Prostate Distillate

If you’re a man, you have a 1 in 8 chance of developing prostate cancer at some point. (Women have a 1 in 8 chance of developing breast cancer.) This will generally happen when you’re older, and in most cases, it will be so slow growing that you will die of something else before your prostate becomes a problem. That’s good news.

It’s still shocking, though, to hear the doctor say you have cancer. My annual PSA test came back with a number that was much higher than the year before, so I knew something was afoot. The news surprised me because I had no physical symptoms of a problem, and I expected to end up in the large “we’ll watch to see if anything changes” group that most men are in where nothing needs to be done. That didn’t happen.

After a number of finger palpitations over the months (digital rectal exams, the dreaded DREs) and a series of scans (bone, CT, PSMA-PET), a biopsy revealed that I had an aggressive form of the cancer. I didn’t have the option of doing nothing. My choice was either surgery to remove the prostate or a combination of hormone chemotherapy and two types of radiation.

Not knowing anyone who had prostate cancer, when I casually mentioned my situation to my male friends, I was surprised to hear how many of them had already been flagged by their doctors and were being monitored. They hadn’t spoken of this before, as if it was an embarrassing secret. But then men generally don’t talk openly about any significant health matter that affects their lives. It would be easier if we shared what was going on because then we would have the support of a group of people.

No cancer is good to have. My friend Michael says that if you’re a man and are going to get cancer, this is the kind to get because it’s treatable and curable, especially if it’s caught early, so I’m not likely to die from it. That’s good news, too. But I was diagnosed at Stage 3. Did we catch my cancer early enough?

Researchers are looking into what causes prostate cancer to set up shop, but the findings are so ubiquitous at this point that they don’t offer anything useable. Genetic and genomic screening can tell us who is most likely to develop cancer, but they can’t say if any of these people will. I’ve looked at the stats and know that after I’ve taken care of this cancer, after doctors say “there’s no evidence of any cancer remaining,” that I have a thirty percent chance of it coming back.

While both of my choices, surgery or radiation, had comparable, positive outcomes, what I worried about most, outside of the pain and discomfort of the procedures themselves, were the effects of the treatments on my body. Incontinence and erectile dysfunction are common for those who have surgical removal. There are more bowel and bladder complications with radiation. The PET scan took away the option of surgery because it found cancer cells outside the prostate.

Three years later, my treatments are over. I had brachytherapy, where eighteen radioactive wires were inserted into my prostate for a time, then five weeks of daily photon radiation. Hormone chemotherapy started off with Casodex and then eighteen months of Lupron, and I’m still dealing with the impact, the aftereffects, and the side effects of the treatments. While some disruptions have gone away, others have not, and my doctors tell me to give them more time to fade away. While my PSA has remained low, it continues to go up and down, and not all of the categories on my blood tests have returned into normal ranges, especially my immune system that is replenished by my bones. I will have to wait to see if all of my body’s regulatory and metabolic systems reset, and wait several years to find out if my cancer is truly gone.

Rather than dying in old age as body parts wear out, I have something that might end me sooner. There is anticipatory grief in this because of the dreaded “what ifs” — what if I only have five years left to live? What if I’m left with physical limitations that I have to deal with every day? What if I never feel truly healthy?

Cancer will forever be a horse that is grazing in my back meadow.

© 2025 Mark Liebenow