Well here it is the final episode of my Prostate trilogy. Its been an epic writing journey for me as I don't think I have written so much about 1 topic since College. I will recap just a bit but you can read the full stories here & here.
I first started with a story about how I became ill and it was discovered that I had an inflamed prostate and a UTI. The next step was to go to see a Urologist (which this post will cover). The second post was a complete breakdown of everything the normal person would need to know about their prostate, what it does, and how doctors diagnose issues with it. I think this second post was a huge success as we had a true professional give his expert opinion instead of just getting a bunch of stuff from the internets.
The Boyfriend I Never Wanted
So on with the show. We pick up the story 2 weeks after my UTI. The antibiotics had run their course and I was feeling normal again. I just had to get past this one visit and go on with my life. I met with my doctor who is highly respected in the St. Louis area. In fact there is a college with his Family's name on it. I went over my symptoms with him and he had gotten a full write up on me from my primary care. We started with the "exam" and right away he noticed that my Prostate was still enlarged. He also prescribed some blood work as my Prostate should have gone down in size over the past couple weeks with the infection.
Within a few days the blood results were back and my PSA level was at 4.5. Which at the time to me seemed low. My calmness was squashed in the matter of a second when I heard that for my age a PSA lower than 1 was more normal. I was then asked to come back into the office for some more testing and examining. The next test was still looking at my PSA but they wanted to know the Free:Bound ratio. Now for some reason I will never forget where I was when I received the info back from this test. It was St. Partick's Day and I was celebrating my Irish Heritage at 10am and I think it was a Tuesday or something. I was well on my way to having a great day. Then my phone rang... The results came back with my Free PSA was at 3%. Which if you recall from Dr. Greenfield, the higher the Free PSA the better. My doctor advised that he likes to see around 20-25% Free PSA. What really makes this call really stick out in my head however, is it was the first time the "Cancer" word was mentioned. The timing was terrible.
With 2 strikes against me (Elevated PSA & Low Free PSA) my doctor was concerned. He gave another exam and the size had not gone down. He advised that the next step was to perform an ultrasound of my Prostate. He wanted to get a visual of the area, to see if there was some asymmetry and just try identify if something crazy was going on. The ultrasound was not the same as the one that was performed on my wife's belly when she was pregnant either. In fact, to get a REALLY good look at it they had to dive in. This was the second most uncomfortable experience in my life. He looked around for what seemed like 3 hours took some pictures and went about his ANALysis. He identified some scar tissue that had been there from a previous infection (not the one I just had) and noticed my walnut was large and asymmetrical. Stirke 3.
With all the information gathered, there was but one choice (so I thought). My Doctor seemed almost certain that I had cancer. He even wrote a "Thank you" letter to my primary care. I don't know if he was excited about the thought of a 30 year old with cancer or what... Anyway the biopsy was put on the calendar and my one visit to the Urologist had blown up into 4 visits, 2 rounds of blood work, 1 ultrasound, and now 1 biopsy.
As I said before the Ultrasound was the second most uncomfortable event in my life. The Biopsy remains number 1 and I really hope it doesn't get trumped any time soon. If you are unfamiliar with a biopsy, they have to take small pieces of whatever is at risk, send them off to a lab, and check to see if there's cancer. The Biopsy itself took I think about 30-45 min. They took 16 samples (4 from each region). It was painful and almost humiliating at the same time. When finished I thought the pain would be over, just a little pain here and there, nothing crazy. I was wrong. The rest of the day and the next I had to sit on one of those horseshoe-like pillows. Not to mention when I did business in the bathroom there was a lot of blood associated with it (from both ends). I will chalk that up to not asking about the side effects before i went in. Now with all the physical pain, there's another interesting feeling going on, not knowing if you have cancer or not. That seemed to weigh on me as much as the pain.
To save the suspense, the bioposy results came back negative for cancer. Which was one of the greatest phone calls I've every received. So for the record, I didn't want this to turn into a pity blog for me, I wanted to share this story with you to educate and hopefully make you a better patient. If I would have been armed with future goggles and Dr. Greenfield's information, I don't think I would have gone down this long painful path.
After talking with Dr. Greenfield and going over my history (with no exam +1), he has suggested that I possibly have Prostatitis, chronic swelling of the Prostate. Unfortunately, there is no real silver bullet for this and he did not suggest I take Avodart or Proscar as there are potential side effects that will hinder my baby making abilities. He suggested that I just live a healthy lifestyle, eat well, and exercise. I can live with that.
Thank you to everyone for taking some time to read this and a big thanks to Dr. Greenfield who took these posts to a new level. I hope my mission of providing you with some information & advice was successful. I think this will be the last post about wang for awhile. Til next time...
-S
Showing posts with label Urology. Show all posts
Showing posts with label Urology. Show all posts
Monday, January 10, 2011
Monday, December 27, 2010
PSA on PSA (The Greenfield Diaries)
Now that you are well versed in the beginning stages of my Prostate ordeal, I think it is only fitting that we go over some important words and phrases that I will be using in the upcoming part 3 of this saga a.k.a. "The Boyfriend I Never Wanted."
