Since it was revealed that Joe Biden has Prostate Cancer – I have seen several segments about it on TV. One of the most surprising was that 80% of men over the age 80 have some form of Prostate Cancer. Well, I am a few months from 80; however, I have self-appointed myself into that club because I have the “Big C” – in the form of Prostate Cancer.
Ever since my 40’s – I have received an annual PSA test. Over that last 10 years my PSA results have slowly inched upwards – until it slopped over this year at 6.33. My Urologist felt that I needed a MRI to see what’s going on? The results showed that I had a 1.8 cm PI-RADS 5 on my Prostate, which indicated that clinically significant cancer was highly likely to be present.
I then had a biopsy. There was no anesthesia involved. It felt like the doctor shoved a 6” diameter pipe up my butt and proceeded to snap a rubber band around my Prostate 13 times. The biopsy results showed that I had cancer in two places of the 13 where tissue was taken.
I then had a consultation with the doctor and below are the notes of that discussion:
Assessment and Plan:
Malignant neoplasm of prostate (CMS-HCC)
I had the pleasure of meeting with Mr. Grant in clinic today. I reviewed his diagnosis of prostate cancer and how the Gleason score is used in the risk stratification system together with PSA and clinical examination. I discussed the Gleason score in detail with respect to its role in tumor biology and behavior.
I then discussed the treatment options for a man with favorable intermediate risk disease as outlined by the NCCN in whom at least 10 years of life expectancy is anticipated:
- Surgery with pelvic lymph node dissection +/- adjuvant therapies
- External beam radiotherapy or brachytherapy
- Active surveillance
Radiation
I discussed radiation and the modalities employed in the management of prostate cancer between brachytherapy, external beam radiation, proton therapy, and stereotactic radiotherapy. I explained that there is equivalence between radiation and surgery when each are delivered in standard of care.
Surveillance
I discussed the use of semi-annual PSA testing, periodic MRI and targeted biopsies. I explained that men with favorable intermediate risk disease are at an increased with of metastatic progression during follow-up and that close monitoring will be required. I explained that I would recommend molecular tumor testing in order to better understand their risk if he does chose this approach. I additionally explained that I prefer yearly biopsies in men with intermediate risk disease. Finally, I discussed that with progression on active surveillance there is a treatment intensification that is required and therefore some men elect intervention over surveillance due to the potential need for hormonal deprivation therapy if they desire radiation as a treatment approach on progression.
Surgery
I reviewed the role of surgery and the relevant surgical anatomy and the role of the robotic platform. I explained that surgery for prostate cancer exists on a continuum of quality of life outcomes and cancer control. We reviewed that a maximal cancer surgery is also associated with maximal impacts on quality of life (erectile dysfunction and incontinence). I explained that the approach utilized for the surgery is driven by his goals of cancer care and his particular pathology and staging. We outlined the differences between space of retzius sparing prostatectomy and anterior prostatectomy and the role of nerve sparing versus non-nerve sparing. We discussed the quality of life outcomes between the various approaches and the trade-offs between cancer control and quality of life. I explained my personal outcomes with these approaches.
I also reviewed the specific procedural risks, which include, but are not limited to infection, bleeding, need for blood transfusion, and injury to surrounding structures including the rectum, small bowel, bladder, ureters, blood vessels, nerves, anastomotic complications, and lymphocele.
Plan:
At this time, he is most interested in pursuing active surveillance which I believe is reasonable given his low decipher score of 0.18.
-Return to clinic in 6 months with a PSA prior
I chose the surveillance option for several reasons. I am getting to the age when something will do me in – maybe it will be this cancer? However, I will know what’s happening along the way and it won’t come as a surprise – I can make decisions as the status of the cancer changes.
I saw a report that Joe Biden’s last PSA test was 11 years ago – why? Another report stated that some doctors don’t recommend men getting a PSA test once they reach 70 and beyond. The reasoning – because false positive’s can be prevalent from age 70 forward. So what!!!! Just take another PSA test and/or a MRI. It makes no sense to me to have Prostate Cancer become a surprise to anyone when it can be detected at an early stage – like in my case.
From my personal experience – I would suggest that any man should get a regular PSA test – especially anyone 70 or over. If your doctor does not recommend it then find another doctor who will authorize the test. I am certainly glad that mine was discovered at an early stage and that it was my decision to carry those little buggers around with me for a while longer.
Thanks