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In the late 50s I played High School Basketball and Elgin Baylor was my man. He was a phenomenal player. But when I was a senior in 1960 an new guy named Oscar Robinson came into the NBA. Wow, things just got better. I followed the "Big O" all through the 60s. You could even watch the NBA on TV. It was great. I think the 60s were the NBAs coming out party. There were Super Stars Galore and the "Big O" was right on top.

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I only wish it was as simple as this makes it out to be.  I've just finished reading 5 books on the subject authored by everyone from Dr. Patrick Walsh, the famous surgeon from John Hopkins who pioneered the nerve sparing radical prostatectomy to a chap who is terminal after undergoing a radical prostatectomy after which his cancer re-emerged, then radiation therapy after which is cancer re-emerged to now emasculating hormone deprivation therapy which has slowed the progress of his metastasized cancer, but has him simply waiting for the end in that with current technology, metastasized prostate cancer is pretty much incurable.   The decision-making process is full of conflicting data and poorly run, non-scientific studies, which physicians utilize to quote inaccurate statistics.  Of course now even PSA testing is quite controversial with this press release last Monday:

The United States Preventive Services Task Force announced in its final recommendation Monday that healthy men should no longer get screened for prostate cancer with a prostate-specific antigen (PSA) test because a resulting diagnosis may do more harm than good.  Not surpisingly, the American Urological Association disagrees in that a reduction of PSA testing would also entail a reduction of income to urologists.  But then again, anything to do with prostate cancer seems to have no universal agreement.

In the past it was difficult enough to choose from the plethora of options which includes watchful waiting, active surveillance, numerous types of external beam radiation therapy, proton therapy, various types of radical prostatectomies including entering through the perineal or abdominal area to laparoscopic, and robotic surgery with the Da Vinci machine.  Then there is cryosurgery, HIFU utilizing sonic methods, and Brachytherapy where the prostate is seeded with titanium radioactive seeds. The patient seeking guidance of course will get an opinion based on the bias of the urologist typically dependent upon the procedure utilized by that physician.  And then here is the bad news:

I recently began seeking out all those whom I could find locally who have or have had prostate cancer.  The approaches utilized ran the gamut of watchful waiting to a radical prostatectomy performed at the gold standard of prostate facilities – Johns Hopkins.  To a person, they were all suffering negative side effects with some suffering multiple side effects.  A common thread seems to be impotence and/or incontinence.  One patient who utilized the same surgeon as Mayor Rudy Giuliani at Mount Sinai Hospital in NYC has recently begun suffering from incontinence a couple of years out from the Brachytherapy procedure (not untypical with radiation treatment).  Another utilizing the same procedure now has a reoccurrence of cancer, which has metastasized to his bones many years out from the original procedure.  One patient who travelled to Raleigh Durham to have a robotically assisted prostatectomy by a surgeon who had completed over 1000 of them describes his sex life as “making love with a rope.”  This statement was made 1 ½ years from the original procedure.

I fear virtually nothing, but I do fear prostate cancer.  I watched my grandfather die of metastasized prostate cancer just 3 months after his diagnosis.  My immediate interest arises from some potentially bad news when receiving the results of my yearly PSA test about a month ago.  My PSA had gone from 1.77 to 3.61 in just 10 months.  Some say that a velocity (the term used to describe the amount of PSA increase) of .35 in a year is cause for concern, and others opine that a velocity of .75 over 3 years is cause for concern.  Mine was 1.84 in just 10 months.   Tomorrow I undergo a re-test and keep hoping that I will either awaken from a very bad nightmare or somehow my test was either an error or the results caused by other forces.  Of course a high PSA can be caused by various things other than cancer including BPH, Prostatitis, recent sex, and some even claim that riding a bicycle can cause a PSA increase (I have read a study which claims that is not true).

Should I find myself entering the frightening door leading to the world of prostate cancer treatment, I will enter quite educated.  Not only have I recently read the 5 books I alluded to earlier, but also numerous things on the Internet.  I have even gone so far as to watch a robotically assisted radical prostatectomy video.  I even watched a separate anastomosis procedure, which the one used to reconnect the bladder to the urethra after the operation.  As an aside, when the prostate is removed, the portion of the urethra that runs through the prostate is also removed, hence the remaining portion of the urethra must be attached to the base of the bladder. I think I could pass the urological board exam on the subject of both the prostate and prostate cancer.   

Of course the sad news as stated in the video is that 1 in 6 men will deal with this issue in his lifetime and perhaps a more startling revelation is that prostate cancer approaches a 100% probability if one lives long enough.

And now for a little known factoid.  PSA is incorrectly named in that the substance is not a prostate specific antigen.  PSA is found in women’s breasts (hence certainly not specific to the prostate) which makes me wonder if that subject needs to be more fully explored considering the similarities in statistics between the occurrence of both breast and prostate cancer.