Part 2 of the PSA on PSA "The Greenfield Diaries" wasn't originally planned at first. I was just planning on doing some research on WebMD or something to give definitions. However, it turns out a college friend of mine has made something for himself and is a Board Certified Urologist. So on a whim, and not really speaking with him formally in 10 years, I asked if he would be so kind to answer some questions for the site. He did and it was exactly what I wanted: straightforward answers with minimal amounts of conservatism. This saved me tons of research time and time figuring out how to give credit to a website. So, thank you Dr. Jason Greenfield for your professional input here. Also you should be able to tell the difference between Dr. Greenfield's comments and mine.
So on to the show. We'll start at the beginning. How many of you actually know what your Prostate does? I am going to bet that most of you that are under 40 know very little. Maybe general location or that your dad isn't thrilled when he goes and gets it checked. The prostate is a gland specific to the male gender. It is located next to the bladder and envelops the urethra as it begins from the bladder neck. Its main function is to contribute secretions that compose semen and is the entry point of the the ejaculatory ducts where sperm from the vas deferens and secretions from the seminal vesicles enter. So, without this walnut shaped glad, there wouldn't really be a Suburban FATHER Alliance.
Now that we are squared away on its location lets get more into its function. The Prostate produces PSA. PSA stands for "Prostate Specific Antigen" and its major function is to liquefy semen. It can also be found in blood and is currently used as a tumor marker for prostate cancer. Essentially, the higher the PSA level, the more in your blood. It is a better marker of prostate size but doctors use it to screen for cancer because it is still one of the best markers they have right now. Although, in truth, it is terrible in terms of specificity. It is important to know that a lot of other medical problems can cause the PSA to rise such as urinary infections. -- If I can pause, this last sentence really hits home for me and after talking to Dr. Greenfield, I wished I would have gotten a second opinion with my symptoms. Second opinions only cost a copay but could save you a huge amount of stress.
So a bit more on PSA. When PSA is measured in the blood there is a level associated with it. Now what constitutes a "normal" PSA level is a very complicated answer. A normal PSA level depends on the patient's age, prostate size, and previous levels. For example, most laboratories give a range of 0-4.0 as normal. However, it is definitely not normal for a 30 year old to have a PSA of 3.5. A level of 5.0 may not be abnormal for a man in his 80's. As another example, a very small prostate and a PSA of 3.5 may be concerning whereas a very large prostate and a PSA of 5 or 6 may not be. As a final example, we also look at "PSA velocity". If your PSA one year was 3.9 and the next year was 4.1, that may not be very concerning. If it was 1.5 one year and the following year was 3.0, that can be a red flag. There are also a multitude of other tests involving PSA and it's subtypes. It can be very confusing and one could write volumes of text about PSA itself. Perhaps the best advice is to be aware of what your PSA is and ask your urologist what, if anything, you should be doing about it.
Now, like many substances in our blood stream, PSA exists both bound and unbound to other proteins (mainly albumin). Unbound PSA is often referred to as a "free PSA". Testing for free PSA was developed in the hopes that it would be a more specific test for identifying men who were at risk for prostate cancer. It is given as a percentage and, unlike the test for total PSA, a "lower" value is considered MORE suspicious for prostate cancer versus benign disease. However, it should be noted that the free PSA test has been somewhat disappointing as a tool for identifying higher risk patients. It certainly has not relieved us in our quest for a highly sensitive and specific test for identifying men with prostate cancer.
Finally, one very common complication with Prostates is BPH or an enlarged Prostate. The most important thing to know about an "enlarged" prostate is that a large prostate is in no way a risk for having cancer. It may lead to an elevated PSA but as mentioned above, that does not mean cancer. An enlarged prostate can eventually cause urinary problems as the prostate grows to obstruct the flow of urine through the prostatic urethra. This is often called "BPH" which stands for "Benign Prostatic Hyperplasia". Note the word "benign". This is not cancer. BPH occurs in the central part of the prostate where the urine passes through. Prostate cancer usually occurs in the peripheral part of the gland.
Ok we covered the location, function, and what doctors measure in the Prostate. We can also confirm that each person's Prostate is going to be different in size and in producing PSA. There's no clear formula on what is going to constitute if you have cancer or not. What Dr. Greenfield does recommend is talking with your doctor briefly about whether or not you wish to be screened. If you decide that you do, the recommended age to start screening for a Caucasian male with no significant family history of prostate cancer is age 50. Men of certain ethnic backgrounds, especially men of African descent, are recommended to start at age 40 as well as men with a family history of prostate cancer.
Overwhelmed with info? Mission accomplished. I really hope you all have taken some time to read & re-read this info. Its a lot, but it is necessary to stay informed as patients and to ask the right questions when we visit with our doctors. I cannot thank Dr. Greenfield for his time on this subject. He has probably opened a Pandora's box by being so open and thorough.
Now, for the the final post of this Trilogy I will talk about my experience when I went to the Urologist for the first time not knowing what any of this was and having some discouraging news dropped on me in the middle of a St. Patrick's Day Parade. Thanks for reading.
