1. For the last seven years, it was in the worry-free, yet cautious, active surveillance range of 5.1 to 7.0.
Given my Gleason scores, this seemingly high PSA score for a normal male without prostate cancer was acceptable for me. It was statistically in the “just keep an eye on it range.”
This jump in PSA alarmed my Internal Medicine doctor. He was the one who reported this news to me. I could tell by the tone in his voice that he was concerned.
For the last seven years, since my initial prostate cancer diagnosis, he was the one doctor who said," Don't worry about it. Just keep an eye on it. In all probability, this slow-growth cancer won’t kill you." Now I could tell by his tone that he might be questioning his initial judgment. This got me worrying about it.
I then turned to my urologist.
I’ve been following a regimen called “active surveillance” for the last seven years. This regimen includes regularly scheduled MRIs and prostate biopsies, alternating biannually. When he saw the new 9.1 PSA, he said, “Get a blood test done in another four months.”
“It is not unusual to see the PSA bounce around. One data point does not make for a trend. Let’s repeat the PSA in 4 months. We will then be thirty months from the last MRI. We can order a new one after receiving this new result.”
There are two groups of men in how they think about their prostate cancer. (Let’s be clear, the men I am talking about are those like me. I have a slow-growing or maybe even indolent form of prostate cancer, with a low Gleason score and a PSA below 10. I’m not talking about the men with an aggressive form of prostate cancer.)
Group 1: There are the men who can’t stop thinking about it. They go to bed with it on their mind, and their first thought when they wake up is “I’ve got cancer!”
Group 2: Then there are the men who only think about it when someone asks about it or their urologist schedules them for a procedure to check out the prostate.
The first group must do something right now to get rid of the cancer. They elect to do surgery or radiation.
When I was first diagnosed, I was in the first group. I was consumed by the thought that I had cancer. But then I realized the downside of surgery and radiation. I wondered, “Do I really need to take action now?”
This question started me on a journey of meeting with people who had prostate cancer, how they treated it, and what the physical after effects were. I also read a half dozen books on prostate cancer and treatments. Then, finally, I talked to two other urologists/surgeons and three radiologists. Five out of six agreed I should proceed on the course of Active Surveillance, i.e., no surgery, no radiation, but rather a regimen of biopsies and MRIs..
And that’s what I’ve done for the last seven years. This is how I dealt with my prostate cancer. I was in Active Surveillance, and that was good enough for me. I really didn’t think much about it.
And then my PSA jumped. Now I’m thinking about it again.
Oddly enough, I am not worrying about this cancer killing me. I am worried about what I will most probably have to do over the next several years to keep it from killing me, to keep the cancer in check. And with prostate cancer, there are lots of tools our healthcare system has at its disposal to extend a man’s life.
I am 72 years old. I have friends who are my age and older.
Whether we admit it or not, we are all waiting for the day of “the news.” The uh-oh moment, the moment the blood work comes back positive for the very first time, or the moment when we suddenly feel seriously ill and find ourselves in the hospital. In either case, the life-changing diagnosis becomes our new reality.
Once this happens, once we and the doctors know, life as we know it is lost. We are now on the healthcare conveyor belt.
Doctor visits, blood tests, scans, MRIs, prescription drugs, data, statistics of death potential and cure potential, biopsies, waiting for labs, waiting for doctors to read the labs, surgery, recovery, chemo, radiation, the list goes on. This is what I call the healthcare conveyor belt. Once you are on it, there is no getting off.
Is all this part of my life now? A single change in a data point, and my life now includes all this craziness? Is survival now my life priority?
I realize that what happens to me also directly affects my wife, Kathy. We love our lives. She loves to spend the day with my daughters and our grandchildren.
We love to get away on a motorcycle ride from time to time, travel to London to see our son and his family, be together, go on walks, tour a city, and enjoy each other and our health.
And when we schedule these activities, the only constraints are our mutually busy schedules. Will our schedules now be dictated by the healthcare conveyor belt of exams, tests, treatments, doctor meetings, and recovery time?
I hope not.
All these thoughts consumed my mind the day I received the news of a PSA bump to 9.1. I immediately joined the first group of men who have this disease.
Then my urologist put my mind at ease, so I am back to not thinking about it for another four months, that next PSA test. Until then, life will be as usual.
No, it is not the fear of cancer; it is the fear of what treating cancer will do to our lives. It is the fear of the process and how it will change our lives. It is the fear of making survival my number one priority.
I am not afraid to die. I know I am headed to paradise.
“I heard a loud shout from the throne, saying, “Look, God’s home is now among his people! He will live with them, and they will be his people; God himself will be with them. He will wipe every tear from their eyes, and there will be no more death or sorrow or crying or pain. All these things are gone forever.” Revelation 21: 3-4
When has a single lab result or health scare jolted you into re-examining your priorities, and what change did it trigger? Comment on LinkedIn.