Prostate cancer and other transactions
At some point, early in my surprise diagnosis with Prostate cancer, I remember realizing that I had managed to transactionalize the process and how that had taken the entire experience from one of an unknown, to my home court advantage. I was the buyer, the doctors were the lenders, the treatments were the programs available and the tests were the inspections. I just wasn't clear on who the seller was. God, life, karma, the universal source... but I was pretty clear that it was a higher power of one form or another and I had to understand their needs in the transaction also. This is the file.
Like many men I'm sure, I resist non emergency doctor visits and while I would never let my car go without it's recommended service, I seem to ignore my primary vehicle's service records without either thought or regret. I felt great and if it wasn't for my wife's insistence, I am sure I would have still avoided that one hour inconvenience. So I went to the doctor and he did the things doctors do, and ordered some blood work including a PSA (Prostate Specific Antigen) test and I was to see him in a week.
The test was just barely on the elevated stage. If I spend too much time on this, I hope you will forgive me, but I do so because I hope to generate a few tests of those who read this. It was a 4.4. At my age of 50+ they prefer less than 3.0, but a 4.4 is way short of being dramatically high, that would be closer to a 10. Being the good doctor he is, remember at the beginning I said the lenders in this transaction were the doctors, he referred me to a specialist (underwriting) . My primary physician is Dr. Bradley Lee of the Kapolei Family Medical Center, and I have since gone back and thanked him for saving my life. See... this is not a story of gloom and doom, but one of celebration and thanks.
My referred doctor, Dr. David C. Wei of Hawaii Prostate Center, Dr. Wei's website, reviewed my charts and asked the right questions. He explained that the elevated PSA could be from other things or could be from an early stage of cancer. We could "wait and watch" (which surprisingly is a recognized protocol for Prostate abnormalities) or we could do a Biopsy. I have a LOT of family history and am one of those who has always known that Prostate cancer for me was not a matter of if, but when. I chose the Biopsy. In my mind, it was precautionary and solely intended to put my mind back to rest, and a week later it was done and I was to check back in a week for the results.
If you haven't been in a Doctor's office hearing the word cancer as it applies to you, it's a little hard to describe. I kept wanting to change the channel. It was August 7th when the magnitude of the situation arrived. Again, the biopsy was very encouraging indicating a small, non aggressive and early stage cancer. 20 years ago, when my father was diagnosed I would have been hearing a death sentence. In todays world, most of the options are age determinate. If I'd been 80 or in poor health hormone and radiation would have been very likely. The preferred technique for my circumstances was the removal of the prostate. I remember listening as his conversation covered the details and hearing the word "remove" like a splash of ice cold water on my face. If I hadn't been paying attention up to that point, I was now. As little as five years ago and certainly 10, this procedure would have almost certainly created continence and potency issues. Today, it isn't like that at all. It is still a game of percentages and you can improve your percentages by having an experienced doctor, but no doctor can guarantee you that their won't be some losses. I think incontinence is less than 5% and impotency is between 30% to 50% depending on the study. It is not a procedure that I would want someone to learn on me. These are good questions to ask.
Dr. Wei described the Laproscopic Robotic surgery known as the DaVinci procedure, and I left to meet with him in a week after I'd had a chance to digest all of this. I got a 2nd opinion, spoke with a good friend who'd had prostate cancer in 2001, spoke with a Dr. friend and called my old Doctor in Topeka. There was no disagreement between all of them that removal was the choice. For me the good news was that once removed, I would have a 98% chance to eliminate future prostate cancer for the rest of my life. Can't get it if you ain't got it. I tell people that I am now faced with trying to decide what will be my most likely cause of demise, since I just eliminated the most likely one.
