I have prostate cancer.

Recently my PSA (prostate-specific antigen) level has been rising. The number hasn’t reached a scary level yet, but the rate by which it is increasing is rapid, indicating I may have an aggressive cancer.

PSA levels aren’t particularly reliable indicators but they do indicate when further tests are needed.

A biopsy found cancer cells. I’m one of the red guys on the bottom right of the chart. Dang.

Cells removed during the sublimely unpleasant needle biopsy found cells with Gleason scores of three and four. Much to be wished is a prostate full of healthy little green glands like those on the left of the figure. My tumor contains cells that look like the yellow and orange ones.

Appearances of Prostate Cancer Cells
with Corresponding Gleason Scores

Cat scans and an MRI were negative for metastasis. Looks like the disease is confined to the prostate.

My Baylor University urologist, a top specialist in treatment of prostate cancers, gave me the bad news and saddled me with the task of choosing a treatment option. I have spent the last six months (when not running around Australia) learning more about the subject than I ever wanted to know.

Post-mortem data suggest half of all men in their fifties have prostate cancer; the rate is 80% by age 80. But only 1 in 26 men (3.8%) die from this disease. In other words, men are more likely to die with prostate cancer than from it. For many patients, cancers detected early need only be watched because they grow so slowly. Those lucky men will die from something else before the cancer catches up with them.

Because my cancer is aggressive, I’m probably among the 3.8% likely to die if left untreated. The good news is it was detected early. It appears to be localized, so the prognosis is good. The bad news is I’ll have to treat it. The options all involve killing or removing the prostate—disappointing since I’m rather attached to it.

I’ve elected surgery: radical prostatectomy.

I’m not the best candidate for surgery. Abdominal scarring and adhesions from two prior operations rule out laparoscopy and make conventional open surgery difficult. My heart is damaged from an old heart attack, so general anesthesiology might be problematic.

Given those problems, radiation therapy might have been a better choice if quality-of-life considerations are left out of the equation. But radiation is more likely to cause incontinence and erectile dysfunction. Besides, post-surgical biopsy of the prostate has the possibility of showing that the cancer truly was confined to the gland, putting an end to worry.

The procedure is scheduled to be performed at St. Luke’s in Houston on July 16th. Laura and I are going to luxuriate at the Magnolia Hotel during pre-op and recovery. I mean, you only get to lose your prostate once. Might as well enjoy it.

We live in an age of miracles. I have survived three diseases that would have killed my grandfather. Prostate cancer is life-threatening disease number four, and I expect to survive it as well. Today’s medicine has allowed me to become more physically fit and active than I was at age 50. Even with all the ailments I’ve had, I expect to blow right past today’s median life expectancy of 87 years.

Just minus a few parts, that’s all.