What are the early signs of prostate cancer? Absolutely none, as it turns out. By the time this common, slow-growing scourge is giving you trouble, it’s probably far advanced. It may already be threatening your life.
Prostate cancer is an odd one. If it’s caught early, your chances of survival are very high — but so are your chances of having your prostate removed, a solution as crude as it is effective.
A guy with no prostate has no prostate cancer (unless he has metastases), but he may not have a lot of sex either. He may also have urinary incontinence.
My Prostate Cancer Diagnosis
I was diagnosed two years ago, at the relatively young age of 51, after a routine PSA test. I had no symptoms, no urinary issues and no “troubles in the bedroom,” as the health magazines carefully refer to it. But I found doctors curiously unwilling to advise me on what to do.
They load you up with documents about the possible side effects of each treatment option. (Prostatectomy: impotence, incontinence. Radiation: impotence, incontinence. Brachytherapy: impotence, incontinence.) They direct you to online “decision-making tools” that ask you questions about how afraid of death you are and how important your sex life is. They make a lot of hand gestures that signal that you’re weighing equally heavy things.
They tell you: yes, I can make pretty sure your cancer doesn’t spread. But your quality of life will be diminished forever. Then they ask: you sure you want me to go ahead?
The Choice to Do Nothing
The thing is, you can also do nothing and still survive. This was an attractive option for me. I found myself in the care of Dr. Laurence Klotz (with Sunnybrook Hospital in Toronto, Ontario), who is a leading proponent of “active surveillance” of low-grade, slow-growing prostate cancers.
Dr. Klotz has won the Order of Canada for his contributions in this field, though his research remains controversial. (Cancer is inherently dangerous, some doctors say, so why not remove it if you can? This is why the option of active surveillance is not given to all men who have prostate cancer.)
Surprising Prostate Cancer Research
Klotz’s research includes a ground-breaking study that followed 993 men with low-grade prostate cancer over 13 years. Under active surveillance with “selected delayed intervention” (meaning the guys get treated if their cancer grows), 95% of patients survived, which is about the same rate as conventional treatment. Two-thirds of the study’s patients avoided treatment entirely.
Klotz’s process is simple. He gives his patients a PSA test every three months, and conducts a biopsy every couple of years. If he detects a sudden change, he will intervene surgically. Interestingly, my young age is of no advantage to me here. Many doctors don’t like active surveillance for guys who have long lives ahead of them, as it gives the cancer more years to grow.
The Criteria for Active Surveillance
My own cancer met the three Cancer Care Ontario criteria for active surveillance:
- It is not detectable by a digital exam (i.e., there is no lump).
- My PSA score is under 10 and steady.
- My Gleason score (a rating, out of 10, as to how aggressive or fast-growing it is) is under seven.
For me, active surveillance is by no means an easy decision. I feel fear every time I await the results of my PSA test. I know there is a significant chance that the next one will require life-changing action, and that this delay incurs a risk that the cancer has spread without my team of doctors knowing it. I have a small child, and the thought plagues me that for his sake I should take less risks. But life itself is risk. I will live with risk and an active sex life for now. I will be a guinea pig for this experimental science.
The chances are that something else will kill me anyway. Why does that make me happy now?