Prostate cancer is tricky and PSA is only a predictor. The prostate is right in the thick of things of all those things we hold dear and the organ itself is hard to reach. Digital exams are helpful but not perfect. You can collect data from ultrasounds, biopsy scores, PSA level and digital exams but at some point, it requires a best guess approach. Our guess was that it was small, early and a 6 on a scale known as The Gleason scale. 6 is the lowest and 10 the highest. When it was all said and done, the pathology after the surgery was that it was not small, it was 20% of the prostate. It was not a 6 but a 7. It should not have generated a mere 4.4 PSA, but it did. In Dr. Wei, I found a Dr. who respected cancer. He approaches cancer as something that has a predictable but not certain behavior. He is proactive and aggressive in his treatment. I highly recommend this approach. Had someone been treating me based on the data and the associated percentages, I may not have had a biopsy yet and I almost certainly would not have had surgery. Had I had surgery, my lymph nodes would probably not have been removed, because of the PSA and Gleason, but instead they were which is what the pathology after the fact would have dictated.
Remember August 7th? It's September 21st today and I've had the surgery, gone to Minnesota for a wedding, had my best month EVER in real estate, and appear to have no side effects from the surgery. (exactly) In fact, the surgery was one month ago today and I often don't remember that I had it unless someone asks how I'm doing.
It was another good closing.
Time for the sermon.
Gentlemen. If you have been putting off a certain examination, make the appointment. I know it is the last thing on your mind, but perhaps it isn't right now. I know it will not be the most fun you had that day. Humor is helpful and I remember in the midst of one examination, the Dr. said, "Now, you only have to worry if you feel both of my hands on your shoulders." When you are having your PSA tested, ask them to explain "Free PSA and PSA" and ask the doctor if it would be good to have a Free PSA done also for a baseline. Get it done and whatever schedule your doctor recommends for periodic checks, get those done too. The only fear of Prostate Cancer is for it to go undetected. The best thing that has happened to me was the detection and removal of what has always been my family's weakest link. Remember this, I was completely symptom free and there was nothing to indicate any presence whatsoever.
Ladies. It is probably safe to assume that as logical as the above paragraph is, the men in your life will ignore it completely. I can identify the doctors who did marvelous doctoring to take me to where I am today, but they never would have had the chance if my wife hadn't made me go in the first place. Use your powers of persuasion and insist. Be non negotiable!
Being presented with the exit sign is an interesting gift. I can actually say that this whole experience has been one of joy and expectation. I always liked this expression, "The best attitude is gratitude."
Like many men I'm sure, I resist non emergency doctor visits and while I would never let my car go without it's recommended service, I seem to ignore my primary vehicle's service records without either thought or regret. I felt great and if it wasn't for my wife's insistence, I am sure I would have still avoided that one hour inconvenience. So I went to the doctor and he did the things doctors do, and ordered some blood work including a PSA (Prostate Specific Antigen) test and I was to see him in a week.
The test was just barely on the elevated stage. If I spend too much time on this, I hope you will forgive me, but I do so because I hope to generate a few tests of those who read this. It was a 4.4. At my age of 50+ they prefer less than 3.0, but a 4.4 is way short of being dramatically high, that would be closer to a 10. Being the good doctor he is, remember at the beginning I said the lenders in this transaction were the doctors, he referred me to a specialist (underwriting) . My primary physician is Dr. Bradley Lee of the Kapolei Family Medical Center, and I have since gone back and thanked him for saving my life. See... this is not a story of gloom and doom, but one of celebration and thanks.
My referred doctor, Dr. David C. Wei of Hawaii Prostate Center, Dr. Wei's website, reviewed my charts and asked the right questions. He explained that the elevated PSA could be from other things or could be from an early stage of cancer. We could "wait and watch" (which surprisingly is a recognized protocol for Prostate abnormalities) or we could do a Biopsy. I have a LOT of family history and am one of those who has always known that Prostate cancer for me was not a matter of if, but when. I chose the Biopsy. In my mind, it was precautionary and solely intended to put my mind back to rest, and a week later it was done and I was to check back in a week for the results.
