“I woke up this morning and found myself dead.”
Just one of the more clever ways I thought to start off this essay about my recent brush with prostate cancer. A close pun to a well known blues and rock song from some decades ago, but, then I thought, no, perhaps go the Woody Allen route:
“A man sticks a finger up your ass and says, ‘I feel something.’ The temptation is great to respond with the exact same declaration.”
This is an allusion to Allen’s great 1986 film, Hannah And Her Sisters, wherein Woody’s character is a hypochondriac who has possibly been diagnosed with a malignant tumor, and preludes into his typical schtick with an ‘Ok, stay calm,’ sort of exhortation.
But, the more and longer I thought of writing about prostate cancer, the more it took me away from just that subject matter, and the more things intervened from tangential areas. Three things that struck were 1) the death of Roger Ebert, the popular film critic, from another form of cancer, 2) the decision by actress Angelina Jolie to have a pre-emptive double mastectomy to eliminate breast cancer risk, due to carrying the BRCA-1 gene, and 3) the casual tossing about of the words “hero” and “courage” in the wake of points 1 and 2.
Ok, but, let’s go back to the beginning. For females or those in the dark about what a prostate is, here is the Federal government’s definition:
The prostate is part of a man’s reproductive system. The prostate gland is the size of a walnut. It is found in front of the rectum and just below the bladder, which stores urine. The prostate makes some of the milky fluid (semen) that carries sperm. The prostate wraps around a tube (the urethra) that carries urine from the bladder out through the tip of the penis.
During a man’s orgasm (sexual climax), muscles squeeze the prostate’s fluid into the urethra. Sperm, which are made in the testicles, also go into the urethra during orgasm. The milky fluid carries the sperm through the penis during orgasm.
Having turned 48 this past February, and having gotten regular annual prostate exams since turning 40 years old, I, later that month, scheduled my annual physical. Fortunately, I have good, solid medical insurance from my employer, which includes totally free annual physicals, which include the usual tests of blood, urine, and what not, along with the annual prostate exam (aka, a “DRE” – digital rectal exam), which includes one’s primary physician donning a rubber glove, poking a couple of fingers up one’s rectum, and then skooching about for 5-10 seconds, to be followed up, as in years past, with a “feels good” proclamation. Except, this time, there was a slight pause, and my doctor said, “Well….I feel something. It seems like a node. Nothing to panic over, but I recommend a follow up with a urologist.” Naturally, one asks if this means cancer has been found, and the physician smiling and stating that, “We don’t want to assume things.”
Cue the old The Odd Couple classic gag about never wanting to assume something, for “when you ASSUME, you make an ASS of U and ME.” But, seriously, my first reaction was indicative of my general demeanor, and that was NOT to panic, but stay calm, get the list of possible urologists to follow up with, make the appointment, then feel the two A’s: annoyance, foremost, then anger. Annoyance because, as I told my wife, I have too much to do to die any time soon, and anger over having to even be annoyed. I won’t say I felt NO mortal fear, for I did, but that was about 1-2% of my emotional reaction, because, unlike many, I came to grips with my own mortality at the age of 6, when I saw the first of many people murdered. But, my adoptive dad did die of leukemia and chronic lymphatic lymphoma, at the age of 66, and my biological mother died of tongue cancer at the age of 43. Still, having just started a long novel manuscript, a little over a week before, I simply did not have the time to waste in having cancer, getting treatments, or an operation to remove the prostate, etc. Clearly, I would do what I needed, but it was annoying.
