In Sickness and in Health

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.”