The world turns upside down

When my wife and I returned to Minnesota a year later, it was time for another annual physical.  I had been dreading this event.  I knew that I wasn't really out of the woods.  Deep inside I was assuming that prostate cancer would eventually be in my future.  At this point, though, my focus was on treatment side-effects (should cancer be discovered).  I was still fixated on incontinence and impotence.  The story in my head was (1.) I get diagnosed, (2.) I have surgery, (3.) I have side-efffect(s) for the rest of my life.  Other dangers were not really part of my internal discussion: "prostate cancer was a slow growing malady", "men didn't usually die from it", "only a small percentage of men have the aggressive form of the disease".

The results came back.  This time my PSA was 12!  My internist commented on the inaccuracy of PSA tests and suggested we repeat it or take a Free PSA test. I was not reassured. I called a urologist immediately to schedule an appointment.  I did take the Free PSA and another PSA test after getting off the bike for a week.  As expected the PSA dropped (to 10...not exactly reassuring) but the Free PSA results came back with a low value (low is bad...indicating the PSA most likely reflects cancer vs. some other prostate issues that can cause an elevated PSA).

The urologist scheduled a biopsy.  The biopsy was very painful for me.  So painful the urologist only took 4 samples instead of the preferred 12.  The slow clock of waiting for medical results began.  A week later I had my answer: "Yes, you have cancer, your gleason score is 7 (4+3)".  I had been expecting the cancer result but had been assuming a 6 score.  The 7 was scary.  More so when I did more research and discovered that a 4+3 is worse than a 3+4 (gleason scores are a total of the score of the primary pattern  + the score of the secondary pattern).  4+3 was considered more akin to a gleason 8.  My biopsy also mentioned "perineural invasion", an indicator of high risk cancer.  Suddenly my fears changed from diapers and erectile dysfunction to death.  The horror of my situation began to dawn on me.

More details...

• My biopsy experience was unusual.  My urologist at the time (who does not do a lot of biopsies) commented that he had not seen somebody have so much pain before.  His guess was that I simply had more nerve-endings than most men.   I was relatively young for a prostate cancer biopsy and research indicates younger men generally have more pain.