-S
Part 2 of the PSA on PSA "The Greenfield Diaries" wasn't originally planned at first. I was just planning on doing some research on WebMD or something to give definitions. However, it turns out a college friend of mine has made something for himself and is a Board Certified Urologist. So on a whim, and not really speaking with him formally in 10 years, I asked if he would be so kind to answer some questions for the site. He did and it was exactly what I wanted: straightforward answers with minimal amounts of conservatism. This saved me tons of research time and time figuring out how to give credit to a website. So, thank you Dr. Jason Greenfield for your professional input here. Also you should be able to tell the difference between Dr. Greenfield's comments and mine.
So on to the show. We'll start at the beginning. How many of you actually know what your Prostate does? I am going to bet that most of you that are under 40 know very little. Maybe general location or that your dad isn't thrilled when he goes and gets it checked. The prostate is a gland specific to the male gender. It is located next to the bladder and envelops the urethra as it begins from the bladder neck. Its main function is to contribute secretions that compose semen and is the entry point of the the ejaculatory ducts where sperm from the vas deferens and secretions from the seminal vesicles enter. So, without this walnut shaped glad, there wouldn't really be a Suburban FATHER Alliance.
Now that we are squared away on its location lets get more into its function. The Prostate produces PSA. PSA stands for "Prostate Specific Antigen" and its major function is to liquefy semen. It can also be found in blood and is currently used as a tumor marker for prostate cancer. Essentially, the higher the PSA level, the more in your blood. It is a better marker of prostate size but doctors use it to screen for cancer because it is still one of the best markers they have right now. Although, in truth, it is terrible in terms of specificity. It is important to know that a lot of other medical problems can cause the PSA to rise such as urinary infections. -- If I can pause, this last sentence really hits home for me and after talking to Dr. Greenfield, I wished I would have gotten a second opinion with my symptoms. Second opinions only cost a copay but could save you a huge amount of stress.
So a bit more on PSA. When PSA is measured in the blood there is a level associated with it. Now what constitutes a "normal" PSA level is a very complicated answer. A normal PSA level depends on the patient's age, prostate size, and previous levels. For example, most laboratories give a range of 0-4.0 as normal. However, it is definitely not normal for a 30 year old to have a PSA of 3.5. A level of 5.0 may not be abnormal for a man in his 80's. As another example, a very small prostate and a PSA of 3.5 may be concerning whereas a very large prostate and a PSA of 5 or 6 may not be. As a final example, we also look at "PSA velocity". If your PSA one year was 3.9 and the next year was 4.1, that may not be very concerning. If it was 1.5 one year and the following year was 3.0, that can be a red flag. There are also a multitude of other tests involving PSA and it's subtypes. It can be very confusing and one could write volumes of text about PSA itself. Perhaps the best advice is to be aware of what your PSA is and ask your urologist what, if anything, you should be doing about it.
Now, like many substances in our blood stream, PSA exists both bound and unbound to other proteins (mainly albumin). Unbound PSA is often referred to as a "free PSA". Testing for free PSA was developed in the hopes that it would be a more specific test for identifying men who were at risk for prostate cancer. It is given as a percentage and, unlike the test for total PSA, a "lower" value is considered MORE suspicious for prostate cancer versus benign disease. However, it should be noted that the free PSA test has been somewhat disappointing as a tool for identifying higher risk patients. It certainly has not relieved us in our quest for a highly sensitive and specific test for identifying men with prostate cancer.
Finally, one very common complication with Prostates is BPH or an enlarged Prostate. The most important thing to know about an "enlarged" prostate is that a large prostate is in no way a risk for having cancer. It may lead to an elevated PSA but as mentioned above, that does not mean cancer. An enlarged prostate can eventually cause urinary problems as the prostate grows to obstruct the flow of urine through the prostatic urethra. This is often called "BPH" which stands for "Benign Prostatic Hyperplasia". Note the word "benign". This is not cancer. BPH occurs in the central part of the prostate where the urine passes through. Prostate cancer usually occurs in the peripheral part of the gland.
Ok we covered the location, function, and what doctors measure in the Prostate. We can also confirm that each person's Prostate is going to be different in size and in producing PSA. There's no clear formula on what is going to constitute if you have cancer or not. What Dr. Greenfield does recommend is talking with your doctor briefly about whether or not you wish to be screened. If you decide that you do, the recommended age to start screening for a Caucasian male with no significant family history of prostate cancer is age 50. Men of certain ethnic backgrounds, especially men of African descent, are recommended to start at age 40 as well as men with a family history of prostate cancer.
Overwhelmed with info? Mission accomplished. I really hope you all have taken some time to read & re-read this info. Its a lot, but it is necessary to stay informed as patients and to ask the right questions when we visit with our doctors. I cannot thank Dr. Greenfield for his time on this subject. He has probably opened a Pandora's box by being so open and thorough.
Now, for the the final post of this Trilogy I will talk about my experience when I went to the Urologist for the first time not knowing what any of this was and having some discouraging news dropped on me in the middle of a St. Patrick's Day Parade. Thanks for reading.
-S
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