Gabriel Garnica
To men and those who love them
By Gabriel Garnica
I usually come to this site writing about conservative values and liberal rationalizations, but this time I do so as a prostate cancer survivor. In January of this year I was diagnosed with prostate cancer and thus began the hellish roller-coaster that all men so diagnosed undergo between that diagnosis and the eventual treatment. I was not supposed to get this thing. After all, I am not yet 50 years old, have no family history of cancer, and seemed in good health. According to the guidelines, my elevated blood PSA was perhaps a sign of the enlarged prostate so many men face as they approach half a century of time on this rock in space. The problem with prostate cancer, with all cancer for that matter, is that it does not know what "supposed to happen" means.
Better Safe Than Sorry... A New Guideline
The guidelines tell you to start worrying when you hit 50 years of age. They also tell you that you should start worrying when a chemical in your blood called PSA goes over 4. I am no doctor, but my experience and research has taught me that both guidelines are misleading. I know people under 50, me included, who got prostate cancer. I also know even more people, including a close friend, who got prostate cancer with a PSA below 4. That alone should tell you that both guidelines are not as accurate measures of problems as many believe.
The problem with prostate cancer, the reason why it killed so many more men in the past, is that it grows in your body while you feel just fine, and rears its ugly head to real detection when it is too late. This is why only going to the doctor when something feels wrong is not a good idea. This is why all men 40 or more should have an annual physical and request a yearly PSA test. Many doctors will smirk and say that you do not need it until you are 50. You will say never mind and I want it now. So forget that age 50 talk. Start when you are 40.
As for the controversial PSA blood test, it is true that an elevated one need not be prostate cancer. However, it is also true that one below 4 need not be ok either. In fact, many doctors argue that anything over 2 or so for men 40 or more might mean something is up. So forget that 4 PSA talk. There is something more important than a fixed number to watch.
More important than a single PSA reading are two other PSA-related numbers. The first is called PSA velocity which is merely how fast does your PSA increase from one year to the next. The second is called free PSA which is a more refined reading of what percent of your PSA is of a certain kind. If your PSA increases more than 0.7 in one year, you should probably have another PSA test and ask for a free PSA reading. If that reading comes in at less than 20%, you should probably have a biopsy. The prostate biopsy is no fun, but dying of prostate cancer when you could have stopped it is no picnic either.
This Gleason is Not Funny at All
You will never be fully prepared to hear the "C-word" directed at you, but that word will bring things out of you that you never knew you had. Men diagnosed with prostate cancer have a number of options, depending on their age and how aggressive their cancer is. In general, prostate cancer aggressiveness is measured by a Gleason Score, which is basically how different your cancerous prostate cells are from normal prostate cells. Two scores with a maximum of 5 are given and added for a maximum total Gleason of 10. The higher your Gleason score, the more aggressive the cancer and the more aggressive your treatment should be. The Gleason score comes in two numbers, with the first being what most cancer cells seen in the biopsy were and the second what the lesser amount were. A Gleason of 4-3, for example, means that most cancerous cells were type 4 with some 3. A Gleason of 3-4, on the other hand, means that most cancerous cells were type 3 with some 4. Obviously, two people can have a Gleason 7 but one could be 3-4 and the other 4-3, so the second diagnosis would be worse than the first.
Research has found that 4-3 Gleasons often act like 4-4 Gleasons, which are considered pretty aggressive. Many men have a Gleason of 6, which is moderately aggressive. As discussed above, a Gleason of 7 can be moderate or somewhat aggressive, depending if it is 3-4 or 4-3. Gleasons of 8 or more are very aggressive. Younger men tend to have more aggressive prostate cancer and older men less aggressive, which makes it even more important for men younger than 70 to move quickly toward treatment.
Treatment Options... A Tough Buffet
Men diagnosed with prostate cancer have a mixed blessing. On one hand, their cancer is one of the more treatable ones if caught early enough. On the other hand, there are enough treatment options to make your head spin. I will not get into too much detail here except to note that surgery to remove the prostate is generally suggested to men younger than 70 and some form of radiation is generally suggested to men over that age. That radiation could be direct or through the implantation of seeds. Hormone therapy is also an option, although it seems that many times this is offered to more advanced cases.
The reason younger men are advised to remove the prostate is that they generally have too many potential years to live whereby the cancer could return. A man aged 75 or 80, on the other hand, would likely die of something else before his prostate cancer kills him. All treatments have their side effects, which is something else to deal with.
