Around most offices there are some tasks so miserable that the only consolation is that it’s better than a sharp stick in the eye. But still other jobs deserve an even darker assessment. A few of the guys at our office say, at the mention of some particularly onerous task or another, that we would prefer to go off for an elective cystoscopy, if only we had the choice.
Cystoscopy — the insertion of a scope through the penis, past the prostrate gland, and into the bladder. The mere thought of it sends the heebie-jeebies through the bones of most men. That’s why I simply shrugged at the June 9 article in this paper on the annual Run for Dad, the Fathers’ Day event intended to promote prostate cancer awareness and to encourage men of a certain age to have their blood PSA checked and a digital rectal exam (DRE) conducted once a year or so.
In our office I am older than the other guys by 20 years or so. That makes me — at 63 — the eminence grise on matters of PSAs and DREs. I got into the annual routine a decade ago, when I began to identify with the commercials aired during major league sports events — the guys who don’t have a “going problem” but really have a “growing problem,” an enlarged prostate that often accompanies middle age or beyond.
Now, before I share my personal perception of PSA scores, DRE, and more, let’s allow the women readers to skip the rest of this article. It may well be TMI — too much information. On the other hand, some women — most of whom endure “procedures” that make the male counterparts seem like walks in the park — may want to stick around. In fact, says Glenn Parker, one of the founders of the Run for Dad event, “When I speak to a group I’m happy to see women in the room. It’s often the women who drag their guy to the doctor.”
Now, about that digital rectal exam: It’s no big deal. In less time than Henny Youngman could recite a one-liner on the subject it’s over. I only will add one word of advice from my old friend Jeb Stuart. Make sure that you don’t rely on the PSA tests alone; always get a DRE to go with it. I consider Jeb a true expert witness — he died of prostate cancer in 2008.
For most men the PSA test has to be the easiest part of the package. They draw the blood; you get the results a few days later. But it’s worth more discussion. People who live their lives by the numbers will tell you that a PSA of 4.0 or below is golden — not to worry.
So when my first PSA test came back at 0.8, I might have been elated. But I knew, for example, that General Stormin’ Norman Schwarkzkopf had been diagnosed with prostate cancer despite a PSA reading in the 1 to 2 range. And I knew better than to live by the numbers. For years my cholesterol has been in the 125 range, well below the so-called 200 danger zone. But that didn’t stop me from developing a 95 percent blockage in a coronary artery. (Since then my cholesterol has dipped a little lower, but the HDL, the good cholesterol, has gone up; the LDL, the bad stuff, has gone down.)
Ever since my first PSA reading my level has stayed at around 0.8 — until this year when a routine physical returned a 1.4. The physician, who hadn’t seen me before, at first said fine. But then I reminded him of my succession of 0.8s. Better see the urologist, he said. A relatively large increase in PSA can suggest a problem more than the absolute value alone.
At this point I fell into testing hell, the kind that makes some experts argue that the PSA test should not even be administered since there’s little evidence that anyone who has the test done fares any better than the people who don’t have it done, and because there are side effects to the treatment prompted by the test.
I saw the urologist, who performed a DRE, which was negative, but also took a urine sample, which showed a trace of blood. He winced, observed that blood in the urine could be caused by many things (including the Plavix blood thinner I take every day), and took another sample of blood for a PSA.
A few days later he called with the results. The PSA was back to 0.8. That result, coupled with the negative DRE, apparently made him think that we could revisit the matter in another six months. At that point I blathered on a minute about the value of testing (in my mind thinking about the PSA and DRE) and how I would rather know more than less. The urologist, however, was thinking about a different test:
“You’re right,” he said. “Why be in doubt? Come into the office for a follow-up look. It will only take five minutes or so. A cystoscopy — not a big deal.”
Easy for him to say. For me, veteran of more digital rectal exams than _______ (insert your favorite one-liner here), the prospect of the full frontal probe was suddenly no laughing matter over the water cooler. I did what probably no one should ever do while contemplating a medical procedure. I Googled it. I came away with a boatload of horror stories — the word that stuck in my mind was harpoon. For three weeks I agonized over making the appointment. Finally I decided that the procedure itself couldn’t be any worse than the mental agony I was enduring. In addition, what if something were wrong, and I discovered it six months from now? What kind of agony would be caused by giving a dangerous disease a six-month head start?
So I girded myself for the worst. When the magic moment came there was lots of lubricant, a little discomfort, and then a sting, not unlike the stinging that probably every man has felt at some time or another while urinating. And in five minutes or so it was indeed over. No big deal, just as the doctor had promised. Better yet, no visible evidence of anything wrong.
Afterward I re-Googled the procedure. I saw the same horror stories, but — to my amazement — I realized my apprehension had caused me to ignore the posts from guys who had come to the same conclusion I had: No big deal. So guys, run for dad, run for yourself, and run on down to your physician and get checked out. It’s better than, well, a sharp stick in the eye.
Run for Dad, Mercer County Park. Sunday, June 20, 7:30 a.m. Annual Father’s Day 5K run and 2K walk to increase awareness about prostate cancer and raise funds for American Cancer Society’s research, education, and screening projects. Register. 732-951-6370 or http://community.acsevents.org/runfordadnj.