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In Sickness and in Health

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Daffodils and prostate cancer awareness ribbon on wooden table

October, with its ubiquitous pink ribbons, has come to symbolize breast cancer awareness.
I’m guessing you didn’t know that September has a ribbon too — a little-seen light-blue ribbon, the sign of
Prostate Cancer Awareness Month. (Muskoka Stock Photos © Shutterstock)

My husband, Bob, has what you might call an allergy to doctors. “I used to measure my health each year by whether I could run the nearly 7.5-mile San Francisco Bay to Breakers race in under an hour,” he says.

So it was on a summer day in 2012 that I had to practically chase my 58-year-old spouse out of the house for a long-overdue physical exam I’d booked for him. (I’d set up my annual physical, complete with mammogram, for the same day.)

What precipitated the doctor visit for Bob was not a symptom — he was perfectly healthy — but rather a vague worry I’d been feeling ever since a good friend of ours was diagnosed with prostate cancer (out of the blue) a few months earlier. And I learned from just the briefest online search that Bob was nearing the age when prostate cancer surges. Dr. Patrick Walsh of Johns Hopkins University, considered one of the world’s foremost authorities on the disease, writes, “After age 60, prostate cancer seems to shift into high gear — and a man is three times more likely to develop it than a woman is to develop breast cancer.”

The American Cancer Society estimates that 232,570 women will be diagnosed with invasive breast cancer this year. The prostate cancer number is almost the same, 233,000. Still, our awareness of the two is not at all equal. October, with its ubiquitous pink ribbons, has come to symbolize breast cancer awareness. Buildings across America, even the White House, light up in pink. NFL players, the epitome of male power and strength, sport the ribbon and don pink accessories to raise awareness. I’m guessing you didn’t know that September has a ribbon too — a little-seen light-blue ribbon that is the sign of Prostate Cancer Awareness Month. I certainly didn’t. But my understanding of the disease was about to grow exponentially.

You may well ask why planning the checkup had fallen to me, but it’s actually quite common for a wife to take on the role of health cop for her family. According to Gary Brice, executive director of the DeGraff Memorial Hospital McLaughlin Center in North Tonawanda, New York, most men don’t like to show weakness and most women “don’t have trouble admitting health problems.” He explains that women are also more familiar with healthcare in general after years of having pelvic examinations, as well as taking children to the pediatrician.

If distrust of doctors was a constant for Bob, he’d reinvented nearly everything else about himself about 10 years earlier. “At 50 everything changed in my life,” he says. At the time, the two of us moved from California to the East Coast after I accepted a promotion (I work in newspaper sales and marketing). For Bob, the move meant leaving behind a 30-year career in automotive service and going back to school. “I didn’t have the opportunity to finish college, so I went back and became the oldest kid in my class.” By 2012, Bob was in his personal prime time and working in real estate.

ON THE MORNING OF THE APPOINTMENT, I REMINDED BOB to be sure to ask for his prostate-specific antigen (PSA) level to be checked as part of the blood work the doctor would order. PSA is an enzyme made by the prostate and an elevated level is considered one of the most useful serum tumor markers for any malignancy. In fact, the majority of prostate cancers are found through the PSA test, not the dreaded digital rectal exam.

Funny thing about the PSA. Recommendations from the U.S. Preventive Services Task Force (USPSTF) urge primary caregivers against using this test. The argument is that PSA tests can give a false positive or detect slow-growing cancers that are unlikely to cause a problem during a patient’s lifetime. Treating these cancers can do more harm than good, argues USPSTF Chair Dr. Michael LeFevre.

Sure enough, his doctor had no plans to offer the PSA test because Bob had no family history of prostate cancer and there was nothing of note on the digital exam. But Bob insisted. “You don’t know my wife,” he said. The doctor reluctantly checked the box on the blood work order.

Much to the doctor’s surprise, Bob’s blood test showed an elevated PSA level. The doctor downplayed it as a likely false positive, and Bob didn’t even bother to tell me about it. “I didn’t want to scare you,” he says.

The doctor ordered a second test. The results were the same, and Bob was referred to a urologist for further evaluation. “I was still in denial even after the second PSA test,” he admits.

Turns out, that’s a common reaction, but at least this time he told me about it. “Research shows that many men do not get tested for prostate cancer, because they fear the effects of surgery they may not even need,” Dr. Drew Pinsky, the popular HLN host and himself a prostate cancer survivor, writes on his blog. “What concerns many males faced with prostate cancer is not the cancer itself, but possible incontinence, and [loss of] sex.”

The urologist performed a biopsy, where tissue samples of the prostate gland and the surrounding area were taken using a needle inserted through the wall of the rectum. He warned Bob that there could be complications from a prostate biopsy such as infection and excess bleeding. But the 30-minute procedure went without incident and Bob experienced very little pain. “It was exactly as the doctor described. And I had no issues afterward. I drove myself home,” Bob recalls.

