My Diagnosis (March 2008)

(This post served as the basis for the second chapter in The Prostate Storm)

A slightly cracked plastic model of a penile implant rested near the elbow of my urologist, who was about to deliver the news on my biopsy. He dropped his eyes just as he started to speak, so I figured this wasn't going to go well.

"Steve," he says, "your biopsy came back positive. You have prostate cancer."

Nothing, no reaction. I was a blank. Staring at the busted implant.

Not a sickening panic in my gut. No gripping fear. My urologist, Dr. WS, had just told me that the biopsy on my prostate had come back with cancer and....I barely nodded.

I was having a brush with my mortality, and nothing was happening. It was almost disappointing.

Instead, I took out a folded piece of yellow paper and a blue-ink pen and prepared to take notes. Like I was gonna do an interview with a new client.

Either I had lapsed into some kind of serious denial or my coping mechanism for really, really bad news was extraordinarily evolved. I knew it was the former. But taking notes was working for me. My memory is so bad. I need to get the facts first....fret later. Which I did do, thankfully, with many sleepless nights and Ambien. More on that later.

First my notes:
Dr. WS told me one of my 12 biopsy samples came back showing cancer, which I figured wasn’t bad. One in 12, okay. At least it wasn’t a huge tumor, right? But just when I started thinking about the half-full glass, he said the Gleason number was 7, “your cancer is on the verge of being aggressive.”

Aggressive gave me a little jolt. Hello, Steve....shit’s happening here, pay attention....

I already knew that a pathologist looks at the biopsy samples and assigns the cancer cells a rating, based on shape and other factors. The more ragged the shape of the cancerous cells, the higher the Gleason score and the worst your situation. Having a 1-4 is pretty good, 5-7 is the middle ground, 8-10 is the worst case. So I was borderline. But stuck on that word ‘aggressive.’

Dr. WS told me that I couldn’t afford to wait “at my age” to see what happens. ‘Watchful waiting’ is an option for older guys who generally have the slow-growing cells. Fifty-five is relatively young for prostate cancer -- so when it occurs, the cancer is generally more -- here’s the word again -- aggressive.

He gave me a primer on the surgical and radiation options, and immediately launches into the risks, so nothing sounds appealing. As a urologist, he wants to surgically remove the entire prostate for me. Slice around all the sensitive sexual equipment and peeing apparatus, and pluck it out. Visions of incontinence, diapers and a bonerless life danced in my head. I told him I want to talk to a radiation oncologist first, and he said he would arrange that for me.

I also asked him if I didn’t do anything, how long would it take for the cancer to kill me? This was purely roadside rubbernecking, I had no intention of sitting on this. But I want to know. How long would I have? He shrugged initially, but I pressed, Two years? And he replied, Probably, if you do nothing.

Wow. Two years....

Dan Fogelberg immediately came to mind. He had just died of prostate cancer, never had an annual PSA till the cancer was raging -- which was too late. Two years later, the music died.

PSA’s saving grace
Fortunately, I had had my annual PSA (prostate-specific antigen) test every year since turning 50 -- five years ago -- when my family doctor discovered my prostate had become slightly enlarged. Year after year, the PSA level came back around 1.0 -- normal. Then, this December, a spike to 6.6 -- and red flags started waving. I suspected prostatitis, a common bacterial infection of the prostate. So they put me on six weeks of hard-core antibiotics. But the PSA barely budged -- to 5.2 and 5.6 -- suggesting something more sinister than bacteria.

So I had the biopsy and waited. And I read. From what I learned, some 230,000+ men are diagnosed with prostate cancer every year, and about 27,000 die from it. The rest die from something else. Catch it early and the chances for survival are excellent -- up to 95 percent. Hey, you can’t get 100% survivability walking down the street; besides, I've run marathons for 25 years. I'm all fight in the 23rd mile. My chances had to be better than excellent.

Game time
Four days after my diagnosis, I find myself few sitting at a baseball game, watching my son, Nick, take the mound in the seventh inning of a 4-3 game. We're winning. It’s up to Nick now, on a beautiful night in early April. Close this thing down. Three other games had ended in our quad, so all the coaches and dozens of players crowded behind the fence to catch the finish. All eyes on Nick.

All the years of playing baseball, the practices, travel and thousands of hours coaching and playing with Nick -- now here he stood, in full 15-year-old bloom, pitching his brains out on a big game with a big crowd. A gentle breeze starts blowing in my face, and my eyes start to water, as Nick strikes out the first batter who goes down spinning in the dirt. Then he gets the second batter to chase a low-outside curve and ground out to second. One more to go.... Nick's on fire.

Suddenly the emotions of the last four days start to wash over me, as Nick fires two fastball strikes and then drops a sick knucklecurve to punch out the last batter and end the game. Behind the fence, I watch Nick get mobbed by his teammates, as big old fat tears well up and run down my face, until I can barely see him.

Coming Next in Into the Aftershock: Now Choose A Cancer Treatment