The most important thing, no matter what treatment you choose, is to stop the cancer before it gets out of the prostate and into your bones or organs, in which case the problem becomes much more serious. Telly Savalas, Bill Bixby and Frank Zappa found that out the hard way.
I chose surgery to remove my prostate given my age, and I know that this was the right option for me. Now I have to have my PSA checked every 3 months for two years and then every 6 months for one year before continuing with yearly checkups.
You Are Not Alone, and You Are Blessed
Many people will think I am crazy for saying this, but I feel blessed to have gotten prostate cancer. First of all, there are far worse health conditions one could get, which are permanent and/or inoperable and lead to eventual death or a greatly diminished quality of life. There are other forms of cancer for which there is no early detection process and for which there is no real effective treatment. Secondly, I now value life and my family like never before. Third, perhaps I can help other people faced with this path.
Many men, famous or otherwise, have walked this path. Rudy Giuliani, Robert DeNiro, Joe Torre, Arnold Palmer, Nelson Mandela, Harry Belafonte, Bob Dole, Colin Powell and John Kerry to name a few. As you can see from the list, prostate cancer is very non-partisan.
Conclusion
There are so many things to write about politically and otherwise right now, but I thought it important to step back and, at least for once, write about something far more important than politics or social issues. Family, faith and life are those things, and a diagnosis like prostate cancer hits you on all three counts. How you respond to that hit may well determine how you will live the rest of your life. How you anticipate, prepare for and, hopefully, prevent that hit may well be one of the best moves you will make.
Eat fish with omega-3 such as salmon, tuna and herring at least twice a week. Eat broccoli and cooked tomatoes. Enjoy sunflower and pumpkin seeds. Exercise and avoid eating junk food as best you can. Most of all, be proactive with your health and with enjoying your family, friends and many blessings. When you go to bed tonight, give an extra kiss to your kids and hug your spouse a little more. I wish that I had read something like this five or ten years ago, but I feel blessed by God to have apparently caught my prostate cancer in time. May you never have to walk this path but, if you ever do, know that I am here to help. I found the websites www.phoenix5.org and www.yananow.net particularly helpful.
© Gabriel Garnica
April 10, 2009
I usually come to this site writing about conservative values and liberal rationalizations, but this time I do so as a prostate cancer survivor. In January of this year I was diagnosed with prostate cancer and thus began the hellish roller-coaster that all men so diagnosed undergo between that diagnosis and the eventual treatment. I was not supposed to get this thing. After all, I am not yet 50 years old, have no family history of cancer, and seemed in good health. According to the guidelines, my elevated blood PSA was perhaps a sign of the enlarged prostate so many men face as they approach half a century of time on this rock in space. The problem with prostate cancer, with all cancer for that matter, is that it does not know what "supposed to happen" means.
Better Safe Than Sorry... A New Guideline
The guidelines tell you to start worrying when you hit 50 years of age. They also tell you that you should start worrying when a chemical in your blood called PSA goes over 4. I am no doctor, but my experience and research has taught me that both guidelines are misleading. I know people under 50, me included, who got prostate cancer. I also know even more people, including a close friend, who got prostate cancer with a PSA below 4. That alone should tell you that both guidelines are not as accurate measures of problems as many believe.
The problem with prostate cancer, the reason why it killed so many more men in the past, is that it grows in your body while you feel just fine, and rears its ugly head to real detection when it is too late. This is why only going to the doctor when something feels wrong is not a good idea. This is why all men 40 or more should have an annual physical and request a yearly PSA test. Many doctors will smirk and say that you do not need it until you are 50. You will say never mind and I want it now. So forget that age 50 talk. Start when you are 40.
As for the controversial PSA blood test, it is true that an elevated one need not be prostate cancer. However, it is also true that one below 4 need not be ok either. In fact, many doctors argue that anything over 2 or so for men 40 or more might mean something is up. So forget that 4 PSA talk. There is something more important than a fixed number to watch.
More important than a single PSA reading are two other PSA-related numbers. The first is called PSA velocity which is merely how fast does your PSA increase from one year to the next. The second is called free PSA which is a more refined reading of what percent of your PSA is of a certain kind. If your PSA increases more than 0.7 in one year, you should probably have another PSA test and ask for a free PSA reading. If that reading comes in at less than 20%, you should probably have a biopsy. The prostate biopsy is no fun, but dying of prostate cancer when you could have stopped it is no picnic either.