A few days later, on my husband’s 59th birthday, we received the results, and the news was devastating. Not only were there moderately aggressive cancer cells concentrated on one side of Bob’s prostate, there were also cancer cells in areas outside of the gland. With evidence that the cancer had escaped the prostate, the urologist ordered a CT scan and a bone scan to see whether Bob’s cancer had spread even farther. The sentence spoken by the urologist on that fateful day woke me up to the serious situation we were facing: “There is no known cure for prostate cancer that has spread to other parts of the body.”

No known cure. Three of the most terrifying words I have ever heard. But it was almost worse when my ever-optimistic, upbeat husband confided to me, “I think we are in trouble.”

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  • Bill Wirth

    I also had no history in our family, but my family doctor was always checking PSA with every physical over the years. I had a small move in numbers and he had me retest. I was 52 and has a urologist perform a biopsy to verify another change in numbers just to be safe. The biopsy confirmed I had prostate cancer.

    At the time, my employer was “reviewing insurance options”. I told them I had to know where they were at with the process so I could decide my treatment options. They told me not to worry, we would have some kind of insurance, and if I had cancer, this was “the best one to have”. That was on a Friday. On Tuesday every employee gets an email saying they will no longer offer insurance and our policy would expire in 1 week. I was torn, as I felt I had no choice to make as there was no time, and with the diagnosis, I wouldn’t have a chance to get insured elsewhere.

    On Wednesday, the urologist called me at 3 pm, aware of my delema. He asked if I wanted to have it removed. If so, I needed to be at the hospital the next morning at 10am. He rearranged his schedule, vacation – everything, so I could have the surgery and be discharged from the hospital the day before the insurance expired. It was so surreal how everything came together.

    I feared the same things your husband did regarding my sex live with my wife. I am happy to report, the first year was tough, but I think some of that was psychological. I have been cancer free for 5 years now. I am amazed at how many men I know have it, and are in stage 3 and 4 now because they were never tested. Your quoted numbers are staggering, but people still are not aware because prostrate cancer seems to have a stigma to it and no one wants to talk about it. We have 5 boys, and I will not be quiet about it. I was lucky to be diagnosed early, and it was contained to the prostate. I too hope it gets the recognition it needs so we can save more lives. Thank you for your story. I will be passing it on!

  • With September being cancer awareness month…
    A good article well worth reading. Informative and sobering.

    For me, good thing I got my annual physical every year because at 52, I got it about 10 years earlier than the average. If I had not found it early it would have spread by the time I reach my 60’s!

    We should see as many blue ribbons as pink, but unfortunately prostate cancer is not talked about much…

  • Ric Chesek

    Ms. Berman,
    Your husband’s story is very similar to my own. His making kale smoothies brought a smile, although I refer to mine as a kale slurry. I have a adopted a vegetarian diet in an effort to avoid a reoccurrence. I hope we will see you and your husband in the Survivors Circle at the Zero Prostate Run this year.

  • Vickie

    I lost my husband to prostate cancer almost 5 years ago. He was diagnosed at stage 3 at the age of 52. Every dr that had examined him said his prostate was remarkably small and no signs of cancer. Even when he had symptoms, his urologist said there was no way he could have cancer. He was too young. After months of testing for other causes they finally did a biopsy. He had a Gleason Score of 9. He had radical surgery, radiation, hormone therapy, chemotherapy and every clinical try they could come up with. We had 5 years of battle before it finally took his life at the age of 57. I pray for and remind men every chance I get to be checked. I feel the medical community still down plays the fact the prostate cancer does take lives.

  • Correction, it was not 118 months but rather 18 months.

  • Your story is very similar to ours. In April 2011 I was back in St Louis where my dad and I were starting hospice for my mother who was in her last month of life battling colon cancer. My husband Dave had had a biopsy done right before I left Texas and we were waiting on the results, not expecting any bad news. I will never forget the sucker punch to the gut I took when he told me that he had prostate cancer over the phone. I just remember screaming on the side of the road after we hung up.

    Shortly after my Mom’s funeral, Dave had his prostate removed. Likewise our surgeon felt good about his margins and he never had a problem with incontinence. The first year he had good PSA results but 118 months after surgery, the cancer had returned.

    We than entered into the world of hormone therapy and 9 weeks of radiation. 12 months post radiation, we are still at undetectable and are hopeful that his next PSA in Nov will be consistent.

    Our sex life pre-cancer is gone…I miss that aspect of our relationship and at times, it’s very difficult. However, we have grown closer and our relationship is more intimate than before. I would rather have the closeness that we share now than all of the physical components of our relationship as it was.

    On the 27th, we will be participating in our 4th Prostate Cancer 5K. We have been able to use our experiences to minister to others who are in uncharted territory. My husband is my hero…

  • Robin

    This is an important and beautifully-written story. Thank you to you and Bob for sharing.

  • Joan eay

    Thanks for Judy Berman’s article regarding prostate cancer. We went through that a few years ago and my husband was told to have the surgery. We were not told about the advantages of robotic surgery nor anything else. The results were very frustrating for my husband, as it affected his urinary tract, etc. It has been an emotional journey for us. I recently checked with the American Cancer Society and there is NOT a support group for prostate patients in Nashville, TN. We certainly need one.

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