Opinion: What I didn’t know about my prostate almost killed me

Opinion by Ed Manning

(CNN) — Recently, a misfiring prostate launched Defense Secretary Lloyd Austin to the forefront of the headlines, followed by the deaths of Dr. Martin Luther King Jr’s son, Dexter, and O.J. Simpson from prostate cancer. While their celebrity status drove the news, their underlying illnesses earned little more than a parenthetical shrug. In the blink of a news cycle, prostate cancer was again casually swept aside as among the best cancer to have.

Treatments are often downplayed as “minimally invasive,” as if they were no more consequential than a teeth cleaning. As a prostate cancer survivor, I can report from painful experience that those misguided assessments are to men’s health and longevity what ice was to the Titanic.

In the shadows of more celebrated organs afflicted by cancer, such as the heart, pancreas, lungs and breasts, mentions of the prostate are often waved off like the eccentric relative no one is comfortable inviting to Thanksgiving. Most men’s knowledge of it extends no further than those riveting seconds during an annual physical when the doctor inserts their gloved finger into the patient’s rectum to feel for abnormalities in the prostate. The exam isn’t a great conversation starter, so few have much to say to the doctor once it’s behind us. I wish I had, because if the prostate becomes cancerous, as I and over 1.4 million men found out in 2020, there is nothing physically or psychologically minimal about it.

For context, the walnut-sized prostate gland plays a pivotal role in the male reproductive system. It is essential in producing seminal fluid and, during sexual climax, its muscles contract, close off the opening between the bladder and the urethra (there is no “p” in orgasm), and forcefully release millions of stampeding sperm and fluids. It is flanked by two neurovascular bundles that are to healthy sexual function what Houston Control is to a shuttle launch. No nerve bundles and the rocket sits lifeless on the pad. That positioning makes treating the prostate complicated and lifts “nerve-sparing” to the top of every man’s prayers as he contemplates radiation, surgery or high-intensity focused ultrasound (HIFU) treatments. As my wife told my surgeon as I shuffled off to surgery, “Take all the time you need.”

Years leading up to my diagnosis, my doctors gave me two gloved thumbs up after my digital viewing. “Looks great,” was the evaluation through my 50s. As I cruised into my 60s, that was downgraded slightly to “looks good,” with an aside that my prostate was slightly enlarged.

“It’s typical of a man your age,” the doctors said. I had nothing to worry about. I was athletic, plant-based, sun-screened, fully flossed and free of trans fats, drugs, tobacco and asbestos. I should have been a poster boy for cancer-free. Missing from that annual banter and less-than-alarming prostate headlines were several arresting details. As the American Cancer Society notes:

• Prostate cancer is the second leading cause of cancer death in men.
• One in eight will be diagnosed with it.
• One in 44 will die from it.

Another point my doctors failed to mention was that no matter how thorough the annual digital screening, prostates can malfunction without any obvious symptoms such as a hardened or bumpy shell, blood in the urine, the need to pee frequently or erectile dysfunction. Cancer can sneak its way in undetected, and if not caught early, break free of the prostate and run unchecked through the body with a particular penchant for bone. For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year relative survival rate is only 32%.

Had I known any of those details, I would have kept a closer eye on possible symptoms, nutritional recommendations and testing options. In my case, it was a chance conversation with my wife that led to a diagnosis.

“You are peeing differently,” she said. “That’s why I want you to book your physical.” Getting directly to the heart of the matter, I said, “You listen?” and then strategized about the best way to immediately change the subject.

“The bathroom door isn’t soundproof,” she continued, “and it sounds like things take longer to get going. You need to tell your doctor. It could mean something.”

It did. What seemed trivial to me put my doctor on alert. He added a Prostate-Specific Antigen (PSA) test to my bloodwork.

“Changes in the way you urinate is something you should have told your previous doctor.  Why didn’t you?” my doctor asked, adding a reprimand on the tail end of his bad news. “And why didn’t you have a PSA test before now? You could have caught this early.”

I explained that changes in peeing were gradual and inconsequential enough to go unnoticed, like the frog in the heating pot of water. Given my lack of knowledge of the prostate’s propensity to become cancerous, I didn’t know what symptoms to look for. I assumed the digital exam had me covered. I never had a PSA test, because none of my previous doctors had ever ordered one. I never asked for one based on the substantive difference between my BA in English Lit and a medical degree.

A PSA test measures the presence of prostate-specific antigens in the blood that can be indicative of cancer. In a perfect world, the score will read under four, according to the National Cancer Institute. At age 62, my first ever PSA score logged in at a harrowing 17. A biopsy confirmed somewhat aggressive prostate cancer, a diagnosis which stunned and terrified me. Six weeks later, after much research and deliberation, I underwent a radical robotic nerve-sparing prostatectomy. That so-called minimally invasive surgery took close to six hours and required multiple incisions. Recovery involved one week with a catheter, a couple of weeks of significant physical discomfort and three months before I was able to tackle even a light workout.

Three years after my surgery, I am in remission and, by the grace of a skilled surgeon and amazing advances in medicine, I don’t suffer the dreaded side effects of incontinence or erectile dysfunction. But technically, I’m not cured. Even after surgery, radiation or HIFU, recurrence is not uncommon. Like most men post-treatment, I take a blood test every six months, at which point my anxiety skyrockets for the days it takes to get the results confirming whether or not I’m cancer free.

While physicians assure me I will “probably die of something else,” I wish that in addition to the cursory “looks good” I had heard over the years, they had provided salient details about my prostate, warning signs and testing options. While it’s too late for me to catch my own cancer early, I encourage anyone with a prostate or anyone who loves a person who has one to talk to a physician. Learn about testing options and the importance of nutrition and staying active. Understand the warning symptoms. Listen to your body or your significant other who might be a better listener than you. What I didn’t know almost killed me. If I had known what to listen for, my former prostate and I might have happily grown old together.

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