After all, a quick online search saw that I did not have any of the ten classic signs of prostate problems associated with cancer:
– frequent urination, especially at night
– difficulty starting or stopping a stream of urine
– weak or interrupted urinary stream
– leaking of urine when laughing or coughing
– pain or burning sensation during urination or ejaculation
– blood in urine
– blood in semen
– swelling in the legs
– discomfort in the pelvic area
– bone pain
So, I went to a urologist, and was quickly disabused of the notion that having none of the above signs was a good sign, as these ‘signs’ were guidelines from thirty plus years ago, long before 98% of prostate cancers were detected with a DRE or PSA tests. (“PSA” tests are Prostate Specific Antigen tests which screen for a protein made by the prostate.) So, I had a blood test for a PSA screening, as well as another DRE, which confirmed I had a node on my right posterior side of the prostate. The higher the level of PSA in one’s blood, the greater the chance of prostate cancer. A rate of 4.0 nanograms of PSA per milliliter (ng/mL) is considered normal. I also had a prostate biopsy scheduled. Now, here comes the fun part, because if you’ve never had a prostate biopsy, well, you may wanna wince.
So, you strip naked and put on a surgical gown, then the doctor and nurse come in, lay you on your side, and expose your ass. The doctor then puts some K-Y jelly in your rectum to loosen you up. Next, you see a large plastic tube, with a hose attached to some high tech machine that allows the doctor to see inside your rectum, colon, and right to your prostate, which is located on the other side of your colon wall. You ask, ‘Is that going up my ass?’ and your insight is confirmed. When I say a large plastic tube, I mean it. If you’ve ever used a vacuum cleaner with a corner extension- that long extension with the tapered end, and about 18 inches long, is about a rough equivalent to this thing.
The doctor asks you to lift one leg up, to grant access to your rectum, and then he shoves the plastic tube up your rectum. It is a jarring experience for any heterosexual male, and while not painful, per say, it is EXTREMELY uncomfortable. The doctor says, “Oh, I guess I should have prepared you more for the entry,” and you say, “I think so.” But, the party has yet to begin. The doctor, having failed to prepare you for the 18 inch long piece of solid plastic that is sodomizing you, now feels compelled to say what to expect next. He says, “Once we turn the machine on, we will take biopsy samples from 10-12 areas about the prostate, to get a general sense of the prostate health. You may feel a slight scratching or stinging sensation after each sample is taken.”
Note – “a slight scratching or stinging sensation.” The machine is turned on, and it sounds like a pneumatic compressor. Then you feel and hear a literal BANG!, and you jump on the table. The doctor says, “Oh, I guess I should have prepared you for that, as well.” You look at him and say, “Yes, I had no idea that the Battle of Iwo Jima would be replayed in my ass.” This World War Two reenactment proceeds in the same manner with each volley until all the requisite areas have yielded samples, and you are allowed to dress, with some trickles of rectal blood staunched by tissues. The doctor says the PSA results will take one to two weeks, and to follow up in that time for the biopsy results.
I drive home, with my wife, feeling fine, until, about a half hour after the biopsy, I start bloating. I feel like a beach ball as I lie on my bed, filled with air not my own, and begin the longest continuous session of farting in my life (which says something, as a heavy milk drinker), most of the gas, though, not being homegrown. Bar none, the plastic tube, Iwo Jima re-enactment, and bloating have, in sum, added up to the most miserable, if not painful, day of my life. Add in the fact that the biopsy can leave blood in your semen and urine for 2-3 months, and it is not a particularly pleasant thing.
Now comes the waiting, which leads me, a walker not talker type, to resolve that my only option, psychologically, is to yank the damn thing if malignant. Wear diapers for a few months, and learn how to re-piss. I’m simply not the type to mess around, have an enemy growing within, or try chemo or radiation therapies. When I war, it’s total war. It or me. My wife tells me not to be hasty, but I am a scorpion in this manner. As I wait each night, I just wanna get things going. Fortunately, my health insurance covers prostate removal via the new robotic surgeries, which cost more, long term, but totally remove any chance of a return of the cancer (call this the Jolie option), but significantly shorten physical recovery time, as well as scarring, and the ability to regain urinary bladder control, from 3-4 months down to 4-6 weeks.
