The day began positively average and uneventful. Dressed and ready for work, I mentioned to my wife, “I’ll be home a bit later than usual – I have an appointment with the urologist.” I was in my late 50’s and seeing a urologist for the first time after a referral from my primary care physician. Digital rectal exam? PSA test? What was I in for? I trusted the doctor who referred me and was confident in our doctor-patient relationship. And I resolved never to laugh at another joke about stirrups! As I closed the door behind me that morning, I felt optimistic it would all be over soon.

This is the first of several posts documenting my journey, beginning with the prostate checkup, including the primary care doctor’s initial digital rectal exam (DRE) and referral to a urologist, additional tests such as the blood-based prostate specific antigen test (PSA), biopsy of the prostate, and my eventual choice for active surveillance.

Time for a digital rectal exam (DRE)

Weeks earlier during my annual physical exam, my primary care doctor asked if I’d ever had a digital rectal examination. I told him I had not. He went on to explain that medical guidelines suggest such an exam for men over 50 years of age or with a family history of prostate cancer. Since my parents had passed, and my brothers had no prostate cancer, I knew nothing about a family history. As for general health, I was a daily jogger in good condition and kept up a healthy lifestyle.

After doing a quick DRE, the doctor said he “might have felt a lump.” He mentioned referring me for further examination. I didn’t know anything about the DRE or the prostate, so I accepted his advice, and his nurse scheduled me with a local urologist.

What is a prostate exam? I soon found out.

I arrived at the local urologist’s office early to fill out paperwork, including the family medical history and medical insurance documents.

The doctor greeted me in the exam room and pointed out a wall chart of the male reproductive system, including location of the prostate. “So, what brings you here today?” he asked. He calmly pulled out a box of latex gloves and listened to my DRE story. I felt a fleeting shot of anxiety when he asked me to drop my pants and underwear and lean over the exam table. He told me I would feel his thumb enter my anus as he felt around what I soon discovered to be my sensitive prostate gland. Oh, Willy!

After completing the more extensive exam, he handed over a large wad of tissues to wipe off the lubricant.  He said, “Your prostate is perfectly smooth.” I knew some tumors of the prostate could be very small, so while the news sounded good, it was not foolproof – the DRE was not a definitive test for everyone. For a moment I relaxed and looked longingly toward the door. But he continued, “We’ll take a simple blood draw for your PSA test and call you with the results. Any questions?” Well, no, I decided, not after that experience! I drove just a little faster than usual on my way home.

PSA test range and elevated levels

The urology office receptionist called several days later to say I needed to come in. She mentioned the PSA test results indicated a level of 3.4 ppm. I asked for more information about the score, but she said it would be best to see the doctor about any questions. After the call, I spent hours online looking up the PSA test. I found many websites and explanations – some frankly rather ominous (I’ll will take a deeper dive into the PSA test in a future posting on this blog).

Later that same month I met with the urologist. The doctor said my PSA was almost double that of most men my age, and that I should schedule a biopsy of the prostate in his office. I made an appointment, then rushed back home and into internet research! However, there were many viewpoints by different doctors and researchers about the effectiveness of the PSA test. I resolved to ask my doctor the next time I saw him.

The prostate biopsy

The endorectal biopsy, also known as a core needle biopsy, was painlessly performed in the urology office. Afterwards I was able to return home.

A few days later the urologist met with me again. He told me I had “hgpin” in three out of twelve samples, that I had “nothing to worry about,” and he would see me in another year for a confirmatory biopsy. He gave me a copy of my pathology report on the biopsy. I went home and again spent hours searching the internet for “hgpin,” PSA test scores, and personal posts by men who had been treated for prostate cancer. Finally, my wife told me to stop worrying, because the doctor was not suggesting any treatment based on the pathology results. Easier said than done.

Each man will face decision points along the care process for prostate cancer depending on test results and shared decision making with a doctor. Join me next time to read about the “confirmatory biopsy,” getting a second opinion about test results, my choice of active surveillance and more decision points along the process of caring for the prostate gland.

Author bio:

Geoffrey T. McLennan, MPA

Geoff is dedicated to helping families and friends support a prostate cancer patient. He joined the board of Active Surveillance Patients International (ASPI) in 2018 and is an 11-year PCa patient. As a PCa patient advocate, he envisions providing a broad understanding of how patients can collaborate with clinicians for realistic medical care. He enjoys meeting and learning from his clinicians, cancer researchers, providing free online programs for patients, and reminds us that “to live, learn and thrive with PCa” is the motto of ASPI. He is glad he took science courses for understanding a healthy lifestyle that includes exercise and diet.

Geoff also volunteers as a board member and past chairman of the Placer County Mental Health Advisory Board where his interest includes therapy and resources for AS men, and a broad oversight of community mental health programs and innovations. He is married to Constance McLennan, a fine artist, has a grown son, and lives in Northern California.

Want to read more like this? Read “What is Active Surveillance?”

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