If you haven't been in a Doctor's office hearing the word cancer as it applies to you, it's a little hard to describe. I kept wanting to change the channel. It was August 7th when the magnitude of the situation arrived. Again, the biopsy was very encouraging indicating a small, non aggressive and early stage cancer. 20 years ago, when my father was diagnosed I would have been hearing a death sentence. In todays world, most of the options are age determinate. If I'd been 80 or in poor health hormone and radiation would have been very likely. The preferred technique for my circumstances was the removal of the prostate. I remember listening as his conversation covered the details and hearing the word "remove" like a splash of ice cold water on my face. If I hadn't been paying attention up to that point, I was now. As little as five years ago and certainly 10, this procedure would have almost certainly created continence and potency issues. Today, it isn't like that at all. It is still a game of percentages and you can improve your percentages by having an experienced doctor, but no doctor can guarantee you that their won't be some losses. I think incontinence is less than 5% and impotency is between 30% to 50% depending on the study. It is not a procedure that I would want someone to learn on me. These are good questions to ask.
Dr. Wei described the Laproscopic Robotic surgery known as the DaVinci procedure, and I left to meet with him in a week after I'd had a chance to digest all of this. I got a 2nd opinion, spoke with a good friend who'd had prostate cancer in 2001, spoke with a Dr. friend and called my old Doctor in Topeka. There was no disagreement between all of them that removal was the choice. For me the good news was that once removed, I would have a 98% chance to eliminate future prostate cancer for the rest of my life. Can't get it if you ain't got it. I tell people that I am now faced with trying to decide what will be my most likely cause of demise, since I just eliminated the most likely one.
Prostate cancer is tricky and PSA is only a predictor. The prostate is right in the thick of things of all those things we hold dear and the organ itself is hard to reach. Digital exams are helpful but not perfect. You can collect data from ultrasounds, biopsy scores, PSA level and digital exams but at some point, it requires a best guess approach. Our guess was that it was small, early and a 6 on a scale known as The Gleason scale. 6 is the lowest and 10 the highest. When it was all said and done, the pathology after the surgery was that it was not small, it was 20% of the prostate. It was not a 6 but a 7. It should not have generated a mere 4.4 PSA, but it did. In Dr. Wei, I found a Dr. who respected cancer. He approaches cancer as something that has a predictable but not certain behavior. He is proactive and aggressive in his treatment. I highly recommend this approach. Had someone been treating me based on the data and the associated percentages, I may not have had a biopsy yet and I almost certainly would not have had surgery. Had I had surgery, my lymph nodes would probably not have been removed, because of the PSA and Gleason, but instead they were which is what the pathology after the fact would have dictated.
Remember August 7th? It's September 21st today and I've had the surgery, gone to Minnesota for a wedding, had my best month EVER in real estate, and appear to have no side effects from the surgery. (exactly) In fact, the surgery was one month ago today and I often don't remember that I had it unless someone asks how I'm doing.
It was another good closing.
Time for the sermon.
Gentlemen. If you have been putting off a certain examination, make the appointment. I know it is the last thing on your mind, but perhaps it isn't right now. I know it will not be the most fun you had that day. Humor is helpful and I remember in the midst of one examination, the Dr. said, "Now, you only have to worry if you feel both of my hands on your shoulders." When you are having your PSA tested, ask them to explain "Free PSA and PSA" and ask the doctor if it would be good to have a Free PSA done also for a baseline. Get it done and whatever schedule your doctor recommends for periodic checks, get those done too. The only fear of Prostate Cancer is for it to go undetected. The best thing that has happened to me was the detection and removal of what has always been my family's weakest link. Remember this, I was completely symptom free and there was nothing to indicate any presence whatsoever.
Ladies. It is probably safe to assume that as logical as the above paragraph is, the men in your life will ignore it completely. I can identify the doctors who did marvelous doctoring to take me to where I am today, but they never would have had the chance if my wife hadn't made me go in the first place. Use your powers of persuasion and insist. Be non negotiable!
Being presented with the exit sign is an interesting gift. I can actually say that this whole experience has been one of joy and expectation. I always liked this expression, "The best attitude is gratitude."
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