Prostate cancer musing…PSA is very reliable when following prostate cancer “after” treatment.

The leaves in Northeast Georgia have been particularly pretty this year and have hung around more than usual. The light comes through the trees behind Penelope about 5 everyday and are almost “illuminated” by the sun.

I had a friend who happens to be a doctor call me to ask me some questions about his post prostatectomy PSA. His surgery was about four years ago and his PSA’s have been negligible up until the last one and for which was the purpose of his call. The PSA had come back 0.3. Now…the PSA is a quirky test, you may have heard of the erudite USPSTF, in the diagnosis of prostate cancer but is very reliable in following prostate cancer after treatment. So his PSA having gone to .3 (which he repeated) is significant. There are cancer cells somewhere. How many, how fast it will grow etc we don’t know and can’t know until a trend is developed with time and serial readings. From a mental aspect it can be devastating. How do I know this? Well, it has been four years since my surgery and about 8 months since I checked a PSA. It scared me. Since I get a cholesterol test, which is a fasting test, with my PSA I can never remember not to eat and then wait another day which turns to weeks. So I had one drawn…my cholesterol is high normal but my good cholesterol HDL is good, so I think I am okay there. The PSA was…..

What are your thoughts on the following comment made on this blog by  a reader this previous week?

Pat:

Medicine has become a business of transactions, unfortunately.  It’s not always the doctor’s fault, but administrators who apply pressure to the medical staff to make the numbers.  Doctors want to make an income commensurate with the sacrifices they made to become doctors.  Income was one of several motivating factor for them seeking a career in medicine in the first place.  So they go along with the bureaucracy because they are often dumb in business and administration and because they want to protect their income and lifestyle.  The system of care then makes excuses or worse, uses a false projection of confidence in the medical interventions to prevent or cure disease.  in other words, the doctor quickly loses his ability to treat a patient and instead treats a “transaction” which helps him make his numbers.  He still TREATS the patient, so he is justified as a doctor and his conscience is clear.  But what is missing is the time and ability for the doctor to think about a patient’s case, to care about what happens to the patient regardless of economic impact to his practice or institution, and to bond with the patient so that the doctor is motivated to treat him as best as possible.  This is the state of medicine in general today.  Of course, there are always exceptions and people who remain committed regardless of external pressures and those are the caregivers we should all seek out, embrace and patronize.

The changes in medicine are part and parcel of much bigger changes in our society.  We are all running faster, working harder, enjoying life less.  Computers and technology were big factors in bringing this life to us and in hindsight, as cool as a lot of what we have invented is, it’s ruined the wonderful lives we had prior.  Pre-high-tech, life was slower, Sunday was truly a day of rest, a ride in the car was relaxing since there was no phone or DVD in the car.  People used to actually go for a drive as a way to relax and have fun!  Today, when you watch how people drive you can easily see that they are stressed, distracted by devices and life and that they suffer from deep, sequestered, unresolved anger.

As a fellow human being, son of a doctor who had prostate cancer along with two brothers, I feel for your experiences as you confront your illness.  I understand what you went through and you have learned for the next time, which hopefully will be when you are in your 90s.  Life is fragile and we all expect too much from it — it simply cannot provide all we expect, want or need.  So, take each day as a gift, smile more, relax about the trivial things we have all gotten to believe are so important and embrace the present moment with vigor.  The past is gone, be grateful for being alive regardless of your prostate status, and don’t fritter away your present worrying about the future.  Enjoy the things that cost nothing and appreciate what is left of your life which is close to two-thirds over, if you are lucky to live that long.