Prostate Cancer Biopsy

Yesterday I had a consultation with a doctor and a nurse practitioner at York Hospital. I viewed the MRI scan of my prostate. Reading a report about an MRI and viewing an MRI are not the same thing. It’s similar to the difference between reading a summary of a baseball game and actually being there in the stands. I saw the two lesions on my prostate. They were bright spots on a dark oval, and that’s a cause for concern. It gave new meaning to the phrase “bright spots.”

I’m going to have a biopsy on November 18th. That’s what I really want to talk about, because I’m not writing this blog to only report on my condition. Believe me, I’d much rather be writing about writing. This is about the second most common form of cancer in men after skin cancer–prostate cancer.

These next three paragraphs are what I recall my urologist and the doctor I met yesterday telling me in conversation. If I’m wrong, I hope some doctor out there will correct me. To get started, the medical “gold standard” for detection of prostate cancer is a biopsy. It’s been that way for 20 years. You wouldn’t know it if you’re young and healthy, but trust me, most medical procedures have advanced tremendously in the last 20 years. I have first-hand knowledge of that. Not so much for prostate screening.

Most biopsies consist of small needles, from 10-12, used to collect tissue samples from the prostate. These samples are then analyzed. The prostate is about the size of a walnut or golf ball. I’m going to use a golf ball for my example. Ever look at the dimples on a golf ball? There are quite a few of them. Now imagine taking 12 samples from twelve dimples. See what I’m saying? It’s not hard to miss something. Yesterday I was told that regular biopsies miss 40% of cancers. The doctor who used that figure is a very firm believer in imaging. He said the ladies have it down pat with breast cancer screening, but men have a long way to go when it comes to prostate screening.

Since I had an MRI, the doctor will be using the images of the MRI to take samples from the specific areas which seem suspicious. In other words, the golf ball dimples get colored in beforehand, and that’s where the needles go (I’m told they also go into other areas).  A recent study published in the Journal of the American Medical Association concludes using MRI with ultrasound produces better biopsy results.

I hope this educates at least one guy out there. Ladies, you may have to help. Men, at least consider a PSA test. All you do is give a blood sample. That’s the starting point. Although prostate issues can be very confusing depending on your age, race, and family history, unless you trust Larry King or some other talking head on TV with your health, it’s something men should consider.

Prostate Cancer

Okay, here’s the thing. I lost a very close friend to this disease one year ago. It’s been on my mind before my PSA started to rise. I’m not a doctor, of course, so I’m not going into areas where I’m not qualified. I suggest if any men or their significant others have concerns, check with a urologist. At least Google some basics, such as PSA.

My PSA started going up a few years back. One point something to two point something–nothing big. The routine is when your PSA gets above four, that’s a possible warning sign. All of this depends on your age. Does this sound confusing so far? Good. Because it is. There is not much that’s certain when it comes to the prostate from what I gather. But here’s what happened to me.

My PSA shot from three point something to five. Not good. So I waited six months. Boom. Now it’s seven. I knew about prostate biopsies. They are, shall I put it, hit or miss. My friend had a biopsy after his PSA went up–negative biopsy. One year later, his PSA hit the roof. Two and a half years later, he was gone.

The biopsy can easily miss a cancerous spot or tumor, if you prefer the more serious term. I went with another test. Google it, guys. MBT prostate cancer. It’s a test following a DRE (do I have to explain that pleasant acronym?) where you pee in a cup and send it to a lab. Mine came back 45% chance of cancer.

On to the MRI. A prostate MRI is quite accurate according to everything I’ve read. I had one. The MRI measures any detected lesions/spots/tumors in terms of PI-Rads, 1-5. 1 PI-Rad is best. Pi-Rads of five aren’t. I have one spot with a four, and one with a five. The good news is, hopefully, this was caught early. I have a biopsy coming up, and that will dictate treatment, obviously.

So my points are these: 1. Get your PSA checked. If it goes up, there are choices other than an immediate biopsy. 2. Read up on the topic if you are faced with a problem. Prostate cancer is VERY curable. 3. Don’t put your head in the sand about your health. Be proactive.

I’ll let you know how all this comes out.

Lieutenant Columbo, Meet President Trump

I haven’t watched TV at dinner time with my brother since the last big election. We’re both retired. We watch a lot of TV. If it were up to my brother, he would never flip from his favorite news channel. Without fail he argues with different viewpoints than those found on his channel. Often, he argues with me before I speak.

