PSA-Not the only way to fly

Until sometime in the late 80s, there was a regional airline in the west called PSA. I don't remember what the letters stood for, but their slogan was, "PSA, the only way to fly."

But there's another PSA that I've been thinking about most recently, which culminated in a biopsy two weeks ago, and I know what those letters stand for: Prostate Specific Antigen. As the song goes, don't know much biology, but I do know this: PSA is specific to the prostate, and it's an antigen, meaning that it's there to do battle with some bad thing in the prostate. That bad thing is sometimes cancer.

My PSA was 13 as of two weeks ago, when I was scheduled for the biopsy at UCSF. And this was no run-of-the-mill biopsy, but one of the "Perineal Anterior" variety, and I'll spare you the anatomical specifics. I just turned 60, but for years--six or seven at least--I've had an elevated PSA level, which hovered around six or seven. In the past couple of years it's climbed to 9 and change, and then spiked to 13. One of the things that doctors look for in PSA is what they call velocity, or the pace at which the PSA level climbs. At my age, I should have a PSA from 0 to, say, 3. Thirteen is quite high, so needles to say I was worried. On a scale of 1 to 10, my worry meter registered 13.

Well, if you'll read the next post you'll see that the biopsy results were all negative, with 32 cores having been taken. My worry, while not unfounded, turned out to have been for nothing (as worry usually is). I asked the nurse, "So, why do I have such a high PSA level?"  She said, "I don't know."

But there is another piece of the puzzle, which is that I (like some 50 percent of men my age, and more who are older) have an enlarged prostate. I'm not sure why, but my urologist tells me that it shows evidence of infection from a long time ago. I think, in fact, that I've probably had some kind of prostate infection for thirty to forty years and that chronic infection--not cancer--is likely the irritant that is making the PSA level spike.

So, take heart, men. PSA was a pretty good airline, but is a notoriously unreliable indicator of cancer, as my case demonstrates.

Negative, in the positive sense.

So, after almost two weeks of anxiety--much of it somewhat beyond my conscious awareness--I got a call today from the urologist's nurse, who had the results of my biopsy. "Everything is negative," she said. No qualifications. No, "howevers," No, "and there's just one more thing."

I'm glad she just spat it out, because any preamble or post script would've only increased my worry because I would have imagined that her next statement would be, "So, we'd like you to come in for a consultation." Nothing good could come from a face-to-face meeting under this circumstance. 

But there is no need for a consultation because all of the poking and prodding--and this was the gold standard of prostate biopsies--has turned up nothing to be alarmed about. As far as I know, there is no more tissue to be jabbed and sampled.

Needless to say I am hugely relieved, and I'm very conscious of that, even though I successfully suppressed the actual anxiety of which I am now relieved. Or, rather, turned it into gloomy and catastrophic pessimism. All of it for nothing. Surely there's a lesson in there of some kind, and eventually I will figure it out. 

For now, all I can say is hooray! 

On Hold

I had a prostate biopsy about ten days ago at UCSF Medical Center.

At least I think I did.

Here's what I remember: I was in a private room, wearing the traditional (and might I add, very flattering) gown. My daughter kept me company, and gave me a little good luck plastic giraffe, which was pinned to the gown. I filled out various forms that relieved UCSF of all potential liability, including losing the plastic giraffe or somehow stitching it under my skin.
I was visited by the anesthesiologist, and the surgeon, and half of the staff of the medical center, it seemed. They kept me occupied for an hour or so, and I did my best to be a cooperative patient.

Anyway, eventually one of the nurses came in and said, "I'm going to give you this pill. It will relax you." Then I woke up in the recovery room, sporting a catheter and feeling like I'd been gang-raped. (I don't really know what it feels like to be gang-raped, by the way. I don't want to know. It's a metaphor).

Allegedly, what had happened between the time the nurse gave me the Alice in Wonderland pill and the time I woke up in the recovery room was that the doctor and the entire (and very impressive) medical team had worked together to stick a horrendously long hollow needle through my skin in a very delicate area and stab it into my prostate, removing some 32 different samples. If you remember those little potato guns--the ones that you'd jab the barrel into a potato and get a little piece of potato, which would then shoot via air pressure out of the gun--you get the idea.

Yeah. Ouch.

I say that the biopsy was allegedly performed because to date the good doctors haven't reported any of the lab results. That is to say, waiting to hear whether I have, gulp, cancer or not. I'd say that I'm sitting on pins and needles, but that isn't exactly the feeling.

I am reasonably certain a biopsy was performed, though, not only because of the pain following the procedure, but because of the rosy glow, not of my cheeks, but of my pee. Okay, I won't subject you to further graphic detail.

Now, of course, life goes on. I think I was much more anxious about the biopsy procedure itself than I was about the results. On an MRI there were two spots that were of concern. Why they couldn't just take that needle and remove them entirely is unknown to me--and I asked one of the doctors. He was amused by my question. I don't know why.

If my reading of the various blogs, medical center reports, and other literature regarding prostate cancer is correct, there is a 60 to 80 percent chance that I DON'T have cancer. I'd prefer 100 percent but they weren't offering that. Now that I've waited ten days to hear the results of all this science and discomfort, I confess that I'm a lot more anxiety than I was previously aware of. That is, I spent all my time dreading the procedure and didn't think much about what they were really looking for.

So I thought I'd spent a while investigating health insurance options via the Covered California website. I made an application a few weeks ago--they can't turn me down, I understand, no matter what the biopsy says--and then for about a month was unable to logon again. But apparently the internet people figured out how to make the site work again. I finished the application, then pressed the button to reveal all of the wonderful health insurance options available to me, in colors ranging from Bronze to Platinum. A veritable rainbow of choices. Well, if your rainbow has four metallic colors to it.

The options available to me? Zero. No plans are offered. Surely this is a mistake, as I've had health insurance for as long as I've lived, and this recent procedure notwithstanding, am in overall good shape. Good enough shape to have backpacked 50 miles last summer anyway. No options? Nothing? Are you serious? I could make no headway on the website, so I called the 800 number, where a recorded voice told me that the wait was either three hours and thirty minutes, or three hundred minutes. It was kind of garbled. With the phone on the table beside my computer, I decided to wait on hole while I posted this long-delayed entry.

And then the connection went dead.