Nervous-Making Moments

BY RALPH BLUM

I’m interrupting my series of Blogs on “Stress” to give you a bulletin from the front. It concerns my latest PSA. It caught me off guard and gave me a bad moment.

I talk about these nervous-making moments often enough with men who contact me after reading “Snatchers.” But that’s them. This is me, my prostate.  And there it is: the sinking feeling in the gut, half-panic, half “Oh s--t!” Not that this toxic cocktail is new to me. But it is never quite something that even my long experience with prostate cancer never lets me to take in my stride.

This time, the moment is triggered by an email from Mark: 

Hi Ralph, 

I have been away on vacation.  Just got back.  Did anyone discuss your elevated PSA with you?  It was elevated to 26.  Can you give me a call today? 

Mark

I realized I had stopped breathing. No, no one has discussed my elevated PSA with me. 26! Ouch! In less than three months—for no reason I can think of—that’s up by more than 40%!

Dialing Mark, I thought what my friend, Harvey, would say: “Well, my PSA is 60—and I don’t even have a prostate! Consider yourself blessed. . . . You’re going to die in your sleep in 20 years after dinner out and a good movie.”  

Yeah, well, I still feel like I’ve eaten rotten fish.

Mark doesn’t sound concerned. He wants to know if I’ve noticed any symptoms of an enlarged prostate. No. Done any heavy lifting? Negative. “Well, let’s put you on an antibiotic for ten days—you tolerate Cipro alright—and then have you see Duke Bahn_for a Doppler MRI. He’s taking Medicare again. Then in about three weeks we’ll do a repeat PSA.”

Makes sense. But the panic is still there; the fear that perhaps I have tempted fate one too many times by not going for a cure.

When I tell my wife, Jeanne, who has a degree in Traditional Oriental Medicine and practices an ancient form of acupressure, her reaction is professional and predictable, but hardly comforting. “You’ve got to stop eating pork. And start eating tomatoes; you’re getting no lycopene. Diet, diet diet.”

And then it occurs to me: There may be an obvious explanation for the PSA spike.  I’ve had the flu for two weeks. Some fever along with the usual symptoms. Was that enough to spike my PSA? It happened once before when we were living in Hawaii. Or is this my body telling me it is finally time to do something?

I remember something Mark wrote in “Snatchers” that is somewhat reassuring: “How the cancer behaves over time is the most important predictor. It supersedes Gleason score, it supersedes stage and PSA. . . In your case, Ralph, we’ve had two decades to observe its behavior, and that behavior has to trump all the stats. 

In Mark’s experience, cancers do not tend to change their stripes after twenty years. “It’s like having new neighbors,” he once said. “With time you learn that they keep their property neat, that their dog won’t poop on your lawn, and that if you want to borrow a cup of sugar, sugar is what you’ll get. Well, the same with prostate cancer.”

Well, maybe prostate cancer has been my closest neighbor for long enough. I am once again in uncharted waters, and ultimately, there is risk in whatever I do. If I do nothing, I risk the cancer progressing. If I chose treatment, I risk unpleasant (or worse) side effects.

What’s the old-time carnival barker’s challenge? “You pays your money and you takes your choice.”

Time for long thoughts.