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Evan Saugstad: More waiting, more tests, more decisions in my journey with prostate cancer

It kind of feels like the bully has got you pinned and is asking which eye he should blacken
Evan Saugstad: "Please support Movember as Men’s Health Month, give generously, and help fund cancer research. If you are over 40 and have not had a PSA test, ask your doctor to prescribe one."


In November 2019, I chose to tell the story about my experiences with prostate cancer. It began:

"Although September is known as Prostate Cancer Awareness Month, I have chosen to tell my prostate journey for Movember, Men’s Health Month. I have also chosen to discuss subjects that are not normally found in our local newspaper; one’s personal health, one’s sexual health and one’s cancer. 

"Movember is the month where the largest percentage of donations are made in support of curing men’s cancers and improving our health. Please support Movember.

"If the discussion of a man’s body parts, or medical procedures or men’s sexual health offends you, then skip the rest. Just be assured I am still alive, still kicking and still adjusting to life with cancer and cancer treatment.   

"My prostate journey started rather innocuously in August 2014. I was in the middle of a driver’s license medical examination when my doctor asked me, “Ever had a PSA test?” 

My prostate was surgically removed in June 2019. The first four parts of my story were published in Alaska Highway News in November. 

Part 1 - My prostate, my journey: I have cancer?

Part 2 - My prostate; my journey: Making a decision

Part 3 - My prostate, my journey: My surgery

Part 4 - My prostate, my journey: Life without a prostate

I left off in 2019 with my first post-surgery PSA (prostate-specific antigen) test coming in at 0.09, considered about normal after prostate removal. Two years later, that was the highlight. Since then, my PSA slowly began its upward creep. Not by a lot, just a steady increase.  

Since one’s post-surgery PSA is normally less than 0.1, it wasn’t long before the doctor concluded my cancer had not been vanquished; it still existed somewhere in my body. Surgery likely never got all that had escaped the confines of my prostate. Most likely, but never for sure, hiding somewhere near.

There was no certainty in the long-term outlook either. It may stay as background noise with no change, it may eventually disappear, or it may continue to grow and eventually begin to impair bodily function. The latter means it is something I must watch for and address with time. With that, another referral back to the BC Cancer Agency in Vancouver. 

As before, I was advised I could still do hormone (androgen deprivation) therapy to eliminate testosterone from my body to slow cancer growth, the side effects being loss of muscle mass and body hair, bone thinning, increase in body fat, fatigue, and no more erections. Hormones won't eliminate the cancer but can stop or slow it from growing and spreading, at least for a while. Maybe be good for a couple years, maybe 10, no way to know with certainty. 

Or, I could use targeted radiation with side effects being the possibility of bladder or colon impairment or destruction. That treatment takes six-and-a-half weeks (five days a week) in either Vancouver or Prince George. Not being certain where this cancer is hiding is the issue. There’s about a 60-70% chance beam radiation would hit the correct spot and zap the offending cells, and only a 30% chance I would still have cancer after surgery. 

With no immediate rush, I booked an appointment for a PET (positron emission tomography) scan, technology that is still in its trial stage in B.C. It’s a six to 10 month wait as the BC Cancer Agency is the only place capable of doing this. 

A PET scan is like a CT scan, the difference being a PET scan uses a radioactive drug (tracer) that binds to cancerous spots, making them more visible and easier to find. It took longer than expected as at first the machine was broken, then there was COVID, but finally I went for another trip south in January 2021.  

The good news was that nothing showed. The bad news was that nothing showed either, but with my PSA still climbing, the cancer was still hiding somewhere. My PSA was 0.32 in September and 0.38 in December 2020. It was up to 0.58 by April 2021 and the doctor suggested we begin looking at radiation as I haven’t been a fan of hormone therapy. After your PSA goes beyond 1.00, targeted radiation is less likely to be successful. I began contemplating when this would be the best fit. 

I waited for June’s PSA and, surprise, surprise, it had dropped to 0.50. My hopes went up, but the doctor wasn’t sure why it dropped: it could be accurate, or it could be false. Either way, I held off on the radiation to see what happened with this past September’s PSA. 

Crap — it jumped to 0.83. Not good. Big jumps are never a good sign. OK, time to look to radiation, I thought, but first a CT scan to see if it can locate any cancer at, or outside of, the prostate area. At least this one could be done here in Fort St. John on Nov. 4. 

It kind of feels like the bully has got you pinned and is asking which eye he should blacken. The good news would be if nothing shows, and I still go for the six and a half weeks of radiation. The best news is maybe cancer shows up at the former prostate site and is still eligible for targeted radiation. The bad news is cancer is found somewhere else in my body — maybe radiation, maybe not, maybe move on to hormone therapy and give up another part of who I am. 

I called to schedule with the doctor on Nov. 9. There’s not much left to the imagination that hasn’t already been discussed. It’s like flipping a coin — heads, you win; tails, you lose — just hoping the wager isn’t too large.

I was out for my morning deer hunt when the doctor called, a couple hours early. The CT image showed shadows on my pelvic bone. The doctor suspects they may be an anomaly but, to be sure, ordered a bone scan for a closer look. That, and another PSA test, and we can talk again in early December. Then the usual conversation: are bowel and bladder functions normal? Anything else abnormal? Yes, yes, and yes, getting older and more things hurt. 

And so, my journey continues. More waiting, more tests, more decisions. The good news - I will be able to finish deer hunting season before I have to leave town. 

Please support Movember as Men’s Health Month, give generously, and help fund cancer research. If you are over 40 and have not had a PSA test, ask your doctor to prescribe one. If you wish to skip that part, book your own appointment and pay the $35 and get your own.

Evan Saugstad lives and writes in Fort St. John.

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