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Take a lesson

A month ago, the exam room door opened and the first words out of the urologist's mouth were, "It's malignant, it's rated 10 on the Gleason Scale, which is as bad as it gets, and I'm sending you to Columbus to have it cut out." Not the most comforting words I've ever heard, especially when they come at you like blunt force trauma.

The consult appointment was set up a little over a month away, with probable surgery a month or two after that. My mind reeled a little—it's cancer, man, what's with the wait? Let's get it gone NOW! I thought I stayed outwardly calm about it—I had actually half expected the diagnosis to not be real good—but my wife saw through my stoicism by the time we got to the car.

Through a series of lucky meetings, someone at Ohio State University Medical Center—on Friday of that same diagnosis week—decided to be my advocate. I managed to get a consult appointment (almost a month sooner than the original one) with not only the very same surgeon, but also with a multidisciplinary group that felt I fit the requirements for a national study on prostate cancer. And prostate cancer now has a very personal relationship with me.

That consult was on the following Wednesday, and two days later, I was accepted into the study. Group A would get immediate surgery, and Group B would get six months of chemotherapy followed by surgery. I'd have been satisfied either way (it was a randomized selection), since I'd get longer and better followup, but I was very happy to land in the chemo group—let's kill it with everything they've got and they'll now follow me until I die. (This study hopes to show, eventually, whether chemo plus surgery gives a better outlook than just surgery.)

Five days later, chemo started and today I'm waiting and watching for any of the long list of side effects I was warned about. So far, so good. But I'm also thinking a lot about the long-term results I could expect, even in the best case scenario. Some degree of temporary or permanent incontinence and permanent ED were the two they hammered into my brain the most. And I may have to change my column picture when I lose my hair and beard. Work days will vary as my tiredness and sickness from the chemo dictates.

Later in the spring, after my course of chemo and surgery is done, I'll follow up with how things have gone. I'm keeping a diary. I'm trying, but I'm not sure how well I can display my real feelings about all this, even just to me.

I don't normally share this type of stuff with this many people, but after talking for hours with the OSUMC/James Cancer folks, I've decided that, this time, it's important enough to overcome my natural disinclination to talk about our male private parts. And this message is not only for the males among us, but even more for the women who are our spouses, friends and family, since you're the ones who will get us off our butts and into the docs to get this checked early. If you don't nag already, start harassing him about his prostate, and do it soon.

I've learned that we're 30 years of research behind breast cancer. Why? Some say it's because women's breasts are visible signs of sex appeal and memories of infancy. Both sexes watch out for them. Men's prostates, on the other hand are—well, to be honest, never much thought about until they don't work right. And when you do see TV commercials, it's for Viagra and Flomax, with only that extra small-print disclaimer to make you remember that not all prostate problems are benign. I've seen a lot of pink ribbons lately, but not much wrapped around men's prostate cancer.

I've learned, the hard way, that a PSA (Prostate-Specific Antigen) screening, by itself, doesn't mean much. While a high PSA may be indicative of prostate problems, it also might be due to things other than cancer, like inflammation or infection. A low PSA doesn't mean a great deal either. (Mine was just over 2, which is low normal for my age.) Lowness does not always equal OK.

You definitely need a yearly digital rectal exam after age 50 (which I didn't do) no matter how much you hate folks messing around down there. Other groups, like African-American males or those with a family history of prostate cancer, should probably start earlier. If you have to find a doc with skinny fingers to make you feel better about it, DO IT. The DRE is what kick-started my trip to chemo.

Other symptoms that should not be ignored include more frequent, more urgent and/or more difficult urination. (I didn't pay as much attention as I should have.) Blood in the urine might not be from your prostate, but get it checked out, dummy! (You could have done a CBC—complete blood count—from mine the vacation Sunday I headed for the Hilton Head Hospital ER at 7 a.m.) Sometimes the prostate can be large enough to cause or increase constipation, as well.

Put all those tests and tribulations together and then next you get the biopsy. It's done through the rectum and it's painful, but it's just absolutely necessary. When the biopsy results aren't good, you get an abdominal CT (computed tomography) scan with contrast medium, a nuclear bone scan and a scope of your bladder. They want to find every possible answer to malignity, severity and spread. Thankfully mine appears well encapsulated, and not spread to bone, bladder or lymph nodes—as far as they can tell. That's not an absolution though, because they could be wrong.

A year ago, I spent some time in the hospital with iron deficiency anemia. Maybe it was telling me something I couldn't yet hear. An upper and lower gastrointestinal and small bowel study showed nothing bleeding. No blood in the urine at that time. Two units of blood and a year of iron supplements brought me back to a semblance of (I thought) normal. I passed off other symptoms as just byproducts of the iron supplements (constipation) and maybe a little benign enlargement.

I was wrong. Don't you be wrong, too.

Dr. Jones is a contributing editor for the Ohio Dental Association. A private practice dentist and lawyer in Mansfield, Ohio, he may be reached