A week after the biopsy and blood test, and a week before my follow up, I get a phone call from the doctor’s office that my PSA test came back a microscopic 0.42, on a scale where 4.0 is normal, 6.0 to 8.0 is troubling, and over 8.0 highly indicative of prostate cancer. So, this is a very good sign that the node, or tumor, is benign. Of course, there are times when prostate cancer occurs with low PSA scores (about 10-15% of the time) and the urologist also said that the fact he felt the node was ‘hard’ increased the chances that it was cancer, or, more properly, malignant cancer. This is not a mere semantic difference, but an important point, because almost all bodily growths that are not viral based – like warts, for example – are a form of cancer; it’s just the malignant ones that are troublesome, and which are called “cancer,” meaning “malignant cancer.”
Then, a few days later, and a few days before the follow up, I get a second call – none of the biopsied areas came back as malignant. Whew! But, I still go in for my follow up. Here, the urologist recaps the good news and explains that my “node,” which, via the term, I had assumed was sort of a singular pimple on the prostate, was more like a series of wavy ridges. In other words, instead of my prostate being smooth, it was like a scrunched forehead. But, I can live with an ugly, wavy but well functioning and healthy prostate. I go back for a follow up this coming January, with an increased sense and appreciation of my own health.
So, why did I want to write this essay? Simple. Far too often health concerns are shortshrifted in our Lowest Common Denominator and celebrity-obsessed culture, and even more often those concerns are wholly ignored if they concern men’s health. As example, according to both government statistics, and those of the American Cancer Society, prostate cancers (and there are a variety of types) are the third most recurrent cancer type in the nation, behind only lung and colon cancers, in terms of frequency, and only lung cancer kills more men. Prostate cancer is more common than breast cancer in women, although it is slightly less deadly. And therein the good news: early detection has made early stage prostate cancer have survivability rates of almost 95% after 15 years. Most of the nearly 30,000 men to die annually from it are men 65 or older who had late stage cancers that went undetected for decades. By contrast, if I had had a malignant early stage prostate cancer, and removed my prostate – as I had planned – the chances are that, within two to three years, my actuarial chances of dying of any other form of cancer would have been virtually identical to that had I never had prostate cancer.
Hence, the key is early detection, and overcoming the latent Puritanism, Victorian mores, and queasy homophobia most men have regarding prostate exams. As example, at work, my near-brush with prostate cancer became the talk of the guys I work with, several of whom are nearing or at the 40 year age mark. The reaction? Not good. Most think it’s ‘gay’ to even get a test, or acknowledge your mortality. Black men, especially, have a higher genetic tendency to get prostate cancer, and my black co-workers showed just as great a disdain toward early detection and prevention as their white counterparts. Add in the unpleasant realities of a biopsy, described above, and the fact that the removal of a prostate can mean a great reduction in achieving and maintaining sexual erections, and also the actual pleasure of the physical act- due to the lack of seminal lubrication, and this is seen as a deal killer in terms of even broaching the subject. Of course, this is FOLLY! Early detection and prevention literally DOES save lives if, as in my case, the digital rectal exam (DRE) is free or, usually, very inexpensive, and there is no reason to NOT get tested annually, save ignorance and fear.
About the only downside to all of this, for me, is that I was born with Hashimoto’s disease, an autoimmune genetic condition which basically means that my hypothalamus does not signal my thyroid to signal my testicles to make enough testosterone, which can result in my getting more tired than usual (my wife jokes on how unlivable I’d be if I had normal testosterone rates). I had been taking androgel for a number of years to combat this, but dropped that as, ironically, added testosterone can increase the odds of prostate problems – from cancer to glandular enlargement. I have a layman’s hunch that the waviness in my prostate was a result of the higher than normal testosterone levels that my body experienced. It will be interesting to see if next year’s follow up exam will show that the discontinuation of androgel has resulted in a better prostate. To compensate for the lower testosterone levels I have changed my diet to more vegetables and higher protein intake, and it seems to compensate nicely and naturally. This was not the first time I had to alter my diet, as, some years back, I had to give up red meat to cope with high blood cholesterol and some colon issues (not cancer).
