Elevated prostate-specific antigen (PSA) levels are the most common reason leading to the detection of prostate cancer in the United States.
Thanks to PSA screening, which debuted in the late 1980s, physicians are diagnosing the disease at earlier stages. “A contemporary man with localized prostate cancer is substantially different from the man with prostate cancer of 20 years ago,” according to a report by the American Urological Association (Guideline for the Management of Clinically Localized Prostate Cancer: 2007 Update).
This trend is of particular interest to me because I am one of those contemporary men. Last May, I was diagnosed with prostate cancer, a disease I have learned a lot about in my six years as editor of Renal & Urology News.
My story begins in August 2007 when my primary-care doctor called with the results of my latest PSA test. My PSA was 6.6 ng/mL, higher than the 4.0 ng/mL widely considered to be the upper threshold of normal. From that moment, I knew my life would no longer be the same. My doctor referred me to a urologist for a digital rectal examination (DRE). I was 51 years old, and it would be my first.
After collecting my thoughts, I called the urologist, but it would be three weeks before he could see me. Ultimately, the DRE was negative, and the urologist reported that my prostate felt perfectly normal. I walked out of his office feeling like a new man, elated that my elevated PSA probably was a false alarm. The urologist prescribed a 30-day course of levofloxacin, a potent antibiotic, after which I was to get another PSA test.
Blood was drawn for that test about a week before Thanksgiving in 2007. On the Friday after Thanksgiving, I received the results from my primary-care doctor: 4.9. With my PSA level declining, I felt reassured that I did not have cancer but rather prostatitis that had responded to the antibiotic.
The prostate biopsy
My elation was premature. Three or four days later, I received a call from my urologist, who said that even though my PSA had come down, it was still above 4.0, the threshold for prostate biopsy. He recommended that I undergo this procedure.
Apprehensive about having a biopsy (mostly because of the pain I presumed would be involved), I told him that I wanted to wait another few months to see if the PSA level declined further. I knew prostate cancer usually is slow growing, and I figured that waiting a few months should not make any clinical difference. But a few months later, my PSA level had risen to 5.6. My urologist again recommended a prostate biopsy and I agreed. It was scheduled for March 22, 2008, seven months after my first elevated PSA.
During the weeks leading up to the procedure, I agonized over what it would be like. The objective of the biopsy is to obtain specimens, or cores, of prostate tissue that would be examined for evidence of malignancy. The procedure would involve 12 needle jabs at strategic locations in my prostate.
The day arrived. I had to give myself an enema and take an antibiotic before the procedure. I lay on a table on my left side, naked from the waist down. A technician inserted an ultrasound probe into my rectum to image my prostate and ascertain its dimensions. Then the urologist came in and quickly went to work. He injected a local anesthetic (a prostatic block) into my prostate and almost immediately took the first sample with the spring-loaded biopsy gun.
I didn’t feel a thing. Eleven more to go, and I was counting down. I was nervous about each impending jab, wondering if the next one was going to hurt. At last, he had obtained all 12 cores, with little pain. It was over and I walked out of the office elated that I had made it through what I thought would be an ordeal. Now, the wait.