Prostate cancer to men is like breast cancer to women

Editor’s note: September is Prostate Awareness Month. In this three-part series, LVN Editor Emeritus Steve Ranson gives a look into the start-to-finish procedure to eradicate the cancer, one of the leading cancers that kills men.

Prostate cancer is to men as breast cancer is to women. I learned that comparison while sitting in my urologist’s office last year.

The second-leading cause of cancer deaths in men comes from a small gland located between the bladder and the penis. If not monitored or treated, prostate can be a killer. Likewise, the No. 2 cause of cancer deaths in women is breast cancer. So what’s the difference? Over the years, more awareness has been directed at breast cancer screening than with the prostate gland. Therefore, with September being Prostate Awareness Month, let’s put the spotlight on this type of cancer.

I’m one of those statistical males where prostate cancer will affect one out of nine men in their 60s. I began screening about every 18 months to two years when I was in my 50s, and then about every year to 18 months after I entered my 60s.

An abnormal PSA or prostate-specific antigen found in the blood alerts physicians that prostate cancer may exist. During the past six years, my PSA slowly climbed from a 3.18 in 2014 to 6.36 in 2017.

In 2019, the PSA more than doubled to 16.57, causing my general practitioner to refer me to an urologist. Dr. Margaret Denton wrote a referral to Carson Urologists, which sends a doctor to Fallon every other week. Other warning signs began to develop during the first seven months of 2019. I had frequent urges to urinate, but the stream was weak. Occasionally, blood would appear in my urine. Sometimes, I would stand over the toilet, straining to empty the bladder.

In late August of that year, I left home for my first visit doctor’s appointment. I took the elevator at Banner Churchill Community Hospital to the third floor, where many of the doctors’ offices are located. My stomach felt queasy because of reading a number of articles on PSA scores and the prostate. When I arrived at the waiting room, I was surprised to see three men I’ve known for years. All with what seemed like long faces were waiting to see the urologist.

Dr. Brian Montgomery, whose been with Carson Urologist for several years, saw me as a new patient. His directness surprised me, but that’s probably what I needed at the time: a doctor who wouldn’t sugarcoat the problem. He quickly re-ordered another PSA. It returned with a score shy of 17.

“The higher the PSA, the more likely prostate cancer,” he said, reviewing the latest result with me.

Montgomery, who completed a residency at Mayo Clinic-Rochester, prescribed two pills to shrink the prostate and improve the urine stream: finasteride and tamsulosin.

A month later and the day after the Nevada Press Association conference in Ely, my medical procedures began. Before I arrived at Carson Urologists, I took several pills, two of which knocked me into a drug-induced stupor. Montgomery completed a core biopsy of the prostate by taking samples from 12 areas. When he presented the results to me two weeks later, I had the presence of cancer in two quadrants, the left base and left lateral apex. Montgomery’s attention focused on the left lateral apex, which measured the adenocarcinoma — cancer forming in mucus-secreting glands —up to 16 mm in its greatest dimension and occupying 95% of the surface area.

The pathologist issued a Gleason grading score of 8, which meant I had a high-grade lesion than can spread more quickly than scores half that. The left base showed adenocarcinoma took up only 5%, but the Gleason score came in at 6. Based on my PSA, however, Montgomery said he expected to see the adenocarcinoma in more than two quadrants.

“It’s all statistics with many different results,” he said.

Before I left his office, he prescribed a meditation to shrink the legions. Bicalutamide slows the growth of cancer cells, but the side effects are noticeable. I began to have hot flashes and back pain. My joints and muscles ached. Literally, after reading more information on this medication, I labeled it my chemo pill.

I wasn’t done with my testing, yet.

Before Montgomery offered his final decision on treatment, he ordered a bone scan. On bone scans, he uses criteria based on National Comprehensive Cancer Network guidelines to determine if the cancer had spread beyond the prostate to another organ or the bones.

Now, I had to wait a few more weeks before the results came in before meeting with Montgomery again.

I had already resigned myself some type of treatment would await me.

Part two: What is my treatment? A radical prostatectomy or radiation.