Now, having detailed the first two points in this essay’s title, let me tackle the final one – heroes and heroism. In the few months since this medical scenario played out, I had been wanting to write on it, in order to urge all men (especially those over 40) to follow through on regular prostate and medical exams, but, as I was working on my book, and other issues arose. I had less time. Then, in the last several months, two issues arose. The first was the death of Roger Ebert, from another form of cancer, and the second was Angelina Jolie’s odd, but swift, reaction to even the threat of cancer, and how people reacted to both things.
Both celebrities were called heroes. Ebert for speaking of his illness (although its ravages made that unavoidable) and Jolie for supposed bravery. Yet, neither person, nor their actions, fits the definition of hero:
1 a : a mythological or legendary figure often of divine descent endowed with great strength or ability
b : an illustrious warrior
c : a man admired for his achievements and noble qualities
d : one who shows great courage
2 a : the principal male character in a literary or dramatic work
b : the central figure in an event, period, or movement
3 plural usually he·ros : submarine
4: an object of extreme admiration and devotion : idol
Definitions 1a and 1b are clearly out, and 1c is sketchy as neither Ebert nor Jolie had any great achievements. Ebert was a noted critic, but not a great one, and, likewise, Jolie a noted actress, but even less accomplished in that field than Ebert in his. 1d is out because Ebert showed no courage in merely admitting his obvious illness, and Jolie could have kept her matters private, but has reaped a great PR windfall for her supposed “courage.” Definitions 2 and 3 are totally out, and definition 4 is possibly barely applicable, in a very loose sense, in that Ebert cultivated a minor cult of personality on his newspaper-based personal blog, and that Jolie is reckoned a sex symbol with millions of male admirers.
But, missing in these definitions of hero is the vital element of risk. It used to be that a hero was someone who did extraordinary things, things above and beyond the norm, with real and considerable risk to himself – his person, reputation, or in some manner. An orphanage is burning, and a passerby runs into it to save some children. That is Heroism 101. This all came to me because, in mentioning my aim to write of my prostate experience, a few people claimed I was “courageous” or “heroic,” and this is simply not the case, and a bastardization of language. Granted, I have a number of incidents in my past that could be claimed to have been genuine acts of heroism, at considerable risk to my person, health, and life, but writing on my health is NOT one of those incidents. This essay is not an example of courage nor heroism, just decency, as I can gain nothing, materially, from its contents – unlike Ms. Jolie’s actions, and I risk nothing by its composition and publication. One might rightly call me a role model for its writing, but certainly not a hero.
Similarly, neither Ebert nor Jolie are/were heroes, but, possibly and arguably, role models. This is an important distinction to make, because the word hero has been bastardized – anyone in a uniform, regardless of their character or actions, is labeled a hero: military personnel, law enforcement officers, firefighters, medical personnel, yet, the risk of death from any of these professions is significantly less, in real numbers, and per capita, than in all industrial-related work accidents in the U.S., and in the world. Doctors and cops and veterans are heroes, yet factory workers, retail workers, and physical laborers are not? Well, the latter half of that equation is correct, and the former wrong. There are hero doctors and cops, but there are also hero production line workers and cashiers. They are all, though, few and far between. Firemen can do great work, about a tenth of a percent of their time on the job, per career. In that moment of crisis, they certainly are more valuable than the guy who fills your produce case. But, the produce worker at the supermarket is ALWAYS providing a needed service (we all need to eat), and he does it, often in pain – with aching joints, swollen feet, or worse. I once worked for almost three weeks with a broken hand, and when examined by a doctor, was told I had incredible pain tolerance, for most people he saw, with far lesser injuries, could barely work. Did that make me a hero? Of course not, just as serving in the military does not make one a hero. Audie Murphy was a genuine hero. Merely getting shot in combat is NOT heroic. It can be, but usually it is just happenstance.
So, to return to the main thrust of this essay, and an obvious non-heroic point: men, go get your prostate examined on an annual basis, to possibly save your life. Despite what we read by pie in the sky Edenists, cancer and other fatal diseases are not going to be cured and eliminated any time soon, so early detection, prevention, and treatment are vital, so that one morning you will not wake up and find yourself dead, nor even headed that way.