This Gleason is Not Funny at All
You will never be fully prepared to hear the "C-word" directed at you, but that word will bring things out of you that you never knew you had. Men diagnosed with prostate cancer have a number of options, depending on their age and how aggressive their cancer is. In general, prostate cancer aggressiveness is measured by a Gleason Score, which is basically how different your cancerous prostate cells are from normal prostate cells. Two scores with a maximum of 5 are given and added for a maximum total Gleason of 10. The higher your Gleason score, the more aggressive the cancer and the more aggressive your treatment should be. The Gleason score comes in two numbers, with the first being what most cancer cells seen in the biopsy were and the second what the lesser amount were. A Gleason of 4-3, for example, means that most cancerous cells were type 4 with some 3. A Gleason of 3-4, on the other hand, means that most cancerous cells were type 3 with some 4. Obviously, two people can have a Gleason 7 but one could be 3-4 and the other 4-3, so the second diagnosis would be worse than the first.
Research has found that 4-3 Gleasons often act like 4-4 Gleasons, which are considered pretty aggressive. Many men have a Gleason of 6, which is moderately aggressive. As discussed above, a Gleason of 7 can be moderate or somewhat aggressive, depending if it is 3-4 or 4-3. Gleasons of 8 or more are very aggressive. Younger men tend to have more aggressive prostate cancer and older men less aggressive, which makes it even more important for men younger than 70 to move quickly toward treatment.
Treatment Options... A Tough Buffet
Men diagnosed with prostate cancer have a mixed blessing. On one hand, their cancer is one of the more treatable ones if caught early enough. On the other hand, there are enough treatment options to make your head spin. I will not get into too much detail here except to note that surgery to remove the prostate is generally suggested to men younger than 70 and some form of radiation is generally suggested to men over that age. That radiation could be direct or through the implantation of seeds. Hormone therapy is also an option, although it seems that many times this is offered to more advanced cases.
The reason younger men are advised to remove the prostate is that they generally have too many potential years to live whereby the cancer could return. A man aged 75 or 80, on the other hand, would likely die of something else before his prostate cancer kills him. All treatments have their side effects, which is something else to deal with.
The most important thing, no matter what treatment you choose, is to stop the cancer before it gets out of the prostate and into your bones or organs, in which case the problem becomes much more serious. Telly Savalas, Bill Bixby and Frank Zappa found that out the hard way.
I chose surgery to remove my prostate given my age, and I know that this was the right option for me. Now I have to have my PSA checked every 3 months for two years and then every 6 months for one year before continuing with yearly checkups.
You Are Not Alone, and You Are Blessed
Many people will think I am crazy for saying this, but I feel blessed to have gotten prostate cancer. First of all, there are far worse health conditions one could get, which are permanent and/or inoperable and lead to eventual death or a greatly diminished quality of life. There are other forms of cancer for which there is no early detection process and for which there is no real effective treatment. Secondly, I now value life and my family like never before. Third, perhaps I can help other people faced with this path.
Many men, famous or otherwise, have walked this path. Rudy Giuliani, Robert DeNiro, Joe Torre, Arnold Palmer, Nelson Mandela, Harry Belafonte, Bob Dole, Colin Powell and John Kerry to name a few. As you can see from the list, prostate cancer is very non-partisan.
Conclusion
There are so many things to write about politically and otherwise right now, but I thought it important to step back and, at least for once, write about something far more important than politics or social issues. Family, faith and life are those things, and a diagnosis like prostate cancer hits you on all three counts. How you respond to that hit may well determine how you will live the rest of your life. How you anticipate, prepare for and, hopefully, prevent that hit may well be one of the best moves you will make.
Eat fish with omega-3 such as salmon, tuna and herring at least twice a week. Eat broccoli and cooked tomatoes. Enjoy sunflower and pumpkin seeds. Exercise and avoid eating junk food as best you can. Most of all, be proactive with your health and with enjoying your family, friends and many blessings. When you go to bed tonight, give an extra kiss to your kids and hug your spouse a little more. I wish that I had read something like this five or ten years ago, but I feel blessed by God to have apparently caught my prostate cancer in time. May you never have to walk this path but, if you ever do, know that I am here to help. I found the websites www.phoenix5.org and www.yananow.net particularly helpful.
© Gabriel Garnica
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