We used to watch the detective genre. I like to see the bad guy get caught. “Murder, She Wrote,” “Hart to Hart,” “McMillan and Wife.” Sometimes I’d pick newer shows such as “CSI: Crime Scene Investigation.” Unfortunately, some of the newer crime shows are very detailed, very scientific. My brother always refused to watch CSI.

I remember my last dinner-time detective show we watched together in the kitchen. It was an episode of “Columbo.” It was very interesting. The murderer was a magician. If you have never had the pleasure of watching “Columbo,” the show’s premise is very simple. In the show’s beginning, a murder is committed. We, the TV audience, witness the crime, the alibi, and, of course, the criminal. We know who did it. The fun is in watching the seemingly inept detective use his smarts to catch the criminal and bring him or her to justice.

This magician was very clever. While supposedly locked in a trunk and then lowered into a tank of water, he killed the nightclub’s owner. But the constant objections of my brother regarding the magician’s guilt during this episode made it very difficult for me to enjoy the show.

We witnessed this magician leave his trunk before the trunk went into the water. We watched as he climbed down a step ladder, went into his basement office, changed into a waiter’s uniform, and snuck upstairs to the owner’s office. He picked the door lock and shot the owner. All this time, the magician was supposed to be locked in a trunk in a tank of water. Despite what we witnessed, my brother wasn’t convinced the magician was guilty.

“I don’t know how you can say that the magician isn’t guilty,” I told my brother.

“It’s simple,” he shot back. “He’s a magician.”

Without trying to sound boastful, I challenged my brother immediately. I reviewed every point of the magician’s steps he took to commit the crime and conceal his guilt. Each time I was met with my brother’s objections. I pointed out that we saw the magician climb down from a trap door out of his locked trunk.

“I didn’t see him leave the trunk. I saw him climb down the step ladder.”

“We watched him put on the waiter’s uniform.”

“I saw many other waiters,” my brother countered.

“We saw the magician shoot the owner.”

“I saw the magician fire a gun. Then the owner fell.”

Imagine my frustration. I tried to explain to my brother the act of pre-meditated murder. The person guilty of the crime must plan or consider the act beforehand. He cannot act out of emotion, nor can the death result from accident or carelessness. The corpus delicti, as the deceased is sometimes called, must be the direct result of a conscious, mindful act.

Over the course of the show, every time we watched Columbo prove part of the magician’s alibi a lie, my brother refused to accept it. He claimed every revealed clue could be a lie. “Don’t be stupid,” he told me.

I told him not to call me stupid. “Columbo follows clues. He doesn’t lie to the TV audience.” Otherwise the rumpled, cigar smoking character whose name also serves as the show’s title would lose all credibility.

He pooh-poohed me. “Clues don’t matter. People use fake clues to throw everybody off track.”

I had him. “That’s exactly what’s happening on the show. The magician’s trying to throw everybody off track. Columbo has to follow a reasonable path. The clues have to add up. They have to make logical sense.”

When a commercial came on, my brother changed to his channel. The brand new President was speaking. He had recently made his inaugural address. I had watched part of the address and recalled it had rained. As a bit of harmless small talk, I mentioned that very fact to my brother. “Too bad it rained for his speech.”

My brother shushed me.

“But we had a massive field of people,” President Trump continued. “You saw them. Packed. I get up this morning, I turn on one of the networks, and they show an empty field. I say, wait a minute, I made a speech. I looked out, the field was—it looked like a million, million and a half people. They showed a field where there were practically nobody standing there. And they said, Donald Trump did not draw well. I said, it was almost raining, the rain should have scared them away, but God looked down and he said, we’re not going to let it rain on your speech.”

“Hah! It didn’t rain during his speech. You don’t know shit,” my brother laughed.

I said, “I remember seeing open umbrellas and ponchos covering people in the audience during the inauguration. Please get my show back.”

“A lot you know,” my brother laughed. “So much for clues.” After he switched back, he pointed at the TV. “Look, Columbo’s wearing a raincoat. I suppose it’s raining inside that nightclub they’re in. That would be some magic.”

After his ridiculous remarks, I left my brother and took my dinner into the den. I heard him change channels. After watching this program for well over an hour, my brother was content to skip the end. This annoyed me. Determined to have my brother witness the inevitable outcome where the magician is proven to be the murderer, I finished eating and waited until the last five minutes of “Columbo” before I returned to the kitchen. As I put my plate in the sink, my brother stood up and handed me the TV remote.

“Go ahead. Watch the end of your program,” he said. “I’m going to take a shower. I’ve seen this one before.”

I’ve eaten in the den ever since.

 

This essay, originally titled, “No Clue,” appeared in different form in From All Corners, a collection of five finalists in an Unsolicited Press essay contest.