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

Although September is known as Prostate Cancer Awareness Month, I have chosen to tell my prostate journey for Movember, Men’s Health Month.
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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 of this. 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 licence medical examination when my doctor asked , “Ever had a PSA test?”

“What is that?” I responded.

“A simple blood test to check for prostate cancer,” she said. “It can be done at the local lab in a couple of minutes.”

The doctor explained that a PSA — prostate-specific antigen — test should be completed on all men when they reach their 50s as it can detect antigens that a prostate produces when cancer is present. But, the doctor cautioned, this test may not tell a complete story. 

“Any family members ever had prostate cancer?” she asked.

“Don’t recall,” I said.

The risk of developing prostate cancer is greater if other family members have had it, and this risk increases with one’s age. I was already 59.  The doctor filled out the form and off I went.

A quick search of the internet, a bit of reading, and I got more up to speed on my prostate.

Men have prostates, women don’t; it’s part of what makes us different.  In short, the prostate gland is about the size of a walnut and located adjacent to the bladder, and integral to the male reproductive system.  It adds fluid to semen to help neutralize its acidity, and helps propel this fluid out through the urinary canal during ejaculation, as the fuel injection system is to a car's engine.

My results came back with a score of just over 4, which meant that it was of interest, but not too disconcerting.

“We better keep track of this,” the doctor said. She scheduled me for another PSA test next year.

By September 2015, my PSA is up to 10.4.  “Better go see a urologist,” the doctor said.

We searched the urologist directory, and chose one based in North Vancouver and book an appointment for January 2016. Although the closest urologist is in Prince George, travel from Fort St. John to Vancouver is as easy and cost effective as Prince George.

After introductions with my urologist, the first question was interesting.  “You related to Stener?” he asked  “Yes,” I replied. “My father.”

“Removed his prostate in the early 90s,” the doctor said. I had forgot about that. I was living up north and my father died shorty thereafter, from issues unrelated to his prostate.  I couldn’t recall Dad talking to me about his prostate and his operation, and I never asked any questions.

A quick finger check of my prostate showed no signs of enlargement or hardness. Things appeared normal for a person my age.  Our discussion then turned to what the prostate does, and what prostate cancer can mean.

Most men — if they live long enough — will develop some sort of problems with their prostate. About 1 in 9 will develop cancer, and if left long enough with no intervention, about 1 in 39 will die.  Prostate cancer is men’s most prevalent cancer and the leading cause of cancer-related deaths.

My next step was a biopsy at Lion’s Gate Hospital in April 2016 to discover what was going on.

A biopsy is not an enjoyable process and is about on par with a colonoscopy.  An overnight fast followed by a couple of enemas allows for a device to be inserted through the rectum and into the colon.  This device then shoots a hollow needle out through the colon and into the prostate on a grid pattern, guided by ultrasound.  It kind of sounds and feels like an industrial stapler being shot off inside you.

The results from my first 12 core samples showed 3 mm of cancer on one of the samples.  My Gleason score was 3+4. This is used to rate prostate cancer on a scale of 1 to 5, with 5 being highest, and it suggested an intermediate probability of further growth.

I have cancer.

I  would have never guessed. 

I feel fine.  Nothing wrong with me.

All body functions are working.  

Doesn’t seem real.

After further discussions with both doctors, and armed with this information and these thoughts, it was agreed we would adopt the “watchful waiting” approach, rather than proceed with any direct treatments.  I would do PSA tests every three months with another biopsy in June 2017 to monitor for any further changes.

It was back to Lion’s Gate for another biopsy with my PSA relatively steady at 10.99.  The results showed about 1mm of cancer on one of the 12 samples, and a Gleason score of 3+3, suggesting a low probability of growth.  Good news. 

I would continue with PSA tests every three months for another year, and if there were no real changes, then once every year after that.  I would schedule another biopsy in 5 years.

Three months later, my PSA was up to 12.28. In December 2017, it was up once again to 14.07.

“Something is going on in there,” the doctor said. “We need more tests, but this time, we’ll try an MRI. There have been some great advancements in prostate cancer detection and monitoring.”

The earliest time and place available was October 2018 at Vancouver General Hospital.  The doctor said there was no need for more PSAs as they weren’t sure if they were telling a true story.

My MRI revealed dark shadow on my prostate.  It was nothing definitive so we scheduled another biopsy in a month.  It was the same process but with more samples taken from this dark shadow, 16 in total.  Three of them showed positive, with 12 mm of cancer and a Gleason score back to 3+4. This meant intermediate risk for further growth.

In my March 2019, my PSA was now up to 18.32, and with that, both my doctors said no more watchful waiting.  I needed to face the reality that this cancer was growing.

I needed to address this issue, either through surgery or radiation.

Evan Saugstad is a former mayor of Chetwynd, and lives in Fort St. John.

• • • •

Read Part 2: Making a decision by clicking here.

Read Part 3: My surgery by clicking here.

Read Part 4: Life without a prostate by clicking here