I imagine it begins, my prostate cancer, with my father. I’m still awaiting results from the genetic test ordered by the oncologist I Zoomed with, who advised it might make a difference in how much hormonal treatment I should receive, once primary treatment is completed. After watching a polished video featuring a trim woman in her thirties delicately massaging her cheeks, I drooled saliva into the plastic tube offered by the DNA analysis lab. The video suggested it might take two to five minutes to spit enough into the vessel to reach the fill line. But I overshot with the first two squirts. Ever since I smashed my jaw on the tailgate of a Silverado pick-up while cycling in preparation for my third Hawaiian Ironman, I’ve had quite an overactive sub-lingual salivary gland behind the rebuilt bony ridge which now houses titanium implants supporting nine perfectly formed crowns, a cool off-ivory, replacing the nine teeth I lost.
The liquid I produced did not seem to reach the bottom of the tube. I assumed after I added the reagent solution and shipped it off in the cleverly folded cardboard mailer, the lab would be pleased to have such a generous sample. Not so. Days later, an email scolded me that my test could not be analysed. One of the possible problems noted was excess solution. They sent me another kit, which I am less than eagerly awaiting. In the meantime, I reflect on my father’s death, from metastatic prostate cancer at age 80, eight years after his initial diagnosis and radiation treatment in Grand Junction, Colorado, 35 years ago.
I watched him suffer the last two months from recurrent cancer which had found its way into his pelvis and spine. Apart from that brief time, I had never seen him sick in the five decades I knew him. Six months after his death, I had my first PSA test.
For the next 20 years, I had twelve more tests which, though slowly rising as is normal with age, remained within normal limits. In June of 2020, that multi-catastrophic year, the PSA more than doubled on 24 months. A faint alarm, a tiny angel’s bell, began to ring. Over the next two years, the number hovered on one side or the other of the lower edge of concern, between 3.54 and 4.8. I practiced a version of Active Surveillance/Watchful Waiting. I avoided sex and bicycle riding for days before each test. At first that worked, keeping my number below the fateful 4.0. By March, 2022, when the result shot up to 5.72, I at last admitted to myself I could no longer ignore the pealing in my head, the knowledge that I would have to travel through a diagnosis and treatment jungle.
A repeat test in June rose again to 6.2. I told my urologist I felt I needed a biopsy to convince myself I did not have cancer. We had an in-depth conversation during which he reviewed the arguments for and against treating prostate cancer, or even looking further for its existence. He explained the side effects of treatment on the bowel, bladder, and sexual functions. He noted that many men – maybe half by the time they reach their mid-80’s – die with cancer present, yet succumbing to other ailments. With no organ failure of any kind, no heart disease, diabetes, dementia, nothing which requires me to take prescription medicine, an extremely fit metabolism due to more than 35 Ironman races since the turn of the century, I told him I expected, without this cancer I was sure I had, I expected to live another 15-20 years.
But I was not quite ready to enter the medical labyrinth. In October, I planned on racing my last Ironman, the sport which has defined me for decades, on Hawaii. I knew that If I underwent a biopsy in, say, August, and it came back positive, I would possibly pull the plug, or at least seriously disrupt that endeavor. So I asked him, “Will this kill me in the next year?”
“No.”We agreed to repeat the test after the race and the one-month vacation Cheryl and had planned in the Southwest. On November 30th, it came back 6.8. Time to